Care Home: Badgeworth Court Care Centre

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What the care home does well People have detailed person centred care plans that include risk assessments where required. The healthcare records were excellent and recorded the support of visiting healthcare professionals. The person centred care plans had comprehensive life histories about people and their interests. This information helps the staff know what is important to people, and how they may prefer to be cared for when promoting their independence. Three relatives and a friend we spoke to told us the care at the home was `excellent`. One person living in the home told us that she was content and had everything she wanted. We observed people in the dementia unit and they appeared to be engaging well with each other and the staff in a calm and anxiety free atmosphere. There are a wide range of activities and entertainment for people to enjoy, and people also engage in individual activities with the four activity staff. There are opportunities for people to be involved with the wider community, for example: visits to the local church, to the garden centre, shops and theatre. On the day of the inspection a piper was playing bagpipes around the home to celebrate the birthday of Robert Burns, the Scottish poet. There was also a harpist in the main lounge providing alternative music. Many other activities were provided during the week, for example; manicures in the beauty room, creative crafts in the activity room and prize bingo for everyone. The home provides a variety of food that people can choose from. The menu is also adapted to the people in each unit, for example; fruit `smoothies` and finger food may be served in the dementia unit to help encourage poor appetites. The AQAA informed us that the home maintains the Badgeworth standard of the Companies 5 star Dining Award. Families and friends can visit for lunch and private celebrations can be held for special occasions. Complaints and concerns are taken seriously, and are recorded and acted upon quickly to help ensure people are satisfied with the service. People are safeguarded in the home by all staff completing the Safeguarding Of Vulnerable Adults training (SOVA), during their induction. The staff told us they had received SOVA training and knew the importance of reporting any incidents of abuse. Recruitment procedures are robust and also help to protect people living in the home. The home is well maintained and clean throughout, providing a safe and homely environment The staff receive excellent training and support, and there are sufficient staff to help ensure that peoples needs are well met. The following comments were received in the surveys from people living in the home and their relatives or advocates; `the home is well staffed with well motivated people all of whom are well trained in providing for the varying needs of people with dementia`, `the staff at Badgeworth are exceptionally helpful and attentive to the needs of my wife`, `staff working on the dementia unit are specifically trained in handling dementia patients needs` and `I think the dementia unit would benefit from another person in the team`. The staff surveys told us that staff have training relevant to their role, which helps them to understand peoples needs and keeps them up to date with new ways of working, which includes healthcare and medication. The views of people, their families, friends and supporters are sought through annual satisfaction surveys. The questionnaires have been designed to deal with specific client groups within the home. What has improved since the last inspection? The AQAA told us that in the last twelve months the following changes have helped improve activities for people; weekly visits to the swimming pool at Leonard Cheshire have included people from both the younger adults unit and the dementia care unit, music therapy sessions for people with advanced dementia and increased resources for activities, with an activity person on each of the four units. Fitness with Care was launched by Barchester to promote and improve activities with three staff attending a training day and extra equipment was purchased. The home has a Wii, a home video game console which is set up on the larger screen television in the main lounge, and people living in the home and their friends and families can play bowls and tennis etc. when they wish. The additional space created in the corridor between the two dementia units has provided an area for people to wander, and themed displays are planned for this area. The AQAA told us about the following changes in the environment, that had taken place in the previous twelve months; Work has been carried out on the roof and guttering, upgrade to the lighting throughout the home, clearing and landscaping of flower beds at the rear car park, replacement of the fire door at the rear entrance, replacement of bedroom carpets as required, and refurbishment of the main bathroom on Declare unit, to include a new specialised bath to assist frail people to bathe. The home is planning to fit all bedroom doors with automatic door closers by the end of January 2010 to enhance fire safety arrangements, and to give people more choice to leave their bedroom doors open. Since the last inspection in 2007 an additional carer is on duty for the morning shift on the younger adults unit, making this five care staff and one nurse in the morning for twelve people. What the care home could do better: The fee information in the service user guide should be more detailed to help ensure that people are able to make an informed choice. Medication is well managed and people are protected by the homes procedures, however, minor improvements to ensure that `as required` medication protocols are recorded must be achieved. The monthly care plan reviews could reflect what has happened in the last month to support that the care plan is working well and does not need to be changed. One person in the younger adult unit requested more individual food from a takeaway Indian curry menu, which we discussed with the manager. Key inspection report Care homes for older people Name: Address: Badgeworth Court Care Centre Badgeworth Court Care Centre Badgeworth Cheltenham Gloucestershire GL51 4UL     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kathryn Silvey     Date: 2 5 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 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: Badgeworth Court Care Centre Badgeworth Court Care Centre Badgeworth Cheltenham Gloucestershire GL51 4UL 01452715015 01452859985 badgeworth@barchester.com www.barchester.com/oulton Barchester Healthcare Homes Ltd care home 65 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: A Registered Nurse on Parts 3 or 13 of the NMC Register and in possession of an ENB N.11 Care of People with a Dementing Illness Certificate, or equivalent, must be in day-to-day control of the unit. The minimum qualification of other Registered Nurses shall be Registration on Part 2 or 4 of the NMC Register To accommodate a named service user under the age of 65 in the Dementia Care Unit. This condition will be removed when the service user no longer resides at the home. Date of last inspection Brief description of the care home Badgeworth Court is a grade two listed building, which has been restored and renovated to include a modern wing. It is owned and managed by Barchester Health Care Homes Ltd. The house is set in eighteen acres of formal gardens and is situated on Badgeworth Green, next to the church. The M5 motorway and Cheltenham town Care Homes for Older People Page 4 of 33 Over 65 24 26 0 0 0 15 Brief description of the care home centre are only a few kilometres away. The accommodation is arranged on two floors accessed by two shaft lifts. All bedrooms have en-suite facilities and only four bedrooms are for double occupancy. There are a variety of communal rooms. The home comprises four units, DeClare unit providing nursing care for older people Norwood providing nursing care for older people with dementia Selwyn Payne providing personal care for older people with dementia Conynghame providing nursing care to younger adults with complex care. Information about the home is available in the Service User Guide, which is issued to prospective residents, and a copy of the most recent CQC report is available in the home for anyone to read. The charges for Badgeworth Court range from 800.00 to 1200.00 pounds per week. Hairdressing, Chiropody, Newspapers, Guest meals and Aromatherapy are charged at individual extra costs. 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. The inspection took place over two days with one inspector. We visited all four units in the home and we spoke to some people living in the home, their family or friends, the staff, the homes trainer, the Head of Care, an administrator and the General Manager. We received completed surveys from people living in the home, their relatives, the staff and a healthcare professional. A number of records were looked at including care plans, risk assessments, health and medication records. The care records of six people were looked at in detail. We also looked at the communal areas and some bedrooms. The staff were observed engaging with people living in the dementia units. Care Homes for Older People Page 6 of 33 The registered manager returned the Commissions Annual Quality Assurance Assessment, this is a self-assessment about the home and is a legal requirement. Care Homes for Older People Page 7 of 33 What the care home does well: People have detailed person centred care plans that include risk assessments where required. The healthcare records were excellent and recorded the support of visiting healthcare professionals. The person centred care plans had comprehensive life histories about people and their interests. This information helps the staff know what is important to people, and how they may prefer to be cared for when promoting their independence. Three relatives and a friend we spoke to told us the care at the home was excellent. One person living in the home told us that she was content and had everything she wanted. We observed people in the dementia unit and they appeared to be engaging well with each other and the staff in a calm and anxiety free atmosphere. There are a wide range of activities and entertainment for people to enjoy, and people also engage in individual activities with the four activity staff. There are opportunities for people to be involved with the wider community, for example: visits to the local church, to the garden centre, shops and theatre. On the day of the inspection a piper was playing bagpipes around the home to celebrate the birthday of Robert Burns, the Scottish poet. There was also a harpist in the main lounge providing alternative music. Many other activities were provided during the week, for example; manicures in the beauty room, creative crafts in the activity room and prize bingo for everyone. The home provides a variety of food that people can choose from. The menu is also adapted to the people in each unit, for example; fruit smoothies and finger food may be served in the dementia unit to help encourage poor appetites. The AQAA informed us that the home maintains the Badgeworth standard of the Companies 5 star Dining Award. Families and friends can visit for lunch and private celebrations can be held for special occasions. Complaints and concerns are taken seriously, and are recorded and acted upon quickly to help ensure people are satisfied with the service. People are safeguarded in the home by all staff completing the Safeguarding Of Vulnerable Adults training (SOVA), during their induction. The staff told us they had received SOVA training and knew the importance of reporting any incidents of abuse. Recruitment procedures are robust and also help to protect people living in the home. The home is well maintained and clean throughout, providing a safe and homely environment The staff receive excellent training and support, and there are sufficient staff to help ensure that peoples needs are well met. The following comments were received in the surveys from people living in the home and their relatives or advocates; the home is well staffed with well motivated people all of whom are well trained in providing for the varying needs of people with dementia, the staff at Badgeworth are exceptionally helpful and attentive to the needs of my wife, staff working on the dementia unit are specifically trained in handling dementia patients needs and I think the dementia unit would benefit from another person in the team. The staff surveys told us that staff have training relevant to their role, which helps Care Homes for Older People Page 8 of 33 them to understand peoples needs and keeps them up to date with new ways of working, which includes healthcare and medication. The views of people, their families, friends and supporters are sought through annual satisfaction surveys. The questionnaires have been designed to deal with specific client groups within the home. What has improved since the last inspection? What they could do better: The fee information in the service user guide should be more detailed to help ensure that people are able to make an informed choice. Medication is well managed and people are protected by the homes procedures, however, minor improvements to ensure that as required medication protocols are recorded must be achieved. The monthly care plan reviews could reflect what has happened in the last month to support that the care plan is working well and does not need to be changed. One person in the younger adult unit requested more individual food from a takeaway Indian curry menu, which we discussed with the manager. Care Homes for Older People Page 9 of 33 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. The home ensures that people are well assessed by qualified staff before they move in, and have sufficient information to help them make an informed choice about the service. Evidence: We looked at some pre-admission assessments and there was sufficient information in most cases to help ensure that admissions were well planned, and that the staff could be sure that peoples need could be met in the home. Healthcare professionals in the community or hospital are contacted to provide information where applicable. Some pre-admission records had more detail than others, there should be consistency to help ensure that admissions are well planned. We spoke to the manager about admissions and sometimes people visit two or three times before they move in, to help ensure that the home is right for them. Care Homes for Older People Page 12 of 33 Evidence: The AQAA told us that the admission process is given sufficient time to help ensure that people have all the information they need. The AQAA also told us that in the last twelve months the homes terms and conditions have been updated and the mystery visit surveys have improved. We looked at the good results of ninetyone percent that was achieved by the home after a Barchester mystery visit was completed by prospective people viewing the home. Out of the ten surveys that were returned to us from people or their relatives five people told us they always had enough information about the care service to help them make a decision, two people didnt know and two told us that they usually had enough information. There had been several emergency admissions in the last year. The manager told us they try to see the social services care plan before an emergency admission to the home. The fee information in the service user guide should be more detailed to help ensure that people are able to make an informed choice. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a person centred care planning system that provides staff with detailed information to met peoples needs and promote their independence. People have the healthcare support they need. Medication is well managed and people are protected by the homes procedures. Minor improvements to record as required medication protocols must be achieved. People are treated with dignity and respect. Evidence: We looked at several care plans in all four units, six in more detail, and spoke to people living in the home and some people visiting the home about the care provided. The care plans in all the units were detailed and were linked to assessments. The AQAA told us that a documentation audit completed recently by Barchesters Regional Clinical Nurse achieved 96.7 percent. The care plans included risk assessments where required and complete healthcare Care Homes for Older People Page 14 of 33 Evidence: records. The examples of risk assessments included manual handling, falls, choking and mobility. All the risk assessments identified the risk and what should be completed to minimise the risk. The healthcare records were excellent and recorded the support of visiting healthcare professionals. This included for example; the doctor, the tissue viability nurse and the Speech And Language Therapist (SALT). People at risk from pressure ulcers developing had a two hourly plan to change their position and the necessary pressure relieving equipment to support them. People are able to have frequent physiotherapy sessions from the homes physiotherapist assistants. One persons care plan indicated that up to four sessions of physiotherapy was given each week. We looked at a care plan where assistive technology was being used to alert staff that a person at risk of falling was leaving her chair. The staff were checking the equipment daily to ensure it was functioning. Wound care was well recorded with clear descriptions of the wounds and photographs taken to record healing, with the persons consent, one person had declined consent. The daily records completed to support the care plan actions were very detailed and informative. The person centred care plans had comprehensive life histories about people and their interests. This information helps the staff know what is important to people, and how they may prefer to be cared for when promoting their independence. The care plans had good nutritional profiles and regular records of weight to help ensure that people were not at risk from malnutrition. The tool used to assess nutrition helps to alert the staff to inform the doctor when required. The monthly care plan reviews were signed and dated only and any changes required would be added to the care plan. We recommend more meaningful reviews recorded about what has happened in the last month to support that the care plan is working and does not need to be changed. For example in a communication care plan for a person with dementia there could have been some reference to how often this person had difficulty communicating her needs in the month and how much support was required. This way an ongoing deterioration or improvement is more easily identified. Three relatives and a friend we spoke to told us the care at the home was excellent. One person living in the home told us that she was content and had everything she wanted. We observed people in the dementia unit and they appeared to be engaging well with each other and the staff in a calm and anxiety free atmosphere. Care Homes for Older People Page 15 of 33 Evidence: We looked at medication management in the home in one unit in particular, however, we also looked at individual medication when looking at care plans in the other units. We completed some spot check audits of medicines in three units and one had an incorrect amount. A controlled drug medication audit was correct, the storage was secure and temperatures were recorded. All units had a copy of the homes medication procedure to include an updated homely remedy protocol, and a medication reference book dated year 2009. The supplying pharmacist completes a medication audit twice a year. We checked a Warfarin administration record and the box of medication was dated when opened to help ensure that a correct audit can be completed. We looked at a medication protocol for a person with epilepsy, which included the doctors permission to administer the medication covertly when required. One medication on the residential unit required a recorded protocol for an as required administration, which we discussed with the manager. We spoke to the staff in the residential unit and they were able to tell us about the medication. The AQAA told us that the care staff in residential unit have the required accredited medication training. The medication administration records were complete and each one had a photograph of the person on it and all known allergies were recorded. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are a wide range of activities and entertainment for people to enjoy, and people are also engaged in individual activities with the four activity staff. There are also opportunities for people to be involved with the wider community. People can choose a variety of food from a varied and changing menu that provides appetising and nutritious meals. Evidence: There is an activity person for each of the four units to help provide a programme of activities and engage people individually. The people living in the home are learning to play musical instruments as the home has a music therapy student for 24 weeks to help them. One person was learning to play a xylophone. We spoke to a fulltime activity person in the dementia nursing unit, and looked at the detailed activity records kept to help ensure that people are completing activities and are able to join in when they can. People in the dementia unit join in with music and movement in the communal rooms on the ground floor and do cooking twice a week. There are a lot of one to one Care Homes for Older People Page 17 of 33 Evidence: activities to engage people individually in the dementia unit, looking at photo albums, reading the newspaper and some people enjoy doll therapy. The activity person we spoke to will be completing an activity course soon to help her learn about creating the right activities for people. Other activities people enjoy are swimming, make-up sessions, looking at memory boxes and painting. The additional space in the corridor between the two dementia units has created more space for people to wander, and themed displays are planned for this area. The AQAA told us that in the last twelve months the following changes have helped improve activities for people; weekly visits to the swimming pool at Leonard Cheshire have included people from both Conynghame and Norwood, music therapy sessions for people with advanced dementia and increased resources for activities. Fitness with Care was launched by Barchester to promote and improve activities with three staff attending a training day and extra equipment was purchased. A Wii, a home video game console, is set up on the larger screen television in the main lounge, and people living in the home and their friends and families can play bowls and tennis etc. when they wish. The local church holds its monthly Sunday School meetings in one of the lounges, staff take people to church and they can also attend Holy Communion in the home. A local artist also holds a weekly art class. We looked at the monthly newsletter for January 2010, which is given to each person and tells them about activities taking place and offers assistance to attend should anyone require it. On the day of the inspection a piper was playing bagpipes around the home to celebrate the birthday of Robert Burns, the Scottish poet, and there was a harpist in the main lounge providing a relaxing atmosphere. There were lots of other activities for the week including manicures in the beauty room, creative crafts in the activity room and prize bingo for everyone. We spoke to people about activities and some were content with entertaining themselves in their own room and joined in the programme when they wanted to. One person we spoke to was dictating a book about her mothers life onto a compact disc. In the six completed surveys returned to us everyone told us that there was always activities to take part in. One relative in the survey told us that younger people in the home may need more activities to include trips out and more interaction with the wider community. Another relative told us that in the dementia unit the activities are Care Homes for Older People Page 18 of 33 Evidence: done well. A member of staff told us in a survey that there are loads of activities The dining areas in all the units looked attractive and inviting. The AQAA told us that meal times are encouraged to be a very sociable event and that staff are encouraged to sit down and eat with people living in the home. People can choose their food at the table, and for those who are unable to understand the menu, food is presented to them so that they can make their own choice. There is a main menu displayed in all the dining areas and a lighter meal menu that can be ordered at anytime. The menu is also adapted to the people in each unit, for example fruit smoothies and finger food may be served in the dementia unit to help encourage poor appetites. We observed the lunch provided in peoples own rooms in one unit and the supper in a dining area in a dementia unit. The food looked appetising and was well presented and people told us that they enjoyed their meal. We observed the dementia unit staff providing calm encouragement where people were treated with dignity and respect. One person in the younger adult unit requested more individual food from a takeaway Indian curry menu, which we discussed with the manager. The AQAA informed us that the home maintains the Badgeworth standard of the Companies 5 star Dining Award. Families and friends can visit for lunch and private celebrations can be held for special occasions. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints and concerns are taken seriously and are recorded and acted upon quickly to help ensure people are satisfied with the service. People are protected by the homes policies and procedures with regard to safeguarding, and staff are trained to recognise and report abuse. Evidence: The AQAA told us that people are given a copy of the complaints procedure in the service user guide and it is also prominently displayed throughout the home. Most concerns are dealt with daily and recorded in the communication books on each unit. The staff are able to deal with minor concerns, and complaints are acknowledged by the manager or senior staff within twentyfour hours. We looked at the record of three complaints in the previous year and discussed them with the manager, one had been acknowledged verbally. We recommend that all complaints received verbally are acknowledged by letter and that any action taken is recorded and reviewed to ensure ongoing satisfaction. In the six surveys returned to us all the people knew how to make a complaint. We spoke to the homes trainer regarding Safeguarding Of Vulnerable Adults training (SOVA), which is provided in house for all staff during induction. Staff told us they had Care Homes for Older People Page 20 of 33 Evidence: received SOVA training and knew the importance of reporting any incidents of abuse. Barchester have safeguarding policies and procedures, to include robust recruitment procedures for staff to follow, to help ensure that people are protected. Care Homes for Older People Page 21 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained and clean throughout, providing a safe and homely environment. Evidence: We looked at a sample of bedrooms in each of the four units and all areas looked at were well maintained, clean and free from offensive odours. There are adaptations in the home to help meet peoples individual needs. The AQAA told us that the internal Health & Safety audit in January 2009 scored 94.81 percent, and the property services audit by the Regional Property Services Manager scored 89.61 percent in September 2009. There are maintenance books for staff to report problems in each unit, and staff told us that issues are usually dealt with quickly by the maintenance team. We looked at the Regulation 26 visits completed by the Regional Director and the environment was reported on. The January 2010 report told us that refurbishments projects were starting soon. The AQAA told us about the following changes in the environment, that had taken place in the previous twelve months; Work has been carried out on the roof and guttering, upgrade to the lighting throughout the home, clearing and landscaping of Care Homes for Older People Page 22 of 33 Evidence: flower beds at the rear car park, replacement of the fire door at the rear entrance, replacement of bedroom carpets as required, and refurbishment of the main bathroom on Declare unit, to include a new specialised bath to assist frail people to bathe. There is also additional space for people in Norwood dementia care unit to wander in the corridor that has been opened up by the passenger lift. The home is planning to fit all bedroom doors with automatic door closers by the end of January 2010 to enhance fire safety arrangements, and to give people more choice to leave their bedroom doors open. Five of the completed surveys told us that the home is always fresh and clean, one told us it is usually fresh and clean. One relative told us that the bathroom attached to my wifes bedroom is tired. All staff have infection control training to help ensure that procedures are followed to maintain good hygiene standards and prevent cross infection. Care Homes for Older People Page 23 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff receive excellent training and support, and there are sufficient staff to help ensure that peoples needs are well met. Recruitment procedures are robust and help to protect people living in the home. Evidence: We visited each unit and asked the staff if there were usually sufficient staff to meet peoples needs and they told us there were. Occasionally a unit may need additional staff due to increased dependency levels and the manager ensures that this happens. Since the last inspection in 2007 an additional carer is on duty for the morning shift on Conynghame, the younger adults unit, making this five care staff and one nurse in the morning for twelve people. Each unit had a relaxed and unhurried atmosphere. We spoke to people in the cafe on the younger adults unit and people in their bedrooms, and they all agreed that their needs were being well met by the staff. The home also has two physiotherapy assistants that help to ensure people get the exercise they need, and each unit has an activity co-ordinator to improve social interaction and the quality of activities. Care Homes for Older People Page 24 of 33 Evidence: There were sufficient ancillary staff to help maintain the excellent standards in the home. Our surveys told us that five people found that there was always enough staff, and one person told us usually. The following comments were received in the surveys from people living in the home and their relatives or advocates: the home is well staffed with well motivated people all of whom are well trained in providing for the varying needs of people with dementia, the staff at Badgeworth are exceptionally helpful and attentive to the needs of my wife, staff working on the dementia unit are specifically trained in handling dementia patients needs and I think the dementia unit would benefit from another person in the team. Five staff surveys told us that there was usually enough staff to meet people individual needs and two told us sometimes. The staff also told us that the staff are happy, and the home is good to work in. The staff told us that improvements could be made in providing training in medical conditions as most training had been for staff working with people in the dementia unit. One staff member wanted better uniforms, replaced more often, and one told us that communication could be improved. All staff told us in the surveys that they have training relevant to their role, which helps them to understand peoples needs and keeps them up to date with new ways of working, including healthcare and medication. The AQAA told us that seven shifts in the last three months have been covered by temporary or agency nurses, and that 121 shifts have been covered by temporary or agency carers. This tells us that staff shortages are covered to help ensure that peoples needs are met. We discussed this with the manager and were were told three staff had recently left the home, none were referred to the Independant Safeguarding Authority (ISA) with regard to protecting vulnerable adults. The homes trainer is well organised and was able to inform us about all the training completed in the last year. All nurses and key care staff have received training on The Mental Capacity Act and the Deprivation of Liberty Safeguards (DOLS). Seven staff have recently completed Level 2 Dementia Awareness and 80 percent of staff had competed Barchesters dementia training course Yesterday, Today and Tomorrow. Four care assistants have graduated in a ceremony at Gloucester Cathedral as Dementia Link Workers, which is part of the National Dementia Strategy. The training records show the training that staff have access to for example; nutrition, continence, management, tissue viability, diabetes,multiple sclerosis, medication updates and leadership skills. One nurse has completed a tissue viability course in Bristol and helps to train other staff in wound care. Care Homes for Older People Page 25 of 33 Evidence: The MacMillan palliative care training course has been implemented and staff have received some excellent training. Eleven staff are currently studying Level 3 through distance learning in Palliative Care. One of the senior nurses has passed Level 3 module in Palliative Care, part way to developing a Diploma to a BSc in Nursing Studies. Skills for Care have provided the home with resources to purchase books about multiple sclerosis and Huntingdons Corea Training planned for the coming year included Continuing Professional Development with regard to the following conditions; depression, multiple sclerosis and dementia. Staff attend medication training at a local college, and there is also compulsory annual updates for all nurses and carers. Should any errors be noted during medication audits the staff involved have extra competency tests to ensure compliance. We looked at three recruitment records that were complete with the relevant information to include; applications, two references and Criminal Record Bureau (CRB) checks. There was little information regarding interview notes, where gaps in employment and more detail about previous experience could be recorded. We were informed that staff do not start work in the home until a full enhanced CRB check has returned. Care Homes for Older People Page 26 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 excellent 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 takes into consideration peoples views to help ensure that quality assurance methods are vigorous. The home has policies and procedures in place to give guidance to staff and help ensure people are safe. Evidence: There is an established management team within Badgeworth and all Heads of Department have been there since 1997. The registered manager is well qualified and very experienced. In the AQAA the manager told us that she has an open door policy for people living in the home, their families and the staff. This means that if the manager is not at the home the staff take a message and people are contacted within twentyfour hours. Care Homes for Older People Page 27 of 33 Evidence: In May 2009 two Saturdays were made available for families to come and meet the manager and discuss any concerns or issues they may have. Seven families visited and one complaint was raised. Staff are also encouraged to pass on the views of the families and the people they care for. We recommend that all concerns raised are recorded to enable issues to be reviewed. The seven staff surveys told us that the manager gave staff regular or often support to discuss how they work. The views of people, their families, friends and supporters are sought through annual satisfaction surveys. The questionnaires have been designed to deal with specific client groups within the home. In the homes 2009 survey eight people living in the home, twentyfour relatives and one friend responded. There had been improvements in many areas from the previous year, and most of the responses meant that Badgeworth was better than most Barchester homes in the region and nationally. There was some room for improvement in value for money, the number and range of social outings, outside the home and the homes response to problems raised. The Barchester mystery visit report in October 2009 noted considerably improvements since June 2009, by more than 25 percent. This records the impressions of a prospective new person looking at the home, the home was scored 91 percent overall in for example; giving the correct information, making people feel welcome and listening to them. The fire officers visit in November 2009 highlighted issue around door closures, which Barchester are already addressing. The Environmental Health Officers report had minor issues to complete. We looked at the latest Regulation 26 reports that the Regional Director completes monthly when visiting the home. It was reported that care plans and food were excellent. We recommend that direct quotes from people living in the home and the staff are recorded in the reports. The AQAA told us that the equipment in the home had been tested or serviced as recommended by the manufacturer or regulatory bodies in 2009, and the homes electrical systems in 2008. The homes policies and procedures were last reviewed in September 2007 and are due to be reviewed again in 2010. Eightytwo staff had received infection control training to help ensure that the correct procedures are followed to prevent cross infection. Care Homes for Older People Page 28 of 33 Evidence: Internal monthly audits take place to cover, medication, health and safety, nutrition and dining, infection control, documentation, professional practice and activities. Improvements in the last twelve months includes the following; new accident and incident forms and improved procedures when employing new staff. We spoke to the administrator with regard to recruitment and peoples personal monies, which were correct. Care Homes for Older People Page 29 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 30 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 1 9 13 Medication where as required is recorded must have a protocol recorded that is agreed by the prescribing doctor. This will help staff to make good consistent decisions to benefit the person and to ensure that the doctors instructions as carried out. 18/04/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The fee information in the service user guide should be more detailed to help ensure that people are able to make an informed choice. We recommend more meaningful reviews are recorded about what has happened in the last month, to support that the care plan is working and does not need to be changed. We recommend that all complaints received verbally are acknowledged by letter, and that any action taken is recorded and reviewed to ensure ongoing satisfaction. Page 31 of 33 2 7 3 16 Care Homes for Older People 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. 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