Care Home: Bethel House

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What the care home does well This service is good at making sure they only take new people who have a problem with their mental health when they judge that they can give them good levels of care and services. The home makes sure that people receive suitable health care. We found that people in the nursing unit get good standards of care and that community resources are brought in for people in the residential unit who need support from district nurses. People in the home get attention from dentists, chiropodists and opticians. Staff are good at supporting people when they are ill and they try to prevent ill health. Medicines are managed correctly and some people get support to take their own medicines. Staff in this home work with people patiently and with respect. We had a lot of positive feedback from surveys about the care and treatment people receive. "I like it here, staff are nice and I get on well with everyone who lives here." "They couldn`t do anything any better." "I am satisfied with the way they treat my realtive...very patient and caring...even when thats difficult." People who live in Bethel House are supported to have their own preferred lifestyle. They are given good levels of help to make suitable decisions. Activities and outings are arranged for people. There are regular visits from local churches. "I like the activities...and the company of other people so I sit in the lounge." People in the home (or their representatives) are able to complain or voice their concerns. They told us they were confident that any worries would be dealt with correctly. Staff understand what is abusive and are trained to spot anything of this kind. The manager deals with any safeguarding issues promptly. Bethel House provides a safe and comfortable environment. There is enough space for people who may, due to their illness, feel restless. Individual bedrooms are private with locked doors and people are encouraged to personalise these. Improvements have been made to shared areas and these are relaxed and comfortable. "I like my flat...its my own place...everything is always nice and clean." The home provides good ratios of staff to residents and most people thought there were enough staff to provide good levels of care. There is always a trained nurse in the building. Some surveys commented on sickness levels but one member of staff said. "The majority of staff work very well as a team and frequently come in at short notice so the residents get the care they need and deserve."One person told us: "Staff always have time to do things with me...there are a lot of us....so sometimes you have to wait but they get back to you...". Staff are suitably qualified. Nurses keep up their clinical practice. Around 70% of carers have National Vocational Qualifications in care at level 2 and all of the senior carers are trained to level 3. There is an ongoing programme of staff training and a number of staff commented on how much they got out of attending training. "We are offered a lot of training and I am keen to have refresher training but also want to learn new things...". New staff are recruited appropriately and checks made on their background and suitability. The Registered Manager has the necessary skills and experience to run a care home with nursing. She is trained to care for people with mental health needs and is experienced in the care of older people and in management. Residents and staff were confident in her management of the home. The home has a Quality Asssurance system and we saw evidence to show that things are routinely checked and that people who live in the home, their relatives and the staff are consulted and their opinions acted upon. Health and safety, maintenance and repair are managed correctly and staff receive training in these matters. The provider and the manager are aware of their legal responsibilities. What has improved since the last inspection? Everyone in the service had an up to date written plan that described how they wanted their care delivered and what their personal preferences were. We judged that these had improved dramatically in the nursing wing and these plans are now very focused on strengths and needs. The plans in the rest of the home meet the standard and we were told that these too will be reviewed. A number of areas had been redecorated and some new furniture purchased. Two new bedrooms have been created and these are of a very good standard. The home has an ongoing programme of maintenance and repair. Some staff have attended new training relating to peoples` rights and liberty. The manager is training staff on how to manage challenging behaviour. The manager has started a new way of appraising staff so that other people on the team can give individuals feedback. What the care home could do better: We want the manager to continue to improve the way care plans are written and recommend a review of care planning on the residential unit. We judged that although activities are a regular part of peoples` lives the home now needs to plan these so they meet the needs of people with dementia. We discovered that although people were happy enough with the food provided there could be more use of whole grain foods and more fresh fruit and vegetables offered. Some nutritional plans were not specific enough to help people who find eating a problem.We want the provider to look at the catering arrangements in the home because we judged that the menus would benefit from some improvements that will benefit peoples` health. The bedroom door locks on the residential unit have had a lot of use over the years and now need updated. We want the manager to make sure that records are kept up to date as we found one or two gaps in training records. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bethel House St Bees Road Whitehaven Cumbria CA28 9UB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Nancy Saich     Date: 0 7 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 28 Information about the care home Name of care home: Address: Bethel House St Bees Road Whitehaven Cumbria CA28 9UB 01946695557 01946695559 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Haven Care Centres Limited care home 64 Number of places (if applicable): Under 65 Over 65 0 0 dementia mental disorder, excluding learning disability or dementia Additional conditions: 64 64 The registered person may provide the following category/ies 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: Dementia - Code DE Metal disorder, excluding learning disability or dementia - Code MD. The maximum number of service users who can be accommodated is: 64 Date of last inspection Brief description of the care home Bethel House provides residential and nursing care to older adults with dementia or a mental health problem. One part of the home has nursing care provision and the other provides residential care. The home is situated on the outskirts of Whitehaven and is set in its own grounds. The home is a Georgian House that has been extensively adapted and extended to provide mainly purpose built accommodation. The two areas of the home are separate but share a main kitchen, laundry and office space. All accommodation is in single ensuite rooms. The home has been operating for a number of years but was sold in January 2007 to Care Homes for Older People Page 4 of 28 Brief description of the care home the current provider. Weekly costs range from £462 to £568 per week depending on need. Further information can be obtained from the home at the above address. Care Homes for Older People Page 5 of 28 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: This was the main or key inspection for this service. We sent the manager a document to fill out called the Annual Quality Assurance Assessment (the AQAA). It is a legal requirement that services complete and return these. This service returned this with appropriate details of what they had achieved and plans for the forthcoming year. We also checked on the information the service is required to give us throughout the year. We consulted with Social Services over some issues they had told us about. These things had been dealt with promptly and appropriately. We then sent out surveys to the residents representative. She gave out these questionnaires to residents and their relatives. We also sent surveys to staff and to Care Homes for Older People Page 6 of 28 professionals who visit the service. We had a good response to these and there was nothing of major concern seen in the returned surveys. We then made an unannounced visit to the service. Nancy Saich, the lead inspector, arrived shortly after 7.30 in the morning. Margaret Drury arrived just after 9.30 and she spent two hours completing a Short Observational Framework for Inspection (the SOFI). We use this to look at how staff interact with people with dementia; how residents interact with each other and as a measure of their well being. We had positive results from measuring these things. What the care home does well: This service is good at making sure they only take new people who have a problem with their mental health when they judge that they can give them good levels of care and services. The home makes sure that people receive suitable health care. We found that people in the nursing unit get good standards of care and that community resources are brought in for people in the residential unit who need support from district nurses. People in the home get attention from dentists, chiropodists and opticians. Staff are good at supporting people when they are ill and they try to prevent ill health. Medicines are managed correctly and some people get support to take their own medicines. Staff in this home work with people patiently and with respect. We had a lot of positive feedback from surveys about the care and treatment people receive. I like it here, staff are nice and I get on well with everyone who lives here. They couldnt do anything any better. I am satisfied with the way they treat my realtive...very patient and caring...even when thats difficult. People who live in Bethel House are supported to have their own preferred lifestyle. They are given good levels of help to make suitable decisions. Activities and outings are arranged for people. There are regular visits from local churches. I like the activities...and the company of other people so I sit in the lounge. People in the home (or their representatives) are able to complain or voice their concerns. They told us they were confident that any worries would be dealt with correctly. Staff understand what is abusive and are trained to spot anything of this kind. The manager deals with any safeguarding issues promptly. Bethel House provides a safe and comfortable environment. There is enough space for people who may, due to their illness, feel restless. Individual bedrooms are private with locked doors and people are encouraged to personalise these. Improvements have been made to shared areas and these are relaxed and comfortable. I like my flat...its my own place...everything is always nice and clean. The home provides good ratios of staff to residents and most people thought there were enough staff to provide good levels of care. There is always a trained nurse in the building. Some surveys commented on sickness levels but one member of staff said. The majority of staff work very well as a team and frequently come in at short notice so the residents get the care they need and deserve. Care Homes for Older People Page 8 of 28 One person told us: Staff always have time to do things with me...there are a lot of us....so sometimes you have to wait but they get back to you.... Staff are suitably qualified. Nurses keep up their clinical practice. Around 70 of carers have National Vocational Qualifications in care at level 2 and all of the senior carers are trained to level 3. There is an ongoing programme of staff training and a number of staff commented on how much they got out of attending training. We are offered a lot of training and I am keen to have refresher training but also want to learn new things.... New staff are recruited appropriately and checks made on their background and suitability. The Registered Manager has the necessary skills and experience to run a care home with nursing. She is trained to care for people with mental health needs and is experienced in the care of older people and in management. Residents and staff were confident in her management of the home. The home has a Quality Asssurance system and we saw evidence to show that things are routinely checked and that people who live in the home, their relatives and the staff are consulted and their opinions acted upon. Health and safety, maintenance and repair are managed correctly and staff receive training in these matters. The provider and the manager are aware of their legal responsibilities. What has improved since the last inspection? Everyone in the service had an up to date written plan that described how they wanted their care delivered and what their personal preferences were. We judged that these had improved dramatically in the nursing wing and these plans are now very focused on strengths and needs. The plans in the rest of the home meet the standard and we were told that these too will be reviewed. A number of areas had been redecorated and some new furniture purchased. Two new bedrooms have been created and these are of a very good standard. The home has an ongoing programme of maintenance and repair. Some staff have attended new training relating to peoples rights and liberty. The manager is training staff on how to manage challenging behaviour. The manager has started a new way of appraising staff so that other people on the team can give individuals feedback. Care Homes for Older People Page 9 of 28 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 28 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. This home makes sure they can give people suitable care and that any new person will fit in with the people who already live in the home. Evidence: We read a wide selection of residents personal files and we saw that good assessments of need were in place before the person was admitted. The manager or a senior member of staff had visited the person before they came in. Most admissions had been arranged by a Social Worker and their assessments were on file. We also discovered that new people had seen a psycho-geriatrician and had been diagnosed with dementia or another mental illness. We were told by staff that new residents could visit but often families visited on their behalf to help the person decide on whether Bethel House was a suitable placement for them. The home provides written information about the care and services provided. Care Homes for Older People Page 12 of 28 Care Homes for Older People Page 13 of 28 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. People who live in the service receive good levels of care that are in the process of becoming more focused on person centred care. Evidence: We read a range of care plans in both the nursing and the residential wing of the home. We read some in depth for specific people we had observed or had spoken to. We also picked some care plans at random. We discovered that everyone had an up to date plan that staff could refer to when working with the individual.We met one or two people who were aware of their plan of care and a partner of a resident who had been consulted about the care plan. The manager told us that all the plans in the nursing unit had been changed to a new format that focussed much more on strengths, preferences and needs. We read a number of these and found them to be of a very good standard. One plan gave detailed strategies for managing a persons nursing and care needs yet also let staff know about a lifelong liking for tidiness and a preference for coffee over tea. We saw that staff followed this plan very well. When we read the plans in the residential unit we judged that the same kind of revision would be of Care Homes for Older People Page 14 of 28 Evidence: benefit. One or two of the plans we read here needed more detail or further information. We recommend that this development is extended to the residential side of the home. The care plans throughout the home showed that people in this service get regular and appropriate visits from their GP and the district nursing service. The staff in the home do their best to make sure that where people have a need they are visited by psychiatric services. The plans we looked at in depth showed that people had visits from opticians, chiropodists and dentists. On the day of our visit one person had been out to a dental appointment. People in the home who received nursing care were being suitably monitored by the nursing staff and we saw good plans in place for wound care and prevention of pressure sores, the monitoring of diabetes and high blood pressure. We checked on the medication in the home and we discovered that medicines are ordered, administered and disposed of correctly. We also judged that there was only minimal use of sedative medication and this was usually after consultation with a psychiatrist. We noted that medicines used by nursing staff were suitably accounted for. Every person in the home is assessed for self medication and one or two people are supported to manage some of their prescription. Both inspectors spent some time observing the interaction between staff and residents. A Short Observational Framework for Inspection (SOFI) was carried out in the residential part of the home.This showed us that staff give people a lot of attention and encourage them to interact with each other. A less formal observation was undertaken in the nursing unit over breakfast time. During both of these observations we saw staff treating people with discretion, dignity and warmth. Some people who live in the service can be very challenging and we observed very skilled and calm interventions with particular individuals that allowed them to be as relaxed as possible. People were given choice and their requests were carried out. For example one person wanted her make-up applied before breakfast time and this happened. Throughout the day we saw people being allowed their own natural dignity whilst also being supported because they were disorientated. Care Homes for Older People Page 15 of 28 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. People who live in this home have a reasonably good lifestyle that could be improved by focusing more on the challenges people with dementia face in their daily lives. Evidence: When we arrived just before eight oclock in the morning some people were already up and dressed but others were still in bed. We sat through the handover from the night staff and we discovered that people who were already up had had a disturbed night. One or two people were able to tell us that they got up and went to bed more or less as they wished. Staff said that they assisted people when they were ready but because most residents were disorientated in time they might have to give them more help and support. During the day we saw people in lounges with staff doing various activities. These included playing dominoes, watching DVDs, listening to music and having the newspaper read out them. The manager told us she had recently appointed a new activities organiser who works three days a week and that staff are expected to also do activities. This home is well staffed and staff told us they did have time to sit with residents. Care Homes for Older People Page 16 of 28 Evidence: The manager told us that various outings were arranged and we saw evidence of people going out for short trips and people from the local community coming in. There are regular visits and services from local churches. One or two of the surveys from relatives said that they would like to see a few more activities. We judged that although there were activities organised every day these were not specifically planned to meet the needs of people with dementia. Residents did seem to be enjoying the interaction with staff but because this is a specialised home for people with dementia and other related illnesses we would now like to see more focused activities. We recommend that the manager and the provider do some research into current good practice in relation to activities and review their plans and help staff to improve on the quality of activities on offer. We met with a number of relatives and friends on the day. They told us they were always made welcome and kept fully informed. One person told us that staff were very sensitive and caring when they visited because their relatives dementia often meant that the visit was distressing. This was also backed up by the positive comments we received in our surveys. We judged that the service sees people as part of the wider community and their family and do their best to make sure people are still included. A number of surveys from residents told us that they thought the food was good. One or two staff surveys said they thought the quality of the food needed to improve.We were around at breakfast time and at lunchtime. Some people ate their meals very well but others found mealtimes more of a challenge. We spoke to the cook who explained some people had liquidised food and some people had finger food. Some care plans had quite detailed strategies for helping people to eat but others were more vague. We looked around the kitchen and we discovered that there were adequate food supplies but that the home uses a lot of frozen vegetables. Although these are nutritionally sound we questioned whether lightly cooked fresh vegetables might be more appealing for people who struggle to eat well. We also judged that the diet did not contain enough whole grains and we think that the time is now right to review the menus and look at nutritional planning and specific diets for individuals. We would also recommend looking at some of the up-to-date research concerning nutrition for people with dementia. Care Homes for Older People Page 17 of 28 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. People in this home are suitably protected from harm and they, or their relatives, are able to voice any concerns and know that they will be dealt with. Evidence: Bethel House cares for a large number of people with very complex needs.This means that sometimes they receive concerns from relatives and other interested parties. The manager of this home deals with these in a prompt manner and always keeps us fully informed by letter or telephone of the actions she has taken. She tries to keep an open dialogue with people who support residents. We had a discussion with the provider about when it might be appropriate for her to complete investigations and she agreed to give this consideration. On the day of the inspection we saw copies of the complaints procedure in the home that were available for anyone. The relatives we spoke to told us that they felt encouraged to make suggestions or voice concerns on behalf of the people they came to visit. The manager also informs us of any issues relating to the prevention of potential or actual abuse. She is quick to refer anything of this nature to Social Services and any Adult Protection matters have been dealt with in a practical and prompt way.This was confirmed for us by a local Social Services manager The home had copies of the most up-to-date information about safeguarding and staff files showed us that members of the team had been fully trained in this matter. We Care Homes for Older People Page 18 of 28 Evidence: also spoke to a senior carer who was able to explain how she would go about protecting a vulnerable person. There was nothing of concern seen in daily notes and returned surveys confirmed for us that people are suitably protected. Care Homes for Older People Page 19 of 28 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. People who live in Bethel House are relaxed and comfortable in their environment. Evidence: Bethel House is situated on the outskirts of Whitehaven and is easily accessible by car or public transport. There is a large visitors car park and suitable outside areas for residents. There are two distinct parts of this home. One provides residential care for people with dementia and a more recently built extension houses the nursing wing which again provides a specialist care for people with dementia. Both of these areas were purpose-built extensions from an older Georgian property. The residential part of the building is built around a circular plan that allows access to small courtyard gardens. The new nursing wing also allows for plenty of space for people who may feel restless. Accommodation is in single rooms with ensuite toilet and wash hand basin. Many of the rooms in all areas of the building exceed the recommended room size for care homes. There is a passenger lift to the first floor and a call bell system to all areas of the building. The home also uses some specialist technology that alerts staff to the whereabouts of individual residents who may be at risk. Our visit started fairly early in the morning and we spent some time on the nursing Care Homes for Older People Page 20 of 28 Evidence: care unit before breakfast time. The home was clean, fresh and airy even at this time of the day. Both inspectors walked around all areas of the building and we judged that staff kept the home tidy and clean. Generally we judged that the home was well maintained and there was evidence of ongoing redecoration and purchase of new furniture. Some of the door locks in the residential wing now need to be replaced and we discussed this with the provider. We recommend that a security review is held for private and shared areas so that people continue to have privacy and security. We saw evidence to show that staff are aware of how to prevent cross infection and they are provided with suitable equipment and materials to keep any problems to a minimum. Care plans showed how to treat people who had infections and this was working well. Residents clothing and bed linens were well cared for. Care Homes for Older People Page 21 of 28 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. This service has well trained staff, in suitable numbers, to give people good levels of care and services Evidence: We saw the current rosters for staffing the home and we asked team members about staffing levels. They told us on the day and in surveys that they thought the home was well staffed. One or two people spoke about having to cover sickness absence. The manager is aware of this problem and manages this as well as possible. A senior member of staff dealt with an issue related to this on the day in a practical and fair way. Relatives and residents didnt have a problem with staffing levels. We judged that the home was well staffed. For example on the day of the inspection the nursing wing had two nurses and seven carers on duty. This meant that people got good levels of individual care and attention. The home also has a team of housekeeping, administrative and catering staff who deal with all non-care tasks. There is a high proportion of staff in this service who are qualified to at least level 2 National Vocational Qualifications (NVQ)in care. Currently this is around 70 with more staff waiting to complete the award and some staff working on NVQ level 3. New staff complete a full induction and are mentored by more experienced senior Care Homes for Older People Page 22 of 28 Evidence: carers. They are given training in all the basic care skills and in things like health and safety and food hygiene. We spoke to staff who were trained in understanding dementia care. The manager was training people that day on how to handle challenging behaviour. We met nurses who were supported to keep up their clinical practice and we read one of their files that showed the person had attended training on new legislation.We learnt that one member of staff had been encouraged and supported to complete a return to nursing course and was now working on the nursing wing. We saw the record of training completed and the new training plan. Staff told us they thought training was very good in the home. We also judged that training was very good in the home. We would now like to see this becoming more targeted around individual needs and aspirations. We suggested to the manager that she might want to extend some of the staff files so that training and personal development outcomes were more defined and actions taken to help staff develop in their role could be clearly seen. We checked on the files of the most recently recruited staff. These were largely in order and we had a discussion with the provider and manager about one aspect of this. New team members have two references taken up,a Criminal Records Bureau check and are confirmed as not having been placed on the Protection of Vulnerable Adults register before they become part of the team. Care Homes for Older People Page 23 of 28 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. This service is suitably managed so that people who live here are safe and well cared for. Evidence: The manager of this service is a Registered Mental Health nurse and has been in charge of the home for a number of years. She keeps her practice up to date and is trained to train others. She has a number of years experience in the home in other roles and has suitable management and care skills. Staff and residents told us they trusted her judgment. The owners of the service live on site during the week and give the manager and the senior team plenty of support. During our inspection we saw evidence to show that there were good systems in place to measure quality outcomes in all areas of the home. We saw that there were regular checks on medication administration and on household tasks, regular updates to care plans and to staff training. The manager sends out surveys to relatives and other Care Homes for Older People Page 24 of 28 Evidence: visitors. There was an example of the management team taking into account the changes in legislation and acting accordingly in the best interest of the individual. We checked on the money held on behalf of residents. This was being managed correctly and only small sums of cash for things like hairdressing were being held. Some of the records in the home that prove staff receive suitable updates to their training and competence need to be kept more up to date and with specific details We looked at the maintenance and health and safety records. On the day things were being managed satisfactorily. There were no hazards seen on the day. We saw evidence that risk is assessed on a regular basis. Staff are trained in infection control and good risk management was evident in a number of care plans. We saw people being helped to move by staff using equipment and special techniques. These were being carried out appropriately. All staff have received training in this and new staff have their competence checked before they work with people. The manager has a good understanding of her responsibilities under the relevant legislation. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 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 1 2 7 12 It is recommended that person centred planning is extended to cover the care of people in the residential unit. It is recommended that arrangements for activities be reviewed so that people who live in the Home have suitable activities that will stimulate but will also help with some of the more distressing symptoms of dementia. It is recommended that the arrangements for providing good nutrition are reviewed in the light of current best practice in old age and dementia care. It is recommended that the registered provider updates the locks in the residential wing. It is recommended that records relating to staffing are reviewed and updated. 3 14 4 5 19 34 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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