Care Home: Averill House

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What the care home does well The manager personally carried out an assessment before anyone was offered a place to make sure that their needs could be met by the staff team and that the environment was suitable. During the assessment visit the manager took a folder which contained pictures of the home and the meals that were served so that people could see where they would living and what they would be offered to eat. Everyone had a care plan which recorded their health and personal care needs which had been reviewed regularly. People had access to GP, opticians, chiropodist and other health care professionals including tissue viability nurse for those who may develop pressure sores. The registered nurses had received training in person centred planning. A copy of the service user guide, menus, activities and complaints procedure were displayed on the notice board in the entrance hall. Pictures of meals had been taken and laminated which were shown by the staff to the people to help them make choices of what they wanted to eat. The manager had introduced tablecloths and small vases of flowers for the tables to make them more inviting. People could bring in personal possessions to make their bedrooms more homely. Each day both morning and afternoon a member of the care team was made responsible for providing the people who lived at the home with an activity. Activities which took place were board games, entertainers, armchair exercises and visits by a representative of the local church. The activities organiser had earlier in the year organised a summer Fayre which was attended by the local Mayor and an ex Manchester United player to raise funds for the Alzheimer`s disease society. The manager followed the organisations recruitment and selection procedures which included people completing an application form, having a face to face interview, two references and a Criminal Record Bureau check. Training in the Mental Capacity Act and Deprivation of Liberty Safeguards had been taken by the manager who had passed this down to the staff team. Other training that had taken place was moving and handling, first aid, safeguarding adults, medication and infection control. All new staff had an induction which consisted of training courses provided by an in house trainer from the organisation and a work book that they had to complete. The manager obtained the views of the people using a variety of ways such as relative meetings, staff meetings, staff supervision and the `managers surgery` when she put aside specific time for people to come to the office to speak with her in private if they so wished. What has improved since the last inspection? At the previous inspection of February 2009 a number of requirements were made all of which had been dealt with and improvements made as follows:All the care plans had been reviewed and re-written to include more information about the persons health, personal and social care needs. This was so the care staff were able to care for the people in a way that they would wish and would meet their needs. The number of Registered Mental Nurses had been increased to three. The remaining five were Registered General Nurses. All the staff had received training in dementia care and challenging behaviour. The training that had been completed had been devised by the Alzheimer`s Disease Society and was called Yesterday, Today and Tomorrow. There had been an incident with the call buzzer ringing and staff not responding in a timely manner. This had been resolved and during this inspection this had not been a problem. For people whose diet was being monitored the amount of food they ate was being recorded on the nutritional chart so that the care staff could make an assessment of their intake of food. Any new bruising that was found on a person was now reported and recorded immediately by the staff team. All staff had received training in safeguarding adults and were aware of the correct procedures to follow in the event of any safeguarding incidents. The cracked pane of glass in the fire door had been replaced on the day of the inspection. The cleanliness of the home had improved and some of the bedrooms and communal areas had been re-decorated and new flooring laid. The equipment such as wheelchairs and hoists was clean. The manager was now registered with us. What the care home could do better: Whilst there had been a number of improvements in the home where the manager had made a difference there was still some way to go. The manager was aware of the shortfalls in the decoration and furnishings of the home which although now clean and tidy and for the most part free from unpleasant odours was looking tired and shabby and in need of major refurbishment. We have not made this a requirement or recommendation as the manager told us there were plans for new carpets and furnishings in the near future. During our visit the inspector discussed with the manager where attention to detail would improve the daily lives of the people who lived at the home and have a positive affect on the staff teams. We also recognised that people who have dementia present challenges to the staff team when attending to their day to day needs. We have however made two recommendations regarding the need for staff to be more aware of respecting peoples right to have their orivacy and dignity respected at all times. The areas where we had concerns were the way in which people were helped to eat at meal times, some people wearing clothing that was well worn and in one instance unclean and finally a medical procedure being conducted in a communal area. These were discussed with the manager who said that they were unacceptable and would be looked into. Key inspection report Care homes for older people Name: Address: Averill House Averill Street Newton Heath Manchester M40 1PD     The quality rating for this care home is:   one star adequate 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: Jacqueline Kelly     Date: 1 2 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 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Averill House Averill Street Newton Heath Manchester M40 1PD 01616886690 01616886602 averillhouse@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Gail Joan OMeara Type of registration: Number of places registered: care home 48 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: Residents requiring care by reason of dementia shall be aged 65 years or over with the exception of one named resident. Should this resident no longer reside at the home or their primary need for requiring care change, this place will revert to the category of dementia, over 65 years of age (DE(E)). Residents requiring care by reason of mental disorder, excluding learning disability or dementia, shall be 60 years of age or above with the exception of one named resident, who is currently below this age. The maximum number of residents shall be 48, of whom no more than 46 require nursing care. Date of last inspection 1 9 0 2 2 0 0 9 1 48 Over 65 48 48 Care Homes for Older People Page 4 of 28 Brief description of the care home Averill House Nursing Home provides accommodation, with nursing care, for a maximum of 48 older people. All residents have been assessed as having mental health needs. The premises are owned by Nursing Home Properties (NHP) PLC and are leased to Southern Cross Healthcare Limited. The home is situated in the Newton Heath area of Manchester close to a local market, shops, public houses, a park and other social areas and amenities. Averill House is a large purpose built home set in its own grounds. Another home operated by Southern Cross is also on the same site. Registered nurses are on duty throughout twenty-four hours and a manager who is also a registered nurse manages the home on a day-to-day basis. The home offers accommodation in 48 single, en-suite bedrooms. Accommodation for residents is provided on two floors accessed via a passenger lift and stairways. Each floor offers two lounges and one dining room. The last CSCI inspection report, service user guide and statement of purpose were displayed in the main reception area for people to access . Fees for accommodation at the home range from £408.00 to £650.00 per week. Additional charges were also made for hairdressing, chiropody services, newspapers and personal toiletries. 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The report was written on behalf of the Care Quality Commission therefore throughout the report the terms we and us were used. We last inspected this service on the 2 February 2009. This was a key inspection and we spent a total of six hours at the home. The manager did not know we were going to visit. We were also accompanied by an expert by experience whose observations have been taken into account when writing this report. Before this key inspection we asked the manager of the home to complete an Annual Quality Assurance Assessment (AQAA), to tell us what they felt they did well, what Care Homes for Older People Page 6 of 28 they needed to do better and to give us current information as to employment of staff and training provided over the past twelve months. The form had been completed honestly and it showed us the manager for the most part saw the service being provided the same way as we did. During the inspection we looked at the care files and care plans of two people who used the service and the personnel records of two care staff. We also looked at other documents such as the complaints file, menus and medication records. We talked with the people who were sitting in the lounges, and in their bedrooms which included relatives and friends. We also talked with the manager, quality service adviser, administrator, cook and a number of care workers. We also briefly met the area manager. Questionnaires were sent out by us to the home for them to distribute to the people who used the service and the care workers. At the time of the inspection none had been returned. We spoke to the manager about this who said that they had been given out. After the inspection we sent another ten of each for service users and staff. Since the draft report was sent to the provider we received three service user surveys and three staff surveys. The comments were received were mostly postive such as; it does well in most areas like we work as a team always; caring for peoples needs; not a bad home the people who work are caring for the residents who live there. Service user comments which were provided by relatives were; the staff always show kindness and support to my wife they all seem very hard working and there when required to ask about my wife; in the main cares adequately for the residents. There was just one comment about dementia care training for the staff and activities in that the person thought they could be improved. However all the people we spoke with were positive about the home. Both relatives and staff said that they thought the people who lived at Averill House were well cared for, that the manager was very supportive and they had no complaints. One person said that they had looked at a number of homes and this was the best they had seen. There had been six complaints over the past twelve months which had been recorded and resolved by the manager to the satisfaction of those concerned. We had received two concerns both regarding the cleanliness of the home. We had also received ten safeguarding referrals that were incidents between residents and did not directly involve members of the staff team. The majority of these were during the first seven months of the year. However during the later months the number had reduced as the manager and staff appear to be managing challenging behaviour and dementia care better. The contracts department of Manchester Social Services had from the 17th July 2009 to 25th September 2009 stopped all referrals to the home due to the number of incidents between residents. These had now started again and the home on the day of the inspection had forty-three residents. The service did not provide intermediate care for people to be rehabilitated into the community. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? At the previous inspection of February 2009 a number of requirements were made all Care Homes for Older People Page 8 of 28 of which had been dealt with and improvements made as follows:All the care plans had been reviewed and re-written to include more information about the persons health, personal and social care needs. This was so the care staff were able to care for the people in a way that they would wish and would meet their needs. The number of Registered Mental Nurses had been increased to three. The remaining five were Registered General Nurses. All the staff had received training in dementia care and challenging behaviour. The training that had been completed had been devised by the Alzheimers Disease Society and was called Yesterday, Today and Tomorrow. There had been an incident with the call buzzer ringing and staff not responding in a timely manner. This had been resolved and during this inspection this had not been a problem. For people whose diet was being monitored the amount of food they ate was being recorded on the nutritional chart so that the care staff could make an assessment of their intake of food. Any new bruising that was found on a person was now reported and recorded immediately by the staff team. All staff had received training in safeguarding adults and were aware of the correct procedures to follow in the event of any safeguarding incidents. The cracked pane of glass in the fire door had been replaced on the day of the inspection. The cleanliness of the home had improved and some of the bedrooms and communal areas had been re-decorated and new flooring laid. The equipment such as wheelchairs and hoists was clean. The manager was now registered with us. What they could do better: Whilst there had been a number of improvements in the home where the manager had made a difference there was still some way to go. The manager was aware of the shortfalls in the decoration and furnishings of the home which although now clean and tidy and for the most part free from unpleasant odours was looking tired and shabby and in need of major refurbishment. We have not made this a requirement or recommendation as the manager told us there were plans for new carpets and furnishings in the near future. During our visit the inspector discussed with the manager where attention to detail would improve the daily lives of the people who lived at the home and have a positive affect on the staff teams. We also recognised that people who have dementia present Care Homes for Older People Page 9 of 28 challenges to the staff team when attending to their day to day needs. We have however made two recommendations regarding the need for staff to be more aware of respecting peoples right to have their orivacy and dignity respected at all times. The areas where we had concerns were the way in which people were helped to eat at meal times, some people wearing clothing that was well worn and in one instance unclean and finally a medical procedure being conducted in a communal area. These were discussed with the manager who said that they were unacceptable and would be looked into. 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 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 11 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. People thinking of moving into the home received information to help them make a decision and their needs were assessed to make sure they could be met by the staff team. Evidence: Everyone who was referred to Averill House and before they were offered a place were seen either in their own home or in hospital by the manager. The manager took with her on this visit a folder which contained photographs of the home, a sample menu, and photographs of the meals that were served. They were also given a copy of the leaflet produced by Southern Cross Healthcare who provided the care. People could also visit the home to see for themselves what it was like. All of the above would help people to make choices about moving to the home. A copy of the service user guide and other information about the home was displayed on the notice board in the entrance hall. Care Homes for Older People Page 12 of 28 Evidence: During the visit by the manager the companys assessment form was completed which recorded information about the persons health and personal care needs to make sure that they could be met by the staff at the home. This information was also used to write a care plan that the staff of the home would follow in their day to day care of the person. A copy of an assessment completed by the local authority was also taken into account. The service did not have intermediate care beds. Intermediate care requires the service to provide rehabilitation facilities to be available which includes qualified or appropriately trained specialist staff in techniques for treatment and recovery so that people can return to community living. Care Homes for Older People Page 13 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Averill House had their health care needs met. However their privacy and dignity was not always respected at all times. Evidence: The manager said that after the previous inspection of February 2009 all the care plans had been reviewed and re-written so that they had up to date information that was relevant to the persons care and social needs. She also told us that all the qualified nurses who were responsible for writing and keeping the care plans up to date had received training in person centred care planning. The two care plans we looked at were satisfactory and showed us that they had been updated regularly and contained information to help staff care for the people and meet their needs. The care plans showed evidence of nutritional screening. For those people with particular eating concerns they also included a record of how much people had eaten. The care files also had letters to health care professionals such as consultants and community psychiatric nurses. Care Homes for Older People Page 14 of 28 Evidence: All the people who lived at the home had access to a GP, chiropodist, optician (who also offered hearing tests), continence assessments and dentist. There were people living at the home who had developed pressure sores. The tissue viability nurse and doctor were involved in assessment and prescription of treatments for the nursing staff to follow. We looked at the medication records which had been completed satisfactorily. The home used the Boots Chemist system. Pharmacists from Boots also provided the staff training. Only the qualified nurses gave out medication. A practice that had taken place during the inspection regarding the administration of medication had been brought to the attention of the manager as it did not respect the persons privacy and dignity. The manager agreed that this was not acceptable and that it would be looked into immediately. Whilst people wore their own clothes a small number of people did not look particularly well dressed as their clothes were well worn and in one case had stains down their jumper. The staff should pay more attention to this as it does not respect the persons dignity. Again this was discussed with the manager who said she would bring this to the attention of the staff through team meetings. Whilst there were policies and procedures on privacy and dignity and this was part of induction the staff may benefit from empathy training i.e. feeding each other so that they can experience what it might feel like being fed. This could lead them to having more respect for the persons dignity whilst feeding them their meal, pay more attention to the person and include the person in the meal time. During the visit we found that the emergency cord in the downstairs toilet had been tied up out of reach. This was discussed with the manager who said that this toilet had previously been used as a visitors toilet and she immediately asked someone to untie the cord. The staff must be aware that they should not tie up emergency cord pulls as it is an unsafe practice. 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. People can make choices and maintain their independence as far as their capabilities will allow. Evidence: During our visit to the home we saw many relatives and friends visiting and we spoke to a number of them who all said that they were happy with the care provided and had no complaints. Each person had a Map of Life completed which included what activities they liked to do. In the entrance hall their was a programme of activities displayed which included board games, armchair exercises and entertainers. A representative of the Catholic church visited each week. The vicar from the local Anglican church had recently left the area and at the time of our inspection he had not been replaced. There had been an activities organiser employed who had recently handed in her notice. The manager was to advertise for someone to fill the vacancy. For the time being each day (both morning and evening) a member of the care staff team had been made responsible to organise an activity. On the day of our visit we saw in the upstairs lounge care staff and residents throwing a large ball to each other. People Care Homes for Older People Page 16 of 28 Evidence: were enjoying this exercise. The people who used the service were given choices as far as their capabilities would allow. No one handled their own financial affairs these were all managed by others such as relatives or solicitors. People could bring in personal possessions and some people had done so. Menus were displayed in the entrance hall and in the dining rooms. People were asked what they wanted to eat the day before. Where necessary people were shown pictures of meals which had been taken and laminated to help people make choices from the menu. There were some issues regarding tablecloths and the type of music being played on the radio in the downstairs dining room. These were discussed with the manager who had replaced the table cloths within a few days of the inspection taking place and was to look into the suitability of the music. 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. People using the service are protected by the complaints and safeguarding procedures. Evidence: There was a complaints procedure displayed in the entrance hall of the home and details of the managers surgery where she puts aside specific time for people to talk to if they so wish. There was also a file where all complaints were recorded. The record was seen during our inspection and it contained details of complaints and how they had been dealt with and any action taken; there were six complaints recorded. There had been a number of concerns and safeguarding referrals and investigations reported to us during the first seven months of 2009. All of these were incidents between residents and did not directly involve members of the staff team. However during the latter part of the year the number had reduced as the manager and staff appear to be managing challenging behaviour and dementia care better. All staff had now received training in dementia care, challenging behaviour and safeguarding adults. All staff prior to commencement of employment had a Protection of Vulnerable Adults (POVA) check and Criminal Record Bureau (CRB) check. Care Homes for Older People Page 18 of 28 Evidence: The manager has completed Deprivation of Liberty Safeguarding (DOLS) training with Manchester Social Services. She had done some training which covered the main points of DOLS with the staff team and had compiled a questionnaire for the staff to complete to show that they had understood what they had been told. Had also received in house training in the Mental Capacity Act. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Averil House was mostly clean and tidy however it does look tired, worn and shabby and is in need of refurbishment. Evidence: We made a tour of the building as part of our visit to Averill House. The previous report of February 2009 said that the home smelt particularly on the first floor and parts of it were dirty. We found that there had been some improvements and the home apart from the upstairs lounge and dining room did not have any unpleasant odours. The upstairs lounge required a new carpet and some new chairs which should solve the problem. The manager was aware of this and said that there were plans to replace the carpet and furnishings. The dining room smelt stale and this could be because it is situated underneath the main kitchen. It was recommended that the company look at putting some expel-air fans to keep the room fresh. However the dining room looked particularly good with tablecloths and small vases of flowers on the table but was spoiled somewhat by a small broken cupboard. Flooring and decoration in some of the bedrooms and communal areas had been replaced and was of a reasonable standard. However there was a need for other rooms within the home to receive the same treatment. The manager had also Care Homes for Older People Page 20 of 28 Evidence: introduced ornaments and pictures in communal areas. Some people had brought in personal possessions which made these rooms look more inviting and homely. We were told in the information we received before the inspection took place that a fire risk assessment was in place and a log book kept of fire drills and fire alarm tests. All staff had received training in the prevention and control of infection. Overall the home was in need of major refurbishment as it looked tired, worn and shabby. 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 people who live at Averill House are supported by a team of staff who know them well and are trained so that staff are kept safe. Evidence: Since the previous inspection of February 2009 the number of Registered Mental Nurses had increased to three; the remaining five were Registered General Nurses. All the registered nurses had done the Yesterday, Today, Tomorrow training which had been developed by the Alzheimers Disease Society. The training showed how dementia impacted on the family and the person. There was a written test at the end of the three day training course which was sent to the Society to be marked. The training was presented by the companys specialist dementia care trainer. The care staff and two of the ancillary staff had also completed this training. There were sufficient care, domestic and kitchen staff employed to compliment the nursing team. The training matrix that we were given showed that people had received training in mandatory courses such as moving and handling, first aid, fire safety, food hygiene and safeguarding adults. The manager told us that fifty-seven percent of the staff team had the National Vocational Qualification (NVQ) level 2 and/or 3. Care Homes for Older People Page 22 of 28 Evidence: The manager used the companys recruitment and selection policy and procedures when employing new staff. We looked at two staff files which contained all the necessary checks and forms such as application form, two references, photograph, copies of any certificates and medical history. All prospective staff had a face to face interview and completed an induction programme. 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 improved the service provided since the previous inspection of February 2009 so that people can live in a home that is run in their best interests. Evidence: The manager is qualified, competent, experienced and registered with us to manage Averill House. The organisation had recently introduced a Quality Service Adviser who was responsible for thirty-two homes and would be supporting managers in their day to day practice. Part of his role was to check on the quality of the service and take a lead role in any major safeguarding investigations that may arise. He had recently completed the organisations own quality inspection which showed that the home had improved. The manager used a number of ways to obtain peoples views such as relative meetings, staff meetings, staff supervision, managers surgery where people could Care Homes for Older People Page 24 of 28 Evidence: talk to her in private. Questionnaires were also sent out to people by the company. Policies and procedures were in place with the majority last being reviewed in 2006 and a few in 2007/2008 and two in 2009. There was a health and safety policy together with moving and handling, first aid, fire safety, food hygiene and infection control all of which were to keep the staff team and the people who used the service safe. The manager kept pocket money for some of the residents. A record was kept. The manager also ensured that the home complied with current legislation, had risk assessments, recorded accidents and injuries. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 Peoples dignity and privacy should be respected at all times which means that where necessary medication procedures should be carried out in a private place such as bedroom or treatment room. Peoples dignity should be respected at all times especially when people need to be helped to eat their meals and need assistance in choosing clothes to wear that are in a good state of repair and is clean. 2 10 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!