Care Home: Birchams Grange

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What the care home does well Relevant information about the service, and what can be provided, is available to assist prospective new people and their families to make the right decisions about whether the service is suitable for them. New people have their needs carefully assessed and they are encouraged to visit and try out the service before making a long term decision. People told us they are supported to be independent and to have their personal and health needs met. They each have their own care plan which they are consulted about. Opportunities are available for everyone living at the home to do the things they enjoy, and if they wish to be involved, there are a range of activities provided. People`s families and visitors are made welcome. Relatives feel they are kept well informed. The accommodation is of a high quality, clean and homely. Improvements are continually being made. People have the equipment they need to remain independent. People feel safe in the home and have confidence that if they raise a concern they will be listened to. People found the staff approach caring. There is a low staff turnover so staff and residents are able to get to know each other. There are safe recruitment practices. The staff are well trained, supported and supervised to help them do a good job. The home is run in the best interests of the residents by a competent Provider and Care Manager. What has improved since the last inspection? Terms and Conditions of Residency are now being agreed at the point the person moves in rather than after the four week trial period. There is a new communal area and other improvements have been made to the building. What the care home could do better: Information about the home could be made clearer for people considering moving in. A wider range of activities could be provided. A choice of two main meals could be offered each lunchtime. The staffing levels could be increased so people have more one to one time with care staff and Mrs Fry can work full time focusing on her management duties.If more people with Dementia are to be offered a service expertise in this condition needs to be developed throughout the staff team. Key inspection report Care homes for older people Name: Address: Birchams Grange Clenchers Mill Lane Eastnor Ledbury Herefordshire HR8 1RW     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jean Littler     Date: 0 1 0 2 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 30 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 30 Information about the care home Name of care home: Address: Birchams Grange Clenchers Mill Lane Eastnor Ledbury Herefordshire HR8 1RW 01531632925 01531632925 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: E.C. Investments (Gloucestershire) Ltd care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 25 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: Old age, not falling within any other category (OP) 25 Dementia (DE) 12 Physical Disability (PD) 25 Date of last inspection Brief description of the care home The registered Provider of this service is a limited company. The Commission has approved Mr. Eric Hardy, as the companys Responsible Individual. He acts as the company representative and maintains regular contact and oversight of the service on behalf of the company. A separate registered Care Manager, Mrs. Jane Fry, is Care Homes for Older People Page 4 of 30 Over 65 0 25 0 12 0 25 Brief description of the care home employed. Birchams Grange is in a village location two miles from Ledbury. There is good road access being seven miles from the motorway and 8 miles south of Malvern. The building sits in its own grounds and consists of an adapted house with a modern purpose-built extension. All residents have single bedroom accommodation, most with en-suite facilities. The service is registered to care for 25 people who are over 65 years of age who have care needs arising from the general ageing process or physical disability. A maximum of 12 people may also have dementia. There is information describing the service available from the home. In February 2010 the fees were £550 per week. There are additional charges for chiropody, hairdressing, newspapers, toiletries and transport. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We, the Commission, carried out this inspection over one day. At the last inspection in February 2007 the service was rated as providing Excellent outcomes for people, therefore an inspection has not carried out for three years. Annual Service Reviews have been carried out in 2008 and 2009. The information received from the service and from surveys at this time indicated that standards had remained high. For this inspection the manager, Mrs Fry, provided us with the Annual Quality Assurance Assessment (AQAA) that registered people are required to complete each year. Survey forms were sent out to people in the home, their relatives, health professionals and staff, so they could give us their views. During the visits to the home the building was toured, records such as medication, care Care Homes for Older People Page 6 of 30 plans, training and staff rotas were sampled. Staff were interviewed and people in the home were spoken with. Mrs Fry and Mr Hardy the owner were both in the home and able to help with the inspection. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Information about the home could be made clearer for people considering moving in. A wider range of activities could be provided. A choice of two main meals could be offered each lunchtime. The staffing levels could be increased so people have more one to one time with care staff and Mrs Fry can work full time focusing on her management duties. Care Homes for Older People Page 8 of 30 If more people with Dementia are to be offered a service expertise in this condition needs to be developed throughout the staff team. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 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. Admissions are carefully considered and planned so that interested people have the information they need to decide if the home will suit them, and the staff understand how to provide the care once the new person arrives. Evidence: There is an up to date Service Users Guide that is made available to everyone in the home and anyone interested in the service. The current format of the Guide is quite detailed and is printed in a small font. Consideration should be given to having a more assessable format in large print that clearly gives the essential points that people, who may have some dementia, need to know when considering where to live. The owner had applied to increase the number of registered places in the home for people with dementia from two to twelve. This was approved just prior to the inspection and a new certificate will be issued in the near future. Care Homes for Older People Page 11 of 30 Evidence: Mrs Fry said that everyone in the home has been given a copy of the Terms and Conditions of Residence. The people who returned surveys confirmed this. Mrs Fry said contracts used to only be issued after the four week trial period, but she now gets these issued and signed as soon as possible after admission. The current fees are £550 per week. This information and details about any extras people will have to pay for is not currently included in the Users Guide. Mrs Fry said she will add this in, in line with the requirements of Regulation 5. Before any admission is agreed Mrs Fry said she gathers as much information as possible to help her decide if the home will be able to meet the persons needs and expectations. Two peoples care records confirmed this. Assessment reports from other care professionals are obtained when possible, such as hospital discharge information. Mrs Fry has also started insisting that social workers provide an assessment for people who are funded by the local authority. The records showed people are consulted while the care arrangements are put in place, for example, signed consent forms regarding any wish to be checked through the night; whether a bedroom door key would be required. Pre admission visits are encouraged and people can have a meal to try the food. The AQAA indicated that there is no referral and admission policy in place. If this is the case one should be developed. A new person said she had met Mrs Fry in hospital and her son had visited before she did. She felt she had been consulted, given information and been made welcome. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person has an up to date plan of care that they have been consulted about. People have their dignity and privacy safeguarded and feel staff support them in a sensitive way. People can be confident that their health needs will be met and their medication managed safely. Evidence: Each person has a plan of care that Mrs Fry completes based on the pre-admission assessment information. The plans sampled showed that the information was clear and written in a respectful way. It reflected each persons preferences and support needs. Mrs Fry reviews this information regularly to take account of any changing circumstances. Peoples keyworkers check with them each month to ensure they arrangements are what they want. The plans are comprehensive and any potential risks are formally assessed so that action can be taken to protect the individual. These included high risk areas such as pressure relief, weight loss, moving and handling whilst helping people remain as independent as possible. Recognised assessment tools are used in this work. Care Homes for Older People Page 13 of 30 Evidence: There is a very useful system of colour coding the care plans so that the staff can easily find those parts that are most essential to each persons safety and welfare. Staff said the care plans are kept up to date and they are informed of any changes in peoples needs at handovers. All feedback indicated that people are satisfied with the personal and health care provided and that peoples privacy and dignity are respected. Two health professionals returned positive comments. One said, There is good liaison with nurses, there is ongoing training for all staff and they cater for the needs of individuals. The other said, The service involved clients in self care where possible, initiates continuing health care assessments where appropriate and raises referrals for nursing services as needed. A GP said, Excellent Home. Relatives comments included, The staff are very caring and give my mother excellent support and compassion. One resident said, They respect our preferences. A worker said, We always respect peoples privacy and dignity and confidentiality. Routine health needs are being met such as chiropody and dental treatment. District and mental health community nurses are asked to support when needed. Suitable action had been taken to care for a person with a pressure sore on her heel. Appropriate arrangements were in place to support a person who was unwell and whose needs were increasing. A diabetes nurse was booked for February to give a talk to staff on this subject. Regular checks were being made of the blood sugar levels of the people with this condition. Someone who is trained to administer insulin is always on duty during the day. Arrangements for managing medication were inspected. The records were in good order and showed that prescribed doses for that period had been given. Mrs Fry checks the medication orders herself and ensures what arrives in the home matches with the doctors prescriptions. Appropriate arrangements are in place for the management of controlled medicines. There is a policy about medication prescribed on an as required basis. These medicines were only in use for pain relief. Staff who administer medication are suitably trained. Staff have attended a 12 weeks distance learning palliative care course. People are consulted about their wishes in the event of their death. The GP is involved in decisions people make with their families about resuscitation. Now Living Wills are legal Mrs Fry should promote the development of these for people who have Mental Capacity so if they loose capacity later their wishes are already clearly recorded. Care Homes for Older People Page 14 of 30 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 feel they are supported to make decisions and follow their hobbies. Their relatives and visitors are made welcome. There is an activity programme and people like the meals offered. Evidence: Mrs Fry is currently completing life history profiles with people. This information is being gathered to help staff gain a holistic picture of the people so activities and conversations can be more personalised. To help meet peoples social and emotional needs Mrs Fry said people are encouraged to follow any hobbies they enjoy, such as knitting. Some regular activities are arranged during the week such as armchair exercises, cards, puzzles and bingo. Volunteers have recently been found to provide an art class and to read short stories. Holy Communion is held in the home every month by two different churches. If people are unwell this is offered in their bedroom. There is a DVD and CD collection that is age appropriate. A cake had been arranged on the day of the inspection for a lady who was celebrating her 100th birthday. Other special occassions are also celebrated. There is no activities organiser employed and no designated member of the care team Care Homes for Older People Page 15 of 30 Evidence: responsible for social activities. A worker said she is a keyworker to four people. She has found out their interests and makes time to play dominos and cards with a person who likes these pastimes. The owner explained that as one person used to teach piano they have arranged for an electric organ to be provided in her bedroom from the benevolent fund. There are plans to keep hens and a rabbit and one man is looking forward to having responsibility to feed them. Feedback indicated that some people were satisfied but others wanted a wider range of activities to be provided. One resident felt more outings could be offered to those able enough to get out. One member of staff said, I feel more residents could get involved in daily activities. The home has an open door policy for visitors. Feedback indicated that relatives feel welcomed when they visit and that they are kept informed of any issues such as poor health. One relative said, They treat residents in a respectful and friendly manner. One resident said, I have just had my 100th birthday, and what a party I had! My friends and relatives were made so welcome. Feedback in surveys indicated that people feel in control of their lives and are able to make their own decisions. Mrs Fry assesses peoples mental capacity to make decisions for themselves. This is positive and is in line with the Mental Capacity Act. She is aware that if people cannot make decisions for themselves then they must be helped to be involved while their supporters make decisions in their best interest. One such meeting took place during the inspection with a resident, her family, the GP and Mrs Fry. One new lady explained that although staff have been very nice she had had to make several adjustments to her lifestyle since moving in. Because staff ask if she wants to get up about 7.30am she has been setting her alarm for 7am to make sure she is awake and ready for them. She has not been able to fit her recliner chair into her bedroom and is missing this a lot. She has always eaten her main meal in the evening but now has this at lunchtime. The evening light meal is at 5.30pm and she finds it a long time between this and breakfast at 8.30am. She said she is offered a supper of sandwiches and Horlicks. Mrs Fry said some people are early risers by choice but there is no pressure on people to get up or go to bed at a particular time. People are each designated a keyworker, but this feedback indicates that this work could be developed so the service is made as personalised as possible from the point someone moves in to help them settle and be content. The meals are prepared in a well equipped, clean and tidy kitchen. They are served in Care Homes for Older People Page 16 of 30 Evidence: an attractive dining room. People can choose to eat in the privacy of their own room. Feedback from people in the home and relatives was very positive about the quality of the food. There are two cooks who have both completed a 12 week distance learning course on healthy eating and nutrition. To support them in their role the owner has arranged for a specialist to review the nutritional content of the menus. This work has not started yet. A choice is offered for all meals except the main meal. The cooks are informed about individuals dietary needs and preferences and alternative dishes are offered for anyone who doesnt like the main meal. It is usual in the care sector for there to be a choice of two main meals on the menu each day. It is recommended that this is introduced. Mrs Fry said she is considering spreading out the meal times to increase the flexibility for people. A specific survey of peoples wishes should be considered. Care Homes for Older People Page 17 of 30 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 the home and their representatives know how to make a complaint and feel able to give their views. People are protected by a team who understand how to identify and report any concerns or abuse. Evidence: Each person has written guidance so they know how to raise any concerns. This is included in information pack provided when people move in. Mrs Fry told us she makes a record of any complaints received and any action taken to address the issue. There have not been any complaints received by the home or us in the last year. All feedback indicated that people feel able to raise issues. One resident said, I have been here six years and so far no complaints. The staff spoken with said they have had training on abuse and they were clear about their duty to report any concerns they have. They felt the manager and owner were approachable and they would be able to voice any concerns. Mrs Fry told us that staff receive information on adult protection as part of their induction. This includes them having to read the homes policy. Training has been provided by the local authority and a refresher course is planned for 2010. Mrs Fry and her deputy have both attended the training provided for managers. One relative told us, The owner and manager approached me with concerns relating to a regular visitor to my relative. Their concerns proved founded and I am very Care Homes for Older People Page 18 of 30 Evidence: grateful to them. Mrs Fry helped this person refer the matter to the local authority Safeguarding Team and the police are investigating. These events have led Mrs Fry to increasing the involvement of the Hereford advocacy service with people who do not have any close family member helping them manage their affairs. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a very well maintained, attractive, safe and clean home, where improvements are continually being made. Evidence: The owner continues to improve the premises, for example, a new communal area has been added and some parts of the home have been redecorated. Two new bedrooms have recently been built and these were approved to be registered just before the inspection. The work has been done to a very high standard, with a lot of attention given to comfort and convenience. For example the mattresses are washable but they are soft to the touch and very comfortable. Each room has a full length mirror and two comfortable chairs. We spoke to a man who had moved from another part of the home into one of the new rooms. He was very pleased and felt being on the ground floor would help him maintain his independence. There are plans to add another ensuite room later in 2010. The grounds and gardens have been landscaped to offer easy access and interesting outlooks from bedrooms. As well as the lounge, conservatory and dining area there is a hairdressing salon that can also be used for health appointments such as chiropody. The premises were very clean, tidy and bright when the unannounced inspection visit took place. Feedback about the premises was very positive. People felt the home is clean, fresh and well maintained. One relative said, The home is always spotless and Care Homes for Older People Page 20 of 30 Evidence: sweet smelling. Everyone has a private toilet. Most have an ensuite facility and the few that do not have a toilet nearby that is designated for their use only. There are four bathrooms. Two are fitted with baths for people with mobility difficulties, although the rooms are not ideal in terms of size or shape for disabled access. There is a walk in shower room and another small domestic bathroom. Staff told us they have the equipment they need to support people who have physical disabilities, such as, slide sheets and a hoist. They have been provided with training to use these. There is a passenger lift between the two floors. The owner said this is serviced every three months. A call bell system is in place and there are long leads available so people are not limited by having to sit next to the bell in their rooms. There is one mobile hand alarm, which can be used if someone wishes to sit in the garden etc. If the system is upgraded in the future a pendant system should be considered to increase peoples chances of being able to call for help from any location. There are wooden swing barriers at the top of both flights of stairs to try to help prevent any falls. The closures were not working well causing the barriers to rest partly open. These should be adjusted so they do not cause a hazard to people walking down the corridor. Adaptations have been made to improve the safety of people with dementia, such as a code keypad being put on the back gate and railing around the patio area so people can come and go freely from the lounge to the patio without risk of falling onto the garden below. Fire exits are alarmed and the front door is now being kept locked. People who wish to and are not at risk are offered a front door key. The owner agreed to consider the potential risk posed by a metal fire escape staircase coming down into this secure patio that a confused person may climb up. Peoples bedrooms had been nicely personalised. The owner explained that familiar things had been put at the entrance to one ladys bedroom to help orientate her. Mrs Fry should research good practice in terms of environmental adaptations for people with dementia if the service is going to offer places to up to twelve people with this condition. Mrs Fry told us there is a maintenance person employed to ensure repairs are carried out quickly. She and the owner regularly audit the safety of the premises so that any maintenance work or potential hazards are promptly identified and dealt with. There is also a gardener to ensure the grounds remain tidy and accessible. Fire records showed Mrs Fry ensures fire equipment is in good working order and that staff are well trained in this area. Mrs Fry told us that infection control measures are in place e.g. cleaning schedules, and that staff are all trained in this area. House keepers are employed who work each Care Homes for Older People Page 21 of 30 Evidence: day. The laundry, which is located in an out building, is suitable equipped. Care Homes for Older People Page 22 of 30 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 like the staff who support them and feel their needs are met. New applicants are carefully selected and there is regular training provided so that staff work safely and professionally. Evidence: There is usually three care staff on duty during the day and at night two waking staff. The numbers of people the home can accommodate is being increased from 23 to 25, which is a ratio of eight people for each carer to support. Care staff are also responsible for meeting peoples social and emotional needs as there is no activities organiser as well as doing some domestic tasks. This is a low ratio for the sector, however, several of the people in the home are still very independent. Mrs Fry works about 34 hrs a week on shift providing additional cover. This is unusual as the manager role is complex and is usually supernumerary in a home of this size, however the owner is also closely involved in the operation of the service. Mrs Fry said she is recruiting two kitchen assistants to free carers up from doing drink rounds and tea duties. Care staff currently also deal with laundry but Mrs Fry wants the kitchen assistants to help with this work. Careful consideration will have to be given to infection control if these workers are going to move between the laundry and kitchen. The current day shifts for carers finish at 7pm. This is unusually early for an adult service. No one in the home complained about this and several people are able to get Care Homes for Older People Page 23 of 30 Evidence: themselves ready for bed when they want to. If up to twelve people with dementia are accommodated in the future the staffing levels will need to be increased and day shifts will need to be lengthened as people will not be able to occupy themselves in the evening and will need full assistance when going to bed. People gave positive feedback about the staff. Comments included, The staff are very caring, training is kept well up to date, the home is always clean; The staff are kind and friendly. One relative said, It would be nice if staff could spend more time with residents. Staff turnover is very low. Mrs Fry is currently recruiting for one permanent post and one for maternity cover. There are currently no male staff. Consideration should be given to trying to recruit a male worker in future to balance the team and better meet the needs of the men using the service. One workers recruitment record was sampled. This confirmed a thorough recruitment procedure is followed that ensures only people who are suitable to work with vulnerable adults are employed. Mrs Fry interviews applicants twice and they do not start until she has received a satisfactory CRB check. Staff then shadow colleagues for up to a week depending on their past experience. They then work with a senior until they are fully competent in the role. There is now a six month probation period. Mrs Fry showed evidence that all new staff are given an induction covering the Common Induction Standards, in house policies and safety areas such as fire evacuation. This process could be improved if a workbook style of induction was used, where the worker has to demonstrate their understanding of each section by answering questions. A training matrix is used to help Mrs Fry plan training. Local training is accessed for some topics and distance learning courses are also used. Some staff are due to attend a two day course given by the mental health team on dementia and associated behaviours. Staff are just finishing a 12 week health and safety course. All have had booklets on the Mental Capacity Act, however a course on this should also be arranged to help them understand their responsibilities, especially as more people with dementia are going to be offered a service. Staff told us they felt the training helped them in their role. Currently 10 of 15 care staff hold a National Vocational Qualification, and two others have started the course. One of the two house keepers and both cooks hold a NVQ relevant to their roles. This is a very good ratio of trained staff. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are benefiting from a well managed service that is run in their best interests. There are some areas that can be further improved, however, we are confident that the owner and manager will consider these and make positive plans. Evidence: The owner, Mr Hardy spends a lot of time in the home, working alongside other staff and meeting people in the home and their visitors. Observations made during the inspection confirmed that people know him and have regular opportunities to speak to him. Mrs Fry has worked in the home for 20 years in various roles. She became the manager in 2002. She is appropriately qualified with an NVQ 4 in care and the Registered Managers award. She is currently studying for a Mental Health and Social Work award. She has been completing the courses she arranged for her staff as well as additional ones appropriate to her role. She has worked for many years with the deputy who holds an NVQ3. Together they make a strong management team who know the people in the home and their representatives well. Feedback about the way the home is run was very positive. Care Homes for Older People Page 25 of 30 Evidence: The home is running smoothly and Mrs Fry seems to be very committed. However, it would be positive if she could be allocated time to research current best practice for Dementia services, if this is how the service is to be developed, to coach senior staff to take on supervision of carers and to coach care staff in keyworking and care planning skills and to further develop the range of activities. She will no doubt benefit from having a new office. Internet access should be provided so she can easily access the professional information needed for her role. Quality assurance systems are in place, such as audits and annual feedback surveys. Mrs Fry gave an example of one person saying in their survey that they would like a television in their bedroom, which was arranged. Residents meetings are not held. Several people in the home would be able to take part in a meeting so these should be considered. The owner does not complete monthly reports usually required under Regulation 26. This has historically been accepted by the regulator because he is present in the home most days so is fully aware of standards and any issues. The homes policies were all updated in 2009. The AQAA indicated there were some gaps, which the owner should review, for example Referral and Admission. Mrs Fry is aware that policies around supporting people with Dementia need to be further developed. The home does not get involved in supporting people with their financial affairs. Relatives or financial representatives more appropriately do this. Small amounts of personal money are kept in safekeeping for some people. Mrs Fry showed us the clear records she maintains of any expenditure such as newspapers, chiropody and hairdressing. If relatives handover cash they are given a receipt and Mrs fry supplies them with copies of the expenditure records. The standard of record keeping seen was very good in all areas. Mrs Fry has reported incidents appropriately to us and she seems to have open and constructive relationships with other agencies. Systems are in place for managing health and safety matters, such as routine water and fridge temperature checks. Risk assessments are used to pro actively manage hazards. Mrs Fry has an emergency plan in case the home needs to be evacuated. She analyses any accident reports and has taken appropriate action such as referring people to the falls clinic. Fire drills are held quarterly, the last being in December 2009. The Environmental Health rating for the Home is good (4 star). Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 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 1 Develop a version of the Service Users Guide that is in a format more accessible to potential new residents. Include clear information about fees and any extra charges in the Users Guide 2 3 11 12 Promote the completion of Living Wills so peoples wishes are clearly recorded whilst they have full mental Capacity. Develop keyworking to help provide as personalised a service as possible. Offer a menu choice for main meals. Consult people in the home about the times meals are provided. Keep the staffing levels and length of the day shifts under review if the service accommodates more people with Dementia. Provide all staff with Dementia and Mental Capacity Act training. Introduce an induction in a workbook style where new staff demonstrate their understanding of each area by answering 4 5 15 27 6 30 Care Homes for Older People Page 28 of 30 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 questions. 7 8 31 37 Provide the manager with Internet access to enable her to keep up to date with care sector developments. Further develop policies around supporting people with Dementia. Care Homes for Older People Page 29 of 30 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. 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