Care Home: Ashley Gardens Care Centre

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What the care home does well The home provides good health and personal care, paying attention to individual care needs, and ensuring that referrals are made to other health professionals as needed. A health professional stated in a survey form that the staff "provide good, dignified care, with compassion, common sense, and humour". A relative stated on a survey form that they are "more than happy with the standards of care, and the kindness shown by everyone". And two other survey forms said they "cannot fault the care"; and "there is a very high standard of care from dedicated staff". Medication is well managed, and includes good auditing procedures to minimise the possibility of errors. There is an excellent range of varied activities throughout the home. The home provides nutritious menus, and food which is well cooked and well presented. A relative stated that the catering staff "provide very good food, and cater well for my relative, who is a fussy eater". The home is well maintained in all areas, and provides a pleasant environment. Although it is a large home, it is divided into smaller units which promote a more homely environment. There is good provision for staff training, which ensures that all staff receive mandatory training and regular updates; and enables staff to dvelop training in additional relevant subjects. The manager and deputy work well with other unit and departmental heads to ensure that the home runs smoothly and efficiently. What has improved since the last inspection? The company has developed a new brochure pack with comprehensive information about the home for enquirers and relatives. Care planning has been developed, and includes better risk assessments and improved recording for wound care. The deputy manager is working with nursing staff to continue to develop this important documentation. There is a greater understanding of palliative care, and good systems in place for obtaining advice from other health professionals when needed. The manager has recruited another activities assistant, and there is an increased range of activities. The staff have developed a cafe area on the ground floor, which has become a focal meeting point for residents. The gardens have been enhanced with additional flower beds and a herb garden. What the care home could do better: The home is developing well in all areas, and we have not made any requirements or recommendations as a result of this inspection. The manager and senior staff are fully aware of areas which could benefit from further improvement (such as more development of care planning; and further staff training and support), and are already working towards these things. We were informed that the company are planning to redecorate the building during the next year, so that all areas of the home are kept in a good state of repair. Key inspection report Care homes for older people Name: Address: Ashley Gardens Care Centre Sutton Road Maidstone Kent ME15 8RA     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: Susan Hall     Date: 2 1 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Ashley Gardens Care Centre Sutton Road Maidstone Kent ME15 8RA 01622761310 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): manager.ashleygardens@lifestylecare.co.uk Life Style Care (2005) Plc Name of registered manager (if applicable) Mrs Joanna Mazza Type of registration: Number of places registered: care home 89 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 89. The registered person may provide the following category/ies of service only: Care home with nursing only - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP) Physical disability (PD). Date of last inspection Brief description of the care home Ashley Gardens Care Centre is a purpose built property, offering a high standard of accommodation, which was opened in 2007. It is owned by Life Style Care (2005) Plc, who also own six other care homes. It is situated on the main road, with off street Care Homes for Older People Page 4 of 28 Over 65 0 89 0 89 0 89 1 8 1 1 2 0 0 8 Brief description of the care home parking. It is close to local amenities, including a post office, large supermarket, and local transport links. Ashley Gardens provides care to a mixed category of residents in five different suites as follows: On the Ground Floor: The Hopfields Suite is for older people with nursing needs, and has 23 beds. The Invicta Suite is for adults aged over 18 with physical disability, and has 10 beds. On the First Floor: The Medway Suite is for older people with dementia and nursing needs, and has 20 beds. The Oasts Suite is for older people with dementia and nursing needs, and has 16 beds. On the Second Floor: The Biggin Hill Suite is for older people with dementia and nursing needs, and has 20 beds. Each unit is provided with suitable communal areas, comprising a dining room and servery, one or two lounges, activities and hobbies rooms, assisted baths/shower rooms, and sufficient toilet facilities. There is a multi-sensory room situated on the second floor. All bedrooms are for single use, and have en-suite toilet and washbasin facilities. Some also have their own showers. All areas of the home can be accessed by two large passenger lifts. These have keypad codes to use for the units with dementia residents, to promote their safety. The garden area surrounding the premises has lawns and flower beds and patio areas. These are fenced off from the side road and adjacent properties. Residents accommodated on the upper two floors are able to gain access to the garden through ground level communal areas. Current fee levels range from £562.71 to £942.00 per week, depending on the assessed needs of residents. Care Homes for Older People Page 5 of 28 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: The home is assessed as having a rating of Good, 2 stars. This was a key inspection, which includes assessing all of the information obtained by the Commission since the previous inspection, as well as a visit to the home. Information is obtained from phone calls and letters about the service; legal notifications which the home is required to send in; any complaints or safeguarding issues in which we are involved; and an Annual Quality Assurance Assessment (AQAA) provided by the home. This is a comprehensive document which the home is required to complete each year, telling us about ongoing developments in the home, and any changes. We received the AQAA back within the specified timescale, and it was very well completed. We (i.e. CQC) did not send out any survey forms for this inspection, but viewed the results of the homes own surveys. Care Homes for Older People Page 6 of 28 The inspection visit took place over six hours, commencing at 09:00a.m. The manager and the deputy manager were present throughout the inspection, and provided the inspector with documentation on request. During the visit, we viewed all areas of the home, and talked with nine staff members, eight residents, and one visitor. We also met several other residents briefly and viewed some activities taking place. We inspected medication, and viewed documents which included care plans, maintenance files, some policies and procedures, staff recruitment files and auditing procedures. The home was clean in all areas, and attractively presented. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 28 The home is developing well in all areas, and we have not made any requirements or recommendations as a result of this inspection. The manager and senior staff are fully aware of areas which could benefit from further improvement (such as more development of care planning; and further staff training and support), and are already working towards these things. We were informed that the company are planning to redecorate the building during the next year, so that all areas of the home are kept in a good state of repair. 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 28 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 28 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. Comprehensive information is kept available in the foyer for all enquirers; and is provided to each new resident and their family members. Each prospective resident has a detailed pre-admission assessment. Evidence: The statement of purpose and service users guide are checked and updated regularly to ensure that they accurately reflect the running of the home. During the last year, the management have developed a new brochure pack, which consists of a glossy cover, with various inserts providing information about the home. This pack is well produced, and gives a good first impression of the home. It includes the service users guide, and contains excellent information about the admission process; details of the registered providers and manager; staffing information; and good general information such as meal times, visiting, and activities in the home. There is a copy of the service users guide in each bedroom; and there is an additional copy in the foyer, which is in large print. Care Homes for Older People Page 11 of 28 Evidence: The statement of purpose is provided on admission, and includes details of the contracts and terms and conditions of residency; the fees payable, and items which are not included in the fees (such as hairdressing, chiropody and toiletries). There is also a copy of the statement of purpose in the foyer. A detailed pre-admission assessment is carried out for all residents prior to admission, to ensure that the home can meet their individual needs. We viewed three preadmission assessments, and noted that they contain clear information about the persons medical and mental health history. This includes information such as the persons ability to communicate, and details of daily living management such as mobility, nutrition, continence, personal hygiene, and social needs. The manager or deputy also obtain joint assessments from Social Services and health provision prior to admission. Prospective residents are invited to visit the home if possible prior to admission, and can stay for an afternoon, or for a meal, with or without their relatives, if they wish to do so. Admissions are for a trial period of four weeks, with a review at the end of this time to ensure that the placement is suitable for permanent stay. The homes satisfaction surveys include some very positive comments from relatives about the admission process, and how they felt welcomed into the home. For example all of the staff have been very helpful; and the staff helped enormously with enabling my relative to settle into the home. Care Homes for Older People Page 12 of 28 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. The home provides detailed and up to date care plans, which ensure that residents individual health and care needs are met. Evidence: Detailed admission assessments are carried out for all new residents, to check if there have been any changes since the pre-admission assessment. These assessments then form the basis for care planning, which incorporates all aspects of the persons health and care needs. Care plans are reviewed each month to ensure that they accurately represent the care to be given; and include care needs such as mobility, nutrition, medication, continence, personal care and social preferences. The deputy manager is the clinical lead for the home, and is in the process of changing the care plans so that the documentation is easier to follow. The main focus of the care plan will be on the residents medical condition, and how this affects them in all other areas of life. There are ongoing staff meetings to ensure that all nursing and care staff understand how the care plans will be implemented in the future. Care Homes for Older People Page 13 of 28 Evidence: The front of each care plan includes a page called all about me, which is a quick overview showing the residents preferred times for getting up and going to bed; the name by which they wish to be called; their food likes and dislikes; preferred radio and television programmes; and if they like to join in with social activities. We viewed five care plan files from four of the units: Hopfields, Invicta, Medway and Biggin Hill. The files contain well completed care plans, and include clear directions such as (e.g. for eating and drinking): the resident is a slow eater, ensure that you give sufficient time between mouthfuls; needs feeding for all meals; uses a two handled beaker for all drinks. Care plans for wound care are put into a wound care pack in the residents folder, and show the state of the wound at each dressing. The deputy manager has implemented an evaluation form whereby there is a written description of the progress of the wound at each dressing change. This is an improvement since the last inspection visit. Photographs are taken at regular intervals to demonstrate the healing process. Care plans include risk assessments for risks such as being unable to use the call bell, risk of falls, unable to use own room keys, and risk of choking. We viewed some of these, and they show the action to be taken to prevent risks, such as hourly checks, or use of bed rails. Some other care plans include the identified risks, but have not yet been completed with the preventative action. The deputy manager said that because new care plan formats are being implemented, some of the risk assessments have not yet been completed. However, we noted that the care plans themselves contain the same relevant information in regards to risks; so the information is included, but may be less easy to find at present. The home is fortunate to have a GP who is a visiting medical officer for the home, and visits the home at least twice per week. This GP is therefore familiar with the individual residents and their medical conditions; and also carries out medication reviews on an ongoing basis. The home has good links with other health professionals such as the tissue viability nurse, occupational therapist, dietician, hospice nurses and physiotherapy; and employs a physiotherapy assistant. The physiotherapy assistant ensures that the directions given by the physiotherapist are applied; and carries out daily exercises, and assists residents with their mobility. We inspected medication storage and administration on Medway unit, and found that there are good systems in place. The storage cupboards are kept neat and tidy, and there is no overstocking or out of date medication. Policies and procedures are clearly Care Homes for Older People Page 14 of 28 Evidence: written, and are kept available for nursing staff. Most medication is administered using a monitored dosage system. We found that there is good management of as necessary medicines, with clear records kept of when these are given and why. Bottles of medication are dated on opening, and this is an example of good practice. The home has put procedures in place to count stocks of controlled drugs twice daily. This ensures that any discrepancies are found immediately. This is another example of good practice. Monthly stock audits are carried out for each item of medication. Medication Administration Records (MAR charts) include a photograph of the resident, and show if they have any allergies. We viewed all of the MAR charts for this Unit, and did not find any errors. The home has a strong emphasis on treating people with respect and dignity, and a dignity audit has been commenced and is carried out twice per year. We viewed the results for the last audit, and found it to be extremely detailed. It includes feedback from residents and relatives on items such as the cleanliness of the home; if there is privacy with the use of curtains and screening; using a phone in private; and knocking on doors before entering. Staff are trained in customer care and effective communication, and the audit showed that residents and relatives are confident in the promotion of privacy and dignity throughout the home. Staff are given training in death, dying and bereavement, and some trained staff have had more detailed training in palliative care. The staff liaise with nurses from a nearby hospice for additional advice when needed; and there is an emphasis on ensuring that residents are kept as pain free and as comfortable as possible. The trained staff and deputy manager use a format called the Gold Standards Framework, which is an advance directive for the type of care which residents would prefer. This indicates if they would want to have treatment in hospital, or if they would prefer to stay in the home. There are also clearly signed forms showing if residents have the mental capacity to make these decisions for themselves; and if not, who is making the decisions on their behalf, and how they have arrived at that decision. Care Homes for Older People Page 15 of 28 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. Residents can choose from a wide range of varied activities, and are enabled to follow their own lifestyles. The chefs provide a good range of food to meet all dietary needs and preferences. Evidence: The activities staff have worked hard to develop a varied and and interesting activities programme, and there is now a wide range of activities and entertainment throughout the week. A monthly activities programme is displayed in the ground floor lobby for specific events, which are in addition to daily activities on all floors for things like jigsaws, quizzes, reminiscence and arts and crafts. A new activities assistant has been recruited, so that there is now one assistant for each floor. Activities are also carried out between floors, so that people can attend them on any unit. For example, on the day of the inspection visit, there were fourteen residents from all units enjoying music and movement in one of the lounges on the ground floor. Each floor has a hobby room, and these are set up quite differently so that residents can go where they want to. One hobby room has a keyboard to play, and a knitting machine; another has hand prints covering one wall, and painted collages; and another includes a relaxing sofa. A previously little used room on the ground floor has been set up as a cafe, complete Care Homes for Older People Page 16 of 28 Evidence: with small tables and chairs, and old fashioned crockery and a sideboard. Staff can make a variety of hot or cold drinks for residents, and there are always biscuits or small cakes available. This has been a great success, and residents love to sit in the cafe and chat together. A first floor room has been set up as a shop, and this is manned at certain times, but can be opened specifically if a resident requires something. The shop sells items such as toiletries, biscuits, birthday cards and tissues, all at reduced prices.There is also a small area on this floor set up with benches as a bus stop, and this is very helpful for residents with dementia who can feel that they are waiting for a bus. The top floor has a sensory room, and this is a very relaxing area with music and lighting etc. The gardens are used for as much of the year as possible for sitting outside, and barbecues etc. and the home had its first Summer fete this year, which was very successful. The activities staff use any occasion possible to enhance the lives of the residents. The inspection day was on National Apple Day and there were associated activities throughout the day to celebrate this. There are photographs throughout the home showing other events such as red nose dayand pink day activities for charity events. The home also has a video club for residents to watch movies together; and external entertainers such as a guitarist, pets as therapy, essential clothing visits (for shopping), and music therapy and massage sessions. Residents also enjoy a weekly visit from the ice cream trolley. There is a monthly church service held in the home for those who wish to attend, and the staff will support residents in visiting other churches or places of faith if requested to do so. Other ministers and priests are invited to visit the home according to residents requests. Music is provided in dining rooms so as to make the meal times more of a social activity. There is a dining room for each unit, and each one is set up with their own individual colours for tablecloths etc; and have flowers on the tables, and menus available. Residents can choose where they wish to eat, and are offered a choice of food for each meal time. We chatted with four residents having breakfast, and noted that they each had different items, ranging from bacon sandwiches to toast or porridge. The residents are asked for their choice of menu before each meal (rather than on the day before) as this helps some to remember what they have ordered. The chefs will also provide alternatives to the set menu choices, as they recognise that residents will Care Homes for Older People Page 17 of 28 Evidence: sometimes change their minds. The menus run on a four weekly cycle, and are changed for the different seasons. We briefly met the chef and viewed the kitchens. These were awarded five stars for cleanliness and hygiene when the Environmental Health Officer visited the home during the year. The chef sends out his own questionnaires to residents about the quality and the variety of the food, and implements changes according to the residents wishes. Care Homes for Older People Page 18 of 28 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 encouraged to voice their feelings, and are confident that concerns and complaints will be listened to and properly addressed. Evidence: Residents are supported in voicing their ideas and feelings through having key workers, as well as on a day to day basis with care and activities staff. This is particularly important for residents with dementia. The complaints procedure is included in the service users guide, and one of these is kept in the foyer, and one in each bedroom. The complaints procedure clearly states how to apply to the registered manager and to the companys operations director; and gives timescales for responses. We viewed the complaints log for the last year, and this showed that complaints are properly investigated, and that appropriate action is taken to deal with them. The home provides a monthly audit for the head office. All staff are trained in the recognition and prevention of abuse to vulnerable adults. This training is provided as part of the induction programme, and staff are then required to attend six-monthly updates. We viewed two staff personnel files, which confirmed this training as part of the induction programme. All staff have POVA First and Criminal Record Bureau (CRB) checks prior to confirmation of employment. Care Homes for Older People Page 19 of 28 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 home is well designed to meet the needs of residents; is well maintained, and is attractively presented. Evidence: Ashley Gardens is a purpose built care home, which has wide corridors for easy manoeuvrability of wheelchairs and other equipment. The building is light and airy, and is well maintained in all areas. There are two large lifts for access to all floors, and these have keypad security codes for the safety of residents with dementia. The home is divided into five units, and all of these have their own lounge, dining room and hobby room. Two of the units have two lounges each. Residents are able to visit other units and different lounges, dining areas and hobby rooms, so that they have a wide variety of places to sit or to visit. The communal rooms are well equipped with comfortable seating and soft furnishings. Dining areas are equipped with a suitable number of dining tables and chairs; and are attractively presented with matching tablecloths and vases of flowers. Access to stairways and to the gardens is protected with keypad security codes. The gardens include lawns and flower beds, and have seating areas for residents to enjoy sitting outside in good weather. Care Homes for Older People Page 20 of 28 Evidence: All bedrooms have en-suite toilet and wash basin facilities, and many have en-suite showers as well. The en-suite areas are of a sufficient size for wheelchair users to access them. There are many other disabled toilets, assisted baths and shower rooms on each unit. These are well presented and maintained. Disabled toilets in units for residents with dementia, are colour coded with yellow doors. We viewed all units, and several bedrooms in each unit. Bedrooms can be personalised according to choice. The home is equipped with profiling beds in all bedrooms. Additional equipment such as pressure-relieving mattresses and cushions, hoists, raised toilet seats, and hand rails were seen in all units. We noticed that bedroom doors for residents with dementia are painted in different colours, and each have a door knocker. This helps the residents to retain their individual identity; and helps them to locate their own rooms. The home has a full time maintenance man, who carries out routine checks for equipment such as the fire alarm system, nurse call system, wheelchairs, hot water temperatures and portable appliance testing. There are good records in place to confirm these checks. The laundry facilities are situated on the top floor, and include a suitable number of commercial sized washing machines and tumble dryers. There are dedicated laundry staff who manage all of the laundry. The home was seen to be clean in all areas, and without any offensive smells. The domestic staff use a carpet cleaning machine on a daily basis to try to keep all carpets clean at all times. Care Homes for Older People Page 21 of 28 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. There are good numbers of appropriately trained and competent staff in all areas of the home. Evidence: Numbers of nursing and care staff have been increased since the last key inspection, and reflect good numbers in line with the dependency needs of residents. There is one nurse on duty each day and night shift for each unit. Larger units usually have five or six care staff on duty in the day times; and smaller units have three or four care staff for day shifts. Night shifts include one or two carers depending on the size of the unit, and the dependency levels of residents at that time. The manager or unit managers will move staff where they are most needed if dependency levels change significantly. The home employs sufficient numbers of administration, maintenance, domestic, catering and activities staff to ensure the smooth running of the home. The company promote the training of staff to NVQ levels 2, 3 and 4. At the time of the inspection, there are sixty-one per cent of care staff trained to NVQ level 2 or higher; and there are more care staff who are commencing training. The home has good recruitment practices in place. These include POVA first and Criminal Record Bureau (CRB) checks prior to confirmation of employment; two Care Homes for Older People Page 22 of 28 Evidence: written references; details of all previous employment history; proof of identity, and a health questionnaire. An interview record is retained, and all staff are given a staff employee handbook and a contract of employment. We viewed two recruitment files, and found them to be accurately completed. All mandatory training (e.g. health and safety, infection control, fire awareness and basic food hygiene) is carried out during the induction period. Staff are then required to complete six monthly or twelve monthly updates, depending on the specific subject. We viewed the staff training data sheets, which confirmed that staff training is kept up to date. All staff also receive training in the protection of vulnerable adults; and in dementia care. Nursing staff are enabled to keep their skills and competencies up to date; and additional training courses are available to those who wish to attend. Recent courses for care staff have included pressure area care; death and dying; nutrition; and customer care. Nursing staff have attended courses such as venepuncture, verification of death, male and supra-pubic catheterisation, diabetes awareness and wound care. Care Homes for Older People Page 23 of 28 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 manager and senior staff work well together to ensure the effective running of all areas of the home. Evidence: The registered manager is a level one nurse who has several years of experience in caring for older people. She is in the process of completing an NVQ level 4 in Leadership. She promotes an open door policy for all staff and visitors to the home, and oversees staff meetings for all departments. For example, there are specific meetings for heads of departments, for night trained staff, for different units, and for clinical practice in the home. The deputy manager works closely with the manager, and carries the responsibility for directly overseeing all aspects of clinical care. The home has produced very good information for new enquirers, and this is followed up by onoing contact with relatives at care planning reviews and at residents and relatives meetings. The meetings are held every two months. Yearly satisfaction questionnaire surveys are given to residents and sent out to relatives, and the results Care Homes for Older People Page 24 of 28 Evidence: of these are collated and made available. Last years surveys included 79 per cent of people who thought there was good communication between staff and relatives; and 89 per cent who find the manager approachable. Results from this years surveys are just coming in, and we read comments such as we are always kept informed of any changes; we are always made welcome however busy the staff are; and the home is calm and peaceful and has an open and friendly atmosphere. The separate dignity audit provides further useful information about how people view the standards of care in the home. Most residents have a relative or appointee to manage their finances. The home looks after small amounts of pocket money for a few residents, and there are good processes in place to ensure that proper records are maintained. All items are countersigned, and all receipts are retained. Staff supervision is delegated to different departments, and all staff have one to one supervision sessions to ensure that any specific needs, including training needs, are identified and dealt with appropriately. Policies and procedures are reviewed yearly, and are kept up to date. We viewed records for different aspects of the running of the home, such as medication records, maintenance records, minutes of meetings and staff training records; and found these to be well documented and available for viewing. Health and safety management is recorded in different manuals, and includes risk assessments for carrying out work in the home. We read two of these for the person working alone; and for the maintenance person using power tools. A folder for emergency procedures gives clear details for the action to take in the event of problems such as fire, flooding, severe weather conditions, and lift breakdown. Accidents and incidents are recorded in line with the directives from the Health and Safety Executive, and in accordance with the Data Protection Act. Care Homes for Older People Page 25 of 28 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 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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