Care Home: Bare Hall

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What the care home does well The owners and their manager lead the continued development of the home, both in the environment, and in the way care is provided at the home. People living at the home are given choices, and are helped to maintain their usual daily routines as much as possible. Assessments of need and care plans provide person-centred information for staff, enabling them to know how best to look after each individual. The resident`s surveys returned to us told us that they always received the care and support they needed. `The staff look after me well and provide good meals. They are friendly`, stated one resident. Staff we spoke to had a good understanding of residents` needs, and we saw good interaction between the staff and the residents living at the home. Staff attend various training courses, and 82% of them hold NVQ qualifications. Staffing levels are kept high to provide opportunity for 1:1 time and activities with residents. The home has a relaxed and friendly atmosphere, and the furnishings are very homely and comfortable. Bedrooms are attractive, with warm fabrics and cosy features. The addition of personal belongings makes them all individual. Residents told us that there are some activities organised that they could take part in if they wish, and showed us the dominoes table they used, and talked about bingo and the entertainer who called. The manager was aware of the need to encourage people to join in any outings, and had plans in place to motivate residents to do this in small groups. Personal interests were taken into consideration, and one resident who was an avid reader enjoyed the the mobile library calling. A dedicated cook plans and prepares meals, and all of the residents we spoke to told us they enjoyed the food at the home. Meetings with residents are held to discuss any problems, or take on board any suggestions for things such as meals, activities, or decor. The owners and their manager told us that the approach in the home is open, and they try to encourage staff to discuss issues, and residents to chat freely and express opinions. All of the residents we spoke to were satisfied with the way they were looked after, and could not think of anything they would like done differently. The home hold the Investors In People (IIP) award, showing a commitment to the development of staff, and the home is certificated to International Standards Organisation (ISO) standards. The home also employ an independent consultant on a weekly basis to audit all areas of performance, to help ensure they maintain their high standards. A visitor had complimented the care her relative had received, and said in a letter `It`s a fantastic, well run, friendly, happy home. (My relative) was treated with dignity and respect and cared for by all`. The owner told us `We are proud of the service we deliver. We will maintain the service by keeping it under regular formal review and we employ an independent consultant on a weekly basis to audit all areas of our performance`. What has improved since the last inspection? The owners are continually maintaining the home, and have ongoing plans to develop and improve the environment. All of the window frames in bedrooms have been replaced with double glazed units, and the central heating boilers have been updated, providing a more efficient system. The fire alarm systems have been replaced. Ten of the bedrooms have been provided with en-suite facilities for the residents` comfort and convenience, and most of the home has been redecorated. What the care home could do better: The pre-admission assessment could be signed by the resident or their relative, as well as the person assessing, to show they agree with the care that needs to be provided for them. Daily notes for each resident could be made by staff in individual files. These would provide a full picture of their day to day life in the home. When body maps are completed to show any skin marks of an individual, they could be kept up to date to show that person`s present circumstances. Any handwritten entries on the Medication Administration Record (MAR) could be signed, witnessed and countersigned, to minimise the chance of any errors in transcription. There could be no secondary dispensing taking place, where one staff member `pots up` residents` medication for another staff member to administer. All medication could be administered from the original container, with the person administering it signing the MAR. These actions would minimise the chance of incorrect administration. Key inspection report Care homes for older people Name: Address: Bare Hall 20 Bare Lane Bare Morecambe Lancashire LA4 6DF     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: Jennifer Hughes     Date: 2 8 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 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 29 Information about the care home Name of care home: Address: Bare Hall 20 Bare Lane Bare Morecambe Lancashire LA4 6DF 01524410906 01524401057 brian@barehallhome.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Brenda Diane Wainwright,Mr Brian Neil Wainwright care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 32 Date of last inspection Brief description of the care home Bare Hall is situated in the Bare area of Morecambe and close to all the amenities such as shops, post office, bus stop etc. Morecambe promenade and Happy Mount Park are also within easy reach. There is a small car park at the side of the home, with available parking in nearby roads. The home is a detached, grade 2 listed building and can accommodate a maximum of 32 older people of both sexes who do not need nursing care. A garden area is maintained for residents to sit in and watch the world go by, and a conservatory at the Care Homes for Older People Page 4 of 29 0 Over 65 32 Brief description of the care home front of the home allows for residents who do not wish to venture outside. The home has been adapted to suit the needs of older people. For example two stair lifts are in place, with one at either end of the home to improve accessibility for residents, grab rails are fitted and ramps give ease of access. All the bedrooms are single occupancy apart from five double rooms. The double rooms are generally used for married couples or people who have consented to share a room, or occasionally may be used as single occupancy if people do not wish to share. Eight rooms have ensuite facilities, with bathrooms and toilets being conveniently situated. There is sufficient communal space with two adjoining lounges, a conservatory and a dining room. Staffing is provided over 24 hours, every day of the year. Information about the service the home provides is available in brochure form, and in a Service User Guide, and CQC reports are readily available from the owners or manager to anyone who asks to see them. As at 28th January 2010, the fees ranged from £386.50 to £630 dependent on need, with additional charges for such as hairdressing, telephone and newspapers. Further details about fees are available from the home. Care Homes for Older People Page 5 of 29 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: This was an unannounced visit to the home, in that the owners and the manager were not aware that it was to take place. The site visit was part of the key inspection of the home. A key inspection takes place over a period of time, and involves gathering and analysing written information, as well as visiting the home. The length of the visit was for 6 hours. Every year the registered persons are asked to provide us (Care Quality Commission) with written information about the quality of the service they provide. We use this information, in part, to focus our assessment activity. This document is called the Annual Quality Assurance Assessment (AQAA). Surveys were sent and received from residents of the home. Care Homes for Older People Page 6 of 29 During the site visit staff records and resident care records were viewed, alongside policies and procedures of the home. The owners, manager, residents, and care staff were spoken to, and their responses are reflected in the body of this report. A tour of the home was made, viewing lounges, dining room, bedrooms and bathrooms. Everyone was friendly and cooperative during the visit. Care Homes for Older People Page 7 of 29 What the care home does well: The owners and their manager lead the continued development of the home, both in the environment, and in the way care is provided at the home. People living at the home are given choices, and are helped to maintain their usual daily routines as much as possible. Assessments of need and care plans provide person-centred information for staff, enabling them to know how best to look after each individual. The residents surveys returned to us told us that they always received the care and support they needed. The staff look after me well and provide good meals. They are friendly, stated one resident. Staff we spoke to had a good understanding of residents needs, and we saw good interaction between the staff and the residents living at the home. Staff attend various training courses, and 82 of them hold NVQ qualifications. Staffing levels are kept high to provide opportunity for 1:1 time and activities with residents. The home has a relaxed and friendly atmosphere, and the furnishings are very homely and comfortable. Bedrooms are attractive, with warm fabrics and cosy features. The addition of personal belongings makes them all individual. Residents told us that there are some activities organised that they could take part in if they wish, and showed us the dominoes table they used, and talked about bingo and the entertainer who called. The manager was aware of the need to encourage people to join in any outings, and had plans in place to motivate residents to do this in small groups. Personal interests were taken into consideration, and one resident who was an avid reader enjoyed the the mobile library calling. A dedicated cook plans and prepares meals, and all of the residents we spoke to told us they enjoyed the food at the home. Meetings with residents are held to discuss any problems, or take on board any suggestions for things such as meals, activities, or decor. The owners and their manager told us that the approach in the home is open, and they try to encourage staff to discuss issues, and residents to chat freely and express opinions. All of the residents we spoke to were satisfied with the way they were looked after, and could not think of anything they would like done differently. The home hold the Investors In People (IIP) award, showing a commitment to the development of staff, and the home is certificated to International Standards Organisation (ISO) standards. The home also employ an independent consultant on a weekly basis to audit all areas of performance, to help ensure they maintain their high standards. A visitor had complimented the care her relative had received, and said in a letter Its a fantastic, well run, friendly, happy home. (My relative) was treated with dignity and respect and cared for by all. Care Homes for Older People Page 8 of 29 The owner told us We are proud of the service we deliver. We will maintain the service by keeping it under regular formal review and we employ an independent consultant on a weekly basis to audit all areas of our performance. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clear information is provided, which enables people to make an informed decision about the home. The assessment that is carried out for all residents means that a service is provided that is tailored to an individuals needs and preferences. Evidence: The home provides very clear information about the service it provides in the form of a Service User Guide and a brochure that contain information that clearly details who owns and manages the home, and what services the home provides. There is detail on what people who live there can expect from the day to day running of the home, and the staff who will look after them. Residents told us that they knew about the home before they moved in. The owner told us the information would be made available in different formats for people if needed, such as large print or another language. We viewed the individual records of four residents we randomly selected. There is a set procedure for admitting someone to the home, and all of the files held preCare Homes for Older People Page 11 of 29 Evidence: admission assessments carried out by senior staff from the home. We found that the assessments held information about all aspects of the physical, social and psychological care of the individuals. The assessments made sure that the individual needs were identified, and the home could meet those needs. Following admission we saw that a plan of care for each individual was devised from the assessment that had been carried out, and this had been signed in agreement by the resident or their relative, as well as staff of the home. We advised that the preadmission assessment should also be signed by the resident or relative to show they had participated in the decisions on what care they required. Staff told us that they were always given up to date information about the care needs of people they support, and were able to view the assessments the manager had made for more information. They were able to tell us about the needs of residents, and how to meet those needs. Staff told us that they felt the communication systems in the home were very good. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of residents are well met in this home. Some medication practices could effect residents health if they continued. Evidence: Care plans are written records that describe the care that is given to each resident. We noted that the care plan format at the home prompted comprehensive information and were very structured. The files we viewed held some good person centred information about residents and the care they required, such as likes her clothes coordinated, hot drink with two biscuits at night, prefers a bath late morning and likes three pillows, all little things that are important to individuals. The plans identified the areas of need for each person, with good instructions for staff on what they must do to meet that need. We saw that regular reviews of the care provided were carried out, with additional guidance for staff if there were any changes. Appropriate aids and adaptations are assessed for by professionals, and available in the home for those residents who need them. Care Homes for Older People Page 13 of 29 Evidence: Assessments are made of any risk to the residents, with action for staff to take to reduce that risk. We saw there was a system in place to monitor each person daily, and to pass on that information to care staff, through the use of communication books and shift handover systems. We advised this information should be included in daily records for each person, so as to give a full picture of their day to day life in the home. We noted that one resident had visits from the district nurse to treat a pressure sore. These visits were recorded, but due to the lack of daily notes on the individuals file there was no ongoing record of the progress of the resident between medical visits. We also advised the care plan may need to be updated to include direction on how future skin problems may be avoided. We also noted the use of body maps to identify any skin marks. The staff need to ensure these are kept up to date to show the residents present circumstances. It was clear that health professionals had regular contact with the residents when needed. We saw residents being treated with respect, and heard staff chatting with residents who clearly felt able to say how they felt and what they wanted. They look after me well, said one resident, I cant find anything to grumble about said another. We looked at a sample of medication records and stock. We also observed a medication round, when we saw staff administering medication correctly and carefully. Patient Information Leaflets were available for the medication in the home, and staff were aware of administering at the correct time of day, and before or after meals, as per instructions. Most staff who administer medication have attended a medication awareness course, with some who administer having been assessed as competant to do so by the manager. We advised all staff involved with administering medication should attend accredited training. The owner told us of the close link between the GP and their pharmacist, who carries out medication reviews for all of the residents. We saw regular audits and records of receipts and returns of medication. We noted some handwritten entries on the Medication Administration Records (MAR), and advised that any handwritten entries should be signed, witnessed and countersigned, in order to avoid any transcription errors. We saw that the manager had potted up some medication for senior staff to Care Homes for Older People Page 14 of 29 Evidence: administer later in the day, in her absence, and she said it was to save the staff time during a busy period of the day. We discussed the dangers of secondary dispensing, and strongly advised that the practice should stop so as to avoid any chance of errors in administering medication, and that all medication must be administered from the original container, signed for by the person administering it. Care Homes for Older People Page 15 of 29 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. Residents daily lives and social activities are generally catered for, and people benefit from living in a home that tries to continually develop to provide people with opportunities to live lives that are fulfilled. Evidence: The individual care plans we saw included information on each persons life history, their religious needs, and what hobbies and activities they preferred. Residents told us that there are some activities organised that they can take part in if they wish. They told us about playing dominoes, bingo and other board games, and about having their nails done. The owner told us about the Easter and Halloween celebrations they had, and we saw staff preparing a birthday tea with birthday cake for one of the residents, for all to join in with. Surveys told us there were always some activities provided in the home. A relative said Manicures, bingo, card games and dominoes filled her day, and she couldnt believe that not an hour went by without a tea trolley or a meal being prepared. The owner told us about flexible plans for activities, with an entertainer calling Care Homes for Older People Page 16 of 29 Evidence: regularly for a sing a long. Some residents liked to go for a short walk, either alone or with assistance. We saw visitors calling into the home through the day. Staff told us about how some residents liked to sit in the conservatory and watch the world go by without having to go outside. The home operate a three weekly varied menu, and the owner told us an alternative would be offered if a resident did not want the main meal. There is one choice of main meal, and a choice at tea time, although the owner said that the menu was flexible, and a rough guide. Residents told us that they either always or usually liked the meals on offer. The main meal at this visit was ham, mashed potatoes, carrots and sweetcorn, and we saw that most of the residents sent back nearly empty plates. A resident commented They provide good meals. Meals are served in the dining room, which we found to be pleasant and airy. Staff were tactful when helping residents with meals, and quietly monitored the meal time. Some residents chose to have their meal in their own room. We saw that the cook had records of peoples likes and dislikes, and was able to provide for different diets. Care Homes for Older People Page 17 of 29 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. The residents benefit by being supported and protected. Evidence: There is a complaints procedure in place, and a file in which to record any complaints which come to the owners attention. There are copies of this available in the entrance of the home, and in information about the home given to residents. We advised that the information in the procedure should be updated to show the contact details for social services for a complainant to go to if they are dissatisfied with the homes investigation outcome, and also the updated address for the Care Quality Commission who may also be contacted. All of the residents we spoke to said that they knew how to make a complaint, and what they would do. Id tell any of the staff here if I didnt like something, said one resident. Responses in surveys also told us that they knew who to speak to if they were unhappy, and how to make a complaint. The owner told us that they plan to continue to monitor peoples satisfaction and act on any issues, to help them continue to receive no complaints. We saw that staff had attended training about abuse awareness, or safeguarding. Care Homes for Older People Page 18 of 29 Evidence: Safeguarding procedures must be in place in all homes, and must be followed if it is suspected that a resident has been the victim of any kind of abuse. We spoke to staff on duty, and found they had a good understanding of the procedures. We advised that safeguarding training for staff needed refreshing to ensure staff were always up to date with procedures. Care Homes for Older People Page 19 of 29 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 has a well maintained environment, which provides aids and equipment to meet the care needs of the residents. It is a pleasant, safe and homely place to live. Evidence: The home is a grade 2 listed building, and both internally and externally is maintained to a high standard, keeping within the restrictions put in place by the city council for the development of historical buildings. The owner told us that better access facilities for more disabled residents are planned, but may not be possible due to the restrictions. A garden area at the front of the home is kept neat and tidy for people to sit in during the better weather, and in addition the conservatory at the front of the home allows residents to view the garden and watch the world go by, without having to venture outside. We found that since our last visit the home had undergone some redecoration, and some new carpets had been laid, with eleven en-suite facilities being installed. Residents confirmed that they had been involved with helping to choose colour schemes. The owner told us maintaining a good standard of decor was ongoing, and on a rolling programme. Care Homes for Older People Page 20 of 29 Evidence: We toured the home, and saw that all of the home was clean, tidy and fresh. The home was kept comfortably warm. Domestic staff have set routines to follow to keep the home to a good standard of hygiene. Surveys returned from residents told us that the home is always fresh and clean. The bedrooms we saw were personalised with residents own belongings, such as pictures, ornaments, and small pieces of furniture. All of the residents said that they were happy with their rooms, and that they were kept clean. Residents and visitors with mobility problems are helped to get around the home with the use of handrails, ramps and a stair lift. Aids and adaptations are also in place to help with toileting and bathing needs. The laundry room was clean and tidy. Policies and procedures were in place for the prevention of cross infection. The owners employ an independent consultant to undertake an annual health and safety check of the home and gardens, to ensure the continued safety of the residents, staff and visitors. Care Homes for Older People Page 21 of 29 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 home is properly staffed, which means that the residents are supported by sufficient numbers of trained and well-motivated staff. Evidence: Two staff files were selected, and we saw there is a recruitment procedure in place showing that the necessary recruitment checks are carried out to ensure the protection of residents. References, POVA 1st checks and Criminal Records Bureau (CRB) disclosures had been received for all staff working at the home. Clear records were held throughout the recruitment process. We saw that on occasion staff started work following receipt of the POVA 1st only, while waiting for the CRB to be returned. The owner told us she was aware that this must only happen in exceptional circumstances, and confirmed that these staff always worked under supervision until the CRB arrived. All new staff are given induction training, when they are given guidance and information on their terms and conditions, and working practices in the home. The staff we spoke to confirmed that they felt their induction covered very well what they needed to know to do the job. Care Homes for Older People Page 22 of 29 Evidence: We saw that most of the staff at the home were long term employees, so offering continuity of care. Staff told us about training they have received, finding it relevant to their role, and helping them to understand and meet the individual needs of people. The manager told us in information sent to us that 24 of the 29 staff (82 ) have obtained National Vocational Qualifications (NVQ) in care. A training matrix showed a variety of training that staff have attended, for example covering food hygiene, abuse awareness, medication awareness, health and safety, moving and handling, dementia and challenging behaviour, catheter care and infection control. The staff rota we saw showed that there is always a good level of care staff on duty to meet the needs of the residents, as well as the manager, the owner, domestics, laundry assistant, and the cook when she is on duty. Staff told us that they felt well supported with regular contact with the manager. Its a team of staff here and we all work together to make sure people are looked after. There are good communication systems used in the home, and the manager is very easy to talk to, said one staff member. The staff told us about the staff meetings they had with the manager and owner, and about the 1:1 supervision and appraisal sessions they had. A resident told us staff were very good at Caring for residents Care Homes for Older People Page 23 of 29 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 owners lead a team of staff who work to make sure people who live at the home are as safe and comfortable as possible. Their aim is to continually improve services and so provide a good quality of life for residents. Evidence: The present owners have managed and owned the home for about 25 years, and continue to have a daily input into the provision of the service. They also employ a staff member who helps them to manage the home, and who has achieved the Registered Managers Award and NVQ level 4 in care, as has one of the owners. The owner and staff told us that there is an open door approach to management in the home, and we saw staff and residents calling into the office freely and easily chatting with the owner. We found residents are encouraged to be involved with the running of the home, and their suggestions have prompted changes to things such as menus and increased numbers of en suite facilities. Care Homes for Older People Page 24 of 29 Evidence: The owner told us about how residents are encouraged to be involved in decision making, and how they measure their satisfaction with the use of anonymously completed surveys. These are also provided to relatives and other professionals. A communication book to pass on daily information about residents, and a shift handover session, ensures all staff on duty are up to date with events in the home. We saw that staff receive supervision sessions from the manager, and annual appraisals, which identify any problems or training needs. We saw that the home follows strict procedures regarding residents finances, and where needed maintain good records and receipts, and good liaison with relatives. Records showed that maintenance and servicing checks of equipment were up to date and correct. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 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 must be administered from the original container, with the MAR signed by the person administering it. There must be no secondary dispensing To minimise the chances of any errors being made 26/02/2010 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 3 The prospective resident or their relative should sign the pre-admission assessment to show their participation in and agreement with the assessment of care they require. There should be daily notes linked to the care plan of each resident to give a full picture of their day to day life in the home. When used, body maps should be kept up to date to reflect the residents present circumstances. All staff who are involved with administering medication to residents should attend accredited medication awareness training. 2 7 3 4 8 9 Care Homes for Older People Page 27 of 29 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 5 9 Any handwritten entries on the MAR should be signed, witnessed and countersigned, to minimise the chance of errors in transcription. Care Homes for Older People Page 28 of 29 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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