Care Home: Ashwood Nursing Home

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What the care home does well Ashwood nursing home provides prospective residents with good level of information about the home, services provided and the costs involved. The assessment process followed ensures people are assessed, and are assured that their needs can be met. On the whole the dependency of residents in the home are of a low nursing need and the level of care provided within the home is good, and ensures the health care needs of residents are well met. Residents like living at the home and have a close friendly relationship with staff and the family members of the manager. The atmosphere at the home is relaxed, and both residents and visitors reflected on this as a very positive aspect of the home. The emphasis of the home is to treat residents as family members. Ashwood nursing Home provides a clean, comfortable and pleasing environment that is well maintained. The food provided is of a good quality and enjoyed by the residents. It was very evident that Ashwood is a community resource that responds to the local needs of people living in the neighborhood. Many of the residents in the home have had previous experience of the home and strong links with the community are maintained. The home was found to be very welcoming encouraging visitors to spend quality time in the home. All staff were found to be helpful and pleasant. What has improved since the last inspection? Six requirements were made at the last inspection and the manager has worked hard to address these along with embedding the improvement confirmed at the last key inspection. She manager has continued to maintain a high profile in the home, directing the care provision and providing a clear leadership, and stable manager for the home. The improvements to the care documentation have continued, and the individual care needs of residents are now more clearly reflected, and include an assessment of their nutritional status. The AQAA records that the management of medicines has improved and the manager has agreed to implement individual guidelines for each resident on `as required` medicines, to ensure they are given in a consistent way and in accordance with individual prescriptions. Staff training is being organised and recorded in a structured way, with evidence that further specialist training is being provided when needed. The home has established some systems for quality monitory and the completed AQAA demonstrated that this was used as an auditing tool. Residents views have been sourced and their views have been responded to with the provision of activities identified for further improvement. The home is has systems for regular risk assessment to be completed and responded to. The AQAA also recorded that much work in the area of policy and procedure review had been undertaken to set the home and the management on a `sound footing`. What the care home could do better: The established improvements and stable management arrangements in the home now need to be maintained, to ensure a a continued good standard of provision on an on going basis. The records held in respect of staff employed in the home need to be improved to ensure all the required information is retained within the home. The AQAA recorded a number of planned improvements to the service, and the manager has confirmed her commitment to implement these over the next 12 months. Key inspection report Care homes for older people Name: Address: Ashwood Nursing Home Burwash Common Etchingham East Sussex TN19 7LT     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: Melanie Freeman     Date: 2 3 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Ashwood Nursing Home Burwash Common Etchingham East Sussex TN19 7LT 01435-883434 01435883091 ashwoodnh4@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ashwood Nursing Home Ltd Name of registered manager (if applicable) Miss Ann Elizabeth Morrissey Type of registration: Number of places registered: care home 19 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 19 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category ; Physical disability (PD) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Ashwood is a nursing home that provides nursing care up to nineteen older people or those with physical disabilities over the age of 65 years. Ashwood is in the hamlet of Burwash Common and set in grounds with flat access for residents. A well-stocked and managed garden is available to be used by the residents. There is ample off road parking for visitors. The nearest town is Heathfield; the village of Burwash is two miles Care Homes for Older People Page 4 of 28 Over 65 19 0 0 19 2 7 0 4 2 0 0 9 Brief description of the care home away. The home is situated on the bus route and there is a railway station in Stonegate a nearby village. The home provides eleven single rooms, and four shared rooms over two floors, situated on the ground and first floors. Eight rooms provide ensuite facilities. Day space consists of a combined lounge/dining room. A passenger lift allows level access throughout the home. Current weekly fees range from £500 to £850, excluding hairdressing, chiropody, physiotherapy, newspapers and aromatherapy. Ashwood Nursing home is owned by a limited company and Anne Morrissey is a Director of this company and the homes registered manager. 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 reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at Ashwood Nursing Home will be referred to as residents. This was a key inspection that included an unannounced visit to the home on Friday 23 April 2010 by the allocated regulatory inspector. The visit was completed over a four hours and the homes registered manager facilitated this, and received the feedback at the conclusion of the visit. The registered manager is also the Company Director and will be referred to throughout this report as the manager. This inspection focused on outcomes for residents and to assess if the improvements made by the manager at the time of the last key inspection have been maintained and built on. A tour of all communal areas was undertaken and a selection of residents Care Homes for Older People Page 6 of 28 accommodation was seen with relevant consent. A range of documentation was reviewed including the homes statement of purpose and service users guide, preadmission assessment procedures, the systems in place for handling complaints and protecting residents from harm, staff recruitment files, quality assurance systems and some health and safety records. The care documentation pertaining to two residents were reviewed in depth and each of these residents were spoken with. At the time of the inspection 12 residents were living at Ashwood Nursing Home and the majority of these residents were spoken with and given the opportunity to share their views on the home. Three visitors to the home at the time of the inspection visit were spoken with, and a health care professional was also contacted following the inspection for her view on the service. At the time of compiling the report, in support of the visit, the Care Quality Commission received survey forms about the service from eight residents, and three staff members. The required Annual Quality Assurance Assessment (AQAA) was very well completed by the manager and returned when requested, and was used to inform this inspection report. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? Six requirements were made at the last inspection and the manager has worked hard to address these along with embedding the improvement confirmed at the last key inspection. She manager has continued to maintain a high profile in the home, directing the care provision and providing a clear leadership, and stable manager for the home. The improvements to the care documentation have continued, and the individual care needs of residents are now more clearly reflected, and include an assessment of their nutritional status. The AQAA records that the management of medicines has improved and the manager has agreed to implement individual guidelines for each resident on as required medicines, to ensure they are given in a consistent way and in accordance with individual prescriptions. Staff training is being organised and recorded in a structured way, with evidence that further specialist training is being provided when needed. The home has established some systems for quality monitory and the completed AQAA demonstrated that this was used as an auditing tool. Residents views have been sourced and their views have been responded to with the provision of activities identified for further improvement. The home is has systems for regular risk assessment to be completed and responded Care Homes for Older People Page 8 of 28 to. The AQAA also recorded that much work in the area of policy and procedure review had been undertaken to set the home and the management on a sound footing. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 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. The home provides prospective residents, with a good level of information about the home, its facilities, services, and the costs involved. The admission procedure allows for the needs of prospective residents to be assessed by a competent person before admission. Evidence: The home was able to provide a copy of the homes statement of purpose and service users guide on request. The manager confirmed that a copy of these documents are given to prospective residents when it is likely for them to be admitted to the home. On the whole these documents were full and informative and contained the required information. Following the inspection visits the manager advised that she would update the contents of these documents to ensure accurate, and record where a copy of the last inspection report completed by the Care Quality Commission can be located. The main aim of the home recorded in the statement of purpose is to offer a Care Homes for Older People Page 11 of 28 Evidence: caring family approach to residential care in a safe surrounding. Feedback from residents and relatives confirmed that many of them chose Ashwood nursing home, based on personal experience, being in close proximity to loved ones, or recommendation, and relatives spoken to were clear on the financial arrangements and the service provided. An assessment of the admission process included a review of the documentation used in respect of the last admission to the home. These demonstrated that a needs assessment was completed by the manager, it was found to be comprehensive recording where and when the assessment was completed. The AQAA recorded that any needs assessment is completed in peoples present care setting to ensure that the home can meet their needs. Once the needs assessment was completed it was noted that a subsequent letter was sent to the prospective resident to confirm that the home could meet his assessed needs, and was suitable for his admission and provision of care. Terms and conditions of residency are also sent to the prospective resident prior to admission. The current occupancy of the home reflects a low dependency and one that fits with the homes statement of purpose and the skills of the staff working in the home. Intermediate or rehabilitative care is not provided at Ashwood Nursing 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 individual plans of care set out residents personal and health care needs, and care is delivered in such a way that promotes and protects the residents privacy and dignity. Residents health care needs are well met being supported by community resources as necessary. Residents on the whole are protected by the efficient and accurate administration and recording of medicines. Evidence: Each resident had an individual plan of care and two of these were reviewed as part of the inspection process. The residents that these pertained to were spoken with, and were able to express their perceptions and views on the care and the service provided at the home. The care documentation reviewed demonstrated that individual plans of care are developed from a needs assessment, completed following admission. The plans were accurate, generally well maintained, and reflected the individuality of people and how their care needs were to be met, with reference to choices and preferences. Care Homes for Older People Page 13 of 28 Evidence: The AQAA confirmed that the home takes a person centred-approach to care working with residents and, if appropriate their family and friends. There was evidence within the care documentation that residents or their representatives are consulted with, and information held within completed life historys gave an insight into each residents individuality. The documentation recorded community health care professionals input into care when contacted, and daily records are maintained and provide a record of residents activity, wellbeing, and medical condition. Base line observations are also completed and provide information on health care needs. There was evidence that risk assessments are used routinely and include those related to falls, pressure sore development, and safe moving and handling. The home have recently implemented a nutritional assessment tool, and plan to buy a pair of sit on weighing scales with money gifted from relatives. These risk assessments are translated into the plans of care, to promote appropriate planned care. All feedback received from residents and relatives was very positive, supporting the view that the home provides a high standard of individual care, whilst providing a supporting and caring role for relatives and friends through difficult times. The family approach of the home is important to residents and visitors alike. Comments received included It is a caring and very friendly with a family atmosphere I am Very happy with the arrangements and have a great deal of faith in the home and how it has allowed my mother to remain individual but to live safely I have been so impressed with the excellent care provided to my father throughout his stay in the home and his subsequent death The care to the resident includes a huge amount of support and care for relatives I was Very happy with the care and way that it was delivered, I feel that this home is extraordinary in its provision, as it knows the resident and family extremely well, and tailors the care and support bearing this knowledge in mind. The medicine records examined were well maintained and accurate and indicated that prescribed medicines are administered in accordance with what has been prescribed. Practice observed confirmed that procedures followed ensured the safe administration of medicines and that they are always handled by the registered nurses working in the home. The home continues to work closely with residents doctors to ensure all medicines are appropriate and are used only when needed. A small number of medicines are prescribed as required medicines and although general guidance is provided on the administration of as required medicines, individual guidelines specific to the medicine Care Homes for Older People Page 14 of 28 Evidence: prescribed still need to be provided to ensure these medicines are given in a consistent way. This was clarified with the manager during the inspection visit, she confirmed an understanding of this matter and agreed to address this shortfall. It was observed during the inspection visit that residents are treated as individuals and respected as such. Contact between and staff and residents was seen to be positive and appropriate, with staff using a preferred term of address when talking to residents. Each residents room is seen as their own personal space, and residents were positive about their choices and lifestyles being respected. One relative made an effort to seek out the inspector to tell her about her experience of the home, particularly relating to her fathers stay in the home and his subsequent death, how well her father was looked after, and how the home involved the family and supported them through his death. She explained how important it was for her father to be treated as an individual and with respect, and with acknowledgment of who he was. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Links with friends, relatives and the community are encouraged and are an important part of the home, choices made are respected. Some pastimes and activities are available although the main focus of the home is around family, and daily life activities. Residents benefit from a wholesome and nutritious meals. Evidence: Since the last key inspection the home has recognised through quality monitoring that activities and entertainment in the home are not well developed, or representative of residents needs. With this in mind they have organised some structured activity and entertainment that is advertised in the home, and plan to assess individual expectations and abilities further to provide a person centred approach to this provision. This commitment was recorded within the AQAA. The main focus of the home remains the promotion of a family setting where people can maintain the environment and lifestyle that they enjoyed at their own home, with the benefit of supporting framework provided by Ashwood nursing home. One residents said how much he liked the garden and that the staff take him outside to enjoy the fresh air. Ashwood nursing home is family business and the manager is supported by family Care Homes for Older People Page 16 of 28 Evidence: members in the running of the home. This in turn gives residents an interest in her family, which includes small children that they clearly enjoy interacting with. The manager is aware of the risks associated with small children in the home and has agreed to provide suitable risk assessments. Visiting is not restricted and visitors spoken with commented on how they are welcomed to the home and able to visits and stay as they wish. As the home serves the local community many of the visitors and residents are known to each other. They also get to know the manager and her family and staff well, allowing strong support networks to develop within the home. Feedback from residents and visitors recognised that the home supported peoples individual choices allowing them to spend their time as they wished this home suites me I can do as I wish No one is made to attend or do anything they do not want to do. During the inspection visit it was noted that residents were supported in making a vote at the forth coming election. Peoples faiths are respected and explored within the care documentation, a local vicar who has a relative in the home is heavily involved in all those residents that want this input. There is a well established chef who has worked at the home for many years and has all the necessary qualifications. She knows the residents very well and accommodates their requests and preferences individually. Comments from residents confirmed this individual approach and that the food provided in the home was of a good quality. The soup is very filling and we have this at lunch and supper the food is very good as I do not eat meat they always supply some fish. During the inspection visits it was noted that fresh vegetables were supplied from a local source, and the meal served looked appetising and was enjoyed by residents eating communally in the dining room. Residents have the opportunity to eat communally but most choose to eat in their own rooms. Care Homes for Older People Page 17 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. The home has a complaints procedure and residents and their advocates feel that their comments are listened to and acted on. The home has relevant policies and procedures around Safeguarding Vulnerable Adults and staff have received appropriate training to ensure residents are safeguarded against all forms of abuse. Evidence: The home has a clear complaints procedure and a copy of this is available within the service users guide, and displayed on the wall in the entrance hallway. The manager has agreed to update this to ensure it reflects the current registering authority and correct contact address. The AQAA recorded that no complaints had been received in the last 12 months but recognised that the recording of small concerns could be improved to demonstrate the homes response to any issue. It also confirmed the use of a relatives forum in the future to engage better with relatives and encourage both complaints and compliments. Although residents spoken with said that they would raise a complaint with the manager and one said I would have no hesitation in raising a concern with the homeowner or her daughter and I am confident that she would to me. Two of the surveys received indicated that residents did not know how to complain. This was raised with the manager who agreed to provide information on how to make complaints to residents and their representatives again, to ensure people are fully Care Homes for Older People Page 18 of 28 Evidence: aware of the process. The home has a Safeguarding Vulnerable Adults and Whistle blowing procedure in place and the most recent local procedures are available in the home. Records confirmed that staff had received training on Safeguarding Vulnerable Adults and that an ongoing training programme was in place. The manager explained that if there was any concern raised in respect of safeguarding she would be contacted immediately, and would come to the home at any time if needed. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in an attractive home like environment, that is well maintained and clean. Evidence: Ashwood nursing home is a converted premise that has retained a home like environment. The home was found to be clean with many of the residents rooms being very personalised. Residents rooms are viewed as there own space and reflect the interests and past life of the person occupying the room along with their health and personal care needs. Residents spoken with confirmed a satisfaction with their private rooms saying I have have everything I need here my room is clean and comfortable. The environment was found to be light and clean and each room had a call bell available for use. The manager confirmed that redecoration was ongoing at that she would be taking into account residents views on the colour and furnishing when redecorating rooms. During the inspection visit it was noted that some old furniture was being stored under the stairs along with some unidentified cleaning fluids. This was raised later with the manager who confirmed that the furniture would be removed, and that the cleaning fluid was for the washing machines. This had just been delivered and in future would be stored safely in a secure place. Care Homes for Older People Page 20 of 28 Evidence: The AQAA confirmed that required checks are maintained on all lifting equipment and that an up to date fire risk assessment has been completed. There is a large well-maintained garden at the rear of the home for residents to enjoy in good weather. The communal space available is located on the ground floor and consists of one room that is used as a lounge and a dining room. Although this room is large enough for the current occupancy and current use, this facility needs to be kept under review to ensure continued suitability when the occupancy of the home increases. The laundry facilities were seen and were appropriate for the size of the home, the manager has in the past confirmed that the two washing machines have sluice cycles that can be used for any soiled laundry. During the inspection visit staff were seen to be following suitable infection control practices and the AQAA confirmed that staff have received training on infection control. 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. Staffing arrangements including the qualified staff provision ensure that residents health and personal care needs are met. Whilst the homes recruitment practice ensures that all the necessary checks are completed in respect of the staff employed, not all the required records are held by the home. Evidence: During the inspection visit the staff were found to be attentive and kind, and residents were responsive and happy to be with them. A duty rota was available and this recorded that a registered general nurse worked in the home over the whole 24 hour day. The manager is recorded as working 2-3 shifts in the home on a weekly basis, and advised that she attends the home most days and is always available on the telephone. When residents were asked about the staffing they advised that staff were always available when requested and relatives also said that there was enough staff working in the home. Observation confirmed that the care was not routine led and that the staffing arrangements allowed for interaction with residents and visitors and for care needs to be responded to in a flexible way. Feedback received about the staff was all positive comments included Provides a very Care Homes for Older People Page 22 of 28 Evidence: homely, non-institutional environment, kind and attentive patient staff there is a regular staff team working in the home, and they have a good knowledge and insight into the care provided Staff are very kind and attentive. A review of the staffing rota identified that a registered nurse and a care staff were working very long hours. This was discussed with the manager who confirmed that this was a temporary arrangement in response to individual staff requests, and that she was monitoring closely, to ensure the ongoing effectiveness of staff. The recruitment records pertaining to two new staff members were reviewed as part of the inspection process. These demonstrated that the recruitment process was on the whole thorough including the required check. It was however noted that copy of the employees identification records are not retained in the home as required. This was raised with the manager at the time of the inspection visit for her to address. Staff records confirmed that the home completes an induction training schedule. A training matrix supplied following the inspection confirmed that staff are completing mandatory training as required, and further training to ensure staff can meet the care needs of residents has been established. A planned training record was displayed in the office and covered planned mandatory training including Safeguarding Vulnerable Adults, fire, safe moving and handling and infection control. The home employs most of their care staff from India and have recognised within their AQAA, that they need to document more clearly the legislation with respect to immigration, and possibly recruit a more ethnically representative work force for residents whenever possible. The AQAA also recorded the intention of the home to ensure that all staff newly recruited to the home undertake the Skills for Care induction and foundation standards, and for the home to have a better understanding of the staff development needs, and how to meet these. Discussion with the manager confirmed that it may not be necessary for new staff to complete all the standards if they have already completed an National Vocational Qualification in care at level 3 or 4, but she would need to assess their skills and knowledge and complete those relevant as necessary. A registered nurse spoken with confirmed that the staff training had improved and was well developed with good attendance. 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 registered manager has the relevant skills and experience, and is able to provide direction and leadership to the home. Quality assurance processes have been used to develop the service, and residents financial interests are safeguarded. The health, safety and welfare of residents and staff are generally well promoted with the use of risk assessments. Evidence: The homes manager is a Registered Nurse and has attained the Registered Managers Award and has owned and run Ashwood nursing home for over 20 years. She has a deep understanding of the needs of each resident, and shares her knowledge and experience with the rest of the nursing and care team. Although she only works a few shifts in the home she maintains a high profile with the AQAA recording that she has made arrangements to be on site more often, in order to meet the needs of residents and to manage the business better. She is always available when a resident becomes ill and is able to provide direct care and support. She confirmed that she remains committed to the home and maintaining high standards of care and services. Care Homes for Older People Page 24 of 28 Evidence: Although she openly acknowledges that paper work is not her strong point she has established good systems for record keeping, and the AQAA confirmed that the operational policies and procedures were all reviewed in October 2009. The AQAA was well completed and used as a quality monitoring tool, setting out how the home is to be developed and improved over the next twelve months. This document had been completed with a view of working with another local provider to enhance the service at Ashwood nursing home. The manager advised that this joint working was no longer in place, but confirmed her commitment to implementing fully the content of the AQAA. There was evidence within the home that stakeholders views have been sought although these are not fully reported on, they have however been used to change and improve the service at the home. The manager has acknowledged within the AQAA that arrangements for quality assurance of the home and the service are not as strong as they could be, and that resident forums are to be set up to improve feedback. The manager confirmed that she does not have any involvement with residents monies and all residents have an identified person who deals with their finances. The home has suitable systems in place to ensure the home and the equipment is suitably maintained and that regular checks on equipment are maintained. Evidence of this was recorded within the AQAA and the manager confirmed that new fire risk assessment has been completed along with environmental risk assessments. Discussion took place around the risk of young children in the home and the manager provided a full risk assessment to cover children in the home before this report was completed. 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 1 29 19 The registered person must ensure that the necessary checks and records are completed and held in respect of each employee. This will ensure only those staff suitable to work in the home are employed 01/07/2010 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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