Care Home: Birkin Lodge Care Home

Similar services:

• The Shelley
• Springfield House
• Sutton Lodge Nursing Home
• St Helier`s Residential Hotel
• St Joseph`s
• Ridgemount
• Wingham Court
• Old Hastings House

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Birkin Lodge Care Home Camden Park Hawkenbury Tunbridge Wells TN2 5AE     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Hall     Date: 0 2 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Birkin Lodge Care Home Camden Park Hawkenbury Tunbridge Wells TN2 5AE 01892533747 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): birkin.lodge@fshc.co.uk Four Seasons Homes (No 6) Limited (A wholly owned subsidiary of Four Seasons Healthcare) care home 50 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 50 old age, not falling within any other category Additional conditions: 0 The maximum number of service users to be accommodated is 50 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender; Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Birkin Lodge is a large, detached, property in Hawkenbury, which is on the outskirts of Tunbridge Wells. It is about five minutes walk away from the local shops, church and post office; and there is a large public park nearby. The home provides residential and nursing care for up to fifty older people. The accommodation is provided on three floors; lower ground, ground, and first floors. Thirty-five bedrooms are for single use; and there are seven shared rooms. Some Care Homes for Older People Page 4 of 31 Brief description of the care home bedrooms have en-suite toilet facilities. There are two large lounge/dining rooms and a smaller quiet lounge. There are two passenger lifts for easy access to all floors. The home is surrounded by well-maintained gardens that are suitable for wheelchair users. There are areas for car parking to the front and side of the building. Current fee levels range from 334 pounds per week to 725 pounds per week; and depend on the individually assessed needs of each resident, and whether they need residential or nursing care. In some cases there is a contribution from the Primary Care Trust towards the cost of nursing fees. Additional charges are made for hairdressing, chiropody, newspapers, toiletries and outings. Care Homes for Older People Page 5 of 31 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: The home has been given a rating of excellent, 3 stars. This means that CQC has assessed the home as providing an excellent standard of care for residents. A key inspection was carried out by one inspector, and this included a visit to the home lasting for nearly seven hours. During this time, we (i.e. CQC) viewed documentation such as admission data, care plans, staff recruitment files and staff training records; viewed all areas of the building; inspected medication; and chatted with six residents, seven staff and two visitors. One of these was a care manager who was carrying out a care review, and she spoke highly of the care given by the home, stating that she never has any concerns about the standards of care given by the staff team. Care Homes for Older People Page 6 of 31 We also sent out survey forms to residents and staff, and received ten completed forms, which contained very positive comments. Residents stated that staff listen to me; the staff are always kind and helpful; and we are always very well looked after. Staff comments included the managers listen to staff, and sort out any problems which arise; and I had a very helpful induction when I started work. The inspection also included assessing all information obtained by CQC (formerly the Commission for Social Care Inspection, or CSCI) during the past year, such as letters and telephone calls received, and formal notifications. We informed the providers of one complaint which was made to CSCI, and the home dealt swiftly and appropriately with this matter. There was also one referral made to the Social Services Safeguarding Adults team, and this referral was made by the the home manager. The home provided full co-operation with the Safeguarding team in regards to an investigation. What the care home does well: What has improved since the last inspection? What they could do better: Care planning could be further improved in the future, by showing how decisions are made for any residents who lack the mental capacity to make their own decisions. This would demonstrate compliance with the Mental Capacity Act 2005. Although the environment has been improved in many areas, bedrooms and bathrooms would benefit from refurbishment. Walls have been repainted, but other areas of the bathrooms are not well maintained, with scuffed radiator covers and skirting boards; and some bedrooms viewed did not appear homely or well presented. Cleaning staff work hard to keep the building clean in all areas, but there seem to be insufficient cleaning staff for the size and layout of the building, to keep it as clean as it could be. The laundry room is very small and not fit for purpose. This matter was raised as a requirement at the last key inspection, and is now being addressed. Care Homes for Older People Page 8 of 31 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 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 31 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. The home provides comprehensive information for enquirers; and there are good admission procedures in place. Evidence: The homes Statement of Purpose is provided in a large folder, which is kept readily accessible for anyone to read. It states the aim of the home is to foster an atmosphere of care and support, encouraging residents to live as full a lifestyle as possible. The Statement of Purpose includes data about the rooms and facilities available; and has good information about services such as chiropody, hairdressing, optician and physiotherapy arrangements. It includes the terms and conditions of residency, and the procedures for making a complaint. However, a few minor points itemised in Schedule 1 of the Regulations were missing; such as the qualifications and experience of the manager; and the arrangements for fire prevention and emergency procedures. The manager stated that she would check Schedule 1, and amend the Care Homes for Older People Page 11 of 31 Evidence: Statement of Purpose accordingly. The Service Users Guide is well presented in an attractive folder, with loose leaf inserts. This is provided for enquirers to view; and a copy is given to each new resident on admission. This ensures that they have relevant information about items such as meal times, complaints procedure, GP arrangements, different categories of staff and their roles, and the activities available. The Guide also includes a detailed breakdown of the Four Seasons standards for ensuring that residents have a full nutritional assessment, and are provided with the suitable range of foods for their individual needs. This includes any specific food preferences related to ethnic, cultural or religious needs. All residents have a comprehensive pre-admission assessment carried out, which includes all aspects of daily living. We read three of these assessments, and noted that they contained good information in regards to care needs such as moving and handling, nutrition, pain assessment, continence care, general risk assessments, communication ability and social preferences. Terms and conditions of residency are very clear, and include items such as a breakdown of the fees, and arrangements for personal finances and belongings. Residents (or their representative) are provided with a contract. There is a trial period of six weeks from admission, after which a review is held with the resident and appropriate relatives or care management to decide on the suitability of making the placement permanent. Care Homes for Older People Page 12 of 31 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. Health and personal care needs are well managed by the home. Staff treat residents with caring and kind attitudes. Evidence: Nursing or senior care staff carry out detailed assessments when residents are admitted to the home as a back up to the initial pre-admission assessments. These are called the Care and Health Assessment Profiles. The resulting information forms the basis for care planning. The care plans are drawn up with the agreement of the resident or their representative; and the assessments and care plans are reviewed on a monthly basis. We examined three care plans and looked briefly at a fourth. Two of these were for residential clients, and two for nursing clients. Care plans are clearly set out with an index system so that it is easy to find the required information. As well as detailed assessments, we found that care plans are well written by senior staff, and include suitably detailed information for care staff to carry out care effectively. For example, Care Homes for Older People Page 13 of 31 Evidence: personal care plans include residents preferences for a bath or shower; if they need assistance with dressing, and if they need one or two care staff to help them. Moving and handling care plans clearly show if specific equipment is needed, (such as hoists and slings), and state the type of hoist and size of sling. Other care plans viewed had comprehensive information about continence care, medication, nutritional needs and special diets, skin integrity and wound care. Wound care management is very well carried out, with a full assessment of each wound every time a dressing is changed. There is a separate written account of the progress of wound healing, as well as wound assessment charts. Nursing staff are quick to contact the local PCT tissue viability nurse for ongoing advice about the best way to treat and heal individual wounds. The care plans indicate that there are good links with other health professionals such as physiotherapist, GP, district nurses and chiropodist. Physiotherapy can be arranged privately, or may be offered for some specific residents who are admitted for short term care. These are people who have suffered injuries which need plaster of Paris, and inhibits them from managing their own care at home until such time as the limb is healed. District Nurses visit the home to attend to the nursing needs of residential clients; while nursing clients are provided with first level nurses on duty twenty-four hours per day. Medication is stored in a large clinical room, and has separate medication trolleys for residential and nursing clients. We inspected all aspects of storage and administration for the nursing clients including Medication Administration Records (MAR charts); and the MAR charts for the residential clients. No out of date medication was found, and storage is properly managed. This includes external medication stored separately from internal medication; correct storage of some items in a locked drugs fridge; and correct storage for controlled drugs. The clinical room and drugs fridge temperatures are checked and recorded each day. Suction and oxygen equipment is checked and recorded each week, and there is a correct oxygen hazard warning sign on the door of the clinical room. The nursing staff check the amount of controlled drugs in storage at handover twice daily. This is good practice, and ensures that any discrepancies will be found immediately, and can easily be followed up. MAR charts are excellently completed. Handwritten entries are signed by two appropriately trained staff. Care staff were observed as treating residents with care and dignity, and ensuring that their privacy is maintained. Residents said that they all look after us very well; and the staff are all very good. A comment on a survey form stated that the staff listen Care Homes for Older People Page 14 of 31 Evidence: to me, and act on what I ask. Residents and relatives are asked at admission to complete a form about end of life preferences, so that staff can follow through on specific wishes if a resident is dying. The manager and some senior staff have had training on the implications of the Mental Capacity Act 2005, which ensures that there is an awareness of each individual residents ability to make their own choices and decisions. This may impact on residents decisions in regards to their wishes about possible resuscitation or not; and other serious life decisions. It is recommended that there is more information provided in care plans, in the future, to demonstrate that this has been taken into account. Care Homes for Older People Page 15 of 31 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. Residents are enabled to follow their preferred lifestyles. Visitors are made welcome in the home. Food is of a high standard, and provides good nutrition for older people. Evidence: The home has a variety of activities available on specific days each month, and a monthly planner is displayed on notice boards, and given to each individual resident. An activities organiser, who is self employed, comes in on four days per week to provide activity sessions such as reminiscence, quizzes, musical events, singing, poetry and discussion groups. There is also input from another outside source who provide motivation classes, which are felt to be very stimulating. We saw an organiser carrying out a quiz in one of the lounges during the afternoon, and seven to eight residents were very much enjoying this activity. Some of the care staff also assist with activities, and one was seen playing bingo with six residents during the morning. One carer is particularly good at nail and beauty care, and this gives opportunity for one to one time with residents. The manager is aware that more could be done to provide one to one time for residents who are confined to their rooms, or who do not wish to take part in group activities, and she is Care Homes for Older People Page 16 of 31 Evidence: currently recruiting for a part time person for this. Residents said that they are very satisfied with the level and type of activities available, and find that sufficient activities are provided. Residents are taken out by care staff for walks in the gardens, or for visits to the local shops; and there are a variety of places to sit outside in good weather. Outings are arranged to nearby places of interest, and parks, and seaside visits; and sometimes theatre or pantomime visits. There are barbecues and fetes in the Summer, and the home takes part in local events such as a horticultural show. Visitors are made welcome in the home, and are invited to join in with activities and outings. Residents different spiritual needs are taken into account, and care plans show if residents have a specific faith or not. Residents who wish to do so are invited to attend a church meeting in the home on a monthly basis. A Roman Catholic priest visits monthly to give communion; and the home facilitates visits for individual residents from their own church ministers or friends. Residents are enabled to bring in specific items of their own to personalise their rooms; and are encouraged to retain independence where possible, with such matters as managing their own finances. Residents spoke highly of the food in the home saying that it is lovely and there is always lots of choice, and lots to eat. A cooked breakfast is available every day, and residents can choose which cooked items they prefer. The cooks are on duty from 8am to 7pm, and are assisted by kitchen assistants throughout the day with preparation of food, and serving meals and drinks. There are always choices of meals at lunch time and tea time, and there are occasions when the cooks will buy in specific items just for one person at a time (for example, one resident expressed a wish for cockles for tea one day, and the cooks were arranging this). The food is home cooked, including home made soups and cakes. Fresh fruit and vegetables are actively offered each day. The menus are discussed and arranged between the chefs and cooks, and they ensure that the menus provide good nutrition for older people. The Service Users Guide includes the companys standards for food and nutrition. This informs residents that their likes and dislikes will be taken into account; that they will be supported to air their views about the food; and that any faith, cultural or ethnic preferences in regards to food will be followed. Drinks and snacks are available at any time , but two residents said that they never need anything extra, as they have plenty at meal times. The manager leads the way in ensuring that there is a relaxed atmosphere in the dining areas, and that no loud music or television is on; so that the dining experience is pleasant and enjoyable. Care Homes for Older People Page 17 of 31 Evidence: The kitchens were seen to be clean and well organised. The home has been awarded a gold standard award for food and hygiene, by the Environmental Health Officer, for the second consecutive year. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure is accessible to residents and visitors. Residents know that their views will be taken into account; and that any concerns will be dealt with properly. Evidence: The homes complaints procedure is included in the Service Users Guide, and each resident has a copy of this in their bedroom. A scaled down version of the procedure is also displayed on a notice board, so that it is accessible to people coming into the home. Anyone with concerns is directed to speak to the person in charge in the first instance, and then to apply to the home manager if they need to do so. The procedure includes the data for contacting the regional manager, and the companys operations director, if complainants should wish to follow this course. All concerns are taken seriously, and are investigated. The manager will respond within twenty-eight days with an outcome of any investigation. The company has a system in place whereby complaints from each home are forwarded to the head office on a monthly basis, and these are audited. This ensures that any patterns are quickly brought to light, and appropriate action will be taken to address ongoing concerns. We viewed the complaints log, and this showed that the Care Homes for Older People Page 19 of 31 Evidence: manager deals with all complaints according to policy, and takes action accordingly. Staff are trained in the recognition and prevention of all aspects of adult abuse; and records showed that staff training is kept up to date. Safeguarding training is delivered to all categories of staff on a yearly basis. Care Homes for Older People Page 20 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable and homely atmosphere. However, more refurbishment is needed in bedrooms and bathrooms; and more cleaning hours are needed. Evidence: The home is a large, detached, older building, set in its own grounds. The grounds are generally well maintained, with large lawns and flower beds at the rear, and with a variety of seating areas for residents. There is car parking space at the front and side of the building. At the time of the inspection, there was building work taking place to extend the laundry premises. This was properly sealed off, maintaining the safety of residents and staff. The home has accommodation on three floors, lower ground, ground, and first floor; and there are two passenger lifts providing access to all areas. The home has two large lounge and dining areas on the lower ground floor, and on the ground floor; and these provide comfortable seating areas for residents. There is also a small quiet room on the first floor. This is used for residents who wish to sit and read quietly, and also for residents to have a separate place to meet with relatives; for example, for family birthday parties. All communal sitting areas in the home, and all corridors, have been redecorated since the previous inspection, and are well presented. Care Homes for Older People Page 21 of 31 Evidence: There are toilet facilities near to communal and bedroom areas, and six assisted bathrooms, and one shower room. The bathrooms are generally functional, but are not at all homely, and could be improved with further refurbishment. There are many areas in the bathrooms where radiator covers, pipework covers, and skirting boards, would benefit from further repairs and upgrading. Most have had the walls repainted, but the general fabric of bathrooms is not of high quality. Some bedrooms have ensuite toilet facilities. These are mostly quite cramped, and would also benefit from upgrading. There are sluice rooms on two floors, and these were seen to provide the services needed, and are kept clean and orderly. The home has a suitable amount of hoists and other equipment available, such as raised toilet seats, grab rails, and pressure relieving equipment; but storage is very limited, and hoists are often kept in bathrooms. There is a gradual increase in the purchase of new nursing profile beds. Several bedrooms were viewed, and are personalised by residents according to choice. However, many appeared cluttered with equipment, especially some of the shared rooms; and again, were seen to be in need of refurbishment. Socket covers, and call bell points are not well placed in many bedrooms, and get easily damaged when beds are moved. One was reported by cleaning staff on the day of the inspection, and exposed wires could prove dangerous. The breakage was being dealt with as a priority, but re-siting these points could prevent damage in the future. The home has a full time maintenance person, who redecorates bedrooms as they become vacant; but most bedrooms viewed need full refurbishment, not just repainting the walls. The manager provided us with the homes Annual Quality Assurance Assesssment; and this included the maintenance dates for equipment and servicing checks, which were all up to date. The maintenance man carries out ongoing checks for items such as hot water temperatures, wheelchair checks, and bedrail checks. The laundry premises were the subject of a previous requirement, and it was good to see building work being carried out to improve laundry facilities, which are currently poor. Cleaning is carried out by two domestic staff on most days, and occasionally three. It is a large, old building, and this level of domestic staff is not sufficient to keep the building as clean as it should be. It is not possible to clean all bedrooms, bathrooms and communal areas properly every day; and there are insufficient domestic staff to carry out additional tasks on a daily basis, such as cleaning carpets; and cleaning skiting boards, behind beds, window ledges etc. The cleaning staff work hard to maintain the home to a reasonable standard of cleanliness generally, but more cleaning hours are needed. Care Homes for Older People Page 22 of 31 Care Homes for Older People Page 23 of 31 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. The home has a competent and efficient staff team. Ongoing training programmes ensure that staff keep up to date with changes in care. Evidence: The home is divided into two separate units for managing the care for either residential or nursing clients. The first floor is just for residential clients; the lower ground floor is just for nursing clients; and the ground floor has both nursing and residential clients. Care staff are deployed permanently for either residential or nursing care, so that they become familiar with the needs of those clients. The nursing unit usually has two trained nurses on duty in the mornings (in addition to the manager); and one at all other times. They are assisted by four or five care staff in the mornings, which is the busiest time; three care staff in the afternoons and evening; and two carers at night. The residential unit has a senior carer in charge at all times; and they are assisted by three other care staff in the mornings; two in the afternoons and evenings; and one at night. These numbers of staff are found in practice to be sufficient to manage the care of residents, and to meet their needs. Additional staff include a cook and kitchen assistants throughout the day; administrative staff, and domestic and laundry staff. Care Homes for Older People Page 24 of 31 Evidence: Care staff are encouraged to study for NVQ 2 or 3 in health and social care. The home currently has thirteen care staff out of a total of thirty two who have completed NVQ 2 or 3, and this is over forty per cent. Anther seven are currently working towards NVQ training, and when they have completed it, the level will rise to sixty-two per cent. This shows an ongoing committment by the home to ensure that care staff are appropriately trained. Recruitment is well managed by the home, and staff recruitment files are kept in excellent order, and with all appropriate checks carried out. We viewed three staff files, and they demonstrated that the management carry out POVA and CRB checks; proof of identity; nursing PIN number checks; full employment history, health check, and an interview assessment. Two satisfactory written references are received prior to confirming acceptance of employment. Four Seasons have a very detailed induction programme, with initial mandatory training followed up by a twelve week induction course. All new staff are provided with a starter pack, which includes terms and conditions of employment, a job description, and a comprehensive employee handbook. A staff training matrix is kept on a computer data base, and shows when staff have had training, and when they are due for updates. The training matrix confirms that all mandatory training is kept up to date in the home, and this includes fire prevention, moving and handling, health and safety, and infection control. The home has staff who are trained as trainers for moving and handling, and this enables staff to be kept up to date with this important subject. Additional training is provided for one to two staff on subjects such as diabetes, and this training is then cascaded down to other staff. Care Homes for Older People Page 25 of 31 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. Residents benefit from knowing that they have a manager who listens to their views and acts on them. The manager runs the home competently and efficiently, and shows a caring attitude towards both residents and staff. Evidence: The manager is a level 1 nurse, who has completed the Registered Managers Award, and has many years of experience in caring for older people. She has managed this home for eight years, and maintains a good day to day presence in the home. Residents and staff are confident in her leadership, and feel that she is supportive. Several staff and resident survey forms included positive comments, such as: the management listen to staff, and sort out any problems as they arise; we have good training, and are always supported by the manager; and I am very happy with the home and the way it works. Staff meetings are held every months, and the last one was attended by seventeen Care Homes for Older People Page 26 of 31 Evidence: staff, which is a good percentage. The manager meets separately with different groups of staff, such as heads of department, nursing staff and kitchen staff. There are also separate meetings for different subjects such as clinical governance, and health and safety. A staff member stated that communication in the home is well managed. Managers from associated company homes meet together every two months for feedback and ongoing support and direction. Residents and relatives meetings are held every two to three months, and residents know that they can talk with the manager at any time. Relatives are invited to attend meetings, and to join in with activities when visiting. The home carries out a yearly process of questionnaires, and the results from the most recent survey were currently being analysed by the companys head office. These surveys are used as a basis for making relevant changes in the home, as requested by residents. Residents are enabled to manage their own finances where possible., and small sums of pocket money can also be stored safely by the home on their behalf. All credits and debits are properly recorded, and balance sheets and receipts are made available as required. These accounts are audited on a monthly basis by a regional manager. Staff members have formal one to one supervision sessions carried out by delegated senior staff; and yearly appraisals by the manager. Supervision also extends to practical skills and checking competency in different areas. The manager and deputy carry out various audits each month. We viewed the most recent medication audit, which had been excellently completed by the deputy manager. There are good systems in place for documentation generally, and policies and procedures are kept up to date. All relevant records are stored confidentially. Health and safety meetings are carried out each month, and identify specific areas of concern, and action to be taken. The manager keeps the Care Quality Commission informed of formal notifications for specific incidents or accidents in the home. Care Homes for Older People Page 27 of 31 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 28 of 31 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 26 23 To ensure that there are a 14/05/2009 sufficient number of cleaning staff and cleaning hours to keep the building clean in all areas, at all times. The registered person must ensure that all parts of the care home are kept clean and reasonably decorated. 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 11 To develop more information in care plans which demonstrates how the Mental Capacity Act 2005 is being applied in regards to residents ability to make specific decisions about their care, including end of life decisions. To review the state of bathroom and toilet facilities, with a view to improving the general quality and comfort provided by these facilities. To review the current storage space available for equipment, such as wheelchairs and mobile hoists. To review the general comfort and quality of bedrooms, with a view to refurbishing these to a higher standard. Page 29 of 31 2 21 3 4 22 24 Care Homes for Older People Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!