Care Home: Bexton Court

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What the care home does well The information that tells people how the service works (the statement of purpose and service users guide) is clear and gives people the information they would need to help them decide whether Bexton Court was the right place for them. People had received checks on their individual needs before they came to stay at Bexton Court. This meant that they and the staff had the information they needed to decide if the person`s needs could be met by the service. The home has an established staff team who were keen for high standards to be maintained. People`s plans of care and individual care notes on the whole were well written and reflected each person`s needs. This helps to make sure that each person received the care and support they need in the way they prefer. Bexton Court provides a variety of activities for the people who stay there. These activities help to keep people busy and give them a chance to join in on social occasions. A good standard of hygiene was seen throughout the home and the standard of decor and furnishings throughout the home was good. Thought has also been given to making sure there is enough light and heating throughout the home. Relatives of people who were staying at Bexton Court commented, "My relative is happy with all aspects of Bexton Court and the staff are caring and helpful. Bexton Court provides everything that is required. Staff are always on hand to help with any queries we may have", "In our experience of using Bexton Court facilities over the past three years, everything is done very well and to very high standards. Having Bexton Court reduces stress levels for both the carers and the cared for", "They look after my relative very well and the home is so friendly at all times and the staff are kind. The home is so warm and every member of staff makes you welcome. We are more than pleased with the way it is run", "The staff are wonderful and my relative loves it here. The staff look them in the eye, smile and treat them like special people, my relative is loving it and blossoming after being poorly" and "They provide a safe, warm and clean environment. Provide an excellent choice of food which is served in the dining room, with clean tableware and nicely presented". Staff commented: "Bexton Court has an excellent team who have specialist dementia training. Service users, families, visitors are always made to feel welcome. Activities and dining facilities are good and staff have a good understanding of service users needs"; "The staff work well as a team, which is helpful when working with dementia clients. We support each other when needed and we try to do activities, lots of singing and dancing and cinema evenings. The clients need a lot of reassurance"; "The home cares for the individuals needs and concerns very well. The home also supplies a clean and safe environment for clients and staff. In my opinion Bexton Court offer a brilliant and professional service"; "Bexton Court takes care of service users needs and personal welfare. There are usually enough staff on to meet clients needs"; "We care for clients, support relatives, support other employees. We take people with hugely varying degrees of dementia and other mental and physical disabilities"; "Bexton Court gives care and support to people and their families who are living with dementia. They provide daily activities and stimulation, personal care with dignity and wellbeing"; "They pass on information between staff continuously and effectively thereby giving everyone up to date information on clients, their current situation and their needs. They encourage activities such as quizzes, music, singing, exercises, crafts etc and they welcome visitors and relatives"; "The home is person centred. We are family orientated and welcome the family input. We have numerous activities though the day which blends in with all our day care clients. All our staff highly experienced and strive to meet the needs of the clients, family and carers. I believe that Bexton Court is one of the best homes, they put all clients needs first and the home is clean and friendly"; "Communication between staff and families is good. We take care of clients needs providing a caring and safe environment and first class meals and snacks"; "I am usually given enough information about the needs of the service users. They provide a safe and secure environment for people living with dementia. The maintain their well being and provide social stimulation. Also provides a link for carer`s to other organisations and provide and excellent professional and committed staff team". What has improved since the last inspection? The home has maintained its hygiene and environmental standards. The staff team continue to strive for high standards to be maintained. There is now an training matrix to show at a glance staff training needs and achievements. What the care home could do better: One requirement was made during this visit. Risk assessments must be completed for all people staying at Bexton Court and these must be signed and dated by the assessor. A number of recommendations were made and these included adding review dates to the information booklet (service users guide) and statement of purpose so that people have up to date information available to them and know when it was last reviewed, Also to offer staff regular formal supervision and annual appraisals so that staff can discuss with their manager their current work and future training needs. Medication record sheets should be fully completed so that accurate records are kept of medication that is administered to the people staying at the home. An individual record should be kept of the activities each person undertakes whilst staying at the home, to show which activities they enjoy taking part in. The financial records of people who are staying at Bexton Court should be checked regularly to ensure that no accounting errors occur so that good accounting practices are in place. Within the quality standards report, comments made on surveys should be included to give an overall view of what people have said about the home. Staff commented that areas where improvements could be made included organising more outings; have dedicated laundry staff; have more outside entertainment brought into the home; have some pets; improve communication between senior staff and support staff; learn more about dementia; and to employ more staff at certain times across the day and when more dependent people are staying at the home on respite. Key inspection report Care homes for older people Name: Address: Bexton Court Bexton Court Bexton Road Knutsford Cheshire WA16 0BZ     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: Maureen Brown     Date: 1 4 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 29 Information about the care home Name of care home: Address: Bexton Court Bexton Court Bexton Road Knutsford Cheshire WA16 0BZ 01625374166 01625374167 Jill.Greenwood@cheshire.gov.uk http/www.cheshire.gov.uk Cheshire East Council Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Vivienne Jacqueline Thompson Type of registration: Number of places registered: care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability Additional conditions: The maximum number of service users who can be accommodated is: 23 The registered person may provide the following category of service only: Care Home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the Home are within the following categories: Dementia - Code DE - maximum number of places 22, Learning disability - Code LD - maximum number of places 1. Date of last inspection Brief description of the care home Bexton Court is a purpose built community support centre owned and managed by Cheshire County Council. It is near to Knutsford Town Centre, where there are a wide range of shops and other amenities. Care Homes for Older People Page 4 of 29 Over 65 0 0 22 1 3 1 1 0 2 0 0 8 Brief description of the care home The fees at Bexton Court are based on a financial assessment of the individual. Bexton Court provides accommodation on a single floor with some office accommodation sited on a second floor. The premises are physically linked to a ward in the adjoining hospital. The home is registered to provide care to a maximum of 23 service users. This facility offers a range of short- term respite services for people with dementia, which are tailored to an individuals needs. Care can include short breaks, flexible day and overnight care. There is a day care unit, which provides 5 places each day from Monday to Friday. In Bexton Court, all rooms are easily accessible to wheelchair users. There is a secure garden area for service users and visitors to use. 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: We carried out an unannounced visit to the service on 14 April 2010 and the visit lasted nine and a half hours. It was done by one inspector. The report will say we when referring to what was done and found at the visit, as it is written on behalf of the Care Quality Commission. This visit was just one part of the inspection. Before the visit the manager was asked to complete a questionnaire to provide up to date information about the home. We sent out questionnaires to the people who stay at the home and the staff team to find out their views about Bexton Court. Other information about the home was also reviewed. During our visit we looked at various records and the premises. We looked at the care records of three people who were staying at the home, to see how their needs were being met. We also looked at four staff files to ensure that thorough recruitment Care Homes for Older People Page 6 of 29 processes had taken place and that people who stay at Bexton Court were safeguarded from harm and supported safely. We spoke with some of the people who were staying at Bexton Court, the manager and other staff who were on duty at the home at the time of this visit. They all gave their views about the service. Care Homes for Older People Page 7 of 29 What the care home does well: The information that tells people how the service works (the statement of purpose and service users guide) is clear and gives people the information they would need to help them decide whether Bexton Court was the right place for them. People had received checks on their individual needs before they came to stay at Bexton Court. This meant that they and the staff had the information they needed to decide if the persons needs could be met by the service. The home has an established staff team who were keen for high standards to be maintained. Peoples plans of care and individual care notes on the whole were well written and reflected each persons needs. This helps to make sure that each person received the care and support they need in the way they prefer. Bexton Court provides a variety of activities for the people who stay there. These activities help to keep people busy and give them a chance to join in on social occasions. A good standard of hygiene was seen throughout the home and the standard of decor and furnishings throughout the home was good. Thought has also been given to making sure there is enough light and heating throughout the home. Relatives of people who were staying at Bexton Court commented, My relative is happy with all aspects of Bexton Court and the staff are caring and helpful. Bexton Court provides everything that is required. Staff are always on hand to help with any queries we may have, In our experience of using Bexton Court facilities over the past three years, everything is done very well and to very high standards. Having Bexton Court reduces stress levels for both the carers and the cared for, They look after my relative very well and the home is so friendly at all times and the staff are kind. The home is so warm and every member of staff makes you welcome. We are more than pleased with the way it is run, The staff are wonderful and my relative loves it here. The staff look them in the eye, smile and treat them like special people, my relative is loving it and blossoming after being poorly and They provide a safe, warm and clean environment. Provide an excellent choice of food which is served in the dining room, with clean tableware and nicely presented. Staff commented: Bexton Court has an excellent team who have specialist dementia training. Service users, families, visitors are always made to feel welcome. Activities and dining facilities are good and staff have a good understanding of service users needs; The staff work well as a team, which is helpful when working with dementia clients. We support each other when needed and we try to do activities, lots of singing and dancing and cinema evenings. The clients need a lot of reassurance; The home cares for the individuals needs and concerns very well. The home also supplies a clean and safe environment for clients and staff. In my opinion Bexton Court offer a brilliant and professional service; Bexton Court takes care of service users needs and personal welfare. There are usually enough staff on to meet clients needs; We care for clients, support relatives, support other employees. We take people with hugely varying degrees of dementia and other mental and physical disabilities; Bexton Court gives care and support to people and their families who are living with dementia. They provide daily activities and stimulation, personal care with dignity and wellbeing; Care Homes for Older People Page 8 of 29 They pass on information between staff continuously and effectively thereby giving everyone up to date information on clients, their current situation and their needs. They encourage activities such as quizzes, music, singing, exercises, crafts etc and they welcome visitors and relatives; The home is person centred. We are family orientated and welcome the family input. We have numerous activities though the day which blends in with all our day care clients. All our staff highly experienced and strive to meet the needs of the clients, family and carers. I believe that Bexton Court is one of the best homes, they put all clients needs first and the home is clean and friendly; Communication between staff and families is good. We take care of clients needs providing a caring and safe environment and first class meals and snacks; I am usually given enough information about the needs of the service users. They provide a safe and secure environment for people living with dementia. The maintain their well being and provide social stimulation. Also provides a link for carers to other organisations and provide and excellent professional and committed staff team. 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 Care Homes for Older People Page 9 of 29 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 10 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 11 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. People receive good information about Bexton Court for them to make an informed decision about staying there and their needs are checked so they know that these can be met at Bexton Court. Evidence: We saw copies of the information that tells people how the home works, the statement of purpose and the information book. A copy of the information book was kept in each persons bedroom. The information book is produced in larger print format and plain English. There is enough information about the home contained in this for people to decide if they want to stay at Bexton Court. The information included a welcome statement, information about location, map, philosophy of care, care planning, bedrooms, emergency call system and night times, washing, bathing and laundry facilities, medication, valuables, meals, going out and visitors, phone calls and mail, entertainment, hairdressing and podiatry, smoking, health and safety, comments and complaints and gifts and legacies. The information on whos who is not presently Care Homes for Older People Page 12 of 29 Evidence: included as it is being updated. This book had recently been updated to reflect the change in the local council to Cheshire East Council. A recommendation was made that a review date be included so that people were aware of when the information had last been updated. The statement of purpose is a leaflet that contains information on details of the organisation that runs the home, the registered manager and staff, age ranges and sex of service users, range of care needs, nursing services, admission criteria, activities, consultation with service users, fire precautions, smoking, support for religious needs, contact with family, complaints, reviews, room details, respecting privacy and dignity and details of the commission. The manager told us that some of the details were included as an addendum in Feb 2010 but these needed to be added to the main part of the document. A recommendation was made and this was completed by the end of the inspection visit. However, the document also would benefit from a review date being included and a recommendation was made. The manager confirmed that she uses the information provided by the social worker to check the needs of the people who come to stay at Bexton Court for short term care. She transfers this information to the enablement plan and risk assessments and discusses this with the individual person. Once completed these form the basis of the care plan. Intermediate care is provided at Bexton Court. Bexton Court offered a range of flexible residential short break and day services. These offer support in a community setting to enable you to remain in your own home. Care Homes for Older People Page 13 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, personal care and social needs of the people at Bexton Court are met by the staff team in a way that enables them to maintain their privacy and dignity. Evidence: We looked at the care plans of three people who were staying at Bexton Court to check on the care they receive. On the whole these were well written and the language used was person centred. It was noted that acknowledgment to privacy and dignity was included in the care plans. Most files contained a care needs assessment, enablement programme, risk assessments, health care information, daily log sheet and medication details. The daily records were completed for each person and contained information about their well-being and activities they had undertaken during the day. All the files had reviews of the care plans to make sure that the information was up to date and still effective. Some of the people staying at the home were not able to confirm that they had been involved in planning or reviewing their own care; however, they were able to confirm that staff helped them when they needed it such as with Care Homes for Older People Page 14 of 29 Evidence: personal care tasks. Two of the three files we checked had risk assessments but they were not signed or dated by the assessor. One person did not have a risk assessment in place; this was rectified during the inspection visit. One person who was taking medication did not have a risk assessment for this task. A requirement was made that all people must have risk assessments in place and that they must be signed and dated by the assessor. The medication for people staying at Bexton Court is stored in a medication trolley that is kept in one of the offices that has a coded entry system. It can be attached to the wall for added security. People bring in medication in a variety of ways - some in monitored dosage systems, others in packs or bottles. All medication is recorded when people arrive to stay at the home. The manager confirmed that they did not hold any controlled drugs at the time of our visit but have facilities if required to do so. Medication administration record sheets were seen and a random sample were checked. It was noted that there were several errors which included: medication being signed for ahead of time; two boxes left blank with no signature and one had x instead of a signature with no explanation as to why. A recommendation was made regarding these errors. Staff confirmed they had received medication awareness training and that helped to make sure that those who give out medication know how to do it safely so that errors do not occur. Visits from health care professionals were recorded and it was seen that GPs and nurses had visited the service. Most other services were not needed as this is a short term care centre. However, if a dentist or optician was required the manager has details of local people that could be used. Any appointments would be recorded and the outcomes noted on the persons file. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a range of activities for people who are staying at Bexton Court so they have daily variation and interest in their activities. The meals are good and people who stay at Bexton Court have good quality food and variety. Evidence: At the time of our visit, Bexton Court was providing a wide range of activities for the people who stay there. These included bingo, quizzes, crafts, board games, gardening, exercises, music, access to computer and internet and books. The service has recently bought a greenhouse and one of the staff members is a keen gardener; seedlings were being cultivated by the people staying there. Local and national newspapers were available and there is a monthly religious service for those who wish to participate. The hairdresser visits each week on a Wednesday. People who visit the centre on day care have a journal kept of activities undertaken. Activities included manicures, discussions of persons life, work and likes and dislikes, discussions of newspaper topics, shopping for plants, hanging out washing, quizzes, film show, hand and foot massage, draughts, making Easter cards and bonnets, flower arranging, bingo, painting, karaoke, crosswords, knitting, jigsaws, chair aerobics, and skittles. A cheese and wine evening had also recently taken place. Care Homes for Older People Page 16 of 29 Evidence: The journal provided a good record of activities and families also contributed in the book so that any significant events that happened whilst the person was not with them was recorded. As this was only produced for a small group of clients it would be beneficial to complete this for all people staying at the centre or to have some other form of documentation to show what each individual person had been doing. This would also help in the identification and capture of significant information such as a persons past history and likes and dislikes. A recommendation was made regarding this. Activities for other people were recorded in the diary, but names of who did what were not being recorded. The people staying at Bexton Court could be involved in some external activities, and these included going to the local shops, visiting Knutsford, the local garden centres and going to the park to feed the ducks and watch children play. There is a four week menu plan that is based around traditional meals. There was a good variety of meats, cheese, eggs and fish with fresh vegetables and fruit being used throughout the menu. There was a choice of meals at both lunch and tea time. The cook confirmed that she provides special diets such as for diabetics and gluten free. A sheet is provided to check what each person wants for their meal and dessert. The cook explained that a few extra portions were prepared in case people changed their minds. During a discussion with the cook she stated that the kitchen was good to work in, although it did get hot in the summer. The equipment provided was good and any problems are sorted out promptly. She liked working there and the staff team were friendly. It was said that the kitchen was easy to keep clean and we saw it was clean and tidy during this visit. The cook said that the cooks and kitchen assistants do most of the cleaning with some help from the handyman. Temperatures of the fridges and freezers are noted throughout the day to ensure that food is kept at the correct temperature. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Bexton Courts procedures for complaints and safeguarding are effective so that the concerns of the people who stay there are listened to and they are protected from abuse or harm. Evidence: We looked at staff files during our visit and these showed that staff had completed training about safeguarding adults. The manager confirmed this and showed that she was aware of the policy, procedure and guidance on safeguarding. There were also policies available in the home including Safeguarding Adults in Cheshire East, guidance to staff on violence in the work place, challenging behaviour, violence at work, violence by clients and whistle blowing. The manager had a file for recording safeguarding referrals and had not reported any over the last year before our visit. The complaints procedure for Bexton Court was satisfactory and contained details of how to contact us. We had not received any complaints about Bexton Court in the twelve months before this inspection. One informal complaint had been received by the service and had been resolved within twenty-eight days. People who were staying at Bexton Court confirmed they would contact the manager or staff if they had any concerns or problems. Care Homes for Older People Page 18 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Bexton Court is well maintained and furnished to a good standard so that the people who stay there do so in safe, comfortable surroundings. Evidence: During our visit we walked round the building and we saw all the shared (communal) areas as well as a number of bedrooms. The decor was of a good standard in the bedrooms and this was reflected throughout the home. People usually only stay for a short time so they bring what they need for a short stay with them. The communal areas were well decorated and furnished and thought had been given to lighting and heating throughout the home so that it was bright and comfortable for the people staying there. The home was found to be very clean and free from unpleasant odours. Overall the home was well maintained and of a good standard. Relatives of people who stay at Bexton Court commented, My relative always likes the meals, The home is always clean, bright and friendly. The meals are wholesome and tasty, My relative usually likes the meals at the home and the home is always fresh and clean, The home is so warm and every member of staff makes you welcome and They provide a safe, warm and clean environment. Provide an excellent choice of food which is served in the dining room, with clean tableware and Care Homes for Older People Page 19 of 29 Evidence: nicely presented. Care Homes for Older People Page 20 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. People staying at Bexton Court are supported by trained, effective staff who have gone through a recruitment process, so that peoples needs are met and they are safe from possible harm or poor practice. Evidence: The staff rotas showed the number of staff on over the week. There are usually 4 care staff that start at 7.30 am and are joined at 10am by 2 more care staff. Also one senior care on the early shift and one on the late shift and an extra senior is on duty, 3 days a week working 10 - 6. These people are also supported by a full time manager, general assistants, cooks and a handyman. There are 2 waking night staff are on duty each night. The manager confirmed they were fully staffed at present. During this visit there appeared to be enough staff around to meet the needs of the clients. We checked three staff files and they had all of the pre-employment checks in place, including completed application forms, references, photo, Criminal Records Bureau (CRB) checks and medical statements. Staff files were split into training, induction, job description, miscellaneous, employee establishment records, annual leave, sickness, contract, bank details, CRB, medical form, references and application form so that information was easy to find in them. Care Homes for Older People Page 21 of 29 Evidence: Staff had access to a wide range of training which included safeguarding adults, health and safety, moving and handling, fire awareness, dementia awareness, emergency aid, food hygiene and Disability Discrimination Act awareness. Other courses staff had completed included medication administration, mental health awareness, stoma care, catheter and sheath care, risk assessments, falls awareness and person centred care. At the time of our visit the new manager was moving from the old system of recording training which made it difficult to obtain an overall picture to a new system. It was suggested that the new system be continued and that all staff training past and present be gathered onto this so that a full picture could be obtained of what training each member of staff had undertaken and where there were any gaps. All staff had completed an induction. This process included working through the induction handbook and signing off each section and some time spent shadowing other staff. The workbook contains information on the workplace, hours of work, sickness and absence, leave, pay and expenses, health and safety, trade union, code of conduct, managing public funds, communication, valuing diversity, whistle blowing, financial regulations, supervision, Cheshire East Council Department of Social Services and Health, customer service handbook, training and development and further information. A check list is included in each book, which is completed then kept on the staff members file. Excellent progress has been made with National Vocational Qualification (NVQ) training. Seventeen out of twenty care staff had NVQ 2 or above in care. One staff member was undertaking NVQ 2 and two staff are due to start this training shortly after our visit. Both cooks had NVQ 2 in catering, all seniors had NVQ 3 in care and five out of eight general assistants had NVQ level 1 or 2 in cleaning. This means a very high percentage of staff held a nationally recognised qualification to help them provide good quality support for the people who stay at Bexton Court. Care Homes for Older People Page 22 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. Bexton Court has policies and procedures in place to ensure the health and safety of the people staying there are promoted and protected and that the service is run in the best interests of the people who stay there. Evidence: The manager is new in her role, having been promoted in January 2010. She has worked for the organisation that runs Bexton Court for twenty-six years and for the past twenty years in a senior role. She had achieved the Registered Managers Award and was a NVQ assessor and verifier. She had updated her training and knowledge on a regular basis and this had also included the Dementia Care Mapping course. At the time of our visit, she had applied to become registered with the commission. The manager completed the information about the home we ask for each year, the annual quality assurance assessment, which was received when requested. It was well written and gave a good overview of what had been happening at Bexton Court over the twelve months before our visit as well as the plans for improvements in the year Care Homes for Older People Page 23 of 29 Evidence: after the visit. There is a quality assurance process for the service which includes various staff meetings, service user questionnaires, satisfaction forms, regular visits from the provider and compliments file. The staff meetings were generally held on a regular basis. They were split into senior care, care assistants, general assistants, cooks and full staff meetings. The last senior care meeting before our visit was on 23.03.10; the last care assistant meeting was on 22.01.10; the last general assistant meeting was on 01.04.10 and the last cooks meeting was on 21.05.08. A discussion was held with the manager regarding the last cooks meeting and she indicated that there had been problems but it was hoped to have one shortly after our visit. The last full staff meeting was on 12.08.09 and it was well attended. Records were kept of all meetings and these were seen during this visit. The compliments file was available at the home and included a range of letters and emails showing the appreciation of service users and families. Comments included, The care at Bexton Court has been very good, Thank you for all your help, Enormous thank you for the kindness and love you have shown us, I have complete confidence in the way you have looked after my relative and Thank you for all the loving care you have given me, I have enjoyed very minute and you have been a tremendous help towards my recovery. Other comments included Thank you for making me so welcome and I was so impressed by the friendly, caring staff. Satisfaction forms were completed after peoples visits to stay at the home had ended. This information was collected by a phone call by one of the team. Comments included, Staff were excellent. They gave my relative lots of reassurance, time and care, My relative though it was a hotel and enjoyed the holiday, The food was very good, The staff were very good. Very nice atmosphere and I liked the company and banter. A representative from Cheshire East Council visited the home each month to check on how it was running. The most recent visit before our visit was in March 2010, and the report of the visit covered speaking to staff and service users, looking around the premises and looking at a range of records. Client experience surveys are sent out to relatives and carers of the clients that stay at Bexton court and a quality standards report is published each year. The last one was March 2009 and a total of 70 questionnaires were included in this summary. All commentated that the needs of the person they cared for were met by the service and Care Homes for Older People Page 24 of 29 Evidence: that staff were polite and respectful. They also said they were quite or very satisfied with the service provided and all stated that the service definitely helped the relatives. It was recommended that comments made on the surveys received be added to the report, so that more individual comments are included. Day to day supervision of staff is good; however out of the three staff files examined only one formal supervision session was up to date. One staff member had no record and the other one was in June 2009. A recommendation was made about bringing these sessions up to date. Annual appraisals had not been undertaken and a recommendation was made regarding this. Some personal money of people staying at Bexton Court is held at the home on their behalf. This is kept secure and records are kept of money spent. Four accounts were checked and two were found to be correct, one had too much money and another was overspent by two pounds. A recommendation was made that that money is regularly checked to ensure no errors in the accounting procedure and it was suggested that the practice of allowing clients to overspend be discontinued, so that money always balances to ensure good accounting practices. The service has a wide range of policies available. The smoking policy states that the home, grounds and gardens are smoke free and people have to go off the premises to smoke. This was also seen in the information book. The gifts and legacies policy states that staff cannot receive gifts from service users. Safe working practices were in place in the home. There were up to date safety checks on the homes electrical wiring and gas installation; however the certificates were not held at the service. It was suggested that a copy be kept at Bexton Court so that the manager could demonstrate that the home is safe for the people staying there. All checks with regard to fire safety were up to date and checks were also completed on the emergency lights, hot water system and call system. Policies available regarding safe working practices included health and safety, food and environment, first aid, administration of medication, drug, alcohol and substance misuse, moving and handling procedure, no smoking, COSHH and infection control. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 Risk assessments must be 30/06/2010 completed for each person and signed and dated by the assessor. This is so that staff have up to date information of the possible risks and how to deal with these. 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 1 A review date should be included in the information book and the statement of purpose so that people know when these were last updated and know they have access to up to date information. Medication administration record sheets should be fully completed so that people are aware of what medication has been administered. Individual records of activities undertaken should be produced for each person during their visit to Bexton Court so that a picture can be provided of activities each individual likes and to capture information on their life and likes an dislikes. Page 27 of 29 2 9 3 12 Care Homes for Older People 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 4 33 Individual comments from the surveys should be included into the quality standards report to show that peoples views about the home are taken seriously. Money held on behalf of clients should be checked regularly so that errors do not occur and good accounting practices are in place to make sure that clients money is safe. Formal supervision should be undertaken with the staff team so that they have the opportunity to discuss their work with their line manager and so that clients are assisted by well supported staff. Annual appraisals should be undertaken with the staff team so that they have the opportunity to discuss their work and future training needs with their line manager and so that clients are assisted by well supported staff. 5 35 6 36 7 36 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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