Care Home: Avenswood

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What the care home does well We looked at the way people are assessed prior to and also when they come into the home. The assessments are thorough and include attention to peoples capacity to make decisions for themselves. This is important as it gives a baseline for decisions made with respect to choice of admission to the home and any further need to make decisions in that persons `best interest`. This shows that the home are updating themselves with curent best practice. Relatives stated that staff are always available to talk about care issues and that they are kept updated, particularly if there are any changes to care needs. We saw that care records were very personalised and those seen include entries on social aspects of care such as any communication needs. For example one person who has difficulty speaking had a plan which described care interventions for staff to follow. We spoke with both residents and visitors. One relative said: `Its absolutely marvelous. My relative has put on two stone in weight and has never been better. Staff are very good and support her well`. Another commented: `Its great- its more like a home than an institution. The staff are so friendly and the matron is very positive and caring`. One resident reviewed has needs including management of diabetes. It was clear that this person was well supported with medical appointments. The chiropodist had visited the morning of the inspection and the nursing staff monitored the persons blood sugar levels on an ongoing basis. This shows that the home support people health care needs and liaise with external professionals when needed. The provision of specialist nursing equipment and aids such as pressure relief mattresses is very good. This shows that the home are meeting peoples disability needs as much as possible. People spoken with at the inspection said that they were treated with respect and that privacy was maintained when needed. We asked people about toilet and bathing arrangements and they stated that staff were careful to ensure privacy. During the inspection residents were observed to be appropriately dressed and clean and well presented so that dignity is preserved. Staff have good rapport with residents and the general atmosphere in the home is positive with care staff seen talking to and supporting residents. One commented: `Its lovely here - such a nice atmosphere`. another person said: `This is the best home in Crosby. I also had friend in here and they were looked after really well. the staff are excellent. They are all very caring from top to bottom. I couldn`t praise it more`.Although the dependency of the people in the home is high the staff try and encourage regular activities and these are recorded. There are also `residents meetings` which the manager holds to encourage social interaction and also to get any views as to the running of the home. One person said: `I`m comfortable and settled at Avenswood. I have my own hairdresser weekly and the Eucharistic minister comes in`. We found people to feel very safe at Avenswood. There is a complaints procedure and staff receive training in how to identify poor practice and report it. This ensures that people are protected. Residents and relatives comments were very supportive of the staff who were seen as helpful and kind. All comments received from both comment cards and during the inspection were very positive and evidenced a personalised and individualised approach. Staff spoken with clearly enjoyed working in the home. One said: `I feel the home is excellent. Very settled. I have completed a lot of training such as health and hygiene, moving and handling and safeguarding - all last year - and some external training as well as in house`. The manager of the home was described as very approachable and caring. There are good systems in place to monitor care standards in the home so that the home is run in the best interests of people living there. What has improved since the last inspection? Since the last inspection the home has continued to be maintained and upgraded. For example there is a new fire in the lounge giving a more homely look. Redecoration of the lounge and a top floor bedroom and continued redecoration when rooms become vacant. The home have purchased another profiling bed which was required through assessment. Also a new larger capacity Gas Dryer in July enabling staff to provide a same day service to residents. What the care home could do better: We would recommend that any medications left in stock are carried over to the new medication record [MAR chart] so that an accurate record is maintained. Creams being administered are not routinely recorded with respect to times and staff identity and this was discussed with the manager and practical recording processes should be put in place. [This was also discussed at the last inspection and is strongly recommended]. Medications are routinely audited by the supplying pharmacist but we would also recommend that the managers carry out their own audits on a regular basis to ensure standards are consistently maintained.We recommend that staff are made aware of the `wider picture` in terms of how allegations of abuse are investigated through the safeguarding procedures. The routine management audits should also meet the requirements of Regulation 26 of the Care Home Regulations and include staff and resident interviews so that these opinions can also be fed back to the manager. Key inspection report Care homes for older people Name: Address: Avenswood 20 Abbotsford Road Blundellsands Liverpool Merseyside L23 6UX     The quality rating for this care home is:   three star excellent 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: Michael Perry     Date: 2 8 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 30 Information about the care home Name of care home: Address: Avenswood 20 Abbotsford Road Blundellsands Liverpool Merseyside L23 6UX 01519240484 F/P01519240484 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Nursing Home Management Limited care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: 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: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 18 Date of last inspection Brief description of the care home The Home is registered to provide nursing care. In total the Avenswood Care Home provides care for 18 service users over 65 years of age. The Home is privately owned. The registered manager has worked in the Home for a several of years and is a registered nurse. The Home is a converted building on 3 floors; there is no passenger lift to the 1st and 2nd floors. However the establishment utilises a scalamobile chair that is designed to ascend the stairs as well as having stair lifts fitted. There are 12 single rooms, 5 bedrooms with ensuite facilities and 3 double rooms none of which have ensuite facilities. Bedrooms are situated on all floors with a lounge/dining area Care Homes for Older People Page 4 of 30 0 Over 65 18 Brief description of the care home on the ground floor. There are gardens to the rear of the establishment accessible from the ground floor. Avenswood is situated in a residential area in a quite cul-de-sac. The local train station is accessible at the bottom of the street and there are a number of shops within walking distance. Parking is available to the front of the building. The fees for the service are 598 to 623 pounds weekly Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 inspection was a key [main] inspection for the service and covered the core standards the home is expected to achieve. We visited the home unannounced and the inspection took place over one day. We met and spoke with a number of residents and visiting relatives. We also spoke with members of care staff on a one to one basis and the registered manager and the provider who was also in attendance. Resident survey forms [comment cards] were also issued prior to the inspection and some of these were returned and comments have assisted in the inspection process. A tour of the premises was carried out and this covered all areas of the home including peoples bedrooms. Records were examined and these included three of the residents care plans, staff files, staff training records and health and safety records. Care Homes for Older People Page 6 of 30 Prior to the inspection the provider [owner] completed a pre inspection self assessment form [AQAA] which detailed some information about the home and gave some up to date information. Care Homes for Older People Page 7 of 30 What the care home does well: We looked at the way people are assessed prior to and also when they come into the home. The assessments are thorough and include attention to peoples capacity to make decisions for themselves. This is important as it gives a baseline for decisions made with respect to choice of admission to the home and any further need to make decisions in that persons best interest. This shows that the home are updating themselves with curent best practice. Relatives stated that staff are always available to talk about care issues and that they are kept updated, particularly if there are any changes to care needs. We saw that care records were very personalised and those seen include entries on social aspects of care such as any communication needs. For example one person who has difficulty speaking had a plan which described care interventions for staff to follow. We spoke with both residents and visitors. One relative said: Its absolutely marvelous. My relative has put on two stone in weight and has never been better. Staff are very good and support her well. Another commented: Its great- its more like a home than an institution. The staff are so friendly and the matron is very positive and caring. One resident reviewed has needs including management of diabetes. It was clear that this person was well supported with medical appointments. The chiropodist had visited the morning of the inspection and the nursing staff monitored the persons blood sugar levels on an ongoing basis. This shows that the home support people health care needs and liaise with external professionals when needed. The provision of specialist nursing equipment and aids such as pressure relief mattresses is very good. This shows that the home are meeting peoples disability needs as much as possible. People spoken with at the inspection said that they were treated with respect and that privacy was maintained when needed. We asked people about toilet and bathing arrangements and they stated that staff were careful to ensure privacy. During the inspection residents were observed to be appropriately dressed and clean and well presented so that dignity is preserved. Staff have good rapport with residents and the general atmosphere in the home is positive with care staff seen talking to and supporting residents. One commented: Its lovely here - such a nice atmosphere. another person said: This is the best home in Crosby. I also had friend in here and they were looked after really well. the staff are excellent. They are all very caring from top to bottom. I couldnt praise it more. Care Homes for Older People Page 8 of 30 Although the dependency of the people in the home is high the staff try and encourage regular activities and these are recorded. There are also residents meetings which the manager holds to encourage social interaction and also to get any views as to the running of the home. One person said: Im comfortable and settled at Avenswood. I have my own hairdresser weekly and the Eucharistic minister comes in. We found people to feel very safe at Avenswood. There is a complaints procedure and staff receive training in how to identify poor practice and report it. This ensures that people are protected. Residents and relatives comments were very supportive of the staff who were seen as helpful and kind. All comments received from both comment cards and during the inspection were very positive and evidenced a personalised and individualised approach. Staff spoken with clearly enjoyed working in the home. One said: I feel the home is excellent. Very settled. I have completed a lot of training such as health and hygiene, moving and handling and safeguarding - all last year - and some external training as well as in house. The manager of the home was described as very approachable and caring. There are good systems in place to monitor care standards in the home so that the home is run in the best interests of people living there. What has improved since the last inspection? What they could do better: We would recommend that any medications left in stock are carried over to the new medication record [MAR chart] so that an accurate record is maintained. Creams being administered are not routinely recorded with respect to times and staff identity and this was discussed with the manager and practical recording processes should be put in place. [This was also discussed at the last inspection and is strongly recommended]. Medications are routinely audited by the supplying pharmacist but we would also recommend that the managers carry out their own audits on a regular basis to ensure standards are consistently maintained. Care Homes for Older People Page 9 of 30 We recommend that staff are made aware of the wider picture in terms of how allegations of abuse are investigated through the safeguarding procedures. The routine management audits should also meet the requirements of Regulation 26 of the Care Home Regulations and include staff and resident interviews so that these opinions can also be fed back to the manager. 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 10 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are assessed prior to admission so that an effective care plan can be drawn up. Evidence: We looked at care files for two residents. These included various assessments carried out by staff so that care needs can be identified. The assessment process starts before residents are admitted and care files contained pre admission assessments from a senior nurse in the home as well as copies of further assessments from care professionals such as social workers and health care professionals. The assessments are thorough and include attention to any risk factors so that residents can exercise some choice and live their daily lives safely. The assessments also included attention to peoples capacity to make decisions for themselves.This is important given the developments in the Mental Capacity Act as well as giving a baseline for decisions made with respect to choice of admission to the home and any Care Homes for Older People Page 12 of 30 Evidence: subsequent need to make decisions in that persons best interest. This shows that the home are updating themselves with best practice. Residents and relatives spoken with were able to recall how they had been admitted to the home and generally felt that this had been a positive experience in that staff had taken the time to support and answer any questions. There is written material available and this is constantly updated. This ensures that people who are admitted can feel more comfortable and supported. Care Homes for Older People Page 13 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. peoples health and personal care is well monitored so that their rights are maintained and privacy and dignity are maintained. Evidence: Care plans were looked at for three residents. The home are trying to involve both residents and relatives in the planning of the care and some residents had signed plans to say they have discussed how their care is going to be given. Relatives stated that staff are always available to talk about care issues and that They are kept updated, particularly if there are any changes to care needs. Plans were being reviewed by staff on a regular basis, or sooner if needed. This evaluation process is important as it is a discussion and statement of progress made set against the aims and goals of the care plan. The plans were very personalised and those seen include entries on social aspects of care such as any communication needs. For example one person who has difficulty speaking had a plan which described care interventions for staff to follow. The care Care Homes for Older People Page 14 of 30 Evidence: plans seen could be followed easily and gave a good outline of the care needs of the residents concerned. We spoke with both residents and visitors. One relative said: Its absolutely marvelous. My relative has put on two stone in weight and has never been better. Staff are very good and support her well. Another commented: Its great- its more like a home than an institution. The staff are so friendly and the matron is very positive and caring. One resident reviewed has needs including management of diabetes. It was clear that this person was well supported with medical appointments. The chiropodist had visited the morning of the inspection and the nursing staff monitored the persons blood sugar levels on an ongoing basis. The person described how staff had given support and how they are a very good team and very caring. This shows that the home support people health care needs and liaise with external professionals when needed. Care records seen contained easy to read notes of visits by GPs and other professionals. The provision of specialist nursing equipment and aids such as pressure relief mattresses is very good and all of the residents at risk had a mattress in place. Although the home does not have a lift fitted so that level access is impossible the provider has fitted stair lifts and this has extended to the top floor since the last inspection. This shows that the home are meeting peoples disability needs as much as possible. People spoken with at the inspection said that they were treated with respect and that privacy was maintained when needed. The home has three rooms, which are shared. It was observed that portable screens were in each room and one resident said that staff always use these and that privacy is respected. The residents in the shared rooms are currently very dependent. we asked people about toilet and bathing arrangements and stated that staff were care full to ensure privacy. Staff spoken with highlighted issues around privacy and dignity and were observed to be very respectful when attending to residents [for example at meal times]. During the inspection residents were observed to be appropriately dressed and clean Care Homes for Older People Page 15 of 30 Evidence: and well presented so that dignity is preserved. Staff have good rapport with residents and the general atmosphere in the home is positive with care staff seen talking to and supporting residents. Residents reported that medication is always given on time. The medication administration records (MAR) were seen and were generally clear and accurate for those residents reviewed. One person had medication that had not been carried over from the previous MAR sheet and when we came to audit this [count the stock of medication] it was confusing. We would recommend that any medications left in stock are carried over to the new MAR chart so that an accurate record is maintained. Creams being administered are not routinely recorded with respect to times and staff identity and this was discussed with the manager and practical recording processes should be put in place.[This was also discussed at the last inspection and is strongly recommended]. Each resident has a secured and locked space in their bedrooms. This is good practice as it assists staff in making sure that they give the medicines to the correct resident and keeps them secure at all times. Medications are routinely audited by the supplying pharmacist but we would also recommend that the managers carry out their own audits on a regular basis to ensure standards are consistently maintained. Care Homes for Older People Page 16 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The social care in the home is very relaxed and friendly and people are supported in any chosen activity. Evidence: The general atmosphere in the home is warm and welcoming. Residents reported that staff were very friendly and supportive and spent time with them on a daily basis. One commented: Its lovely here - such a nice atmosphere. another person said: This is the best home in Crosby. I also had friend in here and they were looked after really well. The staff are excellent. They are all very caring from top to bottom. I couldnt praise it more. One resident discussed how care staff accompanies him out a lot to various appointments. Visitors are encouraged and can visit at any time. One relative commented that staff are always welcoming. Care Homes for Older People Page 17 of 30 Evidence: We saw the activities folder in the lounge. Although the dependency of the people in the home is high the staff try and encourage regular activities and these are recorded. There are also residents meetings which the manager holds to encourage social interaction and also to get any views as to the running of the home. Staff reported that they had time to spend with residents which helps to personalise the care. Staff spoken to were very knowledgeable about the residents and could give a social history as well as their immediate care needs. During the inspection visit we saw a visiting therapist who regularly attends and does some massage and attends to peoples nails. This was well appreciated. One person said: Im comfortable and settled at Avenswood. I have my own hairdresser weekly and the Eucharistic minister comes in. The pace of the day is very relaxed and this was supported by statements form residents who said that they could get up and go to bed when they wished. All of the residents spoken with were complimentary about the food. Staff organize meals very well in inconvenient circumstances as the home is on three floors the meals need to be carried up by the staff who try very hard to make sure that the meals are still hot and nicely presented. Residents stated that they could choose what they like if they do not want what is on the menu. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a complaints procedure and people are listened to and their concerns addressed so that they feel safe in the home. Evidence: The pre inspection information [AQAA] supplied says: We display our complaints procedure and give new residents a copy within their handbook. Staff are given POVA [identifying and reporting abuse] training and work to these regulations.We adopt the opinion that that each resident has the capacity to make all their decisions unless proved otherwise.We also are aware that their capacity may change and assess this at each individual decision. Those residents and relatives interviewed felt that they were able to approach staff and that their concerns would be listened to. We saw the complaints procedure displayed and in peoples rooms. There have been two complaints about care in the home since the last inspection and both were issues that the management responded to appropriately so that redress was apparent. Staff in the home have attended training sessions around abuse awareness and the local adult protection protocols and those interviewed were aware of how to report any Care Homes for Older People Page 19 of 30 Evidence: allegations or concerns through the line manager. Staff were not, however, aware of the wider picture in terms of how allegations of abuse are investigated through external bodies such as social services [safeguarding] or the police. It is important that staff are aware so that they can fully understand their role if they report such instances. The manager said she will update the home with Seftons new policy document [current one has been superseded] and this can then be used for some in house training sessions to brief staff. Residents interviewed felt very safe in the home and felt that staff could be trusted and approached. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained so that people can live comfortably. Evidence: Avenswood is a pleasant and homely care home. The residents like the way the home looks and a full time maintenance man is available to address general maintenance concerns. There is an absence of any offensive odours and the general cleanliness is of a high standard. The AQAA completed by the provider and sent to the Commission gives evidence of upgrading and ongoing maintenance of the home: We have as previously documented now installed stairlifts to all landings. We have installed a new fire in the lounge giving a more homely look which has been positive from comments received. Redecorated the lounge and a top floor bedroom and continue to redecorate when rooms become vacant. Purchased another profiling bed which was required through assessment. Purchased a new larger capacity Gas Dryer in July enabling our staff to provide a same day service to our residents. This shows that the management are aware of any shortfalls in the environment of the home and are making positive plans to address them and maintain existing facilities to a high standard. Care Homes for Older People Page 21 of 30 Evidence: Bedrooms seen were highly personalised and likewise the shared rooms are made as homely as possible. The laundry area was clean and tidy and fit for purpose and is staffed independently. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are recruited and trained appropriately so that a good quality of care can be delivered. Evidence: For 16 residents in the home at the time of the inspection the staffing was one trained nurse and three care staff on days. Appropriate ancillary staff are also employed on cleaning and in the kitchen and laundry which offers good support for care staff and is a mark of good quality in a small care home were such duties are often shared by care staff. At the time of inspection there were also two health and social care students attending the home as the management have linked in to a local college. This shows that there is enough staff to carry out care. The provider is a regular feature in the home and takes an active role in the daily life and events. There is a steady core of staff who maintain consistency of care with no use of agency staff. The home employs maintenance cover on a daily basis. Residents and relatives comments were very supportive of the staff who were seen as helpful and kind. All comments received from both comment cards and during the inspection were very positive and evidenced a personalised and individualised approach. Care Homes for Older People Page 23 of 30 Evidence: Staff training is organised well and there is a training plan for the forthcoming year. Staff talked about supervision sessions and training needs are identified. Staff stated that there is plenty of training and they generally feel well supported by the manager and senior staff. There is currently nine of the sixteen care staff who have an NVQ qualification. This shows that the provider is committed to training staff so that they have the basic skills to carry out care. One staff [student] commented: I like it here. This is the best [home] Ive been in. The nurses let me be hands on more and do alot of teaching. It has given me good grounding. All staff are good and supportive. another staff said: I feel the home is excellent. Very settled. I have completed a lot of training such as health and hygiene, moving and handling and safeguarding - all last year and some external training as well as in house. Staff were able to identify care which covered a diverse range of care needs and understood the principals surrounding equality of care and how this is materialised through individual assessment and attention to care needs. Staff files were inspected and were found to be inclusive of all of the required checks to ensure that residents are protected. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are systems in place to monitor care standards and to help development of the home so that it is run in the residents best interests. Evidence: Ann McDonnell is the manager of the home. She has been in post for many years and worked in the deputy role prior to this. She works well with the owner of the home who provides regular support. Ann has very good experience in the clinical field and has completed the Registered Managers Award. She has completed updates in clinical nursing practice including palliative care and the home have linked in well with good practice in this area. She was also able to demonstrate more recent updates to support her practice. All staff and residents and relatives were supportive of the managers approach and she was known to all of the residents, relatives and staff spoken to. The home is subject to some external Quality Assurance processes such as a yearly quality audit. The owner also carries out their own audit on a regular basis and this Care Homes for Older People Page 25 of 30 Evidence: was seen covering areas such as care planning and health and safety.We spoke about the need to include medication audits [see Health and Personal care]. The routine audits should also meet the requirements of Regulation 26 of the Care Home Regulations and include staff and resident interviews so that these opinions can also be fed back to the manager. Residents views are sought continually. Being a small home the residents reported that they have a daily discussion with the owner and manager. Views are sought formally as part of the quality processes. Health and Safety records were seen such as fire records and risk assessments, and this area is managed well. We spot checked some safety certificates and these were in order. The AQAA for the service states that all other safety certificates and policies and procedures are up to date.This shows that the home is maintained and people are safe. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 We would recommend that any medications left in stock are carried over to the new MAR chart so that an accurate record is maintained. Creams being administered are not routinely recorded with respect to times and staff identity and this was discussed with the manager and practical recording processes should be put in place. [This was also discussed at the last inspection and is strongly recommended]. Medications are routinely audited by the supplying pharmacist but we would also recommend that the managers carry out their own audits on a regular basis to ensure standards are consistently maintained. 2 18 We recommend that staff are made aware of the wider picture in terms of how allegations of abuse are investigated through the safeguarding procedures. We would recomend that medication audits are included in the routine managment audits for the home. 3 33 Care Homes for Older People Page 28 of 30 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 The routine audits should also meet the requirements of Regulation 26 of the Care Home Regulations and include staff and resident interviews so that these opinions can also be fed back to the manager. Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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