Care Home: Atfield House

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What the care home does well Prospective residents are fully assessed prior to admission and the processes in place ensure the home is able to fully meet their needs. Residents are also reassessed to ensure that the home is able to meet their needs following a trial period. Service user plan documentation is well formulated, personalised and up to date, providing a clear picture of each residents needs. Overall medications are being well managed and the shortfall identified had been investigated and an action plan put in place to address this. Staff care for residents in a gentle and professional manner, and the home has been proactive in working towards person centered care. Residents healthcare needs are addressed promptly. The wishes of residents and their families in respect of end of life care are ascertained and recorded, and the home provides effective end of life care in conjunction with the Palliative Care Team. The activities provision is excellent and residents are encouraged to participate in a range of individual and group activities. The home has an open visiting policy and visiting is encouraged. Information regarding advocacy services is available. The food provision is excellent and the staff must be commended for this. Mealtimes are seen as a important part of the day. The Manager and the staff team are proactive in managing complaints and addressing any safeguarding issues. Staff spoken with were clear about managing complaints and had an excellent understanding of safeguarding adults procedures. The home is being well maintained with evidence of ongoing redecoration and refurbishment. Procedures for infection control are in place and are followed, thus minimising risks. The home is appropriately staffed to meet the needs of the residents. There is an on going programme of training to include NVQ training and training relevant to the diagnosis and needs of the residents. There is an induction programme in place for new staff and systems are in place for staff to be supervised during their induction period. Recruitment processes are robust and protect residents. The home is being very effectively managed and the management style promotes an atmosphere of openness and good communication. The management team are proactive in managing any issues raised. There are clear systems in place for quality assurance and the management team is active in implementing changes which improve quality outcomes for the residents living at the home. Personal monies are not managed by the home. Health & safety is being well managed at the home. Comments received included the following: `The home always seems to have a happy, safe and caring feeling.` `Cares for the residents sensitively and with compassion and respects their dignity`. `Very safe and friendly environment to work in, staff are very friendly and supportive`. `This home meets the needs of every resident in every way which is pleasing to see`. `We as a family are very happy with the care my relative gets from the staff. The home is well maintained and clean. The staff are helpful and polite and always available to help`. `Nursing staff are on `the ball` and are aware of continuing needs and are veryattentive`. `Quality and quantity of food is excellent`. `I am very happy with all aspects of safety and security`. What has improved since the last inspection? Since the last inspection bedrail assessment documentation are in place. Receipts for medications received into the home are clearly recorded. Regular medication audits to check quantities of medications are in place. Controlled drugs are clearly recorded. The home now has in place lancets for professional use when monitoring blood glucose levels. Air conditioning has been installed in two of the clinic rooms and temperatures for the clinic room and the medication fridges were in the required range. There was evidence that fire drills were being undertaken for both day and night staff. Kitchen records viewed were up to date. What the care home could do better: One shortfall was identified in relation to medication administration at the time of inspection and action was taken to address this. We recommended that the home develop a written redecoration and refurbishment plan to evidence all the work undertaken and work which has been planned. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Atfield House St John`s Road Isleworth Middlesex TW7 6UH     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: Rekha Bhardwa     Date: 2 1 0 7 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 28 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 28 Information about the care home Name of care home: Address: Atfield House St John`s Road Isleworth Middlesex TW7 6UH 02085603994 02087580502 venita.couzens@barchester.com 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) : Barchester Healthcare Homes Ltd care home 64 Number of places (if applicable): Under 65 Over 65 0 0 dementia physical disability Additional conditions: 28 36 The maximum number of service users who can be accommodated is: 64 The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia Code DE maximum number of places: 28 Physical disability - Code PD maximum number of places: 36 Date of last inspection Brief description of the care home Atfield House is a purpose built care home with nursing, first opened in 1997. It is owned by Barchester Healthcare. The home is in Isleworth, approximately two miles from Hounslow town centre. There are shops nearby, buses into Hounslow, and Isleworth train station is close by. The home has attractive grounds and a secure garden. Although registered for 64 people, one room has been converted into a hairdressing/therapy room. All bedrooms are single rooms, with 62 of them being ensuite. The home is on two floors, with a lift, and is split into 2 separate units for a total of 36 beds for general nursing care and 28 beds for residents living with the experience of dementia. Residents are also accepted for respite care. Physiotherapy is Care Homes for Older People Page 4 of 28 Brief description of the care home available two days a week within the home. The GP visits each week and as required. Chiropody and optical services are available as required. Three activity organisers provide a programme of activities, one of whom is also qualified as a massage therapist. There is an attractive secure garden area plus other gardens available. Fees range from £1050 to £1100 per week. 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: 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 last key inspection of this home was undertaken in September 2007. This was an unannounced inspection carried out as part of the regulatory process. A total of 20 hours was spent on the inspection process, and was carried out by 2 Inspectors. We carried out a tour of the home, and service user plans, medication records & management, staff rosters, staff records, financial & administration records and maintenance & servicing records were viewed. Residents, staff and visitors on each unit were spoken with as part of the inspection process. The pre-inspection Annual Quality Assurance Assessment (AQAA) document completed by the home, plus comment cards from residents and staff have also been used to inform this report. Care Homes for Older People Page 6 of 28 Care Homes for Older People Page 7 of 28 What the care home does well: Prospective residents are fully assessed prior to admission and the processes in place ensure the home is able to fully meet their needs. Residents are also reassessed to ensure that the home is able to meet their needs following a trial period. Service user plan documentation is well formulated, personalised and up to date, providing a clear picture of each residents needs. Overall medications are being well managed and the shortfall identified had been investigated and an action plan put in place to address this. Staff care for residents in a gentle and professional manner, and the home has been proactive in working towards person centered care. Residents healthcare needs are addressed promptly. The wishes of residents and their families in respect of end of life care are ascertained and recorded, and the home provides effective end of life care in conjunction with the Palliative Care Team. The activities provision is excellent and residents are encouraged to participate in a range of individual and group activities. The home has an open visiting policy and visiting is encouraged. Information regarding advocacy services is available. The food provision is excellent and the staff must be commended for this. Mealtimes are seen as a important part of the day. The Manager and the staff team are proactive in managing complaints and addressing any safeguarding issues. Staff spoken with were clear about managing complaints and had an excellent understanding of safeguarding adults procedures. The home is being well maintained with evidence of ongoing redecoration and refurbishment. Procedures for infection control are in place and are followed, thus minimising risks. The home is appropriately staffed to meet the needs of the residents. There is an on going programme of training to include NVQ training and training relevant to the diagnosis and needs of the residents. There is an induction programme in place for new staff and systems are in place for staff to be supervised during their induction period. Recruitment processes are robust and protect residents. The home is being very effectively managed and the management style promotes an atmosphere of openness and good communication. The management team are proactive in managing any issues raised. There are clear systems in place for quality assurance and the management team is active in implementing changes which improve quality outcomes for the residents living at the home. Personal monies are not managed by the home. Health & safety is being well managed at the home. Comments received included the following: The home always seems to have a happy, safe and caring feeling. Cares for the residents sensitively and with compassion and respects their dignity. Very safe and friendly environment to work in, staff are very friendly and supportive. This home meets the needs of every resident in every way which is pleasing to see. We as a family are very happy with the care my relative gets from the staff. The home is well maintained and clean. The staff are helpful and polite and always available to help. Nursing staff are on the ball and are aware of continuing needs and are very Care Homes for Older People Page 8 of 28 attentive. Quality and quantity of food is excellent. I am very happy with all aspects of safety and security. What has improved since the last inspection? 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 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. Prospective residents are fully assessed prior to admission, thus the home ensures they are able to meet each persons needs. Residents and their representatives have an opportunity to visit the care home prior to making a decision about admission to the home. Evidence: The home completes a comprehensive pre-admission assessment. This provides a very clear picture of the prospective resident and their needs, plus an additional admission assessment document is completed when the resident is admitted to the home. The home also obtains a copy of the assessment completed by Social Services or the Primary Care Trust. Residents and their representatives are encouraged to visit the home prior to admission to help them ascertain if it is the right home for them. We were informed Care Homes for Older People Page 11 of 28 Evidence: that the home also provides a booklet called Dementia Care Matters which is aimed at helping relatives and representatives identify outstanding person centered dementia care. 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 service user plan documentation is well completed to provide staff with the information to meet each residents needs. Overall medications are being well managed at the home, thus safeguarding residents. Shortfalls should be easy to address. Staff care for residents in a gentle and professional manner, respecting their privacy and dignity. The wishes of residents and their families in respect of end of life care are discussed and recorded, and being effectively met by the home. Evidence: We viewed 7 service user plans. Overall these were well completed, comprehensive and provided a good picture of each resident and their needs. There was evidence of involvement from residents and their representatives in the formulation and review of the documentation. We did note that for residents more recently admitted the information was in place for each identified need was in place but needed expanding, however the home was aware of this and does carry out a review and update once they have had the opportunity to assess the resident over a period of time in the home Care Homes for Older People Page 13 of 28 Evidence: environment. Risk assessments for falls had been completed and there was evidence of updates following falls. There is ongoing monitoring of falls to identify any trends so that action can be taken to minimise re-occurrence. Service user plans are updated monthly and whenever there is a significant change in the residents condition, plus a 6 monthly review is carried out with the resident and their representative. We viewed wound care documentation. Waterlow assessments for pressure sore risk are in place and are reviewed monthly. Care plans are in place for each wound and there is also a record of dressing changes, photographs taken with consent, and a Wound Care Chart that lists the healthcare professionals who have been involved with the specific care of the wound and any other risk areas associated with the residents condition. Nutritional assessments are in place and a record of weights is maintained. Where a significant weight loss is noted then the resident is referred to the GP. Moving and handling assessments are in place and clearly identify the numbers of staff and the equipment to be used for each manoevre. We noted several customised wheelchairs and residents looked comfortable and their needs in relation to moving and handling were being well managed. Continence assessments were in place. Bedrail assessment documentation was in place and this recorded the appropriateness of their use and consents for their use had also been obtained. There was evidence of input from healthcare professionals to include GP, chiropodist, tissue viability nurse, psychiatrist, community psychiatric nurse, macmillan nurses, physiotherapist and optician. We viewed the medication management on each unit. Receipts, administration and disposals of medications are all recorded. Where hand written entries are made on the medication administration record (MAR) two registered nurses check and sign each entry. We sampled the MAR charts and with one exception these were well completed and accurate. We noted a discrepancy in the stock balance and the number of tablets as having been administered in one case, and the deputy manager immediately commenced an investigation into this and reported the incident to the relevant authorities. Action was also taken to implement a daily stock check for tablets not supplied in the 28 day monitored dosage system (MDS). We were also informed that a twice daily stock check is now being carried out for residents on Warfarin therapy. Clear instructions were in place for medications with specific administration requirements. Controlled drugs records were accurate and up to date and a twice daily stock check is carried out for all controlled drugs. The temperature in the clinic rooms was within safe range and following the last inspection air conditioning has been installed in 2 of the clinic rooms. The fridge temperatures were being recorded, however we identified that the thermometers were not always being reset, and as a result it appeared that the maximum temperatures were outside safe range. This was addressed at the time of inspection and all staff involved with the monitoring of the Care Homes for Older People Page 14 of 28 Evidence: medication fridge temperatures are being trained in the use of the thermometers. There is ongoing monitoring and review of residents medication and this is discussed with the GP. Overall medications are being well managed at the home and where shortfalls are identified prompt action is taken to address them and to minimise the risk of re-occurrence. Staff were observed caring for residents in a gentle, friendly and professional manner, respecting their privacy and dignity. There was good interaction between residents and staff on all units and the atmosphere was bright and contented. If a resident appeared to be a bit distressed, then staff attended to them to offer them reassurance and support. Personal clothing was labelled and residents were well groomed and dressed to reflect individuality. Residents can have their own telephones, either mobile or landline. Staff have received training in customer care and this is a high priority, with the staff throughout the home offered care and support to residents and visitors. The staff encourage choice in all areas through the use of feedback forms How are we doing?. Choices and preferences are clearly recorded in the service user plan documentation. The Manager explained that as part of the pre-admission process, the wishes of prospective residents in relation to health deterioration and end of life care is introduced, so that this can be considered and then discussed again at a later date. Information on this sensitive topic was available in the care plans viewed, and it was clear that some residents and their representatives had been able to discuss it, whereas others were not yet ready to do so, and their wishes are respected. Barchester Healthcare produces an information leaflet for residents and relatives about resuscitation, to help them understand what it means and to make an informed decision about their wishes. The home does admit residents for end of life care and records are well maintained with the wishes of the residents and their families being respected. 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. The activities provision is excellent, and each residents right to choose to join in is respected, thus meeting their individual needs and wishes. The home has an open visiting policy, thus encouraging residents to maintain contact with family and friends. Information regarding advocacy services is available, thus ensuring the residents right to independent representation is respected. The food provision in the home is excellent, offering variety and choice, with residents choices being respected. Evidence: The home has 3 activities co-ordinators and we saw activities taking place throughout the home, both in groups and individually. Residents looked animated and interested in the activities and there was good interaction. The activities programme for the week is displayed and this lists what activity is taking place where and when and who will be leading it. For some residents life history plans had been completed and these are being progressed for all residents. There was information in each of the service user plans regarding individual hobbies and interests, and these were personalised. An activities diary is also kept for each resident. The home has information on display about advocacy services, to include Alzheimers Care Homes for Older People Page 16 of 28 Evidence: Concern and financial advice. Staff had received training in the Mental Capacity Act 2005 and also for the Deprivation of Liberties Safeguards. The home has an open visiting policy and visiting is encouraged. Visitors spoken with said that they are always made welcome at the home and representatives are kept informed of any concerns. Refreshments are offered and visitors can book to have a meal with their loved one. We viewed the kitchen and it was clean and tidy, with records being up to date. The home has a daily menu and this offers a wide range of choices, plus there is an extensive list of alternatives available for each mealtime. The home operates a restaurant-style service and hostess staff are employed to carry out the refreshment rounds and also to oversee and manage service in the dining rooms. We sampled the 3 lunchtime options on the first day of inspection and the food was of a high quality and was well cooked and presented. Residents spoken with expressed their satisfaction with the food and confirmed that they are always offered a choice. It was clear that the chef and the catering staff take much pride in their work and the home is to be commended for the high standard of catering services they provide. Since the last inspection the home has appointed three care assistants as Nutrition Champions. We were informed that the Nutrition Champions are responsible for monitoring the residents nutrition needs and managing residents weight loss and weight gain. They work closely with the catering team. The chef prepares home baked cakes daily which are served with afternoon tea. We noted that fresh fruit was available throughout the home. Catering staff within the home have also undertaken NVQ training in Care and Hospitality. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has clear complaints procedures in place to address any concerns raised by residents and their visitors. There is a robust system in place for the safeguarding of residents from abuse. Evidence: The home has a clear complaints procedure and this is on display in the home. The home has had 4 complaints in the last 12 months, and all concerns are recorded and addressed under the homes complaints procedure. Complaints records were sampled, and documentation was available to evidence that complaints had been appropriately investigated and responded to. Relatives spoken with during the inspection confirmed that they were aware of the complaints procedure. The AQAA details that that the home views complaints positively and learns from any complaints that have been made. The Manager said that she has an open door policy and that she welcomes feedback from all residents and their representatives. The home has safeguarding adults policies and procedures in place that dovetail with the Hounslow Safeguarding Adults documentation. Staff spoken with said that they had received SOVA training and were clear to report any concerns. Staff also had a good understanding of whistle blowing procedures. Any incidents or issues that may involve safeguarding adults are reported to the Hounslow safeguarding adults team as well as to us. Care Homes for Older People Page 18 of 28 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. The home is being well maintained, to provide the residents with a clean, homely and safe environment to live in. Infection control procedures are in place and are adhered to, thus protecting residents, visitors and staff. Evidence: We carried out a tour of the home. It was clean and well maintained throughout. There was evidence of rooms having been redecorated and we were informed that the areas needing attention in the shower and bathrooms were planned for redecoration. The gardens are well maintained and were colourful and bright. Garden furniture is available for residents and their visitors to sit outside. The reception area is very welcoming and there is lots of relevant information available for residents and visitors. We recommended that the home record this on a redecoration and refurbishment plan. We viewed the laundry room and it was clean and tidy. Procedures are in place for infection control and are followed. Staff all receive training in infection control and there is protective clothing available to include gloves, aprons and masks, thus minimising the risk of infection. The home is proactive in managing any infection an individual may have developed, and ensures these are dealt with without delay. The home was clean throughout and action is taken promptly to manage any odours that may occur, to maintain a fresh environment. Care Homes for Older People Page 20 of 28 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. The home is appropriately staffed to ensure that the needs of the residents are met. Systems for vetting and recruitment practices are in place and protect residents. There is a comprehensive ongoing training programme, providing staff with the skills to meet the needs of residents, to include specialist care needs. Evidence: The staffing levels are based on resident dependencies. At the time of inspection each unit was appropriately staffed to meet the needs of the residents. Staff spoken with confirmed that the numbers of staff on duty are appropriate to meet the residents needs. The home employs administration, catering, domestic, activities and maintenance staff so that all the needs of the residents and the home in general can be met. Representatives spoken with commented that staff are friendly and approachable. One relative commented that nothing is too much trouble for the staff. The staff team has a good skill mix to meet the needs of the residents. Staff commented that the team work well together and support each other. The home has 12 permanent care staff qualified to NVQ level 2 or 3 in care, with plans in place to increase the number of staff with this training. We were also informed that the home is running an Apprentice to university education course. This also incorporates the NVQ training and we were informed that staff can also work towards a Care Homes for Older People Page 22 of 28 Evidence: diploma and a degree course through this scheme. The home also provides NVQ training in customer care, hospitality and catering. We viewed 2 sets of staff employment records. These contained the information required under Schedule 2 of the Care Homes Regulations 2001. The home has a general induction programme in line with the Skills for Care common induction standards. This also includes a comprehensive induction programme planned by Barchester Healthcare. The home has a home trainer who works at the home for 20 hours a week. The home has a comprehensive training programme in place for all staff. Training needs are identified via supervision sessions with individual staff and a personal training plan is developed from this. The home also uses an e-training system of training which is undertaken on-line. The home trainer is also a moving and handling instructor. A training matrix was in place, which evidenced the training undertaken by each member of staff. There is a good skill mix on each unit, and staff throughout the home had attended dementia care training. The AQAA also stated that senior staff at the home had attended the Barchester Leadership in Dementia Care programme. Plans are in place to apply person centered care to staff care practice. The training matrix evidenced that staff had also undertaken specialist training to meet the residents needs. 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 has the skills, experience and acumen to manage the home effectively and promotes an atmosphere of openness and respect, thus making residents, visitors and staff feel valued. Systems for quality assurance are in place, thus providing an ongoing process of review and feedback. Systems for the management of health and safety throughout the home are good, thus safeguarding residents, staff and visitors. Evidence: The Manager is a first level registered nurse and has several years of care home management. She has also undertaken periodic training in topics relevant to her role and the diagnoses of the residents to keep her knowledge and skills up to date with current good practice and legislation. The Manager demonstrates good leadership skills and staff and representatives spoken with confirmed that she is approachable and supportive. There are clear lines of accountability in the home and the Manager is supported by the deputy care manager. The management team is effective in Care Homes for Older People Page 24 of 28 Evidence: maintaining and improving standards throughout the home. The home has in place effective quality assurance and monitoring systems. There is a programme of monthly internal audits which are overseen by the Director of Quality and Care. Where shortfalls have been identified through the audits an action plan is put in place and outcomes are clearly recorded. Audits for accidents, wound care, medication, service user plans and health & safety are carried out regularly. In addition to these audits the home carries out a nutrition and dining audit and a clinical and quality audit. Regulation 26 unannounced visits on behalf of the Responsible Individual are carried out and copies of the report are available to view. Feedback questionnaires are available in the entrance area of the home and an annual survey was carried out in October 2008. The results of this survey were available and an action plan put in place to address shortfalls. Residents and relatives meetings take place. Staff meetings are carried out regularly and the Manager has daily meetings with all heads of department to plan for the day and gain an overview of the home. Residents, visitors and staff are encouraged to comment on the home and make suggestions as to where things can be improved and this is listened to and changes are made. It is clear that the home has a proactive approach to quality assurance to improve outcomes for the residents. The home does not manage residents monies. Maintenance and servicing records were sampled and up to date. The Fire risk assessment was last completed in February 2009. Fire drills are carried out on a regular basis for both day and night staff. Up to date risk assessments for equipment and safe working practices were available. Individual risk assessments were available on the service user plans viewed. The training records show that staff receive training and updates in health & safety topics to include moving & handling, fire safety, food hygiene, infection control, safeguarding adults and First Aid. The home has a health and safety representative and attends the health and safety committee that meets every three months. Staff members in the home have also received specialist training in moving and handling, infection control and fire training. 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 9 13 All medication must be administered as prescribed. To ensure that residents medication needs are being safely met. 07/08/2009 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 19 That the home develops a redecoration and refurbishment plan which details all the redecoration and refurbishment work to be undertaken and work that has been completed. Care Homes for Older People Page 27 of 28 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. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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