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Care Home: Ashfield House

  • Ashfield House Bargates Leominster Herefordshire HR6 8QX
  • Tel: 01568614662
  • Fax: 01568614662
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16062009Ashfield House is a Victorian three-storey detached house, set in large, mature gardens and situated on a main road through Leominster. The service is registered to accommodate 14 older people, male or female, who may have needs arising from the normal ageing process or from dementia related conditions. The Statement of Purpose confirms that the home cannot accommodate residents who may have behaviours that significantly impact on other residents in a negative way.

Residents Needs:
Dementia, Old age, not falling within any other category

Latest Inspection

This is the latest available inspection report for this service, carried out on 29th April 2010. CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

For extracts, read the latest CQC inspection for Ashfield House.

What the care home does well People are given clear information about the home. They have their needs assessed and they are offered visits and a trial stay before making a decision about moving in permanently. People feel staff support them well with their daily care and health needs and that they are treated as individuals. Their care plans contain up to date guidance about their needs, wishes and preferences. Established links are in place with local professionals to meet people`s health needs. The home has a relaxed atmosphere and visitors are made welcome. People can choose how they spend their time and regular activities are provided. The service provides a small and homely environment for people who prefer this to a larger care home. People enjoy the home cooked meals and baking and the mealtimes are sociable. People like the staff who support them and some staff have worked in the home for many years. More than half the staff have achieved a National Vocational Qualification. The management team seek feedback from people and their relatives and supporters and listen to this when deciding how to make improvements. What has improved since the last inspection? Information about the home and how to make a complaint has been made clearer for people using or considering using the service. Care plans have been expanded and are being reviewed regularly. There is a wider range of activities on offer and these are being planned ahead and advertised in the home more clearly. The way medication is administered and recorded has been made safer and staff have been retrained. The environment has been made safer for people with dementia. A programme of redecoration has been started with some bedrooms having a make over. New communal furniture has been provided and two bathrooms brought back into use. Infection control arrangements and waste storage have been improved . Staffing arrangements have been changed to provide more opportunity for short local outings and to relieve evening care staff of catering duties so their focus can be on the residents. More robust checks are being carried out before new staff start work. Staff are being more closely supervised and better supported. Fire safety arrangements have been improved with new equipment and better staff training. There is a more proactive management team and improvements are being made in all areas of the service. What the care home could do better: More opportunities for trips out would be appreciated by some people living in the home. Care plans could be expanded further to show how people`s social needs are being met, particularly those people who have dementia. Moving and handling assessments for the use of equipment need to be carried out by a suitably trained and competent person to ensure only appropriate and best practice techniques are used. All staff need to have up to date moving and handling, and other core training essential to their role. The kitchen staff should have access to clear information about people`s special dietary needs and their meal preferences. Key inspection report Care homes for older people Name: Address: Ashfield House Ashfield House Bargates Leominster Herefordshire HR6 8QX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jean Littler     Date: 2 9 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Ashfield House Ashfield House Bargates Leominster Herefordshire HR6 8QX 01568614662 F/P01568614662 margaret@wenlock8457.fsnet.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Margaret Mary Wenlock Name of registered manager (if applicable) Mrs Margaret Mary Wenlock Type of registration: Number of places registered: care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 1.The registered person may provide the following categories of service only: Care Home only PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old Age not falling within any other category OP 14 Dementia DE 14 Age: Dementia - Code DE age 55 and above. The maximum number of service users who can be accommodated is: 13 The maximum numbers of service users who can be accommodated is:14 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 13 Old age, not falling within any other category (OP) 13 Care Homes for Older People Page 4 of 30 Over 65 0 14 14 0 Date of last inspection Brief description of the care home 1 6 0 6 2 0 0 9 Ashfield House is a Victorian three-storey detached house, set in large, mature gardens and situated on a main road through Leominster. The service is registered to accommodate 14 older people, male or female, who may have needs arising from the normal ageing process or from dementia related conditions. The Statement of Purpose confirms that the home cannot accommodate residents who may have behaviours that significantly impact on other residents in a negative way. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We, the Commission, carried out this unannounced inspection over one day. At the last Key inspection in June 2009 the service was rated as providing Adequate outcomes for people and three requirements were made. A Random inspection was carried out in December 2009 and this confirmed that Mrs Wenlock, the owner and manager, had taken action to address the shortfalls and improve practice. The findings from this Key inspection were much more positive and the rating has been returned to Good. Mrs Wenlock provided us with the annual quality assurance assessment (AQAA for short) before we visited. This is information that registered people are asked to complete each year to inform us about how the service is being provided, what has been improved and what are the future aims. Care Homes for Older People Page 6 of 30 A sample of survey forms were sent out to obtain feedback on the service. During the visits to the home the building was toured, records such as medication, care plans, training and money were sampled. Staff were interviewed and people living in the home were spoken with. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? Information about the home and how to make a complaint has been made clearer for people using or considering using the service. Care plans have been expanded and are being reviewed regularly. There is a wider range of activities on offer and these are being planned ahead and advertised in the home more clearly. The way medication is administered and recorded has been made safer and staff have been retrained. The environment has been made safer for people with dementia. A programme of redecoration has been started with some bedrooms having a make over. New communal furniture has been provided and two bathrooms brought back into use. Infection control arrangements and waste storage have been improved . Staffing arrangements have been changed to provide more opportunity for short local outings and to relieve evening care staff of catering duties so their focus can be on the residents. More robust checks are being carried out before new staff start work. Staff are being more closely supervised and better supported. Fire safety arrangements have been improved with new equipment and better staff training. There is a more proactive management team and improvements are being made in all areas of the service. Care Homes for Older People Page 8 of 30 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 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given clear information about the service. They have their needs assessed and are encouraged to visit and try out the service before making a decision whether to move in permanently. Evidence: There is a Statement of Purpose that is available at the reception area. An information pack is given to interested parties. This contains a brochure and the Service User Guide. Recently this has been improved to make the information clearer and more accessible to older people, some of whom may have dementia. Survey feedback indicated that people felt they had been given adequate information about the home before moving in. Mrs Wenlock said in the AQAA that the needs of new people are fully assessed and people are invited to visit and move in on a trial basis. They can bring personal items Care Homes for Older People Page 11 of 30 Evidence: to help them feel at home. The records sampled and peoples bedrooms confirmed this. One new person gave feedback to Mrs Wenlock about how it felt on arrival. This has been listened to and in future a worker is going to be assigned to each new person to help them feel welcome and settle in. All residents seemed to be appropriately placed and those spoken with were positive about the service. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have there care and health needs detailed in their care plans and these are being regularly reviewed. People are happy with the way the staff support them on a day to day basis with their care needs and they feel they are treated with respect. Medication is being safely managed on their behalf. Evidence: Staff feedback indicated that they felt they are usually kept up to date with peoples changing needs. A sample of care records were seen. The new care plan format Mrs Wenlock had introduced during 2009 has been developed and is proving effective in guiding staff about peoples previous history, preferences, health and support needs. Some information was detailed and nicely personalised. Social and emotional care plans could be expanded. Risk assessment tools have been introduced and there are now falls assessment, nutritional and pressure care risk assessments. This is very positive as it helps protect people if they become ill or generally frailer. Bed rails are not used unless the district nurse recommends and provides them and carries out the Care Homes for Older People Page 13 of 30 Evidence: assessment. Links are in place for people with physical or mental health needs such district or psychiatric nurses visits. Mrs Wenlock is currently completing the moving and handling assessments, although she has not refreshed her basic training for over three years and has never attended a course on completing assessments. Most people only use the stair lift, walking aids and the bath aids, however one person was being hoisted and had more complex needs. Mrs Wenlock committed to making a referral to the persons social worker for a review and an Occupational Therapy Assessment. She confirmed after the inspection that a review was set up, so a requirement has not been made. Hospital transfer information has been completed for each person in case of emergency admission. Mrs Wenlock said the ambulance service have praised the arrangements. She takes people to hospital appointments if they do not have family or friends to accompany them. Health records showed people have annual eye tests and chiropody. An exercise class is held to help promote mobility and Independence. Care planning for people with dementia could be further developed. Assessments are completed on areas such as orientation, memory and behaviour. The daily lifestyle plan could be made more person centred guidance for staff how the person can be supported to help them feel valued and partake in activities that are meaningful to them. There was evidence that each care plan is now being reviewed monthly as recommended, however, in one case weight lost over three months had not been picked up in the review process. Reviews need to flag up changes and the care plan revised along with information being shared with staff and cooks etc. Following feedback at the last inspection from district nurses Mrs Wenlock said she is requesting continuing care assessment more quickly to see if the individuals are eligible for free nursing care. Medication is being stored in a suitable cabinet. Following the requirement made at the last inspection Mrs Wenlock has taken positive action and retrained staff in line with the homes procedure. Safer administration practices are now being used. There were still some occasional gaps on administration charts but these are picked up with the staff concerned. All seniors have been retrained and other staff are due to attend training in July. The system has improved and each persons wishes about how they take their medication are now recorded along with their photograph to help avoid errors. One controlled drug was being managed. Appropriate storage is in place and a Care Homes for Older People Page 14 of 30 Evidence: running balance is being maintained in the bound register. The stocks held balanced with the records. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to live in the way they prefer but within a safe environment. Relatives are encouraged to visit and made to feel welcome. Activities are provided but some would like more opportunity to go out into the local community or for day trips. People enjoy the food and the mealtimes are sociable and relaxed. People are being consulted about the menu and a balanced diet is provided. Evidence: People spoken with said they felt comfortable in the home and could move around freely. People were seen to take themselves to different communal areas or to their own rooms after meals. One person said she prefers to spend time in her bedroom where she had a television and the daily papers. She sometimes has her meals in there too. Mrs Wenlock said in the AQAA the programme of social activities has been developed. This is arranged by her and the deputy. One worker is now staying on an extra hour after her care shift, four days a week, to enable people to go out for walks or do a chosen activity between 12 and 1pm. This worker is not a driver so the house vehicle is still not being used as much as it could be. Currently only Mr and Mrs Wenlock are insured to drive this. Some outings have been arranged such as Christmas shopping trips, however feedback indicated people would like more of these. Care Homes for Older People Page 16 of 30 Evidence: We saw evidence that activities planning has improved and a calender in the reception area shows what is on during the month. Activities listed included Keep Fit, Bingo, Quiz, Musical Interlude, Hairdresser, Communion, Film Show, May Madness Theatre Show, Giant Connect Four, Brain Teasers and Wii Fun. We saw people enjoying a singalong with a musical couple booked to perform in the lounge. Some people used the microphone and the song sheets provided. It is positive that three people help with laying tables or folding washing, however this type of involvement could be expanded in ways that suit each individual. More items could also be located around the home for people to access e.g. dolls, tactile objects like soft toys, magazines to reorganise, things to fold etc. Mrs Wenlocks plans to arrange for two staff to attend training on the provision of therapeutic activities would be a positive step. People living in the home gave the following comments in their surveys; They do everything well, I am contented and happy; They look after me 24/7, are kind and feed me well; I have everything I need, I like having my hair done and having a bath, the food is nice and I dont have to wash up, it is very nice here; Their care and kindness is exemplary and they are very friendly; I am happy here but would welcome additional trips out. Some staff said they would like to be able to offer people more opportunities to go out. Mrs Wenlock said this was an aim for the year ahead. Consideration should be given to recruiting volunteers that can support staff to do this. People were observed to enjoy their lunch and evening meal. Staff were attentive. The atmosphere was congenial and people were not rushed. Two cooks are employed and one spoken with said she had access to fresh ingredients. Home made cakes are baked and she has been making homemade flans and quiches for tea. She has been asked for feedback and has given Mrs Wenlock menu ideas to increase the variety offered. Some people have special dietary needs due to diabetes or weight loss. The new cook could not easily find this information and was not aware that anyone needed a high calorie diet. Mrs Wenlock said staff are currently asking people about their preferences and special needs before a new menu is decided upon and the kitchen file updated. Environmental health gave a three star rating in January 2008. Both cooks are qualified in food hygiene. Care Homes for Older People Page 17 of 30 Evidence: Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to express their views and any complaints will be taken seriously. Arrangements are in place to help protect people from abuse and people using the service feel safe. Evidence: The Commission has not received any complaints about the service since the last inspection. Mrs Wenlock reported in the AQAA that none have been received by the service either. In the past Mrs Wenlock has been open with us about complaints received and addressed them appropriately. Feedback in surveys showed that people felt able to raise concerns with Mrs Wenlock or staff. There is a written complaints procedure and Mrs Wenlock reported that this has been made more accessible with clearer text and a photograph of Mrs Wenlock. A copy is given to each person in their information pack. The new suggestion box is located by the entrance for all to use. Information is available to staff in the office about the local multi agency adult protection procedure. Mrs Wenlock reported in the AQAA that the home has written guidance and staff have received recent refresher training in abuse awareness. In the The staff spoken with said they found Mrs Wenlock approachable and would report any concerns or abuse to her. Care Homes for Older People Page 19 of 30 Evidence: Mrs Wenlock had attended a briefing on the new Deprivation of Liberty Safeguards and the Mental Capacity Act are being considered when planning care and making decisions with people or on their behalf. Improved recruitment and staff management arrangements are helping to provide a framework that protects vulnerable people. The feedback received indicated that people do feel safe and secure in the home. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a comfortable, homely, clean and well maintained home with pleasant gardens. Evidence: The home has a large dining room and conservatory that overlook the gardens. There is also a separate television lounge. The communal areas are homely and comfortably furnished. There is lots of seating in the conservatory if people wish to have some quiet time away from the television. There is a patio area with seating and the door to this is open during the day. The garden is fenced to separate it from the car park and main road and relatively secure. Seven single bedrooms and two double bedrooms are upstairs. Three of these rooms have en-suite facilities. A stair lift is installed on each stair case to enable people with limited mobility to access these areas. There are three bedrooms on the ground floor, two of which have en-suites. The bedrooms seen had a sink and had been nicely personalised. Two residents spoken with in depth were both satisfied with their private rooms. Mrs Wenlock told us privacy screens are now used in all shared rooms. The en-suites include toilets and sinks but not baths. There are three communal bathrooms. A normal bath with a seat hoist, a walk in medi-bath and a disabled access shower. This gives people a good choice over which facility suits them best. As Care Homes for Older People Page 21 of 30 Evidence: well as the bath aides and stair lifts there are two portable hoists. Mrs Wenlock acquired one recently and it has not been serviced since 2006. She agreed to label it so staff know not to use it and she booked a service engineer visit during the inspection. Guidance should be issued in care plans as to which mobile hoist is best suited for use in unplanned situations such as lifting people who have fallen. There is a call system in place and bells were seen to be appropriately placed in peoples bedrooms and in the toilets. There are handsets so people can move around with them and use them on the patio. The front door is fitted with a coded lock to ensure people who have dementia do not leave without staff knowing. Mrs Wenlock has implemented an improvement schedule since the last inspection. A maintenance task book has been re-established to help ensure repair jobs are carried out in a timely manner. Improvements to date include a new pager system so staff can summon help if needed, and alarm has been fitted to external fire doors to help protect confused people from leaving the building unseen, new fire call points fitted, three bedrooms have been refurbished, new lounge arm chairs and new dining tables and chairs. Plans for next year are to improve other areas such as the lounge and dining rooms. Infection control arrangements have also been improved. Gloves and other protective clothing were on show, hand wash systems have been upgraded, red dissoluble bags are in use in the laundry for soiled linen. New waste storage has been set up for household and clinical waste making the patio a more pleasant place to be. Mrs Wenlock is looking into upgrading the commercial laundry equipment, which will provide a sluice facility. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are being supported by staff they like and know well. There are enough staff to meet peoples needs. Staff are being trained but there are gaps and refresher courses needed. Staff are being safely recruited and their performance supervised. Evidence: There were two vacancies in the home so tweleve people were being supported by three carers 8am-12noon and 7-9pm. At other times there is usually only two carers. This needs to be kept under review in regards to how many people have dementia and cannot occupy themselves in a meaningful way. As mentioned earlier one worker is now staying on an extra hour four days a week to enable people to go out for walks or do an activity one to one. There is also now a tea cook between 4-6pm seven days of the week. This is a great improvement as it means care staff are not leaving their care duties to prepare the evening meal. Feedback from people in the home indicated that they liked the staff and found them friendly and helpful. Staff feedback in surveys was positive. They indicated they felt supported and enjoyed their work. Comments included; I can go to Mrs Wenlock if I have any concerns and she will give me advice; There is a homely atmosphere and we meet the residents needs in a safe environment; Relatives and friends are made welcome and every Care Homes for Older People Page 23 of 30 Evidence: resident is treated as an individual. Suggestions for improvements were; I would benefit from Dementia, Diabetes and Moving and Handling training; More day outings would benefit the residents. Mrs Wenlock provided us with a copy of the training provided in 2009. This showed that the majority of staff had attended courses such as Fire Awareness, Swine Flu and Safeguarding. Smaller groups had attended Dementia Awareness and Sensory Awareness. Mrs Wenlock had started to develop the plan for 2010, which included a Bereavement Seminar and Medication Administration. She has set up a new induction programme that meets the Skills For Care standards. All staff have worked through this to ensure new and longstanding staff both have the same knowledge and understanding about the service values and procedures. NVQs are promoted and nine staff hold an award. Others are working towards level 2 and 3 awards and the deputy is going to start level 4. The senior team are due to start a module course on leadership and management. This should help them with the work to bring positive changes to working practices, which some staff have found challenging. Mrs Wenlock was open that some staff have gaps in their training and need to attend courses to bring their knowledge up to date, such as moving and handling refreshers. She told us she is committed to arranging these courses and that this is her priority now many other areas have been improved. We are confident she will achieve this so a requirement has not been made. Two recruitment files for new workers showed that procedures are now more robust and the requirement regarding this has been met. Mrs Wenlock is providing supervision directly at the moment but it is planned that the deputy and senior staff will take this on after being trained. All staff have been issued with new contracts and wages have been reviewed. Staff meetings are being held and the new management team are working with the staff team to introduce a positive programme of modernisation that is already benefiting people living in the home. Helping staff understand the Dementia Personalisation Strategy should also be an aim. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is now being pro actively managed and the service is modernising in the best interests of the people using the service. Evidence: Mrs Wenlock is being supported by a new deputy to introduce new systems and these are now having positive benefits for people using the service. She is allocating more hours for herself and senior staff to dedicate to management tasks. She told us all outstanding policies have now been developed and existing ones reviewed. She is contracting with a Health and Safety company who will help ensure effective risk management systems are in place and any changes of legislation are implemented fully. Record keeping has greatly improved and the management team are aware of the areas that need further work, such as care plans. Mrs Wenlock has been reporting incidents, accidents and deaths to us appropriately, therefore the requirement made at the last inspection has been met. Care Homes for Older People Page 25 of 30 Evidence: Mrs Wenlock has purchased a Quality Assurance package and intends to introduce this to help her monitor the systems in the home to help drive improvements to standards. She completed the AQAA on time and this gave a full and clear picture of the service provided, what has already been improved and what the plans are for the next year. The information accurately reflected what we found during our visit. Fire safety arrangements have been improved both in terms of the equipment and staff training. Fire drills are now being held regularly to ensure staff can carry out the procedure efficiently. Infection control systems have been improved and risk assessments in care plans have been further developed to help protect people. Mrs Wenlock needs to ensure that she thinks through decisions she makes in terms of risk and safety. This is not always evident. For example she left a second hand hoist available to staff when the last service was 2006, and she carried out moving and handling assessments when her basic training was out of date. A sample of financial records were seen and these showed that relatives are being asked to sign if they leave spending money. They have access to a log to see how the money is being used and receipts are kept to provide evidence e.g. for the purchase of newspapers, chiropody and hairdressing. One person manages her own money and people are supported to do this if they wish. Care Homes for Older People Page 26 of 30 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 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Arrange for professional input when people develop complex mobility needs such as the need to be hoisted. Ensure moving and handling assessments are carried out by someone trained and experienced with up to date knowledge. Continue work to develop the care planning system, including social and emotional plans. Ensure monthly reviews pick up changing needs and trigger appropriate action in response. Research and develop the activities and pastimes available to people with Dementia. Support the two staff to attend the planned training opportunity on providing therapeutic activities. 2 7 3 12 4 13 Review how people can be given more opportunities to go out and be part of the local community or go on trips further afield. Ensure kitchen staff have easily accessible and clear information about peoples dietary preference and special needs, such as a diabetic or high calorie diet. Page 28 of 30 5 15 Care Homes for Older People 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 6 7 30 30 The team should work towards fully implementing the Dementia Strategy for Personalised Care. Promptly arrange training for the staff and manager to ensure they have up to date knowledge about core areas of their work, such as moving and handling. Continue the work that has started to modernise the service and raise standards. This process will be aided by the implementation of the new quality assurance system that should bring about a cycle of improvement. 8 33 Care Homes for Older People Page 29 of 30 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!

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