Care Home: Aaron Court Care Home

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What the care home does well The people who live at Aaron Court have their needs met by the way the service identifies their needs before they come to live there and in the way the service obtains information about their needs from other agencies. The service is very good at devising care plans in response to the changing needs of people. Their health needs are met and their health is further promoted by the safe management of medication. People are treated in a dignified and respectful manner. The people who live at Aaron Court are provided with a thorough programme of activities which reflects their preferences and involves their families and the wider community. They are able to maintain their independence and their nutritional needs are met. The people who use the service and their representatives can be confident that any concerns they have will be investigated thoroughly by the service. People are protected from abuse. The people who use the service live in an extremely well maintained, homely and very clean environment. The people who use the service are supported by a staff team which are sufficient in number to meet their needs and whose roles enable all aspects of the service to meet the needs of people. The staff team are very well qualified to perform their role and are trained to meet the needs of people. The recruitment of new staff enables people to be protected from abuse. The service is managed by an experienced and qualified individual who continues to ensure that the service provides excellent outcomes for the people who live at Aaron Court. The service actively seeks the views of all those who are connected with the service to ensure that their views on the quality of support is taken into account. The financial interests of individuals are safeguarded. The health and safety of all individuals is thoroughly promoted. The expert by experience concluded: I was very impressed with the standard of care at Aaron Court and I was particularly impressed with the work of the Activities Coordinator. The work she does together with the rest of the staff really reflected in the residents, many of whom were lively and were also interested in the fact that I had come to visit. Many of the residents in the unit where I had lunch were smiling and joked with me. The two relatives I spoke to had no complaints and seemed extremely happy with the care their mothers were receiving. In the words of one of them: `This is a lovely place! The staff are lovely!` The interaction I observed between the staff and residents gave me no cause to be concerned about the residents` safety. It was warm, humourous, caring and affectionate. The resident I spoke to said she was `very well treated` and that `the staff couldn`t be kinder`.After observing the staff interacting with the residents, and speaking with the nurse in charge of the EMI unit, I would have no hesitation in saying that the residents are treated very respectfully and that the staff seem to do their utmost to be as helpful as they can. There were only 2 family members visiting relatives during my visit. I was able to speak to both of them. One, a man visiting his mother, was happy with the care provided to his mother but couldn`t answer more specific questions about her care because his sisters dealt with such matters. The other relative, a daughter, visiting her mother in the dementia unit was very happy with the care her mother received. Her mother had moved to Aaron Court from another home, the daughter said that although Aaron Court was further away from where she lived than she`d like, the important thing in her words was `I don`t have to worry about her when I leave. She is looking so well now.` We interviewed staff about their experiences of working at Aaron Court. Staff found the manager to be very supportive and very good at her job. They were able to identify those areas which they thought Aaron Court did well but could not think of anything that the service could do better. What has improved since the last inspection? No requirements were raised at our last visit. The service has maintained its excellent quality rating since our last visit in 2006. What the care home could do better: No requirements or recommendations are raised in this report. Key inspection report Care homes for older people Name: Address: Aaron Court Care Home 190 Princes Road Ellesmere Port South Wirral CH65 8EU     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Paul Kenyon     Date: 0 2 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Aaron Court Care Home 190 Princes Road Ellesmere Port South Wirral CH65 8EU 01513571233 01513568216 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Aaroncare Limited care home 73 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, Dementia - Code DE. The maximum number of service users who can be accommodated is: 73. Date of last inspection Brief description of the care home Aaron Court Care Home is registered to accommodate 73 residents over 65 years of age whose care needs are due to physical frailty or are diagnosed with dementia. Five people diagnosed with a dementia aged under 65 years of age can also be accommodated within the 73 beds. The facilities in the home are situated on two floors of two units on each floor. There are sixty-five single bedrooms five of which have ensuite facilities. There are four double bedrooms, two of which have en suite facilities. The registered facilities are close to the centre of Ellesmere Port with local shopping facilities available to service users. The service is located on a main road and has Care Homes for Older People Page 4 of 32 Over 65 0 73 73 0 Brief description of the care home access to public transport, being on a main bus route to Ellesmere port. The building also contains the kitchen, laundry and administration facilities on the ground floor. This service is provided by a private company that operate a number of registered care homes around the country. Fees range from 376.73 to 683.17 pounds per week. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection of Aaron Court. The visit was spread over two days and lasted eight hours in total. For the purposes of this visit, we were accompanied by an expert by experience. This is an independent person who has had experience in either receiving care or being involved with someone who has received care. The expert spent three hours in the service touring the building, talking to staff residents and relatives and had a meal there. The experts comments are included within this report. As part of this visit we examined records relating to the care provided to people, we toured the premises, we interviewed staff and relatives and observed care practice. All this enabled us to form judgements about the service being provided to the people who use the service. The nature of the disability of people is such that it is not always possible to gain their views. We did speak to some people but have used observation to gain views about the service. Care Homes for Older People Page 6 of 32 Care Homes for Older People Page 7 of 32 What the care home does well: The people who live at Aaron Court have their needs met by the way the service identifies their needs before they come to live there and in the way the service obtains information about their needs from other agencies. The service is very good at devising care plans in response to the changing needs of people. Their health needs are met and their health is further promoted by the safe management of medication. People are treated in a dignified and respectful manner. The people who live at Aaron Court are provided with a thorough programme of activities which reflects their preferences and involves their families and the wider community. They are able to maintain their independence and their nutritional needs are met. The people who use the service and their representatives can be confident that any concerns they have will be investigated thoroughly by the service. People are protected from abuse. The people who use the service live in an extremely well maintained, homely and very clean environment. The people who use the service are supported by a staff team which are sufficient in number to meet their needs and whose roles enable all aspects of the service to meet the needs of people. The staff team are very well qualified to perform their role and are trained to meet the needs of people. The recruitment of new staff enables people to be protected from abuse. The service is managed by an experienced and qualified individual who continues to ensure that the service provides excellent outcomes for the people who live at Aaron Court. The service actively seeks the views of all those who are connected with the service to ensure that their views on the quality of support is taken into account. The financial interests of individuals are safeguarded. The health and safety of all individuals is thoroughly promoted. The expert by experience concluded: I was very impressed with the standard of care at Aaron Court and I was particularly impressed with the work of the Activities Coordinator. The work she does together with the rest of the staff really reflected in the residents, many of whom were lively and were also interested in the fact that I had come to visit. Many of the residents in the unit where I had lunch were smiling and joked with me. The two relatives I spoke to had no complaints and seemed extremely happy with the care their mothers were receiving. In the words of one of them: This is a lovely place! The staff are lovely! The interaction I observed between the staff and residents gave me no cause to be concerned about the residents safety. It was warm, humourous, caring and affectionate. The resident I spoke to said she was very well treated and that the staff couldnt be kinder. Care Homes for Older People Page 8 of 32 After observing the staff interacting with the residents, and speaking with the nurse in charge of the EMI unit, I would have no hesitation in saying that the residents are treated very respectfully and that the staff seem to do their utmost to be as helpful as they can. There were only 2 family members visiting relatives during my visit. I was able to speak to both of them. One, a man visiting his mother, was happy with the care provided to his mother but couldnt answer more specific questions about her care because his sisters dealt with such matters. The other relative, a daughter, visiting her mother in the dementia unit was very happy with the care her mother received. Her mother had moved to Aaron Court from another home, the daughter said that although Aaron Court was further away from where she lived than shed like, the important thing in her words was I dont have to worry about her when I leave. She is looking so well now. We interviewed staff about their experiences of working at Aaron Court. Staff found the manager to be very supportive and very good at her job. They were able to identify those areas which they thought Aaron Court did well but could not think of anything that the service could do better. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Aaron Court have their needs met by the way the service identifies their needs before they come to live there and in the way the service obtains information about their needs from other agencies. Evidence: We looked at how the people who use the service have their needs identified before they come to live at Aaron Court. We looked at individuals who had some to live at the service since our last visit in 2006. In all cases, the service had completed its own assessment of the needs of people in a variety of areas that affected their daily living. This included a mix of medical issues as well as their needs in relation to their daily life and social activities. We looked at records relating to six people. In all cases the service had assessed their needs before they had come to live at Aaron Court and had also obtained information from the Local Authority who funds their care about their needs. The services own assessment contains needs which could be linked to the care plan of each person. The service also provides a statement of purpose t people as well Care Homes for Older People Page 11 of 32 Evidence: as a brochure of what they can expect from the 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is very good at devising care plans in response to the changing needs of people. Their health needs are met and their health is further promoted by the safe management of medication. People are treated in a dignified and respectful manner. Evidence: We looked at six care plans. All care plans indicated the support each person needed in their daily lives and how staff could meet these needs. The support required was different in each care plan reflecting the individual needs of each person. The needs of people covered both their physical needs liked to medical issues as well as their social care needs in relation to activities and daily routines. Results from a relative survey earlier this year indicated that all relatives considered that they had been consulted in the care provided to their relations. In addition to this, minutes from the managers weekly surgery evidenced that individual care plans are discussed with relatives when they needed to be. All care plan we looked at showed evidence of review. In some cases, care plans were reviewed more than once a month and this reflected issues that affected the daily Care Homes for Older People Page 13 of 32 Evidence: lives of people. Reviews consistently were detailed and showed how health and other issues had affected each person. In three cases we noted that short term care plans had been introduced in response to the needs of people. Two care plans had been devised to ensure that health infections were dealt with and these indicated how each issue was to be addressed by staff. In both cases, outcomes had bee positive for people and the health issues had been addressed. In one case, an individuals health had deteriorated to the point where the person needed bed rest. In this instance, a care plan had been devised which resulted in the person no longer needing bed rest and as a result the dependency levels of this person had decreased. All care plans were written clearly and provided exact details of how each person should be supported. These in turn are reinforced by detailed daily records. We looked at how the health of people was maintained. We examined six care plans which provided us with the information we needed. All people are registered with a local General Practitioner and there was evidence that when health issues had arisen, the service had taken action to address them through Doctors visiting the service as well as other health professionals such as opticians, chiropodists, continence advisers and community psychiatric nurses. Individuals had also received hospital appointments to address health needs. The service also adopts a proactive approach to the health of individuals with evidence of influenza inoculations being offered to people. The service had assessed people in a number of ways in respect of their health needs. All people had had their nutritional needs assessed with the results providing action which had been taken by the staff team. All people had been assessed in relation to the likelihood that they could develop pressure sores and all had had their continence needs assessed. The risks associated with transferring those people who need help with their mobility had been assessed and functional assessments had been undertaken to determine how the dementia experienced by people had affected their daily lives. We found evidence that the basic health needs of people were maintained through nursing observations such as the blood pressure and temperature of people and there was evidence that people have their weight monitored on a result basis. The activities programme also suggested that there was an emphasis on enabling people to be as physically active as possible through the implementation of light exercises as part of the activity programme. During the visit, the expert by experience who accompanied us on the visit made some observations in relation to the maintaining of health needs. These observations included: Care Homes for Older People Page 14 of 32 Evidence: I could not speak to the residents about their health needs because of the degree of dementia. However just after lunch one of the women in the unit I was in complained about her chest hurting. She was asked immediately whether she needed the nurse and although I didnt hear her response I did observe the assistant immediately telephoning for the nurse to come A daughter visiting her mother was very happy with the way in which her mothers health needs were taken care of. She told me that her mother had been in another care home prior to coming to Aaron Court and had had leg ulcers which had disappeared quickly after shed arrived at the service All the residents were assisted with showering and bathing. This resident named the staff member who took her for a shower. She said that she was very good. Her daughter said that her mother was always clean. All the other residents I saw were dressed well and since it was a Tuesday a hairdresser was visiting to do their hair if necessary We looked at how medication was managed. All medication is stored in a lockable room which in turn contains three trolleys which are locked and tethered to the wall. Some people are prescribed controlled medication which is stored in a separate cupboard.The service also accounts for controlled medications through a register signed by two nursing members of staff. All medication keys are kept on the person of the senior nurse in charge at all times. All medications received by the service are recorded on medication records. Records from the previous month were examined and these showed that medication received was appropriately recorded during that time. All medication records had been signed once medication had been given. The service provided evidence that the stock of medication in the building is audited on a weekly basis. The nature of the disability of people living at Aaron Court at present means that no one manages their own medication at present. Some medications are stored in a refrigerator. The temperature of this is monitored daily to ensure that all medications are stored and managed correctly. An audit by the local primary care trust of medication was conducted in 2009. This indicated that there were no concerns about how the service manages medication yet the Manager stated that links to the local surgery had been reinforced as a result. We looked at whether people were supported in a respectful manner with their privacy Care Homes for Older People Page 15 of 32 Evidence: taken into account. Each person has a list of their personal property devised to ensure that the personal possessions of people are preserved and accounted for. The service has a charter for the people who use the service and states that the service will offer the right of dignity, the privacy of space belief and opinions the people who use the service. Information was available to suggest that the manager had been identified as a dignity champion. Some shared rooms are available in the building. We looked at two shared rooms and found that screening was available to preserve the privacy of the occupants. Clothing is marked in a discreet manner and the preferred terms of address is outlined in care plans. We observed staff throughout the visit consistently knocking on the doors of individuals rooms before entering. We observed people being supported and spoken to in a respectful manner at all times. We were accompanied by an expert by experience who looked at privacy issues. Her observations included: After observing the staff interacting with the residents, and speaking with the nurse in charge of the Elderly mentally infirm unit, I would have no hesitation in saying that the residents are treated very respectfully and that the staff seem to do their utmost to be as helpful as they can All residents were addressed by their first names and there was clearly a lot of warmth, affection and humour in the interaction between the staff and residents Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Aaron Court are provided with a thorough programme of activities which reflects their preferences and involves their families and the wider community. They are able to maintain their independence and their nutritional needs are met. Evidence: We looked at the activities on offer for the people who live at Aaron Court The expert by experience who accompanied us on this visit was able to make observations in respect of the daily lives of people. These observations included Aaron Court has a very active activities coordinator who works 30 hours Monday to Friday She has organised a very impressive variety of activities and the effects of her work were clearly evident There are display boards in each unit with information about the planned activities She is training with the National Association for Providers of Activities for Older People and also gets help from through local Age Concern from where someone comes regularly to assist her with an exercise programme Care Homes for Older People Page 17 of 32 Evidence: She has also accessed support from Thrive a small national charity that uses gardening to change the lives of disabled people In the summer she said most of the activities took place in the garden and the residents were able to have individual raised plots The day my visit took place was during national plant a tree week and she had organised a tree to be planted in the garden that day The activities she had organised ranged from Arts and Crafts to someone with Birds of Prey bringing in owls for the visitors to see exercise music and dance Sunshine Singers come once a month Religious services of different religious denominations are also held at the home once a month For the coming year the activities co ordinator is organising activities on a Round The World theme The first country to be visited will be Italy Pizzas will be made and a masked Venetian Ball is being organised to which an opera singer will be coming The second country to be visited will be China with the activities centring around Chinese New Year Individual residents wishes are catered for through a Wish Tree which is placed in the entrance and on which residents hang their wishes The resident who I was able to speak to told me about the tree and how pleased she had been when she had hung her wish to go out for a meal on the tree As a result she had been taken out once with one of the staff to a pub for a meal She was going to be taken out again for another meal before Christmas She was also delighted that she had not had to pay for this. Other wishes on the tree that I noted were for going swimming to the cinema and to a football match The activities co ordinator was also making photo albums of all the activities at the home and some of the photos were being displayed in the entrance hall as a slide show in a digital frame She said that showing the photos to the residents helped them to remember the activities they had taken part in All residents and their relatives are asked for their permission first for the use of their photos The activities co ordinator is also present at the monthly meeting with Relatives and Residents The resident I spoke to is picked up once a week to go to a local Community Centre for an Arts class Religious services from the different denominations are held regularly at the home We looked at how the service ensures that contact is maintained with the local community. The expert by experience noted: Both relatives I spoke to said that they were able to visit whenever they wished. Staff told me that most visitors came in the afternoon None of the rooms have their own telephones The woman resident in the Residential Nursing Unit upstairs indicated that Care Homes for Older People Page 18 of 32 Evidence: access to the phone wasnt always easy for her to get and depended on how busy the staff were She was considering getting herself a mobile phone Visitors come to the service on a regular basis through the day as evidenced through observations during the visit and through the visitors book. The activities programme indicated that there was significant contact from the local community such as entertainers and local dignitaries and that people had had the opportunity to go on outings to local attractions. The activities programme also reflected that events throughout the year were recognised in the activity programme and that national events such as plant a tree week involved participation by the people who use the service We looked at the way the nutritional needs of people are maintained by the service and the catering arrangements in the service. We looked at six care plans. All of these contained an indication of the dietary preferences of people in terms of their likes and dislikes. There was also information about how people should be presented with their meals and the support they needed in relation to softer diets or assistance in cutting meals up. In all cases, an assessment of their nutritional needs had been made as well as the risk to each person of malnutrition and what steps could be taken by staff to avoid this. These were reviewed monthly and staff training records confirmed that staff had receive training in these assessments. We toured the kitchen. This was a clean and organised facility. Catering staff are available throughout the day. Information was available in the kitchen in terms of the needs of people, their diets and the presentation of meals. Food stocks were sufficient and fresh vegetables and fruit was available. Menus are available in two forms. The first acts as a general guide to staff and indicated choices in menus. The other was a menu for the people who use the service ad this was presented in picture form. The meals provided are also recorded. Dining rooms are available. These are pleasant environment in which people can have meals. We observed meals provided in two areas. We were able to witness staff asking whether people wanted assistance rather than assuming they needed this. Throughout staff asked people if they were alright and whether they needed anything else. The expert by experience who accompanied us on the visit had the following observations: Care Homes for Older People Page 19 of 32 Evidence: There is one main kitchen for the whole home, and lunch is brought to each unit on heated trolleys. I was told that a 3 week menu was drawn up and discussed individually with the residents. The one resident I spoke to said the food was shocking and that she had no choice with regard to her meals. She ate her meals in her room because she didnt like eating with the other residents. She did also say I cant complain given that she wasnt like the others. Information in residents meeting minutes noted that the choices available to this person with meals had been reinforced to her and that a menu had been provided to this person in her bedroom. The meal I had at lunch was certainly not one I would have chosen myself. At the same time I overheard the staff offering one resident something else because she didnt appear to like the lunch served and suggesting that if she didnt want to eat her lunch she could be given something else later if she was hungry then. One of the residents at the table I was sitting at was given a slightly different meal than the others. The daughter visiting her mother said that her mother had been losing prior to coming to Aaron Court and had put on weight since shed been there. She felt the food was good. Care Homes for Older People Page 20 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service and their representatives can be confident that any concerns they have will be investigated thoroughly by the service. People are protected from abuse. Evidence: We looked at the way the service manages any complaints it receives. A complaints procedure is available but this did not contain up to date information on our role in complaints. This was addressed during the visit. Complaints records are available. These suggested that any complaints received are thoroughly investigated and that the outcome of the complaint was always reported back to the complainant. The expert by experience noted: I wasnt able to find out much about the complaints procedure. When I asked the daughter visiting her mother how she would deal with any complaint. She said she would probably first speak to the nurse in charge of the unit and if she wasnt satisfied shed go to the reception downstairs. We looked at the way the service protects the people it cares for. Staff interviews noted that they were aware of whistle blowing procedure and confirmed that they have receive safeguarding training. Safeguarding referrals have been made, two in the past twelve months. These have been investigated by the Local Authority and have Care Homes for Older People Page 21 of 32 Evidence: not been upheld. The service has a Local Authority procedure for the reporting of abuse allegations. We noted in care plans that some people may demonstrate a degree of physical and verbal aggression. Care plans indicate how staff should intervene when this occurs. A procedure is in place for gifts and wills and dealing with peoples finances. The Manager is aware of the protection of vulnerable adults register and no one has been referred to this. Care Homes for Older People Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service live in an extremely well maintained, homely and very clean environment. Evidence: We toured the premises. All areas of the building were well maintained with no issues with decoration noted. All furnishings were to a high standard and no repairs were noted. The service employs maintenance staff who was noted to be present on the days of our visit. A repairs book is available where minor repairs arise and there was evidence that external contractors are used for other repairs. All areas of the building were noted to be home like in appearance with individual living units being created to ensure that the service did not have an institutional feel to it. There is sufficient lounge space in the building which includes lounges, visitors rooms, conservatories and dining areas. The building is decorated with posters and photographs including photographs of the Ellesmere Port area from many years ago as well as posters relating to famous figures from early in the twentieth century. In addition to this, photographs of the people who use the service are available on each bedroom door which is designed to assist people to orientate themselves around the building. A series of coded locks are available in the building to ensure that people are able to move safely around the building and to not enable them to access areas which may pose a hazard to their health and safety.All care plans we looked at included a risk assessment on the use of these locks.Seating is available in the main hallway and a Care Homes for Older People Page 23 of 32 Evidence: digital photograph frame display photographs of people enjoying activities with these being accompanied by music. The building has many posters on display indicating activities available and other information including details of the date, staff on duty and food to be provided that day. The service has been subject to recent fire authority and environmental health checks and these authorities are satisfied that the environment is safe. Garden areas are accessible to all in finer weather. These are well maintained areas and provide a safe area for people to enjoy. There was evidence in garden areas that individuals have been involved in these areas with the creation of raised garden beds which have been maintained by people living there. A mural is also on display on one wall which had been created by the people who use the service. Close circuit television cameras are in use at the front entrance of the building. One monitors the hallway but this is not in use. We looked at the standards of hygiene in the building. We toured the building and found that the building remained very hygienic with no offensive odours present. All areas were fresh and clean. Domestic staff are employed by the service and staff were observed during our visit cleaning all areas of the building. In addition to this, laundry staff are employed. A laundry is available which contains industrial appliances. This is an organised facility. One room is used for the laundering of clothes with another room available for ironing and storing of laundered items. The laundry has an impermeable floor with hand wash facilities available. Sluice rooms are available and these are separate from toilets and bathrooms used by individuals. Soap and towels are available in all toilets. Person protective equipment such as aprons and gloves are used by staff and the service has a contract with a clinical waste company. Care Homes for Older People Page 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service are supported by a staff team which are sufficient in number to meet their needs and whose roles enable all aspects of the service to meet the needs of people. The staff team are very well qualified to perform their role and are trained to meet the needs of people. The recruitment of new staff enables people to be protected from abuse. Evidence: A staff rota is in place. The designation of staff is available on these rotas.-The staff team comprises of management, nurses, kitchen staff, domestic staff, activities, care staff, maintenance staff and administration staff. Rotas confirmed that staffing is consistently maintained in all areas at all times of the day and night. No agency staff is used since care staff confirmed that they do overtime when staffing shortages occur. Interviews with two care staff indicated that they considered they had enough staff on duty. We received information prior to the visit in relation to staff qualifications. This suggested that nearly one hundred per cent of staff had attained at least Level 2 in the National Vocational Qualification. Many had progressed to Level 3. This was confirmed through staff interviews. This standard as a result is exceeded. Care Homes for Older People Page 25 of 32 Evidence: We looked at how staff are recruited into the service. We looked at three files relating to people who had come to work there over the past year. In all cases, information was present to suggest that new staff had been checked for their suitability for their role. We looked at how staff are trained and how they receive inductions when they start work. Four training records were examined. Asa well as doing training which is compulsory in relation to health and safety, staff have attended other courses which are in response to the needs of people living at Aaron Court. These courses included Nutrition, dignity training, safeguarding adults, pressure sore management, continence, medication, supporting people with mental health issues and other clinical training for nursing staff. An interview with one nurse confirmed that they receive training which was linked to their requirement to update their practice as a registered nurse. Staff were also able to confirm through interviews of the amount of training they received. In respect of inductions, all new staff are expected to undergo a first day induction, then a workplace induction and finally a common standards induction. This last induction requires staff to identify and examine their own care practices in relation to what is required to assist the people living at Aaron Court. This induction process leads to enrollment on an NVQ course and paperwork suggested that all new staff had received the same induction process. Care Homes for Older People Page 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is managed by an experienced and qualified individual who continues to ensure that the service provides excellent outcomes for the people who live at Aaron Court. The service actively seeks the views of all those who are connected with the service to ensure that their views on the quality of support is taken into account. The financial interests of individuals are safeguarded. The health and safety of all individuals is thoroughly promoted. Evidence: We looked at the way the service is managed. The Manager is registered with us as the registered manager and has worked in at the service in a managerial capacity for many years. She is a registered nurse and has attained an National Vocational Qualification at Level 4 as well as a registered managers award. She was manager during our last visit when the service was rated as excellent and this visit found that outcomes for the people who use the service remain as excellent. We interview staff about the manager. In all cases, staff were complimentary about the managers ability to manage the service about the way they were supported by her as members of staff. Care Homes for Older People Page 27 of 32 Evidence: We looked at the way the service ensures that its practice provides positive outcomes for the people who live at Aaron Court. We found that the views of people are welcomed and that a number of measures are in place to ensure that their views are listened to. A suggestions box is available in the main hallway. The Manager stated that this was not used much but was still available if comments needed to be made. The Manager holds an open surgery once a week which provides relatives to meet with her to discuss any issues they may have about their relatives care. Minutes of these are recorded and we were able to view these. They indicated that the meetings were not always attended but when they were, notes of comments were recorded and acted upon. The responsible individual of the service conducts monthly visits to the service and reports are made available to the Manager. Reports included detailed observations of the care provided as well as interviews with the people who use the service, staff and relatives. The service conducted surveys of relatives and residents earlier this year and have published findings in a series of charts. This revealed that either people were satisfied with the service or highly satisfied. The surveys provided evidence that families are involved in the care plans of individuals. The service maintains a compliments book as well as a complaints book. There were no requirements from this visit or the last visit. The service co-operated with us during the visit and we were able to tour all areas, examine all records and interview people and staff in private. The service does not deal with the finances of individuals. These remain with families or other representatives who are in charge of these. The service does offer storage of pocket monies. Monies are securely stored and an accountable systems of records are maintained which are in turn are audited by the organisation. We looked at how the service promotes the health and safety of the people who use the service. We noted from staff interviews and training records that staff have attended health and safety training as well as training in infection control, first aid and food hygiene. Fire systems in the home have been checked and these include the servicing of fire extinguishers, fire alarms, emergency lighting and fire drills. All hoists and equipment in the building are regularly serviced as evidenced by certificates and labels attached to equipment.Radiators are of low surface temperatures which minimise the risk to people and window restrictors are in place on upper floors. Water temperatures are tested weekly and there was evidence that electrical wiring, portable appliances and gas systems have been checked for their safety. The water has been tested for legionella in 2009 and general risk assessments are in place. The service records accidents but also audits the occurrence of these events in order to minimise Care Homes for Older People Page 28 of 32 Evidence: their occurrence. The environmental health department has visited the service and no issues were identified. Records suggested that the local fire authorities conduct regular checks on the building. The service has its own health and safety committee identifying issues. The service has obtained current insurance and has its certificate of registration on display. The service always notifies us of any incidents which affect the well being of the people who use the service. Care Homes for Older People Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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