Care Home: Ashlea Court

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What the care home does well The home deals well with the process of assessing and welcoming new people and supplies them with all the information they need. Staff employed are caring and are skilled and competent in their role. They have got to know the people who use the service well and understand their individual needs and preferences. As a result many individuals are able to communicate confidently with staff. Each person is seen and treated as an individual in their own right, this means people have choices about how they spend their time and what they want to do. There is a committed and experienced team of staff at the home who work well together. Staff feel well supported by the management team at Ashlea Court. Staff have also had a significant amount of training in working with older people, especially in meeting their health needs. Consequently people get the benefit of living in a home where they feel supported and their needs are met. The home has achieved good standard in meeting the health needs of people and has close and effective relationships with local health care professionals. This is reflected in the care plans for each person. As well as being very clean and well maintained Ashlea Court has a homely and relaxed atmosphere. One person who uses the service said `It`s an excellent home, I`ve no complaints. It`s just what I wanted. I like the atmosphere it`s well run and it`s always clean and tidy`. Meal provision at the home is good. People are offered a variety of choices at every mealtime and special diets are catered for. One person commented `The meals are very good, the cook comes to see us and asks what we want each day, there is always something I like on the menu`. People using the service are protected by the homes complaints and safeguarding adults policies and also by the recruitment procedures. What has improved since the last inspection? Care plans now contain more information about an individual`s life history, interests and wishes. As a result people are benefiting from care that is tailored to meeting their individual needs and wishes. An increasing number of people are being admitted into the home with a terminal illness, as a result staff have continued to gain more experience and expertise in palliative care, and with guidance and training are improving their skills further in this area. More diverse and regular activities have been provided in the home to support people`s social needs. Improvements have been made to the monitoring of the quality of services and care provided to people, although some further developments to the auditing processeswould be beneficial, the systems in place demonstrate the management teams commitment in providing a service that is run in the best interests of the people that live at the home. There has been ongoing redecoration of the home which has included recent refurbishment and redecoration of the communal areas and hallways. A new nurse call system has been installed. What the care home could do better: The home could make sure that where staff handwrite medication records (transcribing) that another staff member signs the record to make sure the record is accurate. The management should carry out a staffing review to determine if there are enough staff rostered at all times to meet people`s needs. This should include formal dependency monitoring, skill mix review and regular auditing of call bell response times. Although there is evidence that the responsible individual visits the service regularly. Reports to support these visits for the last eight months were not available, the manager needs to ensure that copies of all reports are held in the home. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ashlea Court Ashlea Court Church Lane Waltham Grimsby North East Lincs DN37 0ES     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jane Lyons     Date: 2 8 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Ashlea Court Church Lane Ashlea Court Waltham Grimsby North East Lincs DN37 0ES 01472825225 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : ashleacourt.gr@btconnect.com Winnie Care (Ashlea Court Grimsby) Ltd care home 48 Number of places (if applicable): Under 65 Over 65 48 old age, not falling within any other category Additional conditions: 0 that the home can accept five persons under the age of 65 years (and no other under that age) until those persons reach the age of 65 years or terminate their contract with the home. Date of last inspection Brief description of the care home Ashlea Court is located in a quiet residential area, close to all village amenities. The home provides care including nursing for up to 48 people over the age of 65 and included in that total has five places for persons under the age of 65. The building is of a modern construction; purpose built in 1995 and in January 2002 had a 10 -bed extension registered. Furnishings and fittings are of a high standard. A passenger lift and stairs are provided to access both floors. All bedrooms are for single occupancy and meet the standard regarding minimum standards, 36 of the bedrooms have en- suite facilities and there is Care Homes for Older People Page 4 of 31 Brief description of the care home a range of assisted and non- assisted bathing facilities within the home. There are four lounge areas and a tearoom for people who use the service and visitors to use. There are two courtyard areas, one of which is enclosed. Ample car parking spaces are available. Weekly fees are between four hundred and thirty pounds and five hundred and eighty pounds. The home operates a system whereby the fees include a thrid party contribution. Additional charges are made for the following: toiletries, newspapers/ magazines, hairdressing, chiropody, transport to appointments and escort fees. Information on the service is made available to prospective and current persons via the statement of purpose, service user guide and inspection report. Documents are made available prior to and following admission, copies are always held in the reception area. Care Homes for Older People Page 5 of 31 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: The quality rating for this service is 3 star. This means people who use the service experience excellent outcomes. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) from the last six months including information gathered during a site visit to the home which took approximately eight hours. As part of this inspection process surveys were sent out to ten people using the service, ten staff who work there and five health social care professionals who have had recent involvement with the service. Surveys were received from six staff members, nine individuals and three health professionals. Comments were very Care Homes for Older People Page 6 of 31 positive such as Staff are extremely courteous and very welcoming and Ashlea is very homely and friendly. Anonymised comments from surveys and from discussions on the day of the site visit will be included throughout the report. Throughout the day we spoke to people staying in the home and their relatives to gain a picture of what life is like at Ashlea Court during their stay. We also had discussions with the registered manager, the senior administrator, administrator, nursing staff, care staff, the cook, activity organiser and two visiting health care professionals. We looked at assessments of need made before people were admitted to the home and the homes care plans to see how those needs were to be met while they were staying there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff recruitment, staff training, how the home monitors the quality of service provided and how the home is managed overall. We also checked with people to make sure that privacy and dignity is maintained, that people can make choices about aspects of their lives and that the home ensures they are protected in a safe, clean environment. We observed the way staff spoke to people and supported them and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. We would like to thank the people who were staying at Ashlea Court, the staff team and the management for their hospitality during the visit and also thank the people who spoke with us. This was a very positive and enjoyable visit. We carried out a True Random unannounced inspection visit to the home on the 21st January 2009. These inspection visits are carried out on services which have been assessed as good or excellent and we are satisfying ourselves that nothing has changed and the rating is still valid. At this visit we saw evidence that the two requirements made at the last key inspection had been met and one good practice recommendation was made to provide more person centred care documentation. Reference to this inspection has been made throughout this report. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? Care plans now contain more information about an individuals life history, interests and wishes. As a result people are benefiting from care that is tailored to meeting their individual needs and wishes. An increasing number of people are being admitted into the home with a terminal illness, as a result staff have continued to gain more experience and expertise in palliative care, and with guidance and training are improving their skills further in this area. More diverse and regular activities have been provided in the home to support peoples social needs. Improvements have been made to the monitoring of the quality of services and care provided to people, although some further developments to the auditing processes Care Homes for Older People Page 8 of 31 would be beneficial, the systems in place demonstrate the management teams commitment in providing a service that is run in the best interests of the people that live at the home. There has been ongoing redecoration of the home which has included recent refurbishment and redecoration of the communal areas and hallways. A new nurse call system has been installed. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 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 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessment arrangements ensure that accurate information is gathered and the admission is well planned where possible. The home ensures that the facilities, staffing and specialist services provided meet the health, social and diverse needs of the individual. Evidence: We looked at a sample of files, which belong to people who are staying at the home, and we saw that these contained records of assessments undertaken by the home. The assessments cover all aspects of health and personal care needs. In addition to this, information is also requested from the family and health and social care professionals where possible so that the home has as much information about the prospective individual prior to their admission. Wherever clients are referred through the Local Authority the home has obtained Care Homes for Older People Page 11 of 31 Evidence: copies of relevant assessment reports and care plans. The assessment process also takes account of peoples cultural and social needs. This information is recorded and made available to carers so they have a good understanding and know how people wish to be addressed and their preferred lifestyle. The manager explained that changes to commissioning strategies by the placing authorities and initiatives such as G.P. funded beds has meant an increase in the number of emergency type admissions, where people are usually admitted directly from hospital or their own homes without the home having opportunity to carry out an assessment or the person having the opportunity to visit the service. However there is good evidence that the home obtains as much information as possible about the persons needs prior to admission to ensure their needs can be met. Staff confirmed in discussions that they were always informed of new admissions, the care the individual needed and that any equipment required was provided before they arrived at the home. We visited several homes, before deciding this was the best one. This was the comment from one of the relatives we spoke with. The relative of a person who had recently moved in said they were very pleased with how their relative was getting on and that The care here is very good, this home has the personal touch. We also spoke with a person who was being admitted to the home for respite care support and she told us that her husband needed a break and she was pleased to be coming back as the home is so comfortable and the staff always looked after her well. There was good evidence to demonstrate that care staff are accessing a range of service specific training which will help ensure that they have the skills to enable them to deliver up to date care methods and have a better understanding of the varied conditions common to older people. The home does not provide intermediate care support. Care Homes for Older People Page 12 of 31 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. People find that staff provide care and support that is of consistently high standard. Care plans are tailored and developed according to assessed needs and constantly reviewed to make sure that current needs are identified and planned for. People who use the service and their relatives feel assured and comforted by the fact that the right systems are in place for supporting those approaching the end of life and people can choose to have the care they wish and not be admitted to hospital unnecessarily. Evidence: Individual needs are identified and recorded in written needs assessments. These assessments are use to inform care plans together with input from the person or relative where necessary. Care plans for three individuals were case tracked. This showed that the care plans are very detailed and outline the level of support and care each person requires in ensuring their health, welfare and social needs are being met and regularly reviewed. Care Homes for Older People Page 13 of 31 Evidence: There is very good evidence that the management have acted on advice given at the random inspection of January in respect of making the care documentation more person centred. Detailed personal histories have been drawn up with clear involvement of individuals and their relatives and many of the care plans have been rewritten in a more person centred style which includes much more detail on how people like to receive their care. All the plans seen showed evidence that they had been evaluated regularly and any changes in the persons needs are well documented. Daily records are completed and they describe well how the persons health and personal needs have been met. Discussions with the manager evidenced the homes ongoing commitment to improving the care documentation, a new training programme for staff has recently been developed and the management are clear in the areas they need to work on, for example; the daily records, communication records and ensuring plans are signed by individuals or their representative. Risk assessments are completed for specific activities that staff feel pose a risk to the individual. Those seen included nutrition, skin condition, mobility, use of bed rails and specific health related issues; records show they are reviewed regularly. A number of individuals have medical conditions that impact on mobility, equipment is in place as well as nursing practices to promote tissue viability. Wound care and infection control measures are good with records to evidence this. Continence is promoted discreetly by providing toileting assistance at appropriate intervals, also too provided are aids such as catheters and continence pads. Systems are in place that ensures those people on particular feeding regimes or at risk of poor nutritional intake are safe and well nourished. Records show that nutritional needs are monitored, intake levels recorded and specialist advice is sought where necessary. There was good evidence that people have access to health professionals and any contact and outcomes from discussions and visits were clearly documented. During the visit we spoke with two health care professionals who regularly visit the home, they told us We are very pleased with the home and the quality of care, the staff are very good and communicate well. All our patients are happy and well supported here. Comments in a survey from a local G.P. include People in the home receive excellent care and attention, I have always been impressed with Ashlea Court and their care of my patients, especially the dignity, respect and friendliness shown. There is evidence of a professional approach from the home staff and of close working relationships with external professionals. The management have also introduced a new review system due to the difficulties many relatives said they experienced in attending meetings and from comments received about improvements needed to aspects of communication. Survey forms are issued to all relatives for them to complete and subsequent meetings are arranged at Care Homes for Older People Page 14 of 31 Evidence: the request of the individual and their relative if they feel it is necessary; this system appears to be working well. We looked at some of the review feedback forms and they contained some very positive comments about the quality of care in the home, which included My mother has received care at Ashlea Court for many years, the care and attention from staff during this time has always been excellent. During this visit we checked the way that staff in the home manage peoples prescribed medication. We found that the medication was well managed and safely stored. Records showed that each person got the medication they needed at the right time and staff made sure that accurate records were kept. The nursing staff at the home are responsible for administering the medication.The home uses a monitored dosage system and the majority of medication records are provided by the pharmacy in printed form, for new admissions to the home, staff hand write (transcribe) the medication records, it is good practice for transcribed records to be witnessed by a second member of staff to ensure accuracy. We looked at the management of controlled medication, which was stored safely and recorded properly. People are encouraged to be as independent as possible in controlling their own medication, risk assessments and monitoring systems are in place for those who can self- medicate. There are good systems in place to support end of life care at the home, the manager confirmed that the home uses specific documentation in line with the community health care team to support peoples palliative care needs. One health professional commented in a survey The home provides very good standards of palliative care, they make sure they have the time to spend with individuals and their families to provide all the support they need. People were observed being treated with dignity and having their wishes respected throughout the visit, we saw that staff are sensitive to peoples needs when carrying out personal care support and sensitive and patient when dealing with those people who have some memory loss problems. Care Homes for Older People Page 15 of 31 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 benefit from a choice of activities in the home and are encouraged to pursue their own interests. Staff are good at welcoming relatives and friends so that they also feel part of the home as well as enabling individuals to maintain their relationships. People make their own decisions wherever possible about what they do and when. Peoples nutritional needs are well met. Evidence: People are given choice around their daily living and social activities. When we spoke to people who stay at the home they said they could make choices about activities, meals, how they spend their time and when to get up and go to bed. This was observed during the visit. There are a number of comfortable sitting rooms where people choose to spend their time. On the evidence of this visit around half of the people who use the service spent their time in the lounges and entrance hall and the remainder in their bedrooms. There were a large number of visitors to the home throughout the day. A calm, friendly, relaxed atmosphere has been created. The manager, via the returned AQQA, stated that one of the aims of the service was to provide a life at the home for people similar to the one they would have had in their own homes. Many of the individuals had lived nearby before moving to the home and Care Homes for Older People Page 16 of 31 Evidence: there was encouragement for them to retain their interests, to have visitors and decide how best to spend their time. On the evidence of this inspection the manager and staff have been successful in achieving this aim. I really enjoy the quizzes and the games of dominoes we have regularly. This was the comment of one of the people who use the service. The activity organiser puts on a varied weekly programme as well as responding to individual requests, she told us that a Dog and Duck evening had taken place recently where staff had arranged the dining room into the style of a public house, music and drinks had been provided and everyone had enjoyed the event. Entertainment is provided regularly and special occasions are celebrated such as birthdays and holidays. Photographs of people participating in entertainment at the home were displayed on a notice board in the hall. Cultural and religious needs are responded to with services for different faith groups held at the home. Staff told us that one individual always attends the Sunday service at the local church. Comments from surveys confirm that people are satisfied with the activities provided, one person wrote There are plenty of activities but I choose not to take part in any. Another person told us how she had been shopping recently for a new outfit which she would be wearing to a relatives wedding, and how much she had enjoyed the outing. The manager had issued surveys earlier in the year asking people to comment on the social support at the home, the results had been positive. Residents meetings take place every two months and the minutes show that people and their relatives have the opportunity to raise issues and contribute to aspects of the running of the home. In recent months staff have worked with individuals and their families to help complete pen pictures and this life history information is beneficial in terms of getting an insight into the kind of hobbies, leisure past times and significant events that make up this persons life. Having this information helps staff to see the person as an individual in their own right and to engage people in things they are interested in such as a past hobby or a particular talking point. I always feel welcomed here. This was the comment of one relative and reflected their general view. Relatives said that staff communicate well with them. People who use the service clearly enjoy and value the contact from their families and friends which was adding significantly to their quality of life. The home organises an ongoing programme of outings to get out and about in the community, including visits to the sea front, garden centres, local public houses and shopping trips. One person told us that the staff help her go for a walk around the village regularly which she really enjoys. The home produces a Residents memo to pass on any information which they feel may be of interest. Care Homes for Older People Page 17 of 31 Evidence: The food is first class and All the meals are lovely, we are always given a choice. These were some of the positive comments made by people we spoke to during the visit about the meals. Staff have had training in nutrition so that food intake can be monitored carefully, peoples weights are monitored closely and any concerns are referred to the G.P. and or community dieticians, which records confirmed. The catering arrangements in the home are excellent. People are consulted on admission regarding their dietary needs and preferences. Menus are planned over a four week period with input from the people who use the service, and knowledge of needs and preferences. One of the kitchen staff visits each person daily to discuss meal choices. People were observed enjoying their breakfast and lunch meals in a relaxed and comfortable atmosphere, the meals are well presented with plentiful portions. Most people eat their meals in the dining room but arrangements have also been made for some people to eat in the lounges or their own rooms if they prefer. Staff serve the food efficiently and clearly know people and their food tastes and needs well. The cook has worked at the home for many years, she is qualified, experienced and is committed to providing a high standard of meals at the home. There was good evidence that action had been taken towards the recommendations made following the visit by the environmental health team last year. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home welcomes comments on the running of the service and takes action if necessary. Robust procedures are in place that safeguard people from abuse or neglect. Evidence: Management have an open door policy, people who use the service, relatives and staff are welcomed at any time to raise issues. People who completed surveys responded yes when asked if they knew how to make a complaint, a number had included comments such as havent needed to and have not had any issues or problems with the care at the home. Those people spoken with during the day also confirmed they knew who to go to if they were unhappy about something. The complaints procedure is displayed in the front entrance of the home. Information provided by the home prior to the visit shows that the home has not received any complaints since the last key inspection, nor have we received any complaints about this service. There was evidence that where concerns had been raised the management had addressed them promptly and responded appropriately. The senior management team at the home have recently accessed training on management of complaints from the local Care Trust. The home provides training for all staff in safeguarding procedures that protect people Care Homes for Older People Page 19 of 31 Evidence: from abuse or neglect. It was evident from discussions that staff are knowledgeable about safeguarding adults reporting procedures and know what to do if they witnessed anything that concerns them. All incidents relating to people who use the service are recorded and maintained on file. Appropriate notifications are made promptly to relevant agencies. There have been no allegations of adult abuse or neglect made at the home. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment in this home remains high, providing people with a very safe, comfortable and homely place to live. Evidence: The home provides modern, purpose built accommodation. A high standard of decoration and furbishment has been achieved throughout the home. There is an ongoing maintenance programme in place, information received prior to the inspection detailed that new furniture and carpets have recently been provided in the corridors and communal rooms, fifteen bedrooms have been redecorated, a new nurse call system installed, a bath replaced and new flooring in the kitchen. All people have spacious single bedrooms and en suite facilities are provided to the majority of rooms. The bedrooms seen were personalised and reflected the tastes and preferences of their occupants. People are able to bring personal items with them on admission and can install a private telephone line if they wish. There are a number of communal rooms, which are very comfortable and allow people a choice of where to spend their time. One of the focal points in the home is the entrance area where many people like to sit and chat with each other, one person told us I like to sit here in the mornings and watch everybody coming and going. The Care Homes for Older People Page 21 of 31 Evidence: general atmosphere throughout the visit was very calm and happy. Emphasis is placed on infection control with very good systems in place to control the spread of infection, antibacterial hand gel is placed at points throughout the home with advice to visitors on infection control. We observed good working practices with staff taking care to wash hands and use appropriate aids supplied. Records show that staff have accessed training in infection control. The home was very clean and tidy and there were no unpleasant odours noted in any areas of the home. People who completed surveys said the home is always fresh and clean. Laundry facilities are good and the area is well managed. Kitchen areas were visited during this inspection; the environmental health inspection in June 2008 had awarded the home a three star rating and highlighted a number of issues, such as storage and the flooring, and altogether had made twelve recommendations. We saw evidence to support action had been taken to address all issues. There are very attractive and well maintained garden areas, many people choose to have bird tables outside their windows and told us how they enjoy watching all the birds. There is a path which runs round the perimeter. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from being well cared for and in the safe hands of a professional and skilled staff team. Only staff that are vetted thoroughly and suitable for the role are employed. The service invests in the staff team, it makes sure that staff generally receive all the necessary training and development that equips them for their role. Evidence: My relative is very well looked after here, the staff are very kind and caring. This was the comment of one relative and reflected the general view about staff from the considerable feedback given during the inspection. Throughout the inspection staff interacted in a warm and positive way with people that respected their dignity. At the time of the visit the home was providing care for forty three people. Surveys received from staff and people who use the service were mixed in their comments about staffing levels, three people commented that they sometimes had to wait for support and two staff wrote that sometimes the home was short of staff during holidays or from short notice sickness. The remaining surveys detailed always or usually when asked if there was enough staff. All staff interviewed during the visit told us that the staffing levels were generally good. Staff always come when I need them was the comment from one person who uses the service and reflected the general Care Homes for Older People Page 23 of 31 Evidence: view of people spoken with during the visit. Throughout the day staff were observed to be carrying out their work in a calm, unhurried manner, with time to spend with people. Given that dependency levels during the visit appeared stable and not overwhelming for staff, occupancy had fallen slightly and the rotas demonstrate that staff sickness is generally covered we advised that a staffing review is carried out to look at the skill mix on shifts, effective work allocation and a formal dependency monitoring tool be introduced. The manager confirmed that the new nurse call bell system has a monitoring facility and all staff response times can now be monitored. It would be good practice to include call bell response times within the quality monitoring process. The home also employs a large team of ancillary staff who are highly motivated ensuring that the standards relating to food, cleanliness, laundry and administration are fully met. The home is recognised for delivering high standards and is one of the few in the area which is approved as an assignment centre for students from the local college. A health professional who visits the service regularly, commented, The staff team is good at providing high standards of care, people with complex needs are often admitted and cared for lovingly and safely. The management have introduced a number of reward schemes for staff: a non absence bonus is paid to staff to aid the management of sickness and more recently Employee of the month has proven very successful with staff and people who use the service nominating any staff member for anything they feel should be recognised. Staff tell us they enjoy working there, people feel valued and enjoy using their skills and receiving more learning opportunities. There is an excellent team here, we respect each other and provide a really good quality of care, it is a fantastic place to work this was a comment received from a nurse on duty, it is consistent with the many reports received from staff members. Staff interviews and records show that staff have had a range of relevant training to enable them to do the job well, the home has maintained the target of having at least 50 of care staff qualified at level 2 or 3 NVQ in caring for older people. A training matrix shows that there is an ongoing programme to ensure staff have refresher training as needed in areas such as health / safety, moving and handling, fire safety and food hygiene. Gaps were seen in some of the training records for a small number of night staff which we discussed with the management who confirmed they would address this issue within the next four weeks. New staff have a comprehensive induction so that they can carry out their duties effectively. Care Homes for Older People Page 24 of 31 Evidence: Records show that nursing and care staff have accessed a range of service specific training with a recent focus on bereavement and palliative care. One of the nursing staff has recently developed a comprehensive training programme on care planning which she intends to deliver to all the care staff. The commitment to staff training at the home ensures people who use the service are supported by skilled staff. We looked at a sample of staff records which shows that recruitment procedures are good and make sure that only staff that are vetted thoroughly are employed, these include taking up written references and carrying out checks through the Criminal Records Bureau before appointment. The home is selective, it employs good staff that are committed and that have the necessary skills. Care Homes for Older People Page 25 of 31 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. This home is influenced by and benefits from the ethos and leadership of the management team. People are consulted on their views of the service and their opinions are listened to and acted upon. The health and welfare of people and staff are promoted and protected in the home. Evidence: The registered manager is a registered nurse who is well qualified and experienced to undertake her role. She has been in post for many years and evidence seen and reflected throughout the report show that she is competent and continuously strives to improve the care offered to people at the home. Evidence to support this includes robust management systems in place to ensure staff recruitment remains safe, a commitment to equality and diversity, continuous improvements to care planning systems including a recent focus to demonstrate person centred care practice, operating a pro - active quality monitoring system for the home, a commitment to Care Homes for Older People Page 26 of 31 Evidence: staff training and an open door management style. The registered manager is assisted in her role by a competent and effective staff team including a senior administrator and a deputy manager, the deputy manager is currently working towards the Registered Managers Award. Staff confirmed that moral was good and commented that there was a good team approach to the care delivery at the home. Evidence from staff interviews and staff surveys indicate that the staff consider the management team at the home to be very approachable and supportive. Staff meetings are held regularly, with good attendance and there is evidence that requests and suggestions made at these meetings are discussed and actioned where possible. The home monitors the quality of care it provides in a number of ways. The AQQA which was returned by the home prior to the site visit was well completed and told us about identified areas for improvement. Detailed surveys have been developed and these are used regularly to canvass the views of people who use the service, relatives and care professionals. The findings are clearly produced in graph form and displayed in the hall. Action plans have been developed to follow up any issues identified. Regular audits take place of areas such as the kitchen, facilities, health and safety, accidents and care plans, although the manager confirmed that records to support care plan audits had not been completed as often, but this would be addressed. The views of relatives are regularly sought by means of surveys, review feedback forms, invitations to review meetings if requested and for some by regular visits to the home, where relatives are able to meet and talk directly with the care staff and management. Formal resident and relative meetings are held every two months. The home completes an annual development plan, providing a link with the homes forward planning, advice was given to include more audit and survey results with an evaluation of the feedback received. There is evidence that the responsible individual visits the service regularly. Reports to support these visits for the last eight months were not available; the manager needs to ensure that copies of all reports are held in the home. Peoples financial interests are safeguarded by the financial systems and procedures in place. Individual records are maintained for monies held in safekeeping and receipts obtained for expenditures. Safe working practices are promoted. New staff are trained in safe working practices as part of the induction programme, records show that ongoing mandatory training in this area is also provided. Staff spoken to told us of the opportunities for learning, they have a good understanding of health and safety measures, good practice observed included good hygiene control. The home provides hand gel at strategic points throughout the building. The premises are maintained to a safe and comfortable Care Homes for Older People Page 27 of 31 Evidence: standard with a rolling programme of maintenance, a handy person employed acts promptly to address repairs. All the equipment in the home is tested at the appropriate intervals and all maintenance certificates are up to date. There is a fire safety policy and an up to date fire risk assessment in place. Tests on equipment are undertaken and regular fire drills for staff are carried out. Risk assessments for safe working practices and to support the care delivery to people who use the service are kept updated. Records are made of all incidents to relevant authorities. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 31 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 The home should continue to develop the care documentation to ensure it is fully person centred and carry out the planned work to improve the daily records, communication records and ensure all plans are signed by the individual. The home should make sure that transcribed medication records are witnessed by another member of staff to ensure accuracy. The home should ensure that copies of reports to support visits by the responsible individual are held in the home. 2 9 3 33 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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