Care Home: Amathea Care Centre

What the care home does well The home is good at making sure they give people plenty of information and they complete assessments so that new people will receive the right levels of care and services. This is one relative`s experience: "When I walked into Amathea without an appointment and saw how well run it was I looked no further for my relative. He was assessed and I felt reassured he has the best personal and medical care...This has been a most difficult time for us but the staff have been supportive to all of us." We met with people who were settled and satisfied with the way things are in the home and who interact well with the staff. "I like the staff and get on well with most of them...they are very caring." They receive good levels of personal care and get appropriate medical attention A number of surveys and people on the day told us they were happy with the way staff respected their dignity and rights. We could see that the home`s dignity champions take their responsibilities seriously. "Compassionate care...treat clients with dignity and patience...". "All staff have a good listening ear. Very professional at all times...all are approachable with a good sense of humour and fun. When times require serenity and tact they show empathy." People told us they were happy with the activities and entertainments on offer and would like even more. Visitors are always made welcome. "Managers and staff have been very good to my friend...as a result she is enjoying her stay and is very happy". Most people were very happy with the food provided and we shared a meal with residents. This was well prepared and tables properly set. The atmosphere was relaxed and people ate well. One survey said "The kitchen staff are brilliant !" Another - "They have adapted the menu to meet his specific needs." This company make sure that people are listened to and their complaints taken seriously. "I might have the odd little criticism but usually everything is very good...and people do listen."Allegations of abuse are also taken seriously and managed properly. The building was clean, fresh and well maintained on the day. "My room is always clean and tidy and my clothes ironed". "Encouraged to make my own room cheerful with a personal touch". Staff and residents are making sure that little personal touches are introduced so that the house looks homely. "The home and care assistants make the place feel very homely...I like how close now the employees and residents are together because it gives the home a nice atmosphere." There are suitable mixes of staff on each shift so that staff experience, training and aptitude help people get good standards of care. There is a well thought out company training plan that is supplemented by local courses. Staff told us they enjoyed their training and felt they were being developed and trained properly. Management systems were running well. Quality monitoring is ongoing and recording done correctly. Residents` money was checked and found correct. Health and safety and maintenance are managed correctly. What has improved since the last inspection? During this inspection and at the random visit we made in April 2009 we saw a number of improvements. The written plans that help staff deliver care appropriately have been strengthened and improved over the year. Staff have had training in new ways to approach this. We saw lots of developments in the unit for people with dementia. There have been staff driven changes to the environment, to activities and to the staff approach. The deputy manager has led these changes and was very enthusiastic about introducing innovative practice. The manager has continued to make sure that external specialist health care providers come to the home to see people and to advise nurses and carers. Medication is now managed in a much more precise way with regular quality checks undertaken by management and plenty of staff training and competence checks. The management team are now very confident in how they manage any allegations of abuse or neglect. The manager dealt with one issue in such a way as to protect a number of vulnerable people from harm in other settings. " An incident ....was dealt with swiftly and we were kept informed...dealt with to our satisfaction."The manager has been successfully registered with us and continues to develop her role as manager. She has good support from the company and they keep us well informed of any issues in the service. "The manager and her deputy are always happy to have a word if you have any worries...I have regular appointments with the manager to talk over any worries I have about my partner`s care..." At the random inspection we asked the company to monitor sickness and absence rates and we had evidence to show that the manager has a good strategy in place to do this. Staffing levels have improved partly because of this and because recruitment has been stepped up. There is an improving team spirit. "I enjoy working at Amathea. It is well managed and has lovely atmosphere. I feel the residents` needs are met to the best of the staff`s ability and often above and beyond expectations." Fire safety is now being handled in a more planned and precise way and staff were more confident about their responsibilities. What the care home could do better: There was nothing seen at this inspection that caused us any concern so we had nothing we wanted them to do better. Several surveys said things like: "No concerns...can`t fault them...can`t think of anything that needs improved...". Key inspection report Care homes for older people Name: Address: Amathea Care Centre Newlands Lane Workington Cumbria CA14 3JG     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: Nancy Saich     Date: 1 6 1 1 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 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 29 Information about the care home Name of care home: Address: Amathea Care Centre Newlands Lane Workington Cumbria CA14 3JG 01325351100 0190063269 amathea@schealthcare.co.uk www.southerncrosshealthcare.co.uk Trinity Care Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Sharronn Miller Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following categories of service only. Care home with Nursing - Code N To people 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 (maximum number of places: 20) Physical disability - Code PD The maximum number of people who can be accommodated is: 40 Date of last inspection Brief description of the care home Amathea is owned by Trinity Care Ltd which is a wholly owned subsidiary of Southern Cross Health Care Ltd. Southern Cross owns a number of residential care homes throughout Britain. The home is managed by Sharronn Miller and she is registered with Care Homes for Older People Page 4 of 29 Over 65 0 40 0 20 0 40 2 4 0 4 2 0 0 9 Brief description of the care home the Care Quality Commission. The house is a new purpose built nursing home for people in the categories listed above. The home is situated in a residential area of Workington and is in easy reach of all the amenities of the town. The town has both bus and rail connections. The home has its own secure garden and parking to the front of the property. Accomodation is in single, ensuite rooms and is on two floors. The top floor is for people with dementia and the ground floor for older adults and people with physical disability. Further details can be obtained from the manager or from the company. Charges range from £422 to £671 per week depending on assessed need. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 the main or key inspection for this service for the year. Some weeks before our visit we sent the manager a form called the Annual Quality Assurance Audit (the AQAA). It is a legal requirement that all registered services complete one of these every year. In it we ask for information about the service in the preceding year and the the plans for improvement in the following year. We also ask for statistics about staff, residents and about management systems in the service. Amatheas manager completed this document in time with plenty of detailed evidence of the achievements in the service. We then checked on information they - and other agencies- had given us during the year. We checked on any concerns or complaints we had received. We had gone out during the year as we had received a complaint that we judged needed to be looked at under the Care Standards Act. We went out on 24/04/09 and Care Homes for Older People Page 6 of 29 completed a random inspection where we looked at a number of issues. We found no evidence to support the complaint and in fact saw an improving picture in this service. All outstanding requirements from the key inspection of 2008 had been met in April. This random report can be downloaded from our website or ordered from our helpline. We then sent postal surveys to residents and relatives and to staff and professionals who visit the home. We had a good number returned with mainly positive comments. We quote from some of them in the report. We made our second unannounced visit of the year on the above date. We arrived just after 8 a.m and stayed until late afternoon; met with people who live in the home, spoke to staff and relatives and to other visitors on the day. We sat quietly in lounges and just observed staff and residents interacting. We walked around all areas of the building including the laundry and main kitchen. We read a number of residents files in depth after meeting them in person. We read a range of files and documents that backed up what we saw and what people told us. Care Homes for Older People Page 7 of 29 What the care home does well: The home is good at making sure they give people plenty of information and they complete assessments so that new people will receive the right levels of care and services. This is one relatives experience: When I walked into Amathea without an appointment and saw how well run it was I looked no further for my relative. He was assessed and I felt reassured he has the best personal and medical care...This has been a most difficult time for us but the staff have been supportive to all of us. We met with people who were settled and satisfied with the way things are in the home and who interact well with the staff. I like the staff and get on well with most of them...they are very caring. They receive good levels of personal care and get appropriate medical attention A number of surveys and people on the day told us they were happy with the way staff respected their dignity and rights. We could see that the homes dignity champions take their responsibilities seriously. Compassionate care...treat clients with dignity and patience.... All staff have a good listening ear. Very professional at all times...all are approachable with a good sense of humour and fun. When times require serenity and tact they show empathy. People told us they were happy with the activities and entertainments on offer and would like even more. Visitors are always made welcome. Managers and staff have been very good to my friend...as a result she is enjoying her stay and is very happy. Most people were very happy with the food provided and we shared a meal with residents. This was well prepared and tables properly set. The atmosphere was relaxed and people ate well. One survey said The kitchen staff are brilliant ! Another - They have adapted the menu to meet his specific needs. This company make sure that people are listened to and their complaints taken seriously. I might have the odd little criticism but usually everything is very good...and people do listen. Care Homes for Older People Page 8 of 29 Allegations of abuse are also taken seriously and managed properly. The building was clean, fresh and well maintained on the day. My room is always clean and tidy and my clothes ironed. Encouraged to make my own room cheerful with a personal touch. Staff and residents are making sure that little personal touches are introduced so that the house looks homely. The home and care assistants make the place feel very homely...I like how close now the employees and residents are together because it gives the home a nice atmosphere. There are suitable mixes of staff on each shift so that staff experience, training and aptitude help people get good standards of care. There is a well thought out company training plan that is supplemented by local courses. Staff told us they enjoyed their training and felt they were being developed and trained properly. Management systems were running well. Quality monitoring is ongoing and recording done correctly. Residents money was checked and found correct. Health and safety and maintenance are managed correctly. What has improved since the last inspection? During this inspection and at the random visit we made in April 2009 we saw a number of improvements. The written plans that help staff deliver care appropriately have been strengthened and improved over the year. Staff have had training in new ways to approach this. We saw lots of developments in the unit for people with dementia. There have been staff driven changes to the environment, to activities and to the staff approach. The deputy manager has led these changes and was very enthusiastic about introducing innovative practice. The manager has continued to make sure that external specialist health care providers come to the home to see people and to advise nurses and carers. Medication is now managed in a much more precise way with regular quality checks undertaken by management and plenty of staff training and competence checks. The management team are now very confident in how they manage any allegations of abuse or neglect. The manager dealt with one issue in such a way as to protect a number of vulnerable people from harm in other settings. An incident ....was dealt with swiftly and we were kept informed...dealt with to our satisfaction. Care Homes for Older People Page 9 of 29 The manager has been successfully registered with us and continues to develop her role as manager. She has good support from the company and they keep us well informed of any issues in the service. The manager and her deputy are always happy to have a word if you have any worries...I have regular appointments with the manager to talk over any worries I have about my partners care... At the random inspection we asked the company to monitor sickness and absence rates and we had evidence to show that the manager has a good strategy in place to do this. Staffing levels have improved partly because of this and because recruitment has been stepped up. There is an improving team spirit. I enjoy working at Amathea. It is well managed and has lovely atmosphere. I feel the residents needs are met to the best of the staffs ability and often above and beyond expectations. Fire safety is now being handled in a more planned and precise way and staff were more confident about their responsibilities. 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 10 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This service is careful to give good levels of information and to make sure they only admit a new person when they are sure they can give the right kind of care to them. Evidence: When we arrived at the service we noticed that detailed information (including a copy of the last inspection report) is on display in the foyer. Families told us they were given plenty of information about the company and the home before their relative made a decision about coming into the service. We read the information available and this was informative and up to date. We spoke to a number of residents and their families about the admission process. We also read files on new admissions and we noted that a review of a new persons needs was being completed on the day. We learnt that every person has a visit from a senior person to ascertain their needs Care Homes for Older People Page 12 of 29 Evidence: and wishes and that the person is then invited to look around the home. People do come to the home on a trial basis and their care needs are reviewed and reassessed from the first day of their stay. An interim care plan is started on admission and staff work with individuals and families to ensure they understand the new persons needs and wishes. People who have problems with memory are only admitted to the specialist dementia care unit after a diagnosis of dementia from a psychiatrist. We saw that the manager ensures there are social work assessments on file and that any person who may need nursing has a suitable, multi-disciplinary assessment completed before or just after admission. Staff and residents told us that new peoples needs were considered alongside the needs of the existing residents. The management only admit someone new when they know they can care for them alongside exisiting people. Care Homes for Older People Page 13 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home gives people extremely good levels of personal and nursing care so that they can have a safe, dignified life despite their health care needs. Evidence: We read a number of the written plans of care that help people identify their wishes and give staff guidance and directions for the delivery of care and services. These care plans were detailed and specific, they covered nursing and care needs and also had information about peoples preferences and aspirations. We saw that some plans were very specific and took staff through step by step approaches to everything from personal care to what to say in given situations to behavioural management techniques. People told us they had access to their care plans and some relatives told us they were very involved with drawing these up. We could see that reviewing care plans is a regular job done by groups of staff with residents, families and other professionals. One or two plans needed a little revision but we had evidence to show this was underway and that staff were good at drawing together lots of information. Some Care Homes for Older People Page 14 of 29 Evidence: plans showed urgent action taken when someone had a problem. We judged that the plans and the daily notes are generally of a very high standard. We met a member of the night staff when we arrived and she explained how they had dealt with a health care issue in the night; residents and relatives told us they were happy with the way the staff sought help from health care professionals. We saw in files and in observations that nurses check on things like blood pressure, blood sugar levels and deal with wound care and other nursing procedures.We saw some good examples of proactive and preventative medical care on the team.We learned that staff do use the district nursing service and they ask for up to date advice on nursing matters from nurse specialists. We checked on the medicines in the home. We found that these are ordered, stored, administered and accounted for correctly. No one in the home is given inappropriate medication to sedate them. We saw evidence of regular medication reviews so that people could have the most appropriate medication for their health care needs. This is done with the G.P or with a member of the psychiatric team. Some people are encouraged to manage some of their own medicines. There are regular audits of the medicines held in the home and staff (nurses and some senior carers)are trained and competent in giving out medicines. We observed staff interacting with people at all stages of life and we saw appropriate, patient and discreet approaches to people. Staff working with very frail people and with those at the end of life were sensitive and caring. Staff on the dementia care unit were patient and able to guide and support people correctly. We noted that staff followed directions in care plans very well. For example we saw staff encouraging independence and reassuring people when they were anxious, following the care plan guidance. People told us on the day and in surveys that staff treated them correctly and that their wishes, needs and rights were respected. This company have what is known as dignity champions on the staff. These are specially trained staff members who can ensure that respectful and dignified care is given by staff at all levels. The care staff are involved in this as champions and they are confident that they can challenge any member of the team who is not working to this dignity charter. We saw one person who was at the end stage of life and this person told us she was comfortable and had no pain. The care plan showed the details of the care to be given and this included not only things like pain relief and how to nurse the person in bed but also showed that the staff helped relatives at this difficult time. Care Homes for Older People Page 15 of 29 Evidence: We did notice that all the plans had a section on resuscitation. We spoke to a senior person in the company who agreed to look at this part of their forms in the light of changing legislation and we were given a draft of a reviewed policy on how nurses and carers should deal with this. Care Homes for Older People Page 16 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in this home are supported and encouraged to have as fulfilling a life as possible. Evidence: The inspection started just shortly after 8 a.m and very few people were out of bed at this time. Staff helped people to get up when they wanted and they were given drinks and breakfast as they wished. People told us and we saw for ourselves that people could do what they wanted through out the day. Some people spend a lot of time in their own rooms and eat their meals there and others enjoy socialising in the lounge or dining rooms. We were given information in the AQAA and we heard from residents about the range of activities and outings on offer. Each person in the home has a social care profile developed so that staff can identify activities and outings that people might prefer. They use a special visual aid for people with dementia. This making choices tool is used so that people who find communication difficult can have their preferences known. The home has an activities co-ordinator who arranges group activities and outings and also spends time with people who do not like group activities. This staff member is being trained in therapeutic activities and works with staff on looking at Care Homes for Older People Page 17 of 29 Evidence: things that might be suitable even when people are very frail or have dementia. Nursing staff have adopted a lot of ideas from current good practice for people with dementia and we were pleased to see that nurses and carers are actively working on this. People told us they have religious services on a monthly basis and that entertainers come into the home, Pat-a- dog visit regularly with their dogs, the local museum staff visit and do reminiscence work. The mobile library call and volunteers from the library find specific books for individuals and deliver them to the home. People told us they enjoy the regular themed evenings and coffee mornings and the twice weekly trips out are very popular. People with dementia go out the local Alzheimers club on a weekly basis and a number of people go to tea dances and other local events. We met with a number of visitors on the day and they confirmed that their relatives had choice in how they spent their time. They said they were made very welcome and kept fully informed about the life of the home as well as the individual. There are notice boards around the home that give people the information they need about activities and outings. Visitors and local groups are involved in theming areas of the home so that people will find their environment interesting. We talk about this more later in the report. We had information in surveys and on the day to show us that people enjoyed the meals given to them. The cook follows the companys nutritionally balanced menu plan but is also allowed to modify this to meet the cultural needs of the group and to suit individual preferences. There was plenty of evidence to show that a great deal of work is done to ensure that people on special diets are properly catered for. We sat with people at lunchtime and we saw a well presented meal that was taken in pleasant surroundings. People who needed help with food were given discreet and sensitive attention. Creative ways were used to encourage people with dementia to eat well. Care Homes for Older People Page 18 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in this home know they are listen to and protected from harm by the rigorous attention to the details of safeguarding and complaints work. Evidence: We checked on the log of complaints the manager keeps for the service. There had been some complaints received and they were recorded properly. One of these had come to us and we had asked the company to look into this. We discovered that the company is quick to act on complaints. The investigations are carried out by a senior person and are done thoroughly using different types of evidence gathering. There are action plans and supervision notes showing that this home responds to any complaints by taking the kind of action that improves peoples lives. People in the home and their visitors assured us that the management team take these issues seriously and we found more than one copy of the complaints procedure in the home. This gave clear guidelines about how to complain. We had also visited after an anonymous complaint and we did not uphold the complaint. The manager and the company did take the allegations seriously and double checked for themselves that what we found at this random inspection was correct in terms of their operation. We spoke to a very new member of staff who confirmed that she had received training on safeguarding people and understood that she would be protected if she spoke up Care Homes for Older People Page 19 of 29 Evidence: about abuse. She also told me she felt very comfortable with talking to the head of operations for Southern Cross, that he was in the home regularly and easy to approach. She also named a number of other people from the company she could talk to. However her first course of action was to talk to management. We also spoke to people who live in the home and they too said they would talk to the manager or any officer from the company. They were asked about how well they felt protected and generally they or their relatives said that nothing abusive was going on in the home. People were confident that Southern Cross responds appropriately to any allegation. We had examples that showed they did deal with allegations correctly. We also learned that this company are aligned with Action on Elder Abuse, train staff correctly and never hesitate to protect people. Staff understand that abuse can, and does, result in dismissal. The manager understands how to refer staff to the nursing council and the Independent Safeguarding Authority. She understands her responsibilities as a nurse and a registered person and deals with safeguarding in a proactive way. Care Homes for Older People Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are safe and comfortable in Amathea due to the design of the building and the way the staff use the environment in the best interests of the individual. Evidence: Amathea is situated in a residential part of Workington and is within easy reach of the centre of this busy west coast town. There is a regular bus service, ample parking outside the home and the town has its own rail connection. The home was built some three years ago and is purpose built to counteract some of the problems related to ageing or infirmity. The accommodation is on two floors with access by a passenger lift. All bedrooms are larger than the minimum standard size and are single occupancy with ensuite facilities. There is a modern call bell system with monitoring adaptions for people who cannot use the bell, adapted bathing and a number of other environmental features that allow people to use the environment with ease. During the visit we saw that people who use wheelchairs and other mobility aids could access all parts of their home. There is plenty of space for people who, due to their dementia, may feel restless and want to walk. Staff are changing the decor of the top floor corridor so that people with dementia can walk with a purpose. There are now interesting things to do, see and touch and we were pleased that no one was told to sit down on the dementia care Care Homes for Older People Page 21 of 29 Evidence: unit. They were monitored and guided and we saw people finding things to do or look at and this helped with their restlessness. We judged that this development of the corridor and changes to seating areas is a sign of good practice and we learnt from staff about further changes they plan - including a mural for a wall that will have a reminiscence theme. We saw that the environment and the activities provided for people with Alzheimers follow current research and good practice. All areas of the home were bright and fresh.The building was warm and clean and all areas were tidy. People were very relaxed in the shared areas and all bedrooms were personalised to the individuals taste. Even early in the day the home was well organised and clean. People were happy with the way their rooms were kept clean and tidy and told us the staff looked after their clothing and bed linens correctly. The staff deal with health and safety matters as they have been trained to. There are good systems in place to prevent cross infection and deal with potential hazards. We judged that the manager and staff maintain this purpose built building to a high standard and they also manage to introduce all the little touches that make a large home homely. We could see that the staff team have taken on board peoples needs and wishes and are beginning to turn this building into a home. Care Homes for Older People Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home is staffed by a well trained and enthusiastic work force who have high standards and respect each others skills and experience in giving high standards of care and service. Evidence: We were given copies of the last four weeks rosters. This showed a good mix of skills and experience in all shifts in the home by day and night. There is always two nurses on duty, one of whom is a specialist in dementia care. There are enough care staff to help people appropriately. The care and nursing staff are backed by a team of housekeeping and catering staff who we observed keeping the building clean and safe on the day. We were told by residents that staff were quick to come to help and people thought there were enough staff around to meet their needs. Sometimes in the past there have been some problems with having enough staff on duty due to recruitment and retainment of staff. There is quite a turnaround in staff but the manager has counteracted this by stepping up recruitment and helping staff settle into a team. We have regular updates from the manager and the company who keep us informed of their plans if they have difficulties staffing the service. The manager has this issue as a major part of her forward planning and when we visited there were no staff vacancies and a number of people happy to work on their bank as relief staff. Care Homes for Older People Page 23 of 29 Evidence: We looked at the last round of recruitments in the home. Everyone had been interviewed thoroughly and had their background, qualifications and aptitude assessed. No one starts to work in the home before all background checks are completed. The manager gave us a copy of her record of training for the last year and a plan for the following year. This showed that all staff complete core training in things like fire and food safety, principles of care, manual handling and infection control. We also saw that nurses are given the opportunity to attend specialist training in both theoretical and clinical nursing practice. Some of the senior carers are also involved in the theoretical side of this. Many of the specialist training courses (for example those on dignity, end of life care and managing medicines) have been attended by nurses,carers and support staff. There is a very open approach to learning in this home. For example a number of people felt they needed support with writing records and staff at all levels attended literacy training together. Some training courses have had more carers attending and they have become the experts or champions on topics like dignity and respect and on person centred thinking. There was also a lot of evidence of key players in this home searching out what is innovative in practice and sharing it with colleagues. The home is working on getting all care staff qualified up to at least National Vocational Qualification at level 2 in care. A good number of people have already gained the award and more are on the verge of completion. We judged that the standard is met as the home has only been open for a short time and will soon meet the required numbers of qualified staff. Care Homes for Older People Page 24 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management systems in this home continue to improve and this means that people can relax knowing things are running smoothly. Evidence: The home is managed by Sharronn Miller. She is a suitably qualified and experienced nurse. This is her first post as a manager of a nursing home and she has received suitable support and training from Southern Cross to help her develop in her role. She is now the registered manager for the service and we had lots of evidence to show that she has suitable plans in place for continuing to improve and develop the service. Southern Cross has its own quality auditing system. This is used at all levels in their homes. It covers all aspects of the work of a nursing home. We saw evidence that all the management systems are checked on regularly. There are external auditors who visit and look at how the home is running; senior managers visit on a regular basis and the manager has her quality plan that she works to all year round. Routine things are therefore checked continually and any problems dealt with. People who live in the Care Homes for Older People Page 25 of 29 Evidence: service are asked their opinions through one to one discussions with staff, residents meetings and in confidential surveys. There is an annual quality review and ideas and changes taken forward from this. The company base their business and improvement plans on the outcomes of these quality reviews. We saw reports and check lists and heard from staff and residents that their opinions were sought. We judged that quality matters are high on the agenda for the company and for individual staff members. We checked with the administrator on systems for supporting people who needed help with financial matters. We saw that major financial issues are dealt with by Social Services or by solicitors or family members. Any cash dealt with by the company is minimal and is managed following the company policies and procedures. We checked on these arrangements and found them to be in order. We looked at supervision notes for staff at all levels and found that these one-to-one meetings were part of a wider training and development plan. We judged that the senior team had improved the way they recorded these sessions. Staff told us they were happy with the way they received individual support and attention. We checked on food and fire safety in the service. All records were up to date and people had suitable training in place. Maintenance and repairs were dealt with on a daily basis. Things like fire drills and instructions are carried out appropriately. There are suitable risk assessments and risk management plans in place. We saw nothing hazardous or concerning on the day. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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