Inspection on 18/03/09 for Victoria Care Home

This inspection was carried out on 18th March 2009.

CSCI found this care home to be providing an Adequate 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

Victoria Care Home 21/11/07

Victoria Care Home 28/11/06

Victoria Care Home 10/05/06

Victoria Care Home 25/11/05

Victoria Care Home 28/06/05

Victoria Care Home 02/02/05

Victoria Care Home 29/09/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Victoria Care Home Victoria Street Rainford St Helens Merseyside WA11 8DA     The quality rating for this care home is:   one star adequate 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: Lorraine Farrar     Date: 1 9 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Victoria Care Home Victoria Street Rainford St Helens Merseyside WA11 8DA 01744886225 01744886193 victoria@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Four Seasons Healthcare (England) Limited (Wholly owned subsidiary of Four Seasons Health Care Ltd) Name of registered manager (if applicable) Mrs Siobhan Dean Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Service users to include up to 23 OP and up to 30 DE(E) Service users to include up to 3 DE (out of 30 DE(E) category) Date of last inspection Brief description of the care home Victoria Care Home is owned and managed by Four Seasons Health Care, a large organisation who provide care services across the country. The building is a purpose built care home, providing single bedrooms, shared lounges and bathrooms over two storeys. Outside there is an enclosed back garden with some Care Homes for Older People Page 4 of 32 care home 53 Over 65 30 23 3 0 Brief description of the care home parking to the front. Situated in a residential area of Rainford the home has good transport links. Two different services are provided within the home. Edward Unit is located on the top floor and provides care with nursing for people who have dementia. Alexandra Unit is located on the ground floor and provides care with nursing for older people. Both services provide staff, including registered nurses, 24 hours a day. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate 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 one star. This means that the people who use this service experience adequate quality outcomes. We gathered information for this inspection in a number of different ways. Before we visited we sent the manager a self assessment form to complete. We also reviewed any information we have received about the home since our last big inspection. This all helped us to plan our site visit and in writing this report. We carried out an unannounced site visit on 18 and 19 March 2009. This took place over 15.45 hours and included reading records and looking at the building. Care Homes for Older People Page 6 of 32 We spent time looking at the support the people living at Victoria Care Home receive. This included looking at the support they get with their health and personal care, daily lives and environment. Whilst we were there we spoke with eleven of the people who live there, fifteen members of staff and nine visitors. It currently costs between three hundred and sixty one pounds and five hundred and fifty seven pounds each week to live at Victoria Care Home. What the care home does well: What has improved since the last inspection? The organisation has established links with Bradford University to enable them to improve the services they offer for people who have dementia. This includes additional training for staff in working with people who have dementia so they can understand their views and support them successfully. Plans are also in place to make improvements to Edward Unit to make it easier for people to find their way around and make sense of their environment more easily. Clear recording is now in place to ensure that where people need to be given medication with their meals, this is only done in their best interests and where other alternatives are not working for them. This helps to ensure people are as involved in Care Homes for Older People Page 8 of 32 their care as possible and enabled to make their own decisions, whenever possible. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient information is obtained about and provided to people considering moving into Victoria Care Home. This helps everyone to decide if the home is the right place for the person to live and plan how to meet their needs and choices. Evidence: The people living at Victoria Care Home and their relatives were positive about the home. One of the people living there told us, its good here whilst a relative expressed the opinion that, its a wonderful place, one of the best. Modern, clean, doesnt smell, got all the equipment. Victoria Care Home provides an information pack and guide to inform people about the services they can expect. A picture brochure is also available to help people understand as much of the information as possible. The pack includes information about costs, meals and activities, staff, quality assurance and how to raise complaints Care Homes for Older People Page 11 of 32 Evidence: or concerns. We observed that copies of these are available in peoples bedrooms. In addition relatives we spoke with confirmed that before the person moved in they were provided with this information. A visitor explained that before their relative moved into Victoria Care Home staff visited them and carried out an assessment of their needs and choices. The persons family was involved in this and able to contribute. The care files we looked at had a copy of the persons social services assessment along with fully completed copies of the assessment done by the staff of the home before the person moved in. This is a comprehensive document that covers the persons health and personal care needs, as well as information about their social likes and dislikes and the everyday support they require. This assessment is evaluated when the person moves into the home and a week later to ensure the information remains accurate. The in depth assessment along with the information provided to people helps everyone to decide if Victoria Care Home is the right place for people to live. It also helps staff to plan how to meet the persons needs and choices once they move in. Victoria Care Home does not provide an intermediate care service. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Victoria Care Home receive support to meet their health and personal care needs. However their right to dignity and respect is not always upheld. Evidence: Individual care plans and records are in place for all of the people living at Victoria Care Home. These provide guidance to staff in how to support the person with their personal and health care. Care plans contain a series of assessments that had been completed and reviewed regularly. These include assessments of the persons nutrition, manual handling needs, pain and behaviour. Where assessments indicated that the person has a support need then an up to date care plan is in place and had been reviewed. We found these plans to be clear and easy to follow. The people living at Victoria Care Home told us that they get help from staff if they are unwell and this was further evidenced in reading records at the home. For example records showed that one person had lost weight and staff responded appropriately by liaising with their GP and dietician. Another person had pain in their leg; again staff Care Homes for Older People Page 13 of 32 Evidence: responded appropriately by taking them to hospital and implementing a plan for pain relief. However a number of people had fluid balance charts in their file and not all of these had been completed fully. For example the pre-printed sheet states people must attempt to have 1500mls of fluid daily. However records we looked at for one person showed that on one day they had only 690 mls recorded, whilst on another day no entries had been made. As this chart is in place to ensure people are receiving enough fluids to enable them to remain as healthy as possible, a lack of clear recording of fluids given or evidence that action is taken if their fluid intake is low, could impact negatively on their health. In meeting the people living at Victoria Care Home it was clear that where needed, they had received support from staff with their personal care. People told us that if they use their call buzzer staff respond quickly to provide the support they need. Visitors told us that they are very happy with the care their relative receives from staff and we observed two staff supporting one of the people living there to be moved using a hoist. Staff took their time, offered reassurance and an explanation and used correct techniques. This all helps people to feel confident in the support staff provide. During our visit the majority of staff were seen to speak respectfully to the people living there, knock and wait before entering their rooms and provide support when requested. However the support provided during one meal time did not always take into account the persons right to dignity and respect. No napkins were provided for people, we observed staff talking over people whilst supporting them and not providing sufficient support when people got their meal, so that one person was observed to eat with their fingers. The people living at Victoria Care Home told us that they get the support they need to look after their medication and that they get this on time. One person explained that if they are in pain staff have, a good regime. Get extra meds. During our visit we noted that staff took their time giving out medication. We observed a member of staff taking time to explain to the person what their medication was for and giving them the time to consent to taking it. We also noted that when people need to take their medication covertly (without their knowledge) this is clearly agreed and a care plan in place. We looked at records for one person who may sometimes need their medication given in this way. Records showed that staff always offer the medication to him first and have been successful in this approach. This is all good practice as it helps to ensure people are as involved as possible in controlling the support they receive with their medication. Care Homes for Older People Page 14 of 32 Evidence: We checked samples of medication storage and records and found these to tally. Records also showed that where an issue arises with somebodys medication then staff take action and liaise with their GP to resolve the issue quickly. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Victoria Care Home receive support so they can lead a lifestyle of their choice and continue with their hobbies and interests. However support provided at mealtimes is not always provided in a way that respects peoples right to dignity. Evidence: Throughout our two day visit to Victoria Care Home we noted that there were plenty of visitors to the home. Visitors told us they can visit when they want and are always made welcome. Records showed that peoples visitors are encouraged to join in activities in the home and a relative confirmed this, explaining that they had been invited to spend the day there over Christmas and take part in organised activities. This is good practice as it supports people to maintain contact with their family and friends and spend meaningful time with them. An activity coordinator, who supports people with a variety of activities depending on their individual choices, is employed at the home. One of the people living there told us that activities in the home are, very, very good, they organise a lot. We noted that activities are provided both for groups of people and for individuals. One person told us that they go out to the library with a member of staff and had enjoyed a Care Homes for Older People Page 16 of 32 Evidence: number of organised activities such as a Christmas pantomime, fire works and a visiting entertainer. Care plan records we looked at listed the things the person likes to do and records showed that support is offered regularly with these. For example one persons records showed that in the past three weeks they had received daily newspapers, taken part in board games, exercises and gardening. We observed part of an activity session on Edward Unit that involved old time music and playing a game of skittles. The atmosphere was lively with everyone engaged and lots of laughter. A Catholic service is held in the home weekly and a member of staff explained that they had made arrangements with the local Church of England Vicar to hold an Easter service in the home. She also explained that if people want to got to a local church she can provide support for this. Currently nobody of another religion lives in the home; however a member of staff confirmed that if anyone moved in and wished to, they would make arrangements for them to visit their Church or have a representative visit them. This all supports people to maintain their previous interests and beliefs. It also helps to ensure that they can spend their time in a way that is meaningful and enjoyable for them. Where people may lack the ability to make some decisions for themselves we saw copies of decision making records in their care file. These evidenced that the decision was made with the persons representative and in the persons best interests. This helps to ensure that as far as possible the persons best interests and choices have been taken into account before a decision is taken that will impact upon them. Victoria Care Home provides some storage for peoples money. However they do not act as appointee for anybodys benefit money. Where the person cannot manage this themselves then a relative or representative does so. Again this is good practice as it helps to ensure decisions about the persons money are made by them or by a representative who is independent of the home. The opinion of people living at Victoria Care Home and their relatives with regards to the meals provided was varied. A couple of people told us that the food is good whilst another told us they did not always like the meals provided. However menus showed that there is always a choice of meals available and the cook confirmed that he will make alternatives. The person who did not always like the set menus told us that they were having a dish not on the menu for their evening meal and the cook confirmed that he was making this. We also observed other people asking for options not on the menu and these being provided. In offering various options and alternatives the home is ensuring that people can have a real choice in their meals. We observed part of three mealtimes during our two day visit and found that the support offered was varied. On Alexandra unit we observed a member of staff sitting Care Homes for Older People Page 17 of 32 Evidence: next to a lady, taking time to provide her with dignified support to eat her meal. We also observed staff responding positively to requests for alternative meals or a drink. However the evening meal on Edward unit was was not relaxed and people did not always get the support they need in a dignified manner. Before people began the meal, tables were not laid with cutlery, napkins or condiments and we observed no condiments or napkins being provided throughout the meal. When cutlery was provided people who used a fork were not also supplied with a knife to use. Several people ate their meal sitting at the dining table in their wheelchair, they appeared to be low down to the table which could make it more difficult for them to manage their meal. Staff did talk to people at times but at other times we observed staff moving people around the dining room or putting an apron over their head, without explanation. We also observed staff talking amongst themselves. One lady sat waiting for some time for her meal whilst staff discussed the meals and who they were for. Her meal was put on the table away from her, staff then got a chair and sat down, moved her bowl further away and stated, dont be touching that. They then began helping her before leaving to help another person. At this point the lady began eating with her fingers, staff returned, stood next to her and put two large spoonfuls of food in her mouth whilst she was not looking and whilst the member of staff engaged in conversation with another member of staff. Drinks were given out only midway through the meal. We observed one lady reaching for a drink that was too far away. It took staff some time to note this and pass her drink to her. Some people had a soft diet and this had been sent from the kitchen with each part of the meal liquidized or mashed separately. This is good practice as it not only helps the meal to appear more appealing, it also ensures that people can still enjoy the different textures and flavours. However we observed staff mix the meal together, resulting in an unappealing looking meal that would all taste the same. We observed part of the evening meal the following day on the same unit and found the atmosphere to be calmer with staff sitting and providing consistent one to one support for people to eat their meals. On this occasion napkins had been provided along with a variety of cups to suit individuals needs. However again no condiments or knives were available on the tables. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Victoria Care Home are confident that any concerns they raise will be listen to and acted upon. However recruitment practices in the home do not always ensure people are fully protected. Evidence: The people living at Victoria Care Home told us that they would speak to staff if they had any concerns about the service they receive. One person explained that they would talk to the manager as, she helps me. Information about how to raise concerns or complaints is made readily available to people via the information pack the home provides. A record of all complaints received by the home is maintained. This showed that any concerns or complaints made are taken seriously, investigated and if needed acted upon. There have been two referrals for adult protection investigations at Victoria Court since our last big inspection there. In both instances the home have acted appropriately by informing the relevant authorities and cooperating in investigations. Staff we spoke with had received training on safeguarding adults and were able to tell us about actions they should take in dealing with any potential concerns. When we checked staff files we found that references that had been provided had not Care Homes for Older People Page 19 of 32 Evidence: been thoroughly checked to make sure they were accurate and that the staff were suitable to work with vulnerable people. This means that by not making thorough checks as required, people living at the home were not being fully safeguarded from harm and poor practice. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Victoria Care Home is well maintained so that it provides a warm, comfortable and welcoming home for people to live in, that is adapted to meet their support needs and choices. Evidence: Victoria Care Home is situated in a residential area of Rainford and has good transport links, with parking available near to the home. As a purpose built care home, Victoria Care Home provides single bedrooms, shared lounges and dining rooms and a number of bath and shower rooms. The home has an enclosed back garden, which is nicely laid out with raised planters, seating areas and a pergola. During our visit we observed that the people living there and their visitors were able to make full use of this space. The ground floor of the home is known as Alexandra unit and provides support and accommodation for older people who need nursing care. The upstairs floor is known as Edward unit and provides support and accommodation for people who have dementia and require nursing care. There are a number of aids and adaptations provided at Victoria Care Home. These Care Homes for Older People Page 21 of 32 Evidence: include a lift to the first floor, accessible baths and showers, call buzzers and grab rails. In the self assessment form the manager also explained that in the past year they have bought more specialist chairs, lifting hoists and slings. These all help the people living there with their mobility and in receiving support with their personal care. In addition, Edward unit has some adaptations to make it easier for the people living there who have dementia to understand their environment better. For example all bathroom doors are painted the same colour with clear picture signs. Similarly bedroom doors have a photograph of the person on them with a short life history. We were advised by the manager that permission for this life history to be displayed had been obtained from the people living there or their relatives. Further adaptations are planned to Edward unit, these include providing a Rainbow room which will be a quiet, relaxing room for people to spend time in and take part in activities. They also plan to provide interactive art on the walls. This will again help the people living there to find their way around more easily and will provide them with additional interests when walking around their home. During our visit we noted that all areas of the home are clean, tidy and warm. Decor throughout is modern and comfortable and provides a pleasant environment for people to live in. A laundry room is provided at Victoria Care Home. This had a clear system in place to both ensure the efficient washing of laundry and minimise any risk of cross infection. In addition staff are provided with disposable gloves, aprons and bags. This all helps to reduce or quickly deal with a potential outbreak of infection. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff working at Victoria Care Home have the skills and knowledge to support people safely and well. However a lack of thorough recruitment practices at the time of this visit, may place people at risk. Evidence: The people living at Victoria Care Home and their visitors told us that there generally enough staff available to provide the support they need. During our two day visit there were sufficient staff available to respond quickly to peoples requests for help. We also observed that staff had some time available to sit and talk with the people living in the home. Staff we spoke with had a good understanding of individuals support needs and choices and were able to explain how they meet these. Apart from one of the meal times we observed, staff offered good discreet support to people, took their time and were polite and respectful. We received positive comments from the people living at Victoria Care Home about the staff team. One person told us, staff are very good at meeting requests and another that, staff will do anything for me. Visitors were also positive about the staff, with one visitor describing them as, friendly and approachable and another as, brilliant. A couple of the people living there told us that they had had minor issues with some staff, for example staff talking over them when supporting them with personal care. Care Homes for Older People Page 23 of 32 Evidence: However they had raised this with senior staff who had successfully sorted it out for them. We looked at a sample of files for staff who work in different roles in the home. These showed that checks are carried out on people before appointing them. This includes checking the protection of vulnerable adults register and obtaining a Criminal Records Bureau check. In addition two written references were on file for all staff. However these were not necessarily from the persons last two employers, nor had the home followed up by obtaining references from employers for the person over the past two years. Where a reference contained only brief information, the home had not followed this up to obtain as much information as possible about the person. This lack of thorough checking of a persons employment history could lead to the home employing staff who are not suitable to work with adults who could be vulnerable. Action was taken by the organisation during our site visit to rectify this and obtain the required information. Records showed that staff receive a variety of training in basic care practices such as moving and handling people, fire and the protection of vulnerable adults, as well as more specialist areas such as sensory deprivation, diabetes and meeting peoples health care needs. The organisation that owns the home has a training department that provides regular training for staff. In addition to this staff attend training at the local Primary Care Trust. This all helps to ensure that staff have the knowledge to support people safely and well. New staff undergo induction training which is based on completing a series of work books over a twelve week period. This is a national induction and provides new staff with the basic skills and knowledge they need for their role. The organisation is working with Bradford University, looking at ways to support people who have dementia more effectively. Part of this includes staff attending a course on working with people who have dementia to help them develop the skills to understand and support people more effectively. Some of the staff at Victoria Care Home have attended this course and there are plans for others to do so. In addition some staff have attended other courses on working with people who have dementia . Other staff told us they are waiting to do this training or would like to continue to improve their knowledge in this area. Over half the staff team hold a national vocational qualification in care (NVQ) with others in the process of completing this. The training provided and planned helps to ensure staff are equipped with the skills and knowledge they need to support people effectively and meet their changing needs and choices. Care Homes for Older People Page 24 of 32 Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are effective systems in place at Victoria Care Home to ensure the home is managed safely, run in the best interests of the people who live there and to plan future improvements. Evidence: The manager of Victoria Care Home is a registered nurse and is experienced in managing services for older people and people who have dementia. During our visit she displayed a good knowledge of her role and was clear about her plans to further improve the services offered at the home. Staff told us that they find the manager to be approachable and that they get the support they need from her. One of the people living there told us that they find her easy to talk to and that she helps them when needed. The manager was not registered with us as the manager of the home at the time of our visit but she told us that she had obtained relevant documents and intended to Care Homes for Older People Page 26 of 32 Evidence: apply within the week following our visit to the home. This registration process is a way of ensuring managers are sufficiently experienced and qualified to run a particular care service. There are a number of systems in place within Victoria to assess the quality of the service provided there and to plan future improvements. A senior manager from the company visits the home weekly, unannounced, and carries out a partial review of the service. In addition to this a a monthly visit is carried out by the company where a set format is followed to look at the service provided. This includes speaking with the people who live there and with staff, observing daily life in the home, and examining records. The report of this visit then lists positive aspects of the service provides and gives a clear action plan for any improvements that should be made. The company also sends yearly surveys to the people living at Victoria Court and their relatives. These obtain their views about how the home operates, including the food, staff, environment, activities and personal care. Results from the 2008 surveys showed positive responses to these questions. These surveys provide a clear way for people to influence the care and support they or their relative receive. An overall team audit of the service provided is carried out once a year and actions for future improvements are identified, as well as identifying areas the home are doing well in. A computer system is used to list any actions needed within the home, this can be added to by the manager or by senior staff within the company. Once an action is added it is monitored by the company and cannot be deleted. This is a good system as it provides a clear way to ensure planned improvements are carried out within a set timescale as well as way to monitor the effectiveness of their quality control systems. During our visit the area manager added to this list to ensure all staff files were checked to ensure good recruitment practices had been followed, as it was identified that not all files had been checked thoroughly. Victoria Care Home no longer acts as appointee for anybodys benefit money. However they do provide storage for this and maintain records of any money they hold. This includes ensuring the money is separate from the companys money by storing it in a residents account with a national bank. A sample of money held for the people living at Victoria was checked during the visit; this tallied with records and receipts. Records and certificates showed that regular health and safety checks are carried out on the environment and equipment in the home to ensure they are safe for everyone to use. This includes checking fire protection equipment, bed rails, gas supplies and electrics. During our visit the fire alarm sounded unexpectedly and we observed that staff responded appropriately to this. Up to date risk assessments are in place for Care Homes for Older People Page 27 of 32 Evidence: general tasks and areas of the building. In addition accident forms are monitored monthly and checked by the organisation. This all helps to ensure that Victoria Care Home is a safe place for people to live, work and visit. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 29 19 A system must be implemented to ensure all staff references and employment histories are thoroughly checked before they start working in the home. This will help to ensure staff are suitable to work with people who may be vulnerable. 14/08/2009 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 1 15 Fluid balance charts must be 14/08/2009 fully completed and action taken and recorded if they indicate that the person is receiving insufficient fluids. This will help to ensure peoples fluids intake is sufficient and does not impact negatively on their health. 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. Care Homes for Older People Page 30 of 32 No. Refer to Standard Good Practice Recommendations 1 15 Tables for meals should be fully set prior to people going into the dining room. Senior staff should observe, record and act upon their observations of mealtimes, particular on Edward unit. Soft diets should be served to the person with each item separated. This will help to ensure that people receive support in a way that is dignified and meets their needs and choices. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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