Care Home: Avondale Residential Home

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What the care home does well The home has an information booklet which contains lots of information about the service provided and the running of the home. It had been produced in large print and with pictures and is easy to read. People have lots of information to help them decide if this is the right home for them. People can come and look around the home to see if they like it. Everyone has an assessment to make sure that their needs can be met at Avondale. The relative of a person described how the decision was made about moving into Avondale, "I had to be sure I was happy having cared for her at home for three and a half years." Each person and their family are very much involved in the development of their care plan, which is reviewed every month. Medication is well managed and the home has good working relationships with medical and other professionals to make sure people get the specialist care they need. People have said that staff are friendly and respectful to them and that their privacy and dignity is safeguarded within the home. One family told us, "Overall we are happy. They are there when she needs them. The staff are very kind. They chat away to all the clients. They obviously listen to what we say to them." A person living at the home told us, "When I need anything it is always there very quickly." Staff are getting lots of training to help ensure they understand the needs of the people they support and can give the best possible care to them. Staff told us that, "Communication is very good. Management keep us up to date with residents` individual care needs", and "The care of the residents is what the home does well, along with communication with their families." The home employs an Activities Organiser to engage people in pastimes of their choice and to help to ensure that they enjoy how their days are spent. This includes people getting out and about in the community. The home provides plenty of communal space including three lounges, a conservatory, a dining room and a landscaped garden. People can choose where they want to spend their time. People generally enjoy the meals served at the home and they can have snacks and fruit outside mealtimes. Staff working at the home and people living there understand the complaints procedure and know how to follow it. Arrangements are in place at Avondale to ensure that people are safe and protected. One person spoken with said, "I am happy and I feel safe."Avondale is well maintained and a refurbishment programme of the house and grounds is taking place. The home is clean and tidy and provides a comfortable environment for people who live there. The home has a dementia unit which has signage which is clear and in pictures. The new floor covering looks like a cobbled floor for people to relate to. There are plans to build a shop front with old fashioned books and items from the past in order to develop an appropriate environment for people with dementia. Staff are recruited in a safe way and they are not allowed to start work until all the checks have been made. The manager is well qualified and experienced and is described as being approachable by staff, people and their relatives. She is well qualified and experienced. The registered manager and the deputy manager work in partnership in the day to day running of the service. Staff and people living at the home said that the manager is approachable and encourages their views on the direction and running of the home. One staff said, "The management have lots of ideas for the home and they listen to us." A person living at the home said, ""It`s great here." Relatives also told us that, "The home is very well run now since the new owners came in..." The paperwork known as the AQAA was completed and returned to us by the manager within the required timescale. It contained all the information we had asked for. Discussion with the manager and the provider, and information shared with us in the AQAA, showed us that they are aware of any changes that need to be made and are committed to making improvements within the service. Notifications of significant incidents or occurrences at the home have been made to us without delay. Policies and procedures in place to promote the health and safety of people living at the home, and all the necessary health and safety checks are carried out regularly to make sure the home is a safe environment for everyone. What has improved since the last inspection? Improvements have been made to the records made about people`s care and in assessments for people when they move into the home for a short period of time. This helps staff to understand how to care for them. Before accepting people back from hospital staff now re- assess their needs to make sure that it has been planned how they need to be supported safely, and that they agree to this support. When the district nurse is responsible for the management of pressure sores, a corresponding care plan is now in place within the home`s records, describing this and how their care is managed. When staff at the home record people`s fluid intake, they now total the amount every twenty-four hours and let the doctor know if there are any problems. The management of the home have worked hard with the local authority monitoring and evaluation officers to improve on care planning and risk assessments, particularly in relation to people who are at risk of falls. They have also made sure that staff have suitable training in their work. We have found at this inspection that since that time significant improvement has been made. The management of the home have worked closely with the local authority to make these improvements and have made an appropriate response to their safeguarding responsibilities. What the care home could do better: The management of the home need to continue to sustain the improvements made within the home over the last six months since March 2009. This will help to ensure that people are safe and receive the care they need. Key inspection report Care homes for older people Name: Address: Avondale Residential Home Whitehouse Road Bircotes Doncaster DN11 8EQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Frances Shillito     Date: 0 1 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 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 33 Information about the care home Name of care home: Address: Avondale Residential Home Whitehouse Road Bircotes Doncaster DN11 8EQ 01302743673 01302750556 a5wan99@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Aswan Care Ltd care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 31. The registered persons may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission are within the following category: Old Age, not falling within any other category - Code OP. Dementia - Code DE. Date of last inspection Brief description of the care home Avondale is a detached property that is situated within a residential area. The home is owned by Aswan Care Ltd and offers accommodation for up to 31 Older people including people who suffer from Dementia. There are 27 single ensuite bedrooms and 4 single only. The dementia unit is separated via a locked door and is fully equipped with lounge, conservatory, enclosed garden, and an assisted bath. Some single rooms are not occupied whilst major upgrade is taking place. The Home is undergoing refurbishment and some areas are not in use at the present time. There is a separate smoking lounge. A passenger lift offers access to the first floor and a Care Homes for Older People Page 4 of 33 1 2 0 3 2 0 0 9 31 0 Over 65 0 31 Brief description of the care home range of specialist lifting equipment is available for people with dependent needs. The current charges are £366.00 to £410.00 per week. There are separate charges for hairdressing and newspapers. The service user guide, and statement of purpose are available in the entrance hall and the current Certificate of Registration is also on display. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections carried out by the Care Quality Commission is on the experiences and outcomes for people using a service, and their views on the service provided. This process assesses how well the service provider is able to meet regulations and minimum standards of practice. Our inspections also look at aspects of service provision which need further development or improvement. This was our first visit to Avondale since March 12 2009. This inspection visit involved one inspector, it was unannounced and took place in the daytime. Before the visit an analysis of the home was carried out from information gathered over the last year, including that from the Annual Quality Assurance Assessment completed by the manager. We also sent out survey forms called Have Your Say About... to people living at the home and ten were completed and returned to us. Care Homes for Older People Page 6 of 33 The main method of gathering information followed is known as case tracking. This involves looking at the quality of the care received by a number of people living at the home. We also use evidence from our observations during the visit, we speak with people living at the home and their relatives, about their experience of the service. We look at records and talk with staff about their understanding of the needs of the people they care for. Care Homes for Older People Page 7 of 33 What the care home does well: The home has an information booklet which contains lots of information about the service provided and the running of the home. It had been produced in large print and with pictures and is easy to read. People have lots of information to help them decide if this is the right home for them. People can come and look around the home to see if they like it. Everyone has an assessment to make sure that their needs can be met at Avondale. The relative of a person described how the decision was made about moving into Avondale, I had to be sure I was happy having cared for her at home for three and a half years. Each person and their family are very much involved in the development of their care plan, which is reviewed every month. Medication is well managed and the home has good working relationships with medical and other professionals to make sure people get the specialist care they need. People have said that staff are friendly and respectful to them and that their privacy and dignity is safeguarded within the home. One family told us, Overall we are happy. They are there when she needs them. The staff are very kind. They chat away to all the clients. They obviously listen to what we say to them. A person living at the home told us, When I need anything it is always there very quickly. Staff are getting lots of training to help ensure they understand the needs of the people they support and can give the best possible care to them. Staff told us that, Communication is very good. Management keep us up to date with residents individual care needs, and The care of the residents is what the home does well, along with communication with their families. The home employs an Activities Organiser to engage people in pastimes of their choice and to help to ensure that they enjoy how their days are spent. This includes people getting out and about in the community. The home provides plenty of communal space including three lounges, a conservatory, a dining room and a landscaped garden. People can choose where they want to spend their time. People generally enjoy the meals served at the home and they can have snacks and fruit outside mealtimes. Staff working at the home and people living there understand the complaints procedure and know how to follow it. Arrangements are in place at Avondale to ensure that people are safe and protected. One person spoken with said, I am happy and I feel safe. Care Homes for Older People Page 8 of 33 Avondale is well maintained and a refurbishment programme of the house and grounds is taking place. The home is clean and tidy and provides a comfortable environment for people who live there. The home has a dementia unit which has signage which is clear and in pictures. The new floor covering looks like a cobbled floor for people to relate to. There are plans to build a shop front with old fashioned books and items from the past in order to develop an appropriate environment for people with dementia. Staff are recruited in a safe way and they are not allowed to start work until all the checks have been made. The manager is well qualified and experienced and is described as being approachable by staff, people and their relatives. She is well qualified and experienced. The registered manager and the deputy manager work in partnership in the day to day running of the service. Staff and people living at the home said that the manager is approachable and encourages their views on the direction and running of the home. One staff said, The management have lots of ideas for the home and they listen to us. A person living at the home said, Its great here. Relatives also told us that, The home is very well run now since the new owners came in... The paperwork known as the AQAA was completed and returned to us by the manager within the required timescale. It contained all the information we had asked for. Discussion with the manager and the provider, and information shared with us in the AQAA, showed us that they are aware of any changes that need to be made and are committed to making improvements within the service. Notifications of significant incidents or occurrences at the home have been made to us without delay. Policies and procedures in place to promote the health and safety of people living at the home, and all the necessary health and safety checks are carried out regularly to make sure the home is a safe environment for everyone. What has improved since the last inspection? Improvements have been made to the records made about peoples care and in assessments for people when they move into the home for a short period of time. This helps staff to understand how to care for them. Before accepting people back from hospital staff now re- assess their needs to make sure that it has been planned how they need to be supported safely, and that they agree to this support. When the district nurse is responsible for the management of pressure sores, a corresponding care plan is now in place within the homes records, describing this and how their care is managed. When staff at the home record peoples fluid intake, they now total the amount every twenty-four hours and let the doctor know if there are any problems. The management of the home have worked hard with the local authority monitoring Care Homes for Older People Page 9 of 33 and evaluation officers to improve on care planning and risk assessments, particularly in relation to people who are at risk of falls. They have also made sure that staff have suitable training in their work. We have found at this inspection that since that time significant improvement has been made. The management of the home have worked closely with the local authority to make these improvements and have made an appropriate response to their safeguarding responsibilities. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 33 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 33 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 are given the information and support needed to help them decide if the home is able to meet their assessed needs. Evidence: During the inspection visit we saw that the home has an information booklet which contains lots of information about the service provided and the running of the home. It had been produced in large print and in a pictorial way, making it easy to follow. The registered manager said she will update the booklet to include the contact details of the Care Quality Commission, which was established in April 2009. We also saw that this information about the service and the last inspection report is kept in a file, in case people want to see it, to give them as much information about the home as possible. Before the inspection visit took place the registered manager completed the Annual Quality Assurance Assessment (AQAA). In it she told us that people are invited to visit Care Homes for Older People Page 12 of 33 Evidence: for a day and written information is given to them to help them decide if the home is right for them. Then the registered manager or care manager carries out an assessment with people to ensure that their needs can be met at Avondale. If it is felt that the home can meet a persons needs, they move in on a trial basis for six weeks, which is looked at again to ensure everyone is happy. We also received ten Have Your Say... survey forms, which were filled in by people living at the home. Nine people said that they had received enough information to help them decide if the home is the right place for them, before they moved in. One person said My son dealt with it. Also five people said they had been given written information about the homes terms and conditions or contract. Two people said My son dealt with that. During the inspection visit we looked at the care records of three people. This is known as case tracking and is a method of gathering evidence on the experiences of people using the service. We found that for each person there was a detailed assessment which was carried out before they moved into the home and reflected their individual needs and preferences, in a way that shows respect for the person: Loves a cup of tea and a biscuit and Does not like to be rushed. At the last detailed inspection in August 2008, improvements to the records and assessments for people having short stays were needed. The process of people staying at the home for short periods was found unsafe. During this inspection visit we saw from a persons pre admission assessment and care plan that changes in their needs had been reflected, and that there was an improvement in this area. Staff are now given guidance on how to care for this person in light of these changes. Discussion took place with the registered manager who told us that We assess people to cater for their needs. We make sure we can offer the care they need. We invite them to come, have lunch or a cup of tea and choose a room. One person living at the home said, A woman came out to assess me. Then she phoned up my son on the Friday morning and I was in here that day. I like being in here. The relative of another person described how the decision was made about moving into Avondale, I had to be sure I was happy having cared for her at home for three and a half years. The home does not provide intermediate care. Care Homes for Older People Page 13 of 33 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. People receive care that is tailored to their individual needs. Evidence: The manager and staff told us that each person and their family are very much involved in the development of their care plan, which is reviewed every month. The care plans of three people were seen during the inspection visit. In the AQAA the registered manager told us that the home is meeting needs in line with care plans which are individual to the person, and that there are regular reviews of care plans and risk assessments. She told us that the tool used has been updated, making it more organised and user friendly, and that she had attended a Principles of Care Planning training course in February 2009. Two requirements were in place at the last inspection in March 2009. Before accepting people back from hospital we asked the manager to re- assess their needs to make sure that it has been planned how they need to be supported safely, and that they agree to this support. During this inspection we saw evidence that one person had their needs assessed again before they were discharged from hospital and returned Care Homes for Older People Page 14 of 33 Evidence: home. Therefore this requirement has been satisfied. In addition a second requirement was in place for the manager to make sure that people who are admitted for respite care, have a suitable up to date care plan written up, that reflects their current needs to ensure their health and wellbeing. We saw evidence that for one person who receives respite care at the home, a suitable care plan had been developed to reflect their up to date care needs and how they will be met by staff. Therefore this requirement has also been met. We looked at the care plans of three people and saw that for each person there was a holistic, individualised and person centred care plan in place, which created a clear picture of them and how they should be cared for. These had been completed with the person and their familys input. We saw that a review of these care plans had been taking place regularly. We also saw that for people who were assessed as being at risk of falls, a care plan had been produced. We found that nutritional and pressure sore risk assessments and care plans were in place to guide staff on how best to care for each person. During the inspection the registered manager said, Risk assessments are better, we are using a tool and everyone has a nutritional and pressure area and falls risk assessment. At the last inspection a recommendation was made that when the district nurse is responsible for the management of pressure sores, a corresponding care plan is needed within the homes records, describing this and how their care is managed. During this inspection we looked at records and found that this recommendation had been met. This was also confirmed in discussion with families who spoke of the care their relative was receiving in practice and with staff who provide this care. Another recommendation was that when staff at the home record peoples fluid intake, they should total the amount every twenty-four hours and refer any problems immediately to external health providers. Again during this inspection we saw from peoples records that these checks were being made and that staff at the home were asking for the input of medical professionals in the best interests of the people living at the home. During this key inspection the manager and the staff confirmed that only trained staff administer medication and make appropriate records, and this was observed. The manager explained that a medication audit had taken place just before the inspection visit, with a positive outcome. We looked at the medication records and stocks of medication were also examined and found to be in good order. The manager said that Care Homes for Older People Page 15 of 33 Evidence: plans are being made for staff to attend Safe Handling of Medication training as soon as possible, and that the home has positive working relationships with a range of professionals, such as social workers, occupational therapists, community psychiatric nurses, district nurses, and GPs. Staff also told us that the home enjoys positive working relationships with these professionals and that they work in collaboration with them. Most of the people living at the home who completed survey forms told us that they get medical help when they need it to ensure their health needs are met. Staff told us that Communication is very good. Management keep us up to date with residents individual care needs and The care of the residents is what the home does well, along with communication with their families. In the AQAA the registered manager told us that people are treated with dignity and respect, upholding rights, taking into account individual preferences and life choices. Staff also said that, The home caters for individual needs, listens to the input of relatives as well as the residents, encourages independence where possible and provides a good personal service to those who are more dependent. People spoken with said that staff are friendly and respectful to them and that their privacy and dignity is safeguarded within the home. Observations made during the inspection visit and discussions with staff and people living at the home confirmed this. During discussion with the relatives of one person they said, Overall we are happy. They are there when she needs them. The staff are very kind. They chat away to all the clients. They obviously listen to what we say to them. A person living at the home told us, When I need anything it is always there very quickly. Ten people living at the home completed survey forms and sent them to us before the inspection took place. Generally they said that they receive the care and support they need, that staff are there for them when they need them, and that they listen to them and act on what they say. One person said, I have been here a year now. It isnt like being in my own home and I do miss this still, but it is the nest best thing. Staff told us that, Communication is very good. Management keep us up to date with residents individual care needs and The care of the residents is what the home does well, along with communication with their families. We found during our inspection visit from looking at records, speaking to people, relatives and staff, that arrangements for death and dying were approached in a way that respects the wishes of the person and their family. Care Homes for Older People Page 16 of 33 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 are supported to maintain contact with family and friends and links with the community. Activities within the home are being developed to ensure that people have meaningful daytime occupation. Evidence: In the AQAA the registered manager told us that, The home offers choices in daily living, encouraging people to participate in activities of their choice, and community involvement..... and the home has employed an Activities Organiser to offer a wide range of activities and pastimes. One of the people we spoke to who lives at the home said, An Activities Organiser comes Monday, Wednesday and Friday. He gets cards out with things on them and you put a letter to it. The manager explained that the Activities Organiser has been in post eighteen months. She said that care staff spend time with people and do activities, but that if it is busy it means that activities are not affected. She told us that this worker keeps a file where he records the activities he has been engaging people in. This was looked at during the inspection. The registered manager told us that Avondale is registered with Care Homes for Older People Page 17 of 33 Evidence: St Ledger, DMBC (Doncaster Metropolitan District Council) community transport group, and they hire a minibus from them. Staff said that in August a group visited Clumber Park, and a singer has recently visited the home to entrain people. The maintenance staff said that the management of the home are keen to ensure that people get out and about in the community so they use a minibus to support people doing this, such as going to farms and feeding the animals. This will help to ensure that people living at the home enjoy meaningful daytime occupation. During a tour of the home we saw notice boards displaying clear information about planned activities in large print and in a pictorial format, which is easy to read and follow for the people living at the home. This included sing along, reading, pet/animal therapy, memory games, bingo, gentle exercise, dominoes, bridge / cards, gardening, jigsaws, movies and hired entertainers. We saw that people can watch TV on very large plasma screens in the lounges, which have been pleasantly decorated. We also saw a noticeboard depicting photographs, Our residents enjoying the Strawberry Fayre in Harworth on Sat July 4 2009. We saw that there is a lounge for people to sit in when they want to smoke. The registered manager told us that she has checked with the local authority and this meets regulation. We saw that there is plenty of communal space in the home including three lounges, a conservatory, a dining room and a landscaped garden. During discussion with the maintenance team, they explained that there will be seating for the garden, a shelter for people to sit in and guided paths with something to stop and lean on. They told us that a water fountain is going to be installed to create a pleasant and attractive feature. A speaker system will also be installed so that people can listen to music. They said that this will be an ideal space for BBQs at the home. They told us that other plans include raised flower beds, and a gardening group is going to be set up to involve people in a skill they enjoy, with staff support. They said that this would make a lovely environment for families when they visit to spend time in the fresh air. People living at the home filled in some Have Your Say About..... survey forms. Generally they told us that the home arranges activities they can take part in if they want. One person said, I dont like activities. I like to be in my own room. The relatives of one person spoken with during the inspection said, Staff read to her and encourage her to read. Another person suggested Arrange more day trips for residents. Care Homes for Older People Page 18 of 33 Evidence: We spoke to one person who loves jigsaws and we saw examples of their achievements. Staff told us that they have built links with shops in the local community who have donated jigsaws to the home for the enjoyment and benefit of people living there. During a tour of the home we found that people had personalised their own rooms with photographs, pictures and personal belongings. One person said that they had brought their own furniture with them. The registered manager and staff told us that people are consulted on choice of meals, that catering staff welcome people on admission and identify their individual food preferences. People living at the home who were spoken with confirmed this. During the inspection visit staff said that the dishes that are offered ensure that there is something for everyone. If not staff said that a snack can be prepared for people who want an alternative. We saw that fruit is always available for people to eat if they are hungry around mealtimes. During the inspection visit people were observed having lunch. The meals served looked tasty and where needed, staff were offering support to people whilst they were eating. We spoke to one person to find out if he likes the food. He said, Food is down to the individual. You can pick and choose. We also saw that staff were supporting people to have their meal. One staff said, Ill cut up your Yorkshire pudding to make it more manageable. Another said, Are you going to try to eat this? Eight people who completed survey forms for us said that they always like the meals at the home. One person said, Good food, another told us that, The food is nice, with a view also made known that the home should Improve variations of food. People said they can have drinks and snacks as and when they want. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident in the homes response to complaints and they feel safe and protected from abuse. Evidence: The registered manager confirmed to us in the AQAA that the complaints procedure is explained to people when they move into the home, and that it is prominently displayed. We saw that on the notice board there is information encouraging people to make any concern known: Dont forget, if you are not happy about something let one of the carers know of speak to Ann or Sue. The registered manager also told us that a Whistelblowing policy in place, which was seen during the inspection. Staff spoken with said that they understand the complaints procedure and would know what to do if they were approached in this way. People spoken with during the inspection visit told us that they know how to complain. One person living at the home told us, Id tell anybody if I wasnt happy and theyd sort it out. The relatives of another person said, The management are always approachable, they talk it through. You dont have to make an appointment, you can tap on the door. Its a family approach rather than a business approach. Ten people who filled in the Have Your Say About... surveys forms, said that they know how to make a complaint and that there is someone they can talk to informally if they want to. One person said, As far as I am able to judge, most things I can only Care Homes for Older People Page 20 of 33 Evidence: say, from my point of view, that I have no complaints. During the inspection visit the record of complaints was seen to be appropriately kept. Discussion took place with the registered manager in relation to one concern raised, the investigation which followed and the record made, which had been properly addressed. In the early part of 2009 we had received information about three people who had fallen and sustained fractures as a result. These three people were subject to investigation through Adult Social and Health Care as part of the safeguarding of adults procedures. We had therefore carried out a focused inspection visit in March 2009, as a result of receiving this information. We examined the archived records of three people that had fallen and sustained injuries and found shortfalls in the frequency of assessments for falls and pressure sore risk. We also found that changes in their condition when they had received hospital admissions had not been properly planned for when they returned to the home which did not ensure that staff were aware of how to care for them. The manager told us that since these three people had sustained injuries she had been working hard with the support of the local authority monitoring and evaluation officers to improve on care planning and risk assessments and ensure that staff have suitable training in their work. We have found at this inspection that since that time significant improvement has been made and sustained over that six month period of time. The management of the home have worked closely with the local authority to make these improvements and we have found that they have made an appropriate response with regard to their safeguarding responsibilities. The registered manager told us in the AQAA that a safeguarding procedure is in place, and that staff at the home have received safeguarding training. During discussion with the manager she said that she had attended training facilitated by Nottinghamshire County Council Adult Social Care Service. Policies and procedures were seen in place, including the Nottinghamshire County Council Safeguarding Adults, Policy, Procedure and Guidance for Alerters - October 2007. Staff spoken with during the inspection confirmed that they had received training and they demonstrated that they understand their responsibilities in relation to making a safeguarding alert if they suspected abuse. All staff spoken with said that they would Care Homes for Older People Page 21 of 33 Evidence: approach management first and then the Safeguarding Team. People living at the home said they feel safe and comfortable. One person said, Im very happy and I feel safe. Care Homes for Older People Page 22 of 33 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 provides clean, well maintained and comfortable accommodation for the comfort of people who live there. Evidence: Before the inspection took place the registered manager told us in the AQAA that regular maintenance and decoration is undertaken, that records are kept and that the home receives positive feedback from relatives. She also told us that the facilities within the home are being upgraded, and that the garden area has been improved with new flower beds, to make it more appealing for people living there. One lounge has been refurbished with plasma TV screens. Another is in use as a smoking room. New windows have been fitted to the front of the building and eight bedrooms have been decorated. A garage and front wall have been built to improve the home. During the inspection visit we saw that the garden has been beautifully landscaped and is being developed for the enjoyment of people living at the home, to enjoy the fresh air in safe, pleasant surroundings. A relative told us The decor has been a revelation, it now looks the part. Another said, The home provides a bright, cheery environment with ongoing improvements. Care Homes for Older People Page 23 of 33 Evidence: A tour of home was provided by the registered manager and deputy manager. The registered manager explained that all people are using the main lounge as the unit established for people with dementia is not yet being used. We saw that the accommodation is a large extended house. We found that the home is well maintained, comfortably furnished and attractively decorated. The environment was clean, tidy and in good order. Pleasant flower arrangements and pictures were seen in a number of communal areas. We saw that the home provides ample communal space so that people can choose whether they want to sit in one of the lounges, the conservatory, or in the dining room. The two maintenance workers employed at the home explained that they are employed on a full time basis. They said that they are on hand to respond to any maintenance issues that arise on a day to day basis, as well as working on the ongoing refurbishment of the home. They said that they have worked on laying new floors, the alarm system, refurbishing two offices and many improvements elsewhere in the home. They told us that the call system has been renewed and every person living at the home has access to one. The maintenance workers also said that the Fire Officer had visited the previous day and had found everything in good order. We found that the fire extinguishers were last checked in February 2009 and that there are fire call points at various locations within the home. We identified that the passenger lift was checked in 2009 and found in good working order. In addition we saw that the checks for legionella had been carried out. The maintenance workers told us that plan is to install better emergency lighting, and that the bathroom in the dementia unit is to be refurbished with carpet to be laid. During the inspection visit we found that the dementia unit is accessible by keypad entry only, for the safety of people living there. On the ground floor we saw the bathroom which in need of upgrading and the registered manager confirmed that there are plans to develop this as part of refurbishment programme. She said that at present it is not in use. The registered manager described the plans for the development of the unit, the work already carried out and the achievements reached. We found that there was clear signage which was large and pictorial, to help people find their way around. The new floor covering looks like a cobbled floor for people to relate to. The manager said that there are plans to build a shop front with old books and items from the past, in order to develop an environment for people with dementia that will be engaging for them. Care Homes for Older People Page 24 of 33 Evidence: We saw the designated smoke room and people sitting in there smoking and spending time with family. The registered manager explained that the use of this room is reflected in the fire risk assessment and that she has checked its use out with the local authority. She told us that they have confirmed that so long as there are ventilators, smoke detectors and a risk assessment for smoking for the home, and individual risk assessments in place, this is a satisfactory arrangement. During the inspection visit we spoke with the relatives of one person. They said, The manager is spending a lot of money to update the home. Shes getting the place really homely. Shes made good steps with it. Ten people completed our survey forms. Four people said that the home is always fresh and clean. One person told us, Its a clean and tidy home. Another person said, Get rid of all the cameras that they have up inside the home. You feel like Big Brother is watching you. The registered manager told us that Infection Control training for staff has been carried out and certificates were available for us to see. We also found that schedules for periodic cleaning are in place. We identified that an Infection Control audit took place in July 2009, where areas for improvement were noted and an action plan is in place which the manager said is reviewed quarterly. Care Homes for Older People Page 25 of 33 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. Adequate staffing levels are maintained at the home. Recruitment practices are in line with the policy in place. Staff receive the training that is relevant to their work. Evidence: At the last focused inspection which we call a random inspection, in March 2009, we had found that numbers of staff on duty in the afternoons was unsatisfactory when support during mealtimes was needed. The registered manager had made immediate arrangements to put this right. During the inspection visit the staffing rotas were seen. This included rotas for care staff, kitchen, domestic and maintenance staff. Staffing levels were seen to be satisfactory. Staff spoken with said that there are enough staff on duty to provide care, spend time with people and update their records. We saw that an Activities Organiser is employed at the home three days per week. During discussion with relatives of one person who said they visit the home every other day, they told us, We have never seen a shortage of staff. If a buzzer goes they do answer it. The registered manager told us that she is on call and would come to the home if she was needed at any time. The two maintenance workers said that they are also on call, to ensure that the home is maintained well to provide a safe environment for people living there. Care Homes for Older People Page 26 of 33 Evidence: One member of staff suggested that the management of the home could, Do a months rota instead of a week at a time, it would be better. The registered manager explained that staff do spend individual time engaging with people, in addition to the input from the Activities Organiser. Two staff files were examined and the recruitment records seen were kept in good order. They contained all the necessary paperwork, including proof of identity, satisfactory references and a CRB (Criminal Records Bureau) Enhanced Disclosure. We also saw that there was evidence that staff had an induction soon after starting work. Staff spoken with told us that they were not allowed to start work until all the checks were in place. The registered manager expressed her commitment to staff training and personal development and the plans in place for further improvement. It was confirmed that 70 of staff had achieved an NVQ (National Vocational Qualification) Level 2. A further two senior staff are working towards NVQ Level 3, with the remaining staff at varying stages of completing this training. She added that the home is keen to improve on this to have as many care staff qualified as possible. She told us that two senior staff have Nursing Diplomas from India, so there would be no need for them to do NVQ Level 2, but they will be starting NVQ Level 3 in March 2010. At the focused inspection in March 2009, we saw how staff had previously been left in situations such as medical emergencies, when they had not received any first aid training, however the manager showed us evidence that staff had been booked on a first aid course. After this random inspection we received written confirmation from the registered manager that an Appointed Person First Aid Course took place on April 1 2009, attended by three senior care workers and a number of staff. We also received the paperwork which showed us evidence that this training had taken place. The training matrix at the home was seen. We found that staff have received lots of training in the past six months since our last inspection. They now receive the mandatory and specialist training which is relevant to their work. This training helps staff to provide the best possible care to people living at the home. On the day of the inspection visit we saw that staff were having training in the Mental Capacity Act. The registered manager said that she attended this training in March 2009 and that another date is planned for other staff to attend. We also identified that safeguarding training was due to take place within a week of the inspection visit. In addition we saw that safeguarding training provided by the local authority had been Care Homes for Older People Page 27 of 33 Evidence: attended by managers earlier in the year, and was being briefed out to staff using workbooks. Managers told us about the training plan for the home. Staff told us that they have received lots of training and that helps them in giving the best possible care to people living at the home, including dementia and diabetes awareness. One staff member told us that it is positive that management has a : Focus on training for staff to improve skills and progress. This benefits people and the home. During discussion the registered manager and deputy manager shared their commitment to the regular and effective support and supervision of staff. All staff spoken with said that they receive regular supervision, and that their training needs are raised in these meetings. They also told us that team meetings are held regularly and that minutes are produced for them to read. Staff said that they are a good team and that they work well together. They told us that they have seen many changes and improvements at the home and that the managers are approachable. One staff member said, In general its a great place to work. Another told us, I couldnt work anywhere if I was not happy. Care Homes for Older People Page 28 of 33 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 home is well managed and it is run in the best interests of the people who live there. Evidence: We identified during the inspection that the registered manager is well qualified and experienced. She is a qualified RGN (Registered General Nurse). The registered manager and the deputy manager work in partnership in the day to day running of the service. During this inspection visit we found that a system for people to express their own views on the running of the home is in place. Staff and people living at the home said that the management team are approachable and that they encourage their views on the direction and running of the home. There was evidence that people are consulted and kept informed of matters relating to the running of the home. One staff said, The management have lots of ideas for the home and they listen to us. A person living at the home said, Its great here. Care Homes for Older People Page 29 of 33 Evidence: In addition relatives told us that The home is very well run now since the new owners came in. There are small things to still get right, these are being dealt with very quickly. Another family spoken with said, Very well run home. Open door policy in office. helpful management. The paperwork known as the AQAA was completed and returned to us by the registered manager within the required timescale. It contained all the information we had asked for. Discussion with the registered manager, and information shared with us in the AQAA, showed us that they are aware of any changes that need to be made and are committed to making improvements within the service. Notifications of significant incidents or occurrences at the home have been made to us without delay. During the inspection we saw that there are appropriate policies and procedures in place to promote the health and safety of people living at the home. The manager said that all the necessary health and safety checks are carried out regularly, and that there are service contracts in place in respect of all the homes equipment. A range of records seen during the inspection confirmed this. Care Homes for Older People Page 30 of 33 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 31 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 32 of 33 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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