Care Home: Beechcroft Green Nursing Home

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What the care home does well The home provides a safe, well maintained homely environment for the service users. Service users and relatives voiced satisfaction with the environment, which is maintained well and has an annual improvement plan. Outdoor spaces are very attractive and service users commented that they enjoyed sitting outdoors in the garden in the warmer weather. Assessments and care plans are detailed and inform the practices of the home to meet the needs of the service users. Staff report that they could easily care for a service user from the information recorded in care plans. Service users` healthcare needs are provided for by a variety of visiting professionals. Service users felt safe and secure and happy that staff could look after them properly and treated them with respect. The home`s routines are flexible and it promotes the right of service users to make choices for themselves and exercise personal autonomy within their activities of daily living. A well balanced and varied diet is offered to service users. This can be adjusted to meet their own needs and preferences. Service user`s comments on the food were very positive. The home has a programme of activities that is organised by an activities co-ordinator and is planned around service users` past recreational hobbies and preferences. Whilst talking to service users and the surveys received from relatives and staff provided positive comments about living and working at the home. `Caring and supportive staff`. `Very happy with the home and it feels like home`. `The matron is very supportive`. `I am very content here`. `The staff are wonderful with mum`. `The staff are always happy, friendly and caring`. `The home has helped me tremendously and I hope to go home. They get me a paper every day and any post I receive`. `The nursing care and food are very good here`. `Excellent laundry system and meals are varied and there is always a choice`. `Activities are excellent and the food is good`. `The home is clean and there are never any offensive odours, no complaints at all`. What has improved since the last inspection? There were no matters of concern arising from the last inspection of the home. The AQAA has identified many improvements over the last twelve months some as being; The manager has promoted named nurse and carer teams which has motivated the staff to take responsibility for care plans and documentation for specific service users. A new care planning system has been introduced and this is person centred and identifies care needs and risks. Care plans inform practices and staff say that it gives them all the information to enable them to meet service users` needs. The home has purchased some profiles beds with an ongoing programme to replace all beds with profiles beds The lounge area and some bedrooms have been redecorated and new furniture purchased for the those area. The home provides a wide range of training opportunities for all levels of staff in all departments. . What the care home could do better: The medication trolley should be made secure to the wall or kept in a locked environment. If prescribed medication is transcribed by a member of staff onto the medication administration record (MAR) chart, this should be signed by the person transcribing and a second member of staff sign to verify that the information transcribed is correct. Key inspection report Care homes for older people Name: Address: Beechcroft Green Nursing Home 1 Anglesey Road Alverstoke Gosport Hampshire PO12 2EG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Janette Everitt     Date: 3 0 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 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 34 Information about the care home Name of care home: Address: Beechcroft Green Nursing Home 1 Anglesey Road Alverstoke Gosport Hampshire PO12 2EG 02392585512 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: beechcroftgreen@contemplation-homes.co.uk www.contemplation-homes.co.uk Contemplation Homes Ltd care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 25 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Old age, not falling within any other category (OP) physical disability (PD) Date of last inspection Brief description of the care home Beechcroft Green Nursing Home is located in a residential area of Gosport with easy access to public transport and the town centre. A former rectory and family home the building was converted and extended for its current use as an establishment that provides nursing care. It has bedroom accommodation on two floors and access to the first floor is provided by a passenger lift. The bedroom accommodation comprises 19 single rooms of which 14 have en-suite WCs and 3 shared rooms. Facilities and services include assisted baths, two communal rooms on the ground floor, a secluded Care Homes for Older People Page 4 of 34 0 25 Over 65 25 0 Brief description of the care home enclosed rear garden that is readily accessible, full board and laundry. Contemplation Homes Ltd owns the business, and the company own several other care homes in Hampshire, including another one in the immediate locality. Information on the range of fees can be obtained from the home. The fees do not include the cost of hairdressing, chiropody, newspapers, magazines and transport. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The site inspection visit to Beechcroft Green Nursing Home, which was unannounced, took place on the 30th September 2009 and was attended by one inspector. The registered manager, Mrs R Metelko assisted us throughout the inspection and was available to provide assistance and information when required. For the purpose of this report and being a representative of CQC, the inspector will be referred to as we and us throughout. The visit to the home formed part of the process of the inspection of the service to measure the service against the key national minimum standards. The manager had returned the Annual Quality Assurance Assessment (AQAA) which gave us detailed information and the focus of this visit to the home was to support the information stated in this document and other information received by the CQC since the last fieldwork visit, which was a key inspection on the 4th October 2007. Care Homes for Older People Page 6 of 34 Documents and records were examined and staff working practices were observed where this was possible without being intrusive. We toured the home and spoke to twelve service users, staff and visiting relatives in order to obtain their perceptions of the service the home provides. Those spoken to were very happy and complimentary about the care and services that are provided. Surveys had been distributed to service users, care managers, GP and other visiting professionals. Seven (7) service user surveys were returned to CQC. There was no response from other surveys distributed. The outcome of the surveys and talking to service users indicated that there was a high level of satisfaction with the service and that generally service users are pleased with the care the home provides. At the time of the visit the home was accommodating 25 residents of mixed gender. A small number of residents were unwell and unable to communicate effectively with us to gain their views of the service. There were no residents from an ethnic minority group. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? There were no matters of concern arising from the last inspection of the home. The AQAA has identified many improvements over the last twelve months some as being; The manager has promoted named nurse and carer teams which has motivated the Care Homes for Older People Page 8 of 34 staff to take responsibility for care plans and documentation for specific service users. A new care planning system has been introduced and this is person centred and identifies care needs and risks. Care plans inform practices and staff say that it gives them all the information to enable them to meet service users needs. The home has purchased some profiles beds with an ongoing programme to replace all beds with profiles beds The lounge area and some bedrooms have been redecorated and new furniture purchased for the those area. The home provides a wide range of training opportunities for all levels of staff in all departments. . 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 34 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 34 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 has procedures in place to ensure that service users needs are assessed prior to admission to the home to ensure the home can meet those needs. Evidence: The AQAA told us that pre-admission assessments are carried out by the appropriate trained nurses regardless of funding and any external assessment processing having been completed. A sample of three service users plans was viewed. These evidenced that the manager or her deputy undertake the pre-admission assessments and visit the person in hospital or in their own homes to undertake the assessment and to discuss with the person about moving into the home. The manager told us that she does receive social care needs assessments from care managers if the social services are involved and she also requests discharge summaries from hospitals to enable the home to gather as much information as possible about the person. Care Homes for Older People Page 11 of 34 Evidence: The assessment tool used is comprehensive and briefly covers all aspects of a persons physical, social and psychological needs and gives a base for a more comprehensive assessment of residents needs when they move into the home. The AQAA told us that the pre-admission assessment paperwork is to be reviewed in the coming year to reflect a more person-centered approach and refer to the Mental Health Act 2005 and the persons capacity to make decisions. Six of the seven service users surveys returned to CQC indicated that service users had received sufficient information about the home before they decided to move into the home. A service user spoken to at the time of this visit told us that her friend chose the home and she visited the home before she made the decision to move in. Care Homes for Older People Page 12 of 34 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 home puts the person at the centre of all care planning to ensure that the personal and health care needs of service users are met and medication is managed safely and effectively. Service users privacy and dignity is upheld and promoted. Evidence: The AQAA told us that the home provides comprehensive packages of care that are person centred. These include risk assessments, which are reviewed monthly or as required if conditions change and that promote indepenence, lifestyle, choice and fulfilment whilst still protecting the service user from harm. A sample of three service users care plans was viewed. The care plans address all activities of daily living and record the service users needs both long term and short term. The care plans demonstrated a comprehensive, person centred approach to assessment and care planning. The documents examined were detailed and the plans were based on the assessments the home carried out in order to identify individuals care needs. Care Homes for Older People Page 13 of 34 Evidence: Assessments included a range of potential risks to residents e.g. pressure sores, falls, moving and handling, nutrition, and a risk assessment if bed rails were in use. Where a risk was identified there was a corresponding care plan on how to manage the risk. If bed rails were in use there was a signed consent from the service user for their use. For those who are unwell and remained in bed, care plans include effective monitoring of daily fluid, nutrition and changes of position. records of which were seen in the individual rooms. The manager told us she monitors these daily. The care plans contain personal profiles and document the persons likes, dislikes and how the service users wish to undertake their daily routines. Records indicate that care plans are reviewed monthly or if a persons condition changes, and daily notes record the actions taken by staff to provide the support set out in the care plan. Care plans were in most cases signed by the service user or their representative to evidence their involvement and consent to the plans. Service users health care needs are met by a variety of health care professionals that visit the home. There is a separate document in care plans that records the visits of all health care professionals who attend the home. There was evidence in care plans that one service user had been visited by the community multidisciplinary team and the speech and language therapist to undertake assessments. On the day of this visit the occupational therapist was visiting a service user to assess them for a new chair. The community psychiatric nurse also visits the home regularly to review medication for those under her care. The physiotherapist visits the home fortnightly to see one service user. All service users have access to a chiropodist service every six weeks, the community dentist at the local hospital and an optician that will visit the home. On the day of this visit one service user requested to see an optician to enable him to obtain a spare pair of glasses and the manager said she would arrange this for him. The home has policies and procedures in place for the management of medications. The home uses a monitored dose system that is supplied by the local chemist and boxes and bottles are dispensed for when required (PRN) medications. The home has two medication trolleys, one is stored upstairs and one downstairs. It was observed that the downstairs medication trolley, which is a new acquisition to the home, was not attached to the wall. The security of this was discussed with the Care Homes for Older People Page 14 of 34 Evidence: manager who she said she would arrange with the maintenance man to put a fixing plate on the wall straight away. The upstairs medication trolley was attached to a wall on the first floor. The positioning of the medication trolley downstairs was discussed with the manager who told us that space is of a premium in the home and that this was the safest place to keep the trolley until such times as the anticipated alterations to the home are complete. The cupboards and trolleys which store medication were well organised and clean. There was no evidence that medication that is used on a PRN basis was overstocked in the cupboards. The home has a controlled drug cupboard and controlled drugs are stored safely. The stock and records for these drugs was checked and the balance of stock being stored matched that recorded in the controlled drugs register. The medication administration recording (MAR) charts were looked at. These had been signed appropriately and no gaps identified. Reasons for non administration was being recorded appropriately by code and on the back of the MAR chart. There were individual photographs of the service users on the front of each MAR chart to ensure correct identification. It was observed that on one MAR chart the prescribed medication had been transcribed by a member of staff but not signed. This was discussed with the manager and it was discussed that any transcriptions onto MAR charts should be signed by a second member of staff to say that correct information has been transferred. There was one service user choosing to self-medicate eye drops and this was undertaken within a risk assessment framework and regularly monitored by the staff. The AQAA told us that privacy, dignity and residents rights form an integral part of staff training. This was evident when observing the practises throughout the visit and the interactions between staff and service users, which confirmed that respectful relationships exist between service users and staff. Most service users are accommodated in single rooms and they say they appreciate the privacy that this affords, and particularly those that have the benefit of en-suite WCs. Service users surveys returned to CQC quoted nursing care is very good.Most staff are very friendly and helpful and they have helped me to rehabilitate so I can hopefully go home. The home does everything very well.They look after me very Care Homes for Older People Page 15 of 34 Evidence: well. The nurses are very good and I have progressed to be able to stand and walk a few steps now and feed myself again.All staff are very friendly. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home organises a range of social activities that provides stimulation and it also promotes service users independence, enabling them to exercise choice about all aspects of their daily life. Service users are able to maintain links with relatives and the local community. The dietary needs of residents are catered for with a balanced and varied selection of food available that met their tastes and choices. Evidence: The AQAA told us that personal profiles in the form of My Life Books are completed for each service user by them or with the help of families and friends. It is the information from these that are used to write the social care plans related to the service users interests and hobbies. We viewed good social history records that the home compiles for each service user when being assessed and added to on admission to the home. The activities organiser also maintains an individual record for each service user of what activity they have chosen to take part in and their level of participation and enjoyment. The home employs a person for twenty eight hours per week specifically to organise and co-ordinate an activities programme. At other times carers are designated to take Care Homes for Older People Page 17 of 34 Evidence: on this role. The activities programme is produced on a monthly basis and is individual to all service users, who receive a copy of this to their rooms. At the time of this visit the activities co-ordinator was a day off and the carers were undertaking the role in her absence. The activities programme is varied and demonstrated that entertainers attend the home frequently to play board games, quizzes and cards. A weekly armchair exercise class is enjoyed by service users, which happened to take place at the time of this visit. Service users spoken to and a comment on a service user survey received by CQC said that they thoroughly enjoy the exercise class and wished they could have them more frequently. For service users who prefer to stay in their room, the co-ordinator will plan an individual programme of one to one activities of the service users choice, for when she visits their rooms. Parties are organised for special occasions. The home has a number of photograph albums on display that recorded the garden parties and parties for other festive times of the year when friends and families are invited to participate. A large library of videos is available for residents to use. A mobile library visits the home regularly. The home has regular church services and weekly Roman Catholic pastoral care. We spoke to a service user who had recently moved into the home and he said that at the present time he does not join in the activities but enjoyed sitting watching and that when he becomes more familiar with the home he will take part in more home life. Surveys received from service users indicate that there are usually or always activities arranged to take part in. Comments said Perhaps more voluntary groups could visit the home to give us more company as the staff are so busy. The activities are excellent and wish we could have more and more exercise classes. The home has an open visiting policy and the visitors book demonstrated that the home has visitors to the home every day. One visitor spoken to told us that they are very satisfied with the care being given to their relative and the home is very caring. Families do visit the home to take their relatives on outings into the community or visits to their homes. Although most residents have handed over the responsibility of the management of their finances to relatives or representatives, a number of individuals continued to control their own financial affairs. The manager told us that a visiting advocacy service is made available to those residents who may need this service. Care Homes for Older People Page 18 of 34 Evidence: The AQAA states that the home has a named nurse and carer team system to ensure that routines of the day are flexible, respecting individual choices. Service users spoken to said they are able to spend the day how they wish at their own pace. One lady saying she preferred to stay in her room in the mornings to listen to her music, another saying she was able to come and go as she wished. The inspector observed that the staff were not rushed and people were being assisted to get up at their own leisure. Service users have choice over how they undertake their activities of daily living and this was evidence throughout this visit that service user were being given choices. A service user spoken to told us that the staff are very good and that she is able to spend her days in her room, which she enjoys and that she is only persuaded to sit in the lounge if the housekeepers wish to clean her room. She said she had friends visit her most days and the vicar called regularly to give her communion. Service users were quite complimentary about the food provided and confirmed that they have three meals a day and could have snacks and drinks at other times. Comments on surveys returned to CQC told us that I have no complaints about the food. The food is very good.The meals are varied and each person has a choice from a weekly list. Tea and coffee is available at any time and is always offered to visitors. Food is very good. Another service user spoken to told us that he has the choice of a cooked breakfast every day but chooses to have this twice weekly and thoroughly enjoys the Full English the chef produces. The menus were viewed and indicated that the food was nutritious and there was a wide range of meals provided with choices every day. The list of menu choices for the week was also on display in the entrance hall to the home. One service user told us they receive a weekly menu which gives them choices at each meal time. Individuals food preferences, dislikes and any food related allergies are recorded in residents care plan documents. The catering staff told us that they are very familiar with the food preferences of the residents and that special diets and needs are catered for e.g. soft and pureed meals and vegetarian. Service users can choose where to eat their meals and many preferred to eat in their rooms. It was observed that a small group of service users choose to eat in the dining Care Homes for Older People Page 19 of 34 Evidence: area of the lounge and this appeared quite a social occasion for them. We observed individual trays were laid up for service users with cutlery, condiments and napkins. And jugs of fresh juice were in each service users room and in the lounge area and hot beverages were served throughout the day. We viewed a sample of fluid and food charts that were being recorded for those service users who were unwell and not taking diet and fluids independently. The records were well maintained and recorded appropriately. The care plans evidenced that nutritional risk assessments are undertaken on all service users at the point of admission and care plans are written for those identified as being at risk. Care Homes for Older People Page 20 of 34 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 home has a clear and satisfactory complaints procedure to address the concerns of service users and relatives or representatives. Robust procedures are in place to protect service users from the risk of abuse. Evidence: The AQAA said that the complaint policy has been reviewed to ensure the procedure is clear and simple and there is an advocacy service available for those who lack capacity. The complaints procedure is made available to all service users and is displayed on the notice board in the home. It is also available in other formats. All staff are made aware of the procedure. The AQQA records that one complaint has been logged in the past twelve months and had also been made via CQC. The complaint procedure was followed and the log recorded that the complaint had been resolved and appropriate procedures had been followed. All complaints are logged and reviewed through Regulation 26 visit reports by a senior manager. The manager told us that as a result of this complaint the home had recognised faults and worked on routines and protocols to ensure good practise. Surveys returned to CQC and speaking to service users and their relatives told us that people are aware of who to go to if they wish to make a formal complaint. Comments said I have never had to complain I have nothing to complain about but would talk Care Homes for Older People Page 21 of 34 Evidence: to matron if I did. The home has written procedures available for adult protection and includes No Secrets policy, restraint and Whistle Blowing. These are intended to provide guidance and ensure as far as reasonably possible that the risk of service users suffering harm is prevented. The AQAA said that all staff have received training in the Safeguarding of Vulnerable adults in line with Hampshires Adult Protection Policy and this is discussed at supervision sessions with staff to ensure their knowledge is underpinned. Staff spoken to said that they have received training about safeguarding adults and an examination of staff training records, and viewing the training matrix, confirmed this. The home has not had to report any Safeguarding issues since the last inspection. All staff have received training in the Mental Capacity Act. The training matrix evidence that this has taken place. The manager has undertaken training on the Deprivation of Liberty Safeguards (DOLS) and this is to be cascaded to all members of staff. Where the need has been identified to use bed rails on a service users bed for their own safety, following a risk assessment, written permission and consent for their use was evidenced in a care plan and signed by the service user or their representative as agreement for their use. The home has robust recruitment procedures that ensure that staff have Criminal Record Bureau (CRB)and Protection of Vulnerable Adults (POVA) checks received before they commence employment. Care Homes for Older People Page 22 of 34 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 homes environment is safe and well maintained. There is an infection control policy and procedures in place and staff practice ensures that as far was reasonably possible service users are protected from the risk of infection. Evidence: The AQAA states that the environment is welcoming and the rooms are adapted for individual use and choice. The home has an ongoing maintenance programme of fabric and decoration of the home. The garden is well maintained and colourful and residents have access to this and enjoy sitting in the garden in finer weather. We looked around the home and visited a number of service users rooms. The rooms were pleasantly decorated and had been made very individual with personal items of furniture, pictures and photographs. One room visited had a views of the road and ongoing activity and the service user said she had the best room in the house, I love to look at what is going on outside. The surveys received by CQC from service users indicated that the home is usually clean and fresh and those spoken to at the time of this visit said they are generally happy with their environment. At the time of this visit the exterior and interior of the premises, its decor, furnishings, fittings and equipment were in good repair. The home was clean and no offensive Care Homes for Older People Page 23 of 34 Evidence: odours detected. The manager told us that the lounge area has been redecorated and new furniture obtained for this room. The lounge over looks the garden which, in summer, service users said is pleasant to sit in. A dining area has been formed in the lounge for those wishing to eat together. The other part of the lounge has a table and chairs in it but is also used to store the activities equipment and one of the medication trolleys. This was discussed with the manager and is discussed in standard 9. The home employs a maintenance person to undertake minor repairs and on going maintenance jobs every day and who also maintains the gardens. He was on holiday at the time of this visit and the manager told us the garden was not looking at its best. The lounge area looks out onto the pleasant gardens, which service users reported, they enjoy sitting in or looking onto. A service user told me that the vegetation had been cleared from outside her room and she could now see right down the garden and found a great deal of pleasure with this outlook. The home has created a wet room from one of the original bathrooms and the manager said this is proving to be a great success and service users are favouring this type of shower rather than a bath or conventional shower. The manager said she is involved with forming the annual improvement plan for the home and she will discuss with her manager the alterations or improvements for refurbishment to the home for the coming year. The AQAA lists the improvements to the home in the last year and these include the purchase of 4 new profile beds and new carpets and soft furnishings to a number of bedrooms and the lounge area. The manager told us that there are plans to create more office space, which will in turn allow more storage space for the activities equipment and the downstairs medicine trolley, which are currently stored in the smaller lounge. The AQAA states the home has an infection control policy in place and staff have been trained, many having completed the NCFE level 2 in MRSA awareness. The Environmental Health Officer (EHO) has visited the home and given an excellent report. The home had comprehensive procedures in place concerned with infection control. The training matrix and records identify that infection control training has been provided for staff at induction and ongoing annually. Staff spoken with confirmed that they have received this training a and demonstrated an awareness of what infection Care Homes for Older People Page 24 of 34 Evidence: control meant. It was noted that in accordance with best practise all communal WCs that were seen were provided with liquid soap dispensers and paper towels. Protective clothing was readily available and staff were observed using gloves and aprons appropriately. There were sluice disinfectors available on both floors of the home. The homes laundry although cramped and quite small, was appropriately sited and equipped. The manager told us that there are procedures and training in place in the case of pandemic flu and all ancillary staff have received appropriate training in case they are needed to undertake care. The home has an environmental risk assessment and all service users have a personal emergency evacuation plan which is kept in their room in case of an emergency. Care Homes for Older People Page 25 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an appropriate level and skill mix of staff that ensures the needs of service users are met. The home has clear staff recruitment, training and development procedures that ensured that service users are protected and supported appropriately. Evidence: The AQAA told us that staffing levels are monitored against dependancy levels to ensure the home provides a robust and flexible approach to staffing arrangements with a good skill mix of staff to ensure person centred care is delivered. At the time of this visit there were twenty five service users in residence. The staff rota setting out the minimum number and skill mix deployed in the home as 2 trained nurses and 4 care staff on duty in the mornings, 1 trained and 3 care staff from 1600 until 20:00 and 1 trained and 2 awake care staff on duty from 2000 until 0800 in the morning. The deputy manager is included in the working numbers and the manager is allocated three days per week as management days but other days is also in the working numbers. She told us that she hopes to give the deputy manager one management day a week in the future to allow her time for supervision, training and administration. The manager told us she likes her days as part of the staffing numbers which allows her to keep close to the service users and also supervision of staff. Care Homes for Older People Page 26 of 34 Evidence: The home employs an administrator, maintenance person, two housekeeping staff, a cook, kitchen assistant throughout the week and a laundry assistant as week-ends who incorporates some cleaning duties into her job. We observed throughout the visit that staff were not rushing about and call alarms were being answered quite promptly and staff were demonstrating good teamwork. Service users spoken to told us that they staff are very good and that they supported them well. Surveys returned from service user commented that the home looks after you well. On the whole the staff are very good but I wish they had more time with me. Provide more care staff. Care staff could listen more attentively to what I am requesting. Most staff are helpful and very friendly. The home is committed to staff training. The AQAA tells us that 12 of 20 care staff have achieved their NVQ level 2 and above. The AQAA goes on to tell us that 100 percent of staff are dedicated to achieving NVQ levels 2 and 3 and that 3 of the 20 have NVQ level 3 with four more undertaking is currently. 10 have NVQ level 2 with two more undertaking this. One person has a diploma in Health and Social care with 4 further cares due to undertake NVQ level 2 this current year. The AQAA quotes that there is a good induction programme using skills for care standards for all staff. The manager also takes new employees through the local induction programme at which time she will introduce the Skills for Care induction standards. All trainees are registered on a Skills for Care registration programme. A completed induction programme was seen in a member of staffs file. The home provides a variety of appropriate training. A training matrix and training certificates in personnel files evidenced that staff have undertaken all mandatory health and safety training and a variety of other training is offered according to staff role. Staff spoken to at the time of this visit said they are offered and receive a great deal of training that is appropriate to their role. The manager has introduced a supervision and appraisal programme. There was evidence in the staff files of supervision records and yearly appraisals at which time the manager said training needs are discussed. The home has robust recruitment practises.The AQAA said that all new staff are employed on a three month probationary period which is then reviewed against the induction standards before employment is confirmed. We viewed a sample of three Care Homes for Older People Page 27 of 34 Evidence: recruitment files of staff most recently employed at the home. The files evidenced that all recruitment checks for the Criminal Records Bureau (CRB) and the Protection of Vulnerable Adults (POVA) had been received with two references before employment commences. All staff undergo an induction period when they first commence employment. The files also evidenced that the home employs a mixed culture group of trained nurses and carers. Care Homes for Older People Page 28 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a management team in post that provides effective leadership. There were systems and procedures in place for monitoring and maintaining the quality of the service provided and promoting the safety and welfare of everyone living and working in the home. Evidence: The registered manager has now been in post for 9 years and is a registered nurse and has also achieved the Registered Managers Award. She has completed her mentorship course and the home now offers placements to student nurses. The AQAA states that the manager in the past year has undertaken further training and development and has undertaken various training courses to develop her management Care Homes for Older People Page 29 of 34 Evidence: role. The manager has appointed a deputy manager who pocesses the registered managers award and is an experienced nurse clinically and brings with her experience from a previous post as manager of another nursing home in the company. The home therefore has a strong management team that is committed to run the home in the best interests of the service users. The manager states that equality and diversity of the service users is paramount in her ethos of care. Staff spoken to and observing the relationship within the care team suggests that the staff respect and have confidence in their manager. The Director of Nursing for the organisation undertakes all senior managers supervision and appraisal meetings. The manager and her deputy regularly attend meetings with the Director of Nursing to discuss issues and have group supervision for the senior nurses. The home has a quality assurance system in place. The home distributes questionnaire surveys to service users and relatives, the reports of the outcomes of which was seen by us with the results indicating a high level of satisfaction with the service. Issues that have been identified through the questionnaires are discussed with staff at staff meetings. These meetings are held regularly and it is where the staff can discuss whatever they wish and are able to dictate the agenda. The AQAA stated and the manager told us that the improvements for the coming year would be to hold more group residents and relative meetings. The manager undertakes auditing the home management systems e.g. care plans, medication, falls, accident recording, weights and pressure sores. The results of these are put into a monthly report that is sent to the head office. The Nursing Director attends the home monthly and undertakes the Regulation 26 reports of her visit. A sample of these were seen and evidenced to be comprehensive in content and covered all standards. The home does look after small amounts of money for some service users. The administrator manages this and the monies were seen to be kept in a locked environment and stored in individual containers for each service user. Records of ingoing and outgoing monies were recorded with receipts. We checked the amount of money held against that on the records for two service users and these balanced. It was observed that no large amounts of monies were being stored at the time of this Care Homes for Older People Page 30 of 34 Evidence: visit. A sample of servicing certificates were examined and indicated that the homes equipment, plant and systems were checked and serviced or implemented at appropriate intervals i.e. passenger lift and hoists, fire safety equipment, gas boiler, portable electrical equipment, hot water system, etc. There were contracts in place for the disposal of clinical and household waste. The inspector viewed the accident recording book and the records were being completed appropriately and copies maintained by the manager for evaluation. Staff said that they attended regular and compulsory fire and other health and safety training. The organisation employs a facilities manager for the whole group of homes and they oversee and support Fire and Health and Safety functions within the home. The deputy matron is a moving and handling trainer and undertakes all staff training in this. The inspector observed a number of hoists in the home and profile beds are gradually replacing existing hospital beds, to promote safe working practices. There was evidence in the training files and the training matrix that all mandatory health and safety training had been completed by all staff and was ongoing. The fire log was viewed and this evidenced that the system and equipment was tested at the appropriate intervals. Care Homes for Older People Page 31 of 34 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 32 of 34 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 The registered person must 10/11/2009 ensure that the trolley containing medication is secured in a safe place at all times. The medication trolley must be secured to ensure safe keeping of service users medication at all times. 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 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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