Care Home: Belvidere Nursing Home

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What the care home does well The service ensures that the needs of people are identified before they come to live at Belvidere so that these needs can be met by the service. These needs are further met by the way needs are identified in care plans and the extent to which these are reviewed and involve individuals and relatives alike. The home maintains the health of people through their actions and through the safe management of medication and treats people with respect. The service ensures that people are enabled to participate in activities which are geared to their preferences and involve both activities in the service and in the wider community. People are enabled to be as independent as possible and their nutritional needs are met. Any complaints made by individuals and their families are listened to and acted upon and all are protected from abuse. The building offers a comfortable, well decorated and hygienic environment for people to live in. People who use the service are supported by staff who are sufficient in number, qualified to do the job and trained to meet the needs of people. Individuals are further protected by the way new staff are recruited and introduced into the service. The service is well managed and looks seriously at how it can improve its quality of care. The health and safety of people is promoted. Comments about the service we received from staff and people who use the service included: `It supports the needs of the individuals who live there. I am kept up to date with new ways of learning. There are regular checks on medical issues eg care for the dying, renal failure. Staff work together as a team` `I have worked there for four years, I have enjoyed my time there and feel part of a team, helping each other as much as we can` `It is a well run Nursing home and gives service users the best care possible. We are very good with infection control and exceed in giving high standards of care and provide varied choices with meals, also we have a lot of activities and trips out when possible. I think we do all the best we can in an ideal world each service user would have one to one care but this is not possible` `It has a homely atmosphere where everyone is treated as an individual. Forums are held regularly and views listened to. Relatives are made to feel welcome and are included with the service in planning the care. Standards of care are high. All staff are well trained` `It gives good patient centred care and a wide range of activities` `The home is exceptionally clean and warm. There is pleasant atmosphere due to the friendly nature of the staff and most importantly I feel free to visit at any time. The home always maintains a high standard` `In every way it is run in a superb way. I could to have chosen such a grand home as this. The matron and all the staff treat me as if I were part of their own family. Every part of the home is spotless, very well run with sincere caring staff. My friends room is brilliantly kept. The food is ten out of ten . Jolly nice kitchen and cutlery. The staff do all they can to make the stay happier-they do not need to improve. To this day I have not needed to say one word of complaint-the staff are wonderful, I could not wish for better` What has improved since the last inspection? No requirements were raised at the last inspection. The service returned its Annual Quality Assurance Assessment and considers the following has improved: `More training obtained and more training delivered. Care staff have obtained NVQ is social care. We have continued to audit medication, complaints, falls and care plans. We continue to maintain high standards achieved by our Investors in People award. We have undertaken extensive refurbishment and a lot of the home has been carpeted throughout. The business plan has stated that all bedrooms will have a plasma TV, new curtains, bedding, new carpet and furniture and obviously this is on a rolling rota and will take some time` What the care home could do better: No requirements or good practice recommendations are raised in this report. The service in its Annual Quality Assurance Assessment considers that it will continue to maintain many of the systems that it has introduced. Key inspection report Care homes for older people Name: Address: Belvidere Nursing Home 85/89 Seabank Road Wallasey Wirral CH45 7PB     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Paul Kenyon     Date: 3 1 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Belvidere Nursing Home 85/89 Seabank Road Wallasey Wirral CH45 7PB 01516397773 01516911090 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Belvidere Nursing Home Limited care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code 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 - Code OP. The maximum number of service users who can be accommodated is: 40 Date of last inspection Brief description of the care home Belvidere Nursing Home is owned by Belvidere Nursing Homes Limited, and is managed by Miss Karen Pickford, who is a first level nurse with experience in caring for the client group. This care home is registered to provide nursing care for 40 older people. Belvidere is a large imposing building, which is located in the residential area of Wallasey, close to the promenade and local amenities. Communal areas are bright pleasantly furnished and furbished, and ornaments, flowers and pictures result in a comfortable environment. Televisions, videos, piano, electric organ and a music centre are available. The home is double glazed throughout and ramp access is available at the side front entrance. A lift serves all floors. There is a reception hall with leather Care Homes for Older People Page 4 of 26 Over 65 40 0 Brief description of the care home seating, desk, fireplace, plants and photographs, and there is a choice of lounges and dining rooms. A conservatory and other quiet sitting areas are located in various parts of the building and one small lounge is designated for those service users who wish to smoke. A hairdressing salon is provided. Both single and shared accommodation is provided on three floors and many have the benefit of en-suite facilities. A selection of bathrooms, toilets and a shower are provided on each floor. All are well appointed and assisted bathing facilities are available. The well-maintained rear garden has walkways, sitting areas, gazebo and a summerhouse. Car parking is provided at the front and rear. The fees charged are 446.98 to 521.20 pounds per week including the nursing care which is in line with Wirral Local Authority payments. No top up charges are made. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection of Belvidere and was unannounced. We use key inspections to assess the quality rating of the service. The visit took place in the morning and extended into the afternoon. During the visit we spoke to people who use the service, toured the premises and examined records relating to the care provided in the service. In addition to this, the service sent its Annual Quality Assurance Assessment (AQAA) before the visit and we received a number of surveys from staff and relatives alike with comments about their experiences. These comments are included within this report. Care Homes for Older People Page 6 of 26 What the care home does well: The service ensures that the needs of people are identified before they come to live at Belvidere so that these needs can be met by the service. These needs are further met by the way needs are identified in care plans and the extent to which these are reviewed and involve individuals and relatives alike. The home maintains the health of people through their actions and through the safe management of medication and treats people with respect. The service ensures that people are enabled to participate in activities which are geared to their preferences and involve both activities in the service and in the wider community. People are enabled to be as independent as possible and their nutritional needs are met. Any complaints made by individuals and their families are listened to and acted upon and all are protected from abuse. The building offers a comfortable, well decorated and hygienic environment for people to live in. People who use the service are supported by staff who are sufficient in number, qualified to do the job and trained to meet the needs of people. Individuals are further protected by the way new staff are recruited and introduced into the service. The service is well managed and looks seriously at how it can improve its quality of care. The health and safety of people is promoted. Comments about the service we received from staff and people who use the service included: It supports the needs of the individuals who live there. I am kept up to date with new ways of learning. There are regular checks on medical issues eg care for the dying, renal failure. Staff work together as a team I have worked there for four years, I have enjoyed my time there and feel part of a team, helping each other as much as we can It is a well run Nursing home and gives service users the best care possible. We are very good with infection control and exceed in giving high standards of care and provide varied choices with meals, also we have a lot of activities and trips out when possible. I think we do all the best we can in an ideal world each service user would have one to one care but this is not possible It has a homely atmosphere where everyone is treated as an individual. Forums are held regularly and views listened to. Relatives are made to feel welcome and are included with the service in planning the care. Standards of care are high. All staff are well trained Care Homes for Older People Page 7 of 26 It gives good patient centred care and a wide range of activities The home is exceptionally clean and warm. There is pleasant atmosphere due to the friendly nature of the staff and most importantly I feel free to visit at any time. The home always maintains a high standard In every way it is run in a superb way. I could to have chosen such a grand home as this. The matron and all the staff treat me as if I were part of their own family. Every part of the home is spotless, very well run with sincere caring staff. My friends room is brilliantly kept. The food is ten out of ten . Jolly nice kitchen and cutlery. The staff do all they can to make the stay happier-they do not need to improve. To this day I have not needed to say one word of complaint-the staff are wonderful, I could not wish for better What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 26 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 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service ensures that the needs of people who come to live at Belvidere are met through its thorough assessment process. Evidence: We looked at five assessments relating to people who had some to use the service since our last visit. In all cases, the service had undertaken its own assessment of their needs and this included reference to all aspects of their daily lives both from a medical viewpoint as well as their social needs. In all cases, information from other sources had been obtained to ensure that a full picture of their needs was available. In addition to this, the service ensures that the information about the care it provides, known as a statement of purpose and service user guide, is kept up to date and there was evidence in care plans that all this information is made available to new people and their families and friends. Care Homes for Older People Page 10 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service have their needs met through the way the service devises and reviews care plans. Individuals have their health needs met by the practices of the service and through the safe management of medication. The service ensures that people are treated in a dignified manner and that people have their privacy respected. Evidence: We looked at information relating to five people who have come to use the service since our last visit. We looked at care plans. In all cases, individuals had a care plan all of which had been signed by either the person themselves or a member of their family. Care plans have been reviewed with the exception of people who had only just come to live at Belvidere and these reviews offered a detailed account of how the support required by people had changed. All care plans are backed up by daily records sheets. Care plans are detailed and provide a clear view of what staff need to do in order to meet the needs of each person. Care plans included details of the health and social needs of people as well as their social needs. Reference is made also to the religion, ethnic background and preferred terms of address of each person. Care Homes for Older People Page 11 of 26 Evidence: We looked at how peoples health needs are met. We interviewed three people. All confirmed that while they were generally feeling well, there had been occasions when medical help was needed and that the service responded very quickly to their needs. Records indicated that the health needs of people are identified and included on care plans. A number of assessments are completed in respect of nutrition, continence, how likely they may develop pressure sores and risk assessments. The weight of people are monitored on a regular basis. We looked at how the service manages medication. We found medications were secure and systems accountable. Only one person partially manages their own medication and this has been risk assessed by the service. Doctors have been involved in approving the use of homely medications and the pharmacy supplier inspects the medication systems of the home on a regular basis. There was evidence that the service administer medications as it should and uses medication audits to assess the quality of how medication is given. We looked at how the service maintains the privacy and dignity of people. We talked to three people who all confirmed that they felt that they were treated in a respectful manner and had their privacy promoted. One care plan indicated that one person liked their own company. This was confirmed through our discussions with this person. The service maintains records of the ethnic background and religion of each person as well as preferred term of address of each person. There are no shared rooms in use at Belvidere. We noted that mail addressed to people who use the service is placed in their rooms unopened. The service seeks to ensure that clothing is returned to the right person through discreet labelling of clothes. An inventory of personal possessions is also maintained by the service. We were able to witness, both directly and indirectly, the manner in which staff interacted with individuals. In all cases, interactions were positive and friendly yet were respectful at all times. Care Homes for Older People Page 12 of 26 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 people who use the service are provided with the choice to be involved in meaningful activities which also enables them to maintain contact with the local community. People are able to maintain links with their families and friends and the service seeks to ensure that they can be involved with their relations care. People are enabled to be as independent as possible and their nutritional needs and preferences are thoroughly taken into account by the service. Evidence: We looked at activities that were provided to people living at Belvidere. Each person has a social activity questionnaire on file which outlines their preferences and interests in relation to activities.This was available for five people we looked at on our visit. We spoke to three people about activities. Their comments included: There is bingo and they show films, there is always something to do and it is a chance to mix with others We get the chance to try and make things such as cakes-we also have days out Care Homes for Older People Page 13 of 26 Evidence: There are activities but I prefer my own company. The service employs an activities coordinator who has their own records relating to activities and a diary of events. Notices are on display for outlining weekly events as well as future events planned. There is also a notice for visitors in the hallway relating to activities over the months.Activities take place either in house or outside and reflect significant days in the calendar such as Easter and Saints feast days. On the day of the visit there was a plan to go out to a local park but this was cancelled due to poor weather. Activities on offer include: ludo, making easter cards and cakes, manicures, working in the greenhouse in the garden, bingo, trips out, monopoly, residents meetings, visits from a Eucharistic minister, mobile library and quizzes. There are photographs of activities undertaken as well as easter cards and other items put on display within the building. We looked at the degree to which individuals living at Belvidere are able to maintain contact with the community. Interviews with residents confirmed that they have regular visitors who visit during the day. Individuals are able to receive visitors in private and whenever they wish and care plans revealed that families are involved in the care of people by agreeing with the content of care plans. There was also evidence that surveys were responded to sent by us to the service and completed by members of the family.The service seeks to provide information to families in respect of events and the statement of purpose and service users guide are available.The visitors book provided evidence of families visiting through the day and this was witnessed during our visit. We looked at how independent people are living at Belvidere.All individuals have some family contact and there is no need for advocates at this time although information on display in the building provides phone call and contact points for organisations offering this service.There was evidence in people bedrooms that personal items and belongings have been incorporated into bedrooms and this is reflected in person item inventories maintain by the service. We asked three people about the degree of independence they have in their daily lives. They felt that despite their limitations they felt they were as independent as they could be. Observations were made in respect of eating and mobility for example. Individuals were encouraged to use those skills they still possessed in those areas and as a result were able to eat themselves and able to mobilise through the building either independently or through the use of walking aids. The service does not deal with the finances of any individual with people telling us that their financial interests were all looked after by their families at this time. Care Homes for Older People Page 14 of 26 Evidence: We looked at the food provided by the service. Five care plans we examined all contained nutritional assessments and information about peoples dietary needs and support needed with the presentation of meals and assistance with eating. Interviews with three residents comments included: The food is very good, there is a choice and they let you know what is on offer in advance The food is good,we get fed and if I want something else they ask me and I get it. Menus are available in the service and residents confirmed that they are asked individually what they want. Menus operate on a four weekly rota with choices available with lunch tending to be the larger meal. One person is artificially fed the others are able to eat independently or with support. Dining rooms are available and these are pleasant areas. We observed lunch time.Staff were noted asking if people need assistance though generally people are enabled to eat themselves with softer diets or cut up food available. Information is available in kitchen indicating those on softer diets, cut up food, dietary preferences or dietary needs such as diabetes. Clear records are available in the kitchen in relation to preferences of individuals with food. Some trays are taken up to people who prefer eating in their room and this is accommodated. The kitchen is well equipped and a cook and kitchen assistant is employed by the service. Refrigerators and freezers are well stocked with food being supplied by an external supplier provides food. Food stocks were sufficient with fresh fruit and vegetables available. The kitchen was noted to be clean with the service using a food hygiene check list, cleaning schedules, temperature probe records taken. The cook confirmed that all equipment was working satisfactorily at present. Care Homes for Older People Page 15 of 26 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 people who use the service can be confident that any complaints they have will be listened to and acted upon. People are protected from abuse by the policies and procedures provided to staff as well as the training they receive. Evidence: We looked at the way the service respond to any complaints it may receive and how individuals and their families are able to access the information they need if they wish to make a complaint. The service has a complaints procedure which is on prominent display and clearly outlines how people an make a complaint about the quality of the service. Records submitted to us from the service prior to our visit indicated that no complaints had been received about the service within the past twelve months. We have not received any complaints about the service. The service conducts an audit of complaints as part of its assessment of its own performance. We interviewed three people who live at Belvidere. Two people were clear about who they would speak to about any concerns they had and were confident that the service would address any concerns. They stated that they had no concerns about the care they received. One person was unclear about who to speak to and we advised the service to reinforce the complaints procedure to this person. We looked at how the service protects people who use the service from abuse. The service has not been involved in any abuse allegations but does have a copy of the Care Homes for Older People Page 16 of 26 Evidence: local authority procedure if a referral needs to be made. There was evidence that staff have received training in abuse awareness and that they had access to clear procedures in relation to the receipt of gifts and the involvement of the financial affairs of individuals. The staff team also have access to a document known as a code of conduct form the general social care council which again places emphasis on how carers should support individuals in a manner which protects them. We interviewed three people. In all cases, they stated that they felt safe living in Belvidere. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service live in a thoroughly well maintained, comfortable and home like environment which is hygienic and clean. Evidence: We looked at the standard of the environment in which people at Belvidere are provided with. We held a tour of the premises.Entry to building is secure and the hallway immediately offers visitors and other information about the service and the care it provides.We viewed all parts of the building including a number of bedrooms. All areas are well decorated with some bedrooms undergoing refurbishment with redecoration, recarpetting and the purchase of new furniture. Refurbishment work continued during our visit. We spoke with people living there and they suggested that they had not been adversely affected by the decoration work and that this on the whole had been unnoticed. There was evidence that information had been provided to people and their families detailing that the refurbishment work was carrying on. The service employs maintenance staff who deal with day to day repairs. Environmental health report was available and checks on fire systems and a fire risk assessment indicated that fire safety is complied with. There are close circuit television cameras but these monitor the outside of the building. A garden area is available and accessible to all. This area has been landscaped and Care Homes for Older People Page 18 of 26 Evidence: includes seating areas for people and shade in warmer weather. It also offers privacy and direct sunlight for people. It is easily accessible from the main building. A greenhouse has been included on site which people use for growing plants and is part of the activities programme. The interior of the building offers a home like atmosphere with pictures and ornaments. The lounge areas available are well furnished and well decorated. Interviews with people comments included: I am impressed with it It is very good It is excellent, I am happy with it The tour of the building noted there were no offensive odours in the building. Domestic staff are on duty daily and included in the rota. Towels and soap are available in toilet areas and all areas are very clean throughout. The laundry is sited away from food preparation and food storage areas. Laundry staff are employed. The laundry is well equipped and includes a system of ensuring that items are returned to their owners. Washing machines and driers are industrial appliances. The floor is impermeable and easy to clean and hand wash facilities are available. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service are supported by well qualified staff who are sufficient in number and recruited to meet their needs. Training enables the needs of people to be met. Evidence: We looked at the staffing in the service and the training received by staff. A staff rota is available and this reveals mix of staff including nursing staff, care staff, domestic staff, administrator, maintenance staff, kitchen staff,laundry staff and activities coordinator. Ancillary staff are employed to ensure that carers can concentrate on their roles. Dependency levels are assessed by the Registered Manager and is in place for each person completed on a monthly basis. This is then translated to a monthly dependency providing an at a glance review of dependency needs and how staff levels are altered to reflect this. Comments were made by three people about staffing. Comments included: You can talk to them, they look after me and are very kind and are always there, It is better than the other place I lived at-they are caring and very good Information received form the service prior to the visit confirmed that over fifty percent of staff had attained a National Vocational Qualification at Level 2. We looked at the way the service recruits staff. We looked at three files relating to Care Homes for Older People Page 20 of 26 Evidence: staff who had recently come to work at Belvidere. In all cases there was evidence that checks such as Police checks, initial checks against the protection of vulnerable adult register and references had been obtained prior to them coming to work at the service. We looked at the training received by staff. Training certificates and planned training suggested that staff had received or were about to receive training in mandatory health and safety topics as well as training relating to the needs of people. Training included: manual handling, health and safety, food hygiene, fire awareness and appraisals. Other training included pressure sores, renal failure, abuse, dressing wounds, needs of older people, dementia, chronic obstructive airways disease, artificial feeding, care of the dying, osteoporosis, principles of care, empowerment and bereavement as well as training in mental capacity act. We also looked at how new staff are introduced into their roles in the service. A process of recruitment, shadowing and probationary period run alongside an induction process which include common induction standards. These standards relate to orientation in the building, principles of care, role of the worker, needs of people and safety at work. Evidence of induction was included in the three personnel files we looked at. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Belvidere receive a service that is well managed, listens and acts on their views and promotes their health and safety. Evidence: We looked at how the service is managed, The Manager was not available during this visit but the Deputy Manager was available to provide us with all the information we needed. The Manager has managed the service for many years and has the experience and qualifications to perform the role. The presence of a Deputy Manager suggested that there was a management structure in place. We spoke to three people about the Manager. In all cases they stated that she is very nice and very good We looked at the way the service examines the quality of the care it provides.This is done in a number of ways. The responsible person visits monthly and produces reports of their findings to the Manager. These reports were available to us.These reports included reference to interviews with residents and staff as well as tour around the building and an assessment of the care offered. The service has sent surveys out to Care Homes for Older People Page 22 of 26 Evidence: relatives and residents and these were available for viewing. The surveys also extend to the health agencies that the service work with. The service has undertaken a number of audits in relation to complaints, medication, incidents, medication, pressure sores. Minutes of staff meetings were available as well as evidence of residents meetings. There were no requirements from our last visit and we were able to see all the documentation we wanted and to interview people in private. The service sent in its Annual Quality Assurance Assessment (AQAA) when we asked as well as enabling surveys to be sent to us as part of our inspection process. The service does not deal with anyones finances at present. The service does have an amenities fund for purchasing items which benefit the people who live there.The monies has come form fund raising and donations.The system for administering these monies are accountable with receipts retained and records maintained. We looked at how the service promotes the health and safety of people living at Belvidere. Training records confirmed that staff had receive training in health and safety issues. Other records suggested that equipment used by the staff team to support individuals such as portable hoists had been serviced in January 2010. The service ensures that radiators are covered and that window restrictors are in place in bedrooms on the upper floor. The service monitors water temperatures and has temperature controlled valves to regulate hot water supplies. All portable appliances have been checked recently. The service carries out regular fire drills and ensures that fire alarms and fire extinguishers are tested on a regular basis. A fire risk assessment has also been produced recently to ensure that the risk of fire is minimised in the building. The service monitors any accidents in the service and this is reinforced with risk assessments on the likelihood of people having falls which is contained in each care plan. The service conducts regular maintenance checks to equipment used in the building and has certificates in place to confirm that gas and electrical systems are safe. Care Homes for Older People Page 23 of 26 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 24 of 26 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 25 of 26 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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