Care Home: Belmore Lodge

What the care home does well Prospective residents (and/or their relatives) are able to visit the home before making a decision about moving in. Information about the home is given to prospective residents. The home carries out assessments of those referred for possible admission. Care plans are of a good standard. Residents are able to exercise choice in how they spend their time. A full and varied activities programme is provided and there are specific staff who arrange and provide activities, as well as time for one to one with individuals. Trips out are organised and the home has access to a mini- bus for transport. There is a choice of meals for the residents and the food is of a very good standard. The home is purpose built and is of a very good standard. Each bedroom has an en suite toilet or bathroom. There are a number of lounges with good quality furnishings and decor. A computer with internet and e mail facilities as well as a printer are provided. The home also offers residents computer training if they want it. Sky Sports and Movies are provided as part of the contract price along with an LCD television in each person`s room. The gardens are well maintained and attractive. Staff recruitment procedures are thorough. There is a staff training programme and staff receive regular supervision. The home uses a variety of audit tools and methods for consulting with residents about how the home performs and how it can improve. What has improved since the last inspection? The home has developed a Welcome Pack for new residents. A revised medication audit procedure has been devised. The home continues to develop its activities programme. A gardener has been recruited. Ongoing maintenance and redecoration has taken place. Staff have been trained in customer care in response to feedback from residents. What the care home could do better: Improvements are needed regarding the recording of valuables held on behalf of residents for safekeeping. Key inspection report Care homes for older people Name: Address: Belmore Lodge 20 Milford Road Lymington Hants SO41 8DJ     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: Ian Craig     Date: 1 5 1 2 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 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: Belmore Lodge 20 Milford Road Lymington Hants SO41 8DJ 01590674700 01590672495 belmorelodge@coltencare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Colten Care (2003) Ltd Name of registered manager (if applicable) Mrs Karen Jane Maidment Type of registration: Number of places registered: care home 55 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 who can be accommmodated is: 55 The registered person may provide the following category/ies of service only: 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 categories: Old age, not falling within any other category - OP Physical disability - PD Date of last inspection Brief description of the care home Belmore Lodge is one of several care homes owned by Colten Care (2003)Ltd that are situated in the locality. It is a purpose built establishment that opened in November 2003 and it provides both personal and nursing care for up to 55 older people. It was registered to Colten Care (2003) Ltd. on 02/08/09. Care Homes for Older People Page 4 of 29 Over 65 55 0 0 55 Brief description of the care home Located in a residential area and on a bus route, the home is approximately a mile from the town centre of Lymington, where the facilities and amenities are available to the service users. The homes accommodation is provided on three floors and there is a passenger lift to all levels. All bedrooms are single and have en-suite WCs. The home is well provided with equipment and aids designed to assist people living there be more independent, such as hoists, assisted baths and grab rails in corridors. The home also benefits from large gardens that are accessible to the service users including wheelchair users. 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: 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 inspection consisted of an unannounced visit to the home, which lasted 7 hours. A tour of the building took place. Records, documents, policies and procedures were looked at. Surveys were sent to staff and residents as well as professionals connected to the home asking for their views about the service. These were returned by 15 residents, 3 staff and 3 professionals. Information contained in the surveys has been used for this report. 12 of the residents surveys were completed with the assistance of a member of staff. A more independent source of help with the surveys would have allowed residents greater independence to express their views. 4 residents and 2 staff were spoken to during the visit. 2 residents relatives were also spoken to. Care Homes for Older People Page 6 of 29 Discussions took place with the manager, the Operations Manager, an advisory manager and the Activities Co Ordinator Manager. Care services are required to complete an Annual Quality Assurance Assessment (AQAA). This was completed and returned to the Commission. Information given in the AQQA has been used for this report. Care Homes for Older People Page 7 of 29 What the care home does well: 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. Care Homes for Older People Page 8 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are able to make an informed choice about whether or not to move into the home. The home takes steps to ensure that it accommodates only those whose needs it can meet. Evidence: The home has a document called, Statement of Purpose and Information for our Residents. This contains information about the the homes management and staff as well as the homes philosophy, aims and values and details of the service provision such as meals. The document also includes the complaints procedure. In addition to this, the home also has a brochure with information on the homes activities, menus and significant events. The home also produces its own newsletter which includes details of events and changes at the home. Care Homes for Older People Page 11 of 29 Evidence: 10 residents who returned a survey say that they received enough information about the home before moving in and that this helped them decide it was the right place for them. 3 people said that they didnt receive enough information although one person said that this was because the admission was arranged in an emergency. 2 people said that they did not know if they received any information. The AQAA states how prospective residents are able to come and look round the home and to have a meal to see if it meets their expectations. The process of assessing prospective residents needs before being admitted was looked at for 4 people recently accommodated. Records show that each persons needs are assessed before they are admitted. The manager explained that this is completed by either herself or the Head of Care. The assessment documentation was found to be comprehensive and covers the following needs: personal details such as name, preferred name and next of kin details, daily life including a life diary and preferred daily routines, communication, mental well being, maintaining a safe environment, eating and drinking, elimination, personal cleansing and dressing, skin integrity, controlling body temperature, sleeping, pain, medication, breathing, any advanced care arrangements and the expectations of relatives. 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. Residents health and personal care needs are met although there is room for improvement in the way that staff respond and interact when providing care. Evidence: Each resident has a care plan. These give details how each persons care needs are to be met and include the following: communication, mental well being, mobility and walking, care dressing/undressing, pressure sore prevention, night time care plan for helping sleep pattern, pain management and medication. Care records also include a social and life history. A Daily Life Plan includes details of each persons preferred routines for daily living such as getting up and going to bed. Residents confirmed that they are able spend their time as they wish and that they get up when they wish. Where possible the residents and/or their relative signs the care plan to acknowledge the content. The homes management carry out an audit of the individual care plans and the tissue viability of each person. A record of this is made. The manager also carries out an Care Homes for Older People Page 13 of 29 Evidence: audit twice a week when she asks a sample of residents questions about the delivery of care, such as, Was your room left tidy? Moving and handling needs are assessed and recorded with a care plan for staff to follow. These include risk assessments and assessments of the likelihood of falls and action to minimise this. The home has a number of aids and adaptations for assisting with mobility. A nutrition risk assessment is carried out and a record is made to show that individual residents weight is monitored. Records show that health and personal care needs are regularly reviewed and updated. Staff say that the home meets the health and personal care needs of the residents. Comments were made that residents are looked after on an individual basis. Each resident who returned a survey says that he or she receives the care and support they need, although 1 person said that this is only sometimes the case. A relative described the standard of care as being very good and that his/her relative is looked after well. Comment was made that his/her relative is shaved each day, has clean clothes and always looks well presented. 2 residents commented that the delivery of care was variable from staff to staff member and that some staff carry out care routines without speaking to the resident. Two people said that the personal care routines were not always correctly followed. Residents say that staff are available when they need them, although 3 people said that the staff response when they ask for help by using the call point in their room is sometimes too slow. This was discussed with the homes management who are commited to improving this, and already carry out their own audit of staff response times to activating the call point. Surveys from health and social care professionals state that the home respects the individual residents privacy and dignity. One of these surveys said that the home is excellent in promoting the privacy and dignity of the residents. Residents described the staff as helpful, kind and polite. Residents are able to exercise their right to privacy by using the door handle to lock their door when they are in their room. The previous report identified that some of the residents had not been offered a key to their bedroom door for privacy and security. Since that time the manager states that this facility has been offered to residents, but that a record has not been made to Care Homes for Older People Page 14 of 29 Evidence: demonstrate this. At this inspection 3 residents said that they have not been offered a key to their bedroom door. The homes medication procedures were looked at. Staff sign a record each time medication is administered to a resident. A sample of medication stock was looked at for one person which showed the quantity matched the records. A controlled drug register is used where two staff record a signature to say that they have witnessed the person taking the medication and the remaining balance which is recorded. A sample stock of medication was checked, which showed the amount remaining tallied with the records. Staff receive training in the handling and administration of medication. This was confirmed from staff and from training records. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides an extensive and varied range of activities and stimulation for the residents. Links with the community are promoted and residents are able to exercise control over their daily lives. There is a choice of food and meals are of a very good standard. Evidence: 11 of the 15 surveys returned by the residents state that there are always activities arranged by the home. 2 people said that these are usually arranged, 1 person said sometimes and 1 person did not respond. Residents and relatives spoken to on the day of the visit gave very positive comments on the activities provided although 2 people said that there was less to do at the weekends. A resident described how he/she has been on outings to a Chinese restaurant, to 10 pin bowling, and to a safari park. Relatives confirmed that there are regular fetes and garden parties where money is raised for charity. A resident said how much he/she likes to spend time in the garden in the summer and that activities take place there when the weather is warm. He/she also commented that he/she has a daily newspaper delivered and that he/she particularly likes the scrabble and dominoes games. Care Homes for Older People Page 16 of 29 Evidence: A noticeboard in the hall gave details of the activities being provided for the day, which residents were observed taking part, in as follows: 10.00 am dominoes, 11.00am quiz, 11.30am quoits, 2.00 pm entertainment from visiting singers and 3.30pm scrabble. A notice also gives details of the activities for the month of December 2009. This includes several activities each day, including the following: dominoes, scrabble, quizzes, communion, movies, musical entertainment, a kitten visit, sherry and chat, garden walks, mobile library, arts and crafts and a Christmas shopping trip to Bournemouth. The home has access to a mini bus one day a week for outings. The home has a full time activities organiser who has completed a National Vocational Qualification which includes a specialism in activities for older people. There is also a staff member employed for 40 hours per week whose role is to engage residents in one to one activities and discussion. This person also works at the weekends. The organisation has a manager with responsibility for coordination and supervision of those providing activities for the residents. The inspector met the activities coordinator manager who explained her role and how the home promotes residents having access to a full range of activities and stimulation. The home has a room which is used for activities. This includes craft equipment, books, table games such as table croquet and photograph displays of residents taking part in activities. A resident has his own table croquet in the activities room,which is played by some of the residents. Records are maintained of activities that each person takes part in so that residents needs are monitored. Residents can have a daily newspaper delivered. A selection of daily newspapers are provided by the home in the reception area. Gentle physical exercise classes are available as part of the activities programme. A computer is available for the residents to use in one of the lounges. This has internet, e mail and print facilities for the residents. A resident was observed using the computer. Staff commented that activities are provided to the residents who can choose whether Care Homes for Older People Page 17 of 29 Evidence: or not they wish to join in. Residents are able to choose how they spend their time and the times they prefer to get up and go to bed. This was confirmed from discussion with people on the day of the visit. Residents are also aware that they can bring items to the home such as their own furniture. Some of the residents have their own telephone in their rooms and there is a pay phone on a mobile stand so that it can moved for residents convenience. Residents meetings take place where they are able to make suggestions about any improvements. This was also confirmed by one of the residents. The home has a number of communal areas so that residents can meet relatives. The home also makes space for residents to entertain visitors. Residents are asked a day in advance what they would like to eat for the midday meal. This is recorded. The daily menu is displayed outside the dining room. The midday meal on the day of the visit was: lamb and summer vegetable stew, or, cod in parsley sauce, or, cauliflower and broccoli bake, or, a variety of omelettes. This was served with roast butternut squash, green beans and creamed potatoes. Dessert was a choice from pineapple and peach pudding, or, assorted ice creams, or, stewed fruit, or, a sweet trolley. Residents confirmed that there is a choice of food at each meal time and that they can chose to eat the food in their rooms if they wish. One person said he he/she likes to have a cooked breakfast, which was recorded on a chefs assessment of the persons food preferences. 13 of the 15 resident surveys state that they always or usually like the meals. 2 people said that they only sometimes like the meals. 1 person commented that the meals could be served hotter and another person said that the toast is not warm enough. Residents confirmed that there is a choice at each meal. Snacks and small meals are available in between the 3 main meals. Residents are able to make suggestions about the food at a food committee. Specialist diets are catered for and the chef meets with the homes management on a weekly basis to discuss the special dietary needs. The home employs staff to serve meals and residents were seen to get help with eating where it is needed. Care Homes for Older People Page 18 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 home has an effective complaints procedure and takes steps to protect residents from possible harm. Evidence: The homes complaints procedure is contained in the Statement of Purpose. 12 of the 15 residents surveys state that there is someone available to speak to if they are not happy. 2 people replied that there isnt someone available and 1 person did not answer the question. 12 people said they are aware of the homes complaints procedure and 3 people said they are not. There have been 7 complaints since the home registered. A record of these has been kept alongside details of how the service dealt with the complaint plus correspondence to the complainant. These records show that the service recorded and dealt with 2 matters that could be classed as enquiries rather than complaints. The homes management stated that these were recorded as complaints as the service is conscientious in recording and dealing with any matters raised that might be a complaint. 3 of the complaints concerned the attitude of staff. Records show that these have been addressed with the staff. There has been one theft in the home since it was registered. This was referred to social services under the safeguarding procedures. Additional security measures have been put in place. Care Homes for Older People Page 19 of 29 Evidence: 2 residents have developed pressure sores and these were referred to social services who report that the home has addressed this area of client need. The service has safeguarding procedures including a copy of the local authority procedures for dealing with any suspected abuse plus Department of Health literature on the subject. Staff receive training in this area as part of their induction when they start work and at least once a year thereafter. This was evidenced from training records and from the staff and management. The home plans to extend this training to once every 6 months. The AQAA identifies that the home could be better by ensuring that staff receive training in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The manager has attended this training. Care Homes for Older People Page 20 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a purpose built environment with excellent facilities and furnishings which enhances their daily lives. Evidence: The home is purpose built. There is a car park at the front and gardens to the rear, which are landscaped and well maintianed with lavender walk ways and seating areas for the residents. Residents can get to the gardens from level access via the lounge patio doors. There is an entrance area with a reception desk and seating for visitors. Daily newspapers are available in this area for visitors and residents. The newspapers are provided by the home. Communal areas consist of two lounges on the ground floor, a lounge on the first floor and a library/activities room on the second floor. Residents are able to use the first floor lounge for entertaining guests; this also contains a computer with internet, e mail and a print facility for residents to use. There is a hairdressing salon on the ground floor. There is a kitchenette on the first and second floors, which residents and their relatives can use to make drinks. Notices are used around the home to give information to residents about the nurses Care Homes for Older People Page 21 of 29 Evidence: and staff who are on duty, activities and menus. Each bedroom is single with its own en suite toilet or bathroom. Bedrooms contain personal possessions such as furniture, books, crafts and pictures and ornaments. Each bedroom is provided with an LCD television with Sky Sports and Sky Film channels as part of the contract price. Each room also has a telephone point and several residents have their own telephone. Residents said how much they like their bedroom and the communal areas. There are 7 bathrooms, 6 of which have a specialist bath and there is a walk- in shower room. Furniture and fittings were found to be intact and clean. The home is clean with an absence of any unpleasant odours. Communal areas are served by an air conditioning system. Surveys from residents state that the home is always fresh and clean. There is a laundry area. Staff receive training in infection control. There are 2 passenger lifts, one of which is large enough to accommodate a stretcher. The home has a variety of aids for the moving and handling of residents. Wheelchair users were seen to be able to move around the home without obstruction. Lockable storage is provided in bedrooms. Some improvements are needed so that the home can show that residents have been offered a key to their bedroom door. Care Homes for Older People Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well trained staff team supplied in sufficient numbers to meet their needs, although the response of staff in meeting residents needs is inconsistent. The staff recruitment procedures protect residents. Evidence: The home aims to provide the following staffing levels each day: 8am to 2pm, 2 Registered General Nurses and 9 care assistants; 2pm to 8pm, 2 Registered General Nurses and 6 care assistants. Night time staffing consists of the following waking staff: 1 Registered General Nurse and 4 care assistants. In addition to this, the manager works 40 hours a week and the deputy manager 18 hours a week. An additional carer also works from 5pm to 10 pm each day. The following staff also work in the home: activities coordinator 40 hours a week, a social care assistant for one to one with residents for 42 hours a week, 2 waitresses working from 8am to 3pm and 11am to 7pm each day, a cook, 2 kitchen assistants, 3 cleaners each day, 63 hours laundry staff, housekeeper who manages the cleaning staff, a receptionist, a gardener and a maintenance person. Observation and the staff rota shows that these staff hours are being maintained. 3 staff said that the home provides enough staff to meet the needs of the residents. 1 Care Homes for Older People Page 23 of 29 Evidence: staff member said that the staffing levels are very poor at present due to long term sick leave and staff leaving. Residents said that staff are available when they need them with the exception of 3 people who said that the staff response when they ask for help using the call points is sometimes too slow. The AQAA states that 36 care assistant shifts were covered by agency staff in a 3 month period. The 3 professionals who returned a survey say that the staff have the right skills and experience to support residents health and social care needs. Staff also state that they have enough support, experience and knowledge to meet the differing needs of the people who live at the home. The home employs 9 Registered General Nurses and 25 care assistants. 9 of the care assistants have the National Vocational Qualification (NVQ) level 2 in care and 1 of these also have NVQ level 3. A further 5 care staff are studying for the NVQ 2 in care and 4 are enrolled to start NVQ level 3. Staff confirmed that they have access to training courses. These include the NVQ courses, continence, abuse awareness, infection control, contamination of substances hazardous to health (COSHH), cholostomy care, medication procedures, catheter care, moving and handling and nursing procedures. The home has introduced staff training in dementia care. Staff described the training as being of a good standard. The homes management maintains a record of staff training certificates as well as a training matrix so that training needs can be monitored. Recruitment procedure were looked at for 6 staff recruited to work at the home in the past 6 months. These show that each person completes an application form and that the following checks are carried out before the person starts work: a Protection of Vulnerable Adults (POVA) and Criminal Record Bureau (CRB) check as well as obtaining 2 written references. The home checks that registered nurses are currently registered with Nursing and Midwifery Council (NMC). Records show that newly appointed staff have an induction programme which is recorded. Staff confirmed that they received an induction and that this covered most of what they needed to know. Care Homes for Older People Page 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is effectively managed and run in the best interests of the people who live there. Evidence: The manager is a Registered General Nurse and has a Foundation Degree in Care Home Management. She has also completed training in the supervision and appraisal of staff, and courses which equip her to train staff in adult protection procedures and health and safety. Staff describe the manager as supportive. Staff receive training in first aid, resuscitation, food hygiene, infection control, and moving and handling. The AQAA confirms that the homes appliances are regularly tested and serviced by suitable qualified persons. Colten Care has a management structure to give support and guidance to the home. Care Homes for Older People Page 25 of 29 Evidence: This includes the input of an Operations Manager and activities manager as well as a kitchen and food manager. There is a Suggestions Box in the entrance hall where residents and visitors can post any improvements they think can be made. Regular residents meetings are held which was also confirmed from residents. There is also a food committee group which residents attend to discuss the menus and food provision. The manager meets with residents at a Matrons Happy Hour to discuss life at the home. A 6 monthly satisfaction questionnaire is given to residents and the results summarised on a score basis. A series of audits are carried and recorded by the homes management so that performance can be checked. These include: staff response to call points, tissue viability, staff recruitment, accidents in the home, care plans, odours in the home, monthly medication audit and delivery of care. Monthly visits are made to the home by a representative of Colten Care and a report completed. Copies of these were seen for each month with the exception of April 2009. Staff described the organisations management structure as supportive and that it looks to improve the service provided to the people who live in the home. The home looks after some monies and valuables for residents. Records are maintained of any amounts held and any amounts deposited or withdrawn. Records tallied with the actual amounts. A record of any valuables deposited for safekeeping is maintained. It was noted that 1 valuable item deposited for safekeeping was not recorded. This has not been included as a requirement as the error was immediately rectified. The home does not use a system of receipts when items are deposited for safekeeping, or their return. This should be considered. It is a regulation that the resident signs to acknowledge the return of any item. This will be checked at the next inspection. Staff receive regular supervision. This was confirmed by training records and by the staff and manager. Care Homes for Older People Page 26 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 27 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 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 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). 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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