Care Home: Bolters Corner

What the care home does well The home is managed by a suitably qualified, competent and skilled senior management team led by an effective registered manager. This is a family run home in which the provider is actively involved in its day to day operation. People thinking about moving into the home and their representatives receive information to help them choose and decide about the home`s suitability. They can be confident the home can meet their needs as the home has a comprehensive pre-admission process. Recognition of equality and diversity is embedded in the home`s culture, underpinning its policies and procedures, care and staff recruitment and training. The home is clean and hygienic and odour control mostly satisfactory. Substantial recent investment has enhanced the home`s facilities and equipment and a major building and upgrading programme is ongoing. Nutritional screening is carried out and wholesome meals are served. Health needs are well met. The home`s GP told us, " Staff are very organised, people are looked after very well, staff are very good, well trained, caring and compassionate". The management of medication is efficient and safe. The home is committed to minimal use of medication for managing behaviours. A relative told us, " I am extremely happy with the service. Whilst at this home medication my mother was taking has been stopped and her whole persona has improved. She was unable to walk, now she can with two carers. Staff care for my mother without the need for medication which I totally admire. This is how all home`s should be." The home`s atmosphere is welcoming and friendly. Staff are professional, approachable and skilled in their interactions with people using services. An individualised approach to meeting needs was demonstrated. Staff retention rates are good and the stable workforce enables good continuity of care and consistency of approach in the management of behaviours. A good understanding of risk assessment processes was evident and care practice is underpinned by quality care values. Whilst we were unable to have a full conversation with people who use this service owing to communication difficulties related to their medical condition, individuals were able to comment on the home. One person told us, "Staff are nice", another stated, "Its okay here". Comments from relatives included, "Staff treat the residents with care, respect and dignity", " My wife is well cared for" and " Senior staff and management respond well to any worries or concerns". What has improved since the last inspection? The two requirements at the time of the last inspection had been met. The outcome of these enabled use of a bathroom to be reinstated and improved safety of bed-rails by provision of bed bumpers. Other improvements include the purchase of additional equipment and an ongoing upgrading, redecoration and refurbishment programme which has substantially enhanced the environment and facilities. The home`s management has been proactive in organising staff training and supporting care staff to attain national vocational qualifications (NVQ) in care. What the care home could do better: Shortfalls in staff recruitment vetting procedures were discussed and remedial action agreed. On this basis a requirement was not made. The home would benefit from a quality audit system, care plans could be more holistic and social care provision needs review. It was agreed that radiator covers will be fitted in two bedrooms and a risk assessment carried out in the bedroom with a balcony. Key inspection report Care homes for older people Name: Address: Bolters Corner Bolters Lane Banstead Surrey SM7 2AB     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: Patricia Collins     Date: 0 8 0 6 2 0 0 9 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 27 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) 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Bolters Corner Bolters Lane Banstead Surrey SM7 2AB 01737361409 01737370856 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Eleni Panayi care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 28 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: Dementia (DE) Date of last inspection Brief description of the care home Bolters Corner is a care home with nursing providing specialist dementia care services for older people. Service provision includes permanent and respite care. The 15 - place day service for people living in the community operates independent to the home and is unregulated. The building is a large detached, three - storey property set in spacious, well-maintained grounds with a furnished patio and a car park. The home is situated close to all the community amenities, shops and churches in Banstead village. Communal lounges and a dining area are on the ground floor. Bedroom accommodation is in rooms for single and shared occupancy, mostly with en-suite facilities. These are arranged on the ground and first floor, accessible by a passenger lift. The third floor is used for staff accommodation. Suitably equipped assisted bathing facilities are available on both floors. A major building and refurbishment programme is Care Homes for Older People Page 4 of 27 28 Over 65 0 Brief description of the care home ongoing and is substantially upgrading the environment to a good standard. Weekly fee charges are from 450 pounds to 750 pounds excluding RNCC contributions. Additional charges apply for chiropody and hairdressing. Care Homes for Older People Page 5 of 27 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: Date of last Key Inspection: 29th June 2007. The unannounced inspection visit formed part of the key inspection process using the Inspecting for Better Lives (IBL) methodology. The inspection visit was undertaken by one inspector over eight hours. The report will say what we found as it is written on behalf of the Care Quality Commission (CQC). key inspections are a major evaluation of the quality of a service and any risks it might present and always focus on outcomes for people using services. All key national minimum standards (NMS) are reported on as evidence of outcomes. In carrying out this inspection all available information has been taken into account when forming judgements about how well the home meets the NMS for older people. This includes accumulated evidence and our knowledge and experience of the home since its last key inspection. We have also considered information in survey questionnaires received Care Homes for Older People Page 6 of 27 from three relatives of people using this service and a general practitioner. Each year we require providers registered with the the CQC to complete and send us a self assessment called an Annual Quality Assurance Assessment (AQAA). This provides quantitative information about their service, requiring assessment of the service against the NMS outcome areas, demonstrating both areas of strength and where improvements can be made. The homes AQAA was received on time and its content was overall clear, of good quality and validated by evidence. This information was also used to inform judgements about the home. The inspection process incorporated discussions with some people who use the homes services, the provider and manager, staff and visitors. We toured the premises and viewed the garden. Records were examined also policies and procedures. Medication and care practice was observed, also practice at lunch time. Discussions took place with people using services, staff and a number of visitors. Insight into the general state of well being of people using services who we were unable to verbally communicate was gained through observations of body language, their appearance, staff interactions with them and from information in records and from visitors and staff. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: Shortfalls in staff recruitment vetting procedures were discussed and remedial action agreed. On this basis a requirement was not made. The home would benefit from a quality audit system, care plans could be more holistic and social care provision needs review. It was agreed that radiator covers will be fitted in two bedrooms and a risk assessment carried out in the bedroom with a balcony. Care Homes for Older People Page 8 of 27 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 27 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 27 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 considering using this service and their representatives have the information they need to enable an informed choice of home. Comprehensive pre-admission assessment procedures ensure their needs can be met. Standard 6 was not assessed on the basis the home does not offer intermediate care. Evidence: The homes statement of purpose sets out the service objectives and philosophy of care. This is supported by a service users guide that demonstrates the homes commitment to meeting the multicultural and diverse needs of people using the service. The need to include a clear statement who the home is for and its service provision in this document was discussed. Other minor amendments are also necessary. The homes management understands the importance of having sufficient information when choosing a care home. Usually prospective service users or their relatives or representatives receive a copy of the home brochure, which is currently being updated. Whilst we were informed that the pre-admission process affords Care Homes for Older People Page 11 of 27 Evidence: opportunity for relatives or representatives of prospective service users to read the service users guide, two relatives consulted during the inspection visit were unable to recall seeing this document. A new development is the provision of a reception area and the manager confirmed his intention to display the service users guide in this area. At the time of this inspection 27 people were using the homes services. The admissions route is frequently, though not exclusively via the homes day centre. Admissions of people already attending the day centre has positive benefits. The day service operates a comprehensive pre-admission assessment process and the homes management will already be fully aware of the needs of these individuals and know they can be met by the home. For the individuals themselves and their relatives they will have some knowledge of how the home operates to decide if it is right for them and have established relationships with management and some staff. These circumstances help reduce distress and anxiety at the time of admission. Admissions to the home only take place if the service is confident staff have the skills, ability and qualifications to meet the assessed needs of prospective service users. A qualified nurse always undertakes pre-admission assessments for people referred to the home for admission including emergency admissions, before placements are agreed. The homes assessment tools are holistic and comprehensive and the assessment process includes obtaining copies of assessments carried out by other professionals. Standard 6 was not inspected on the basis that intermediate care services are not provided by the home. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using services receive personal and healthcare support in accordance with their assessed needs. Rights of dignity, equality, fairness and autonomy, within individual levels of capacity, are respected by staff and medication practice is safe. Evidence: Personal and healthcare needs and risks are comprehensively assessed and mostly documented in care plans. These give an overview of health needs and act as an indicator of change in health requirements. The homes records need to demonstrate referrals made for medical assessment of significant weight loss and care plans need to be generated from nutritional assessments. Information from a relative confirmed that in practice, staff ensure good nutrition. All people using services are registered with a general practitioner (GP) who visits the home at least once a week, on a set day and at other times when necessary. He was present at the home during the inspection visit. His feedback in our survey confirmed the homes assessments provide accurate information to enable appropriate services to be planned. He said staff ensure health and personal care needs are properly monitored, reviewed and met and seek advice and act on it to meet health needs. People using services have access to Care Homes for Older People Page 13 of 27 Evidence: specialist medical and therapeutic services, including regular visits from a chiropodist, podiatrist and optician. Nursing needs are met by the homes nurses who maintain their professional practice up to date through the staff training and refresher training programme. All staff have access to training in healthcare matters including infection control, moving and handling, dementia care, first aid and health and safety.The matron attends regular meetings with local incontinence advisers and promotes good practice in the management of incontinence. There has been further investment in equipment for meeting equality and diversity needs and promoting independence. The home has ramps, specialist baths, height adjustable beds, hoists, pressure relieving mattresses and cushions, eating and mobility aids. Work is nearing completion on a new communal wheelchair accessible toilet and wet room. Care plans and risk assessments are regularly reviewed and staff and families attend review meetings convened by funding agencies. Whilst review meetings are not held for people funding their own care, systems ensure good communication with their relatives and representatives, ensuring rights and choices are respected. A relative told us, I am kept up to date with important issues about mum and staff follow the care plan agreed. The personal appearance of people using services and care practice demonstrated respect for their dignity and privacy. Staff were kindly, respectful and caring in their approach and interactions with people using services. They were evidently aware of their individual needs and agreed behavioural plans. There is an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. Medication storage, recording and practice was sampled. Future plans to extend the clinical room will improve medication storage problems exacerbated by a two monthly cycle for dispensing medicines. Discussions with nurses confirmed an ethos of minimal use of medication for behaviour management. Feedback from two relatives confirmed their approval of this which they directly attributed to improvements in the health, mobility and wellbeing of their relatives, since admission. Care Homes for Older People Page 14 of 27 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. Care planning needs to be holistic to identify individual social care needs and provision of activities reviewed to ensure needs are met. People using services are supported in maintaining contact with relatives and friends and receive wholesome meals. Evidence: The pre-admission assessment process establishes a baseline reflecting the life history, strengths, abilities and interests of people using services. The care plans sampled however did not detail holistic care and support needs. Specifically, they did not address social care and communication needs and any impact of the environment. The homes self assessment states that varied social activities are provided though on the day of the inspection visit no social activities took place in the home. It is acknowledged that staff frequently engaged with people using services throughout the day. We were told by the manager there is a structured social activity programme but in practice group activities are not successful and stated that one to one work is more appropriate. It is recognised that the numbers of people at a late stage of dementia can present a challenge, requiring more skill. It is more time consuming for staff to provide opportunities for stimulation for these individuals and to interact with people who can no longer communicate verbally. We were informed by the manager that people using the homes services may join in Care Homes for Older People Page 15 of 27 Evidence: social activities in the day centre which is in a sun-lounge adjacent to a sitting room. The majority of people using the homes services however are unable to independently access this area. Two people who were ambulant did go in and out of the day centre but did not engage in activities. Whilst some people were sat passive in the lounges, others were taking an interest in their surroundings and the presence of staff and visitors. One person was reading a newspaper when observed. There are links with the local community and visits from various clergy provide social stimulation as well as pastoral care. The open visiting policy provides stimulation, visitors noted to be on the premises throughout the day. Some visit daily and spoke with other people using services as well as the person they were visiting. Large plasma televisions are provided in both lounges and music centres. A hairdresser comes in twice a month and an external entertainer provides a monthly musical interactive session. A visitor commented they would like to see an increase in social activities in the home. Three relatives told us how friendly and welcoming staff are and said the home always has a happy atmosphere. One commented, There is always laughter and good rapport between staff and residents. We were informed that the patio and garden is well used in the summer. A relative said they would provision of a shaded area on the patio. The provider confirmed the intention for short local outings in the summer in the homes vehicle. Nutritional screening is carried out by nurses and weights are monitored. Care staff were stated to fortify meals for people using services in accordance with individual needs. The need for this practice to be documented in a care plan and care notes was discussed. Care plans should also detail support needs specific to eating and drinking and feeding aids. A four weekly rotating menu operates and records are kept of meals prepared. The manager stated the menus were examined by a dietitian some time ago when the home participated in a pilot of a new nutritional screening tool. A chef is on duty daily from 7 a.m. to 7 p.m. Though menus do not offer a choice of meal a list of food preferences is kept in the kitchen, enabling these to be accommodated. We were informed by a person using services, I dont like baked beans and staff know this and offer me an egg instead with my chips. The kitchen was clean and all appliances stated to be working. The manager confirmed the long term intention to extend the kitchen and improve ventilation, subject to planning agreement. Discussions with the chef confirmed he has a food hygiene certificate and extensive catering experience. He told us there is always adequate food provision including fresh meat and vegetables. The small dining area was stated to be sufficient to meet the needs of people using services. Most have their meals served in lounges and many require staff assistance with eating and drinking. The two course meal at lunch time was nicely presented, including pureed diets. Good practice was observed when assisting people with eating. The manager agreed to review arrangements for keeping meals warm for people waiting for assistance with meals. Care Homes for Older People Page 16 of 27 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 home has a simple, clear and accessible complaint procedure which includes timescales for the process. People using services are protected from abuse. Evidence: We have not received any complaints about this home since the last inspection. The complaint procedure is displayed in the lounge as well as included in the service users guide. The homes management culture is accessible and transparent and positive relationships were evident between senior staff and representatives of people using services so that any concerns can be promptly identified and resolved. A suggestion box is on the wall by the office though it was not labelled as such or prominently positioned. The manager confirmed plans to move the box to the reception area and replace the label which was removed by a person using services. An annual survey is carried out by the home affording further opportunity to relatives and friends of people using services to raise any issues, make suggestions and give feedback on service provision. A review of the complaint records confirmed no formal complaints had been received and investigated under the complaint procedure, since the last inspection. An entry was made in the complaint book of a safeguarding enquiry which was looked into by care management and no further action necessary. All staff receive safeguarding adults training as part of their induction and refresher sessions are included in the staff training programme. There are robust procedures for responding to suspicions or evidence of abuse or neglect and staff are trained to Care Homes for Older People Page 17 of 27 Evidence: recognise indicators of abuse.New staff read the safeguarding, whistle blowing and harassment policy and procedure during their induction.One allegation was investigated since the last inspection under Surreys safeguarding adults procedures. This matter has been concluded and the allegation was unsubstantiated. The homes policies and practices overall protect people using services. The manager acknowledged there had been a shortfall in the recruitment and vetting procedures that has since been remedied. There is no involvement by the homes management in the financial affairs of people using services and their money is not kept for safekeeping by the home. It was evident that the manager keeps abreast of changes in legislation affecting the home. A policy, guidance and relevant forms had been produced relating to the new legal framework specific to deprivation of liberty and the Mental Capacity Act. A new policy had also been produced and being implemented on de-escalation practice and included guidance for safe practice in the use of restraint. The manager recognises the need for the staff training programme to include training and refresher training in the management of challenging behaviours and use of restraint and said this will be arranged. Other discussions included the need to record consultation with all relevant parties in the use of any equipment or furniture that retrains a persons ability to move around freely and record the rationale for use.This practice protects vulnerable people from their misuse. The home undertakes risk assessments relating to use of bed-rails. The GP is involved in the decision to use bed-rails and written consent is obtained from relatives of people who lack capacity. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service live in a safe, well-maintained environment that is appropriate to their needs ans provides specialist aids and equipment. The home is clean and hygienic and generally free from malodour. A major work programme is ongoing which is gradually upgrading and improving the homes facilities and decor. Evidence: The patio and grounds are well maintained. The buildings design is secure with the use of technology at the entrance and combination of coded and baffle locks and stair gates to minimise environmental risks. The home is well maintained, comfortably furnished and domestic in character. A fish tank has been purchased and this was being installed at the time of the visit. A cleaning schedule ensures the home is clean and tidy and mostly free from malodour. A major building and upgrading programme is in progress. A new two storey extension is nearing completion providing a new entrance hall, hairdressing room, seven spacious en-suite bedrooms, visitors room, wet room and wheelchair accessible toilet. Communal lounge space will be increased as part of this development. A number of bedrooms have been redecorated and a programme of redecoration is ongoing. Other work planned will reduce the number of shared rooms to four and provide en-suite facilities in two existing bedrooms. The fire officer has been consulted on changes to fire evacuation routes. The provider has purchased additional land and is pursuing an application for planning consent to extend the car park. Within the next twelve months the shingle car park surface is to Care Homes for Older People Page 19 of 27 Evidence: be replaced with one more suitable for wheelchair users. Long term, the manager is intending to apply for planning consent to another extension to increase the size of the kitchen and upgrade food storage and laundry facilities. Discussions with the manager included the need to incorporate best practice dementia design principles in the the refurbishment and redecoration programme. Also to ensure sufficient orientating information in the environment. Bathrooms are well equipped and the requirement made at the time of the last inspection had been met specific to a bathroom. Overhead hoist tracking is available in a bathroom and bedroom. The home has grab rails and aids to promote independence and meet its stated purpose. There are sufficient hoists and slings in a range of sizes. Infection control relating to shared use of slings was stated by the provider to be managed by daily laundering of slings. Care Homes for Older People Page 20 of 27 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 using services are protected by the homes recruitment policy and practice, a recent shortfall having been rectified.Staff are trained, skilled and in sufficient numbers. Evidence: The home has recruited and retained a highly skilled group of nurses and is selective in the recruitment of care assistants, to ensure a diverse staff team with a balance of skills, experience and knowledge. Staff roles and responsibilities are clearly defined and understood, based on accurate job descriptions and good team work. The homes management demonstrates a high level of awareness of the staffing levels needed. Staff consulted were of the opinion that staffing levels are adequate to meet the current needs of people using services. The manager attributed the good staff retention record to the competent management of the home by a skilled, suitably qualified and experienced senior team, also the homes ethos and practice. He stated that staff are happy at work and this has a positive impact on their practice and attitude. A care assistant told us that Bolters Corner was the best care home he had worked in. He said his induction had covered all he needed to know to fulfil his role. He appreciated the high management commitment to staff training which enabled him to attain relevant national vocational qualifications at Levels 2 and 3 in twelve months. He said the manager was always accessible and had time for staff which made them Care Homes for Older People Page 21 of 27 Evidence: feel valued. The manager has a good understanding of equality and diversity. This is demonstrated in the homes policies, procedures and practice relating to staff recruitment, induction and training. Shortfalls in staff recruitment were fully discussed with the manager. Specifically a full employment history must be obtained for all prospective staff. Additionally, evidence must be retained of checks carried out against the national list of people unsuitable to work with vulnerable adults (POVA list) before new staff take up post. Staff vetting procedures always include an application made for a Criminal Records Bureau disclosure (CRB) for prospective staff. A delay in applying for a CRB for a staff member was discussed. The manager was reminded that CRB disclosures are no longer portable and under the circumstances described the staff member should not have taken up post. The manager has since improved procedures to ensure future regulatory compliance. The manager was advised to adhere to the Criminal Record Bureau (CRB) policy for the recording, storage and disposal of staff CRB disclosures. Observations confirmed a robust induction process for new staff however the need to ensure this fully covers all the common standards within the specified timescale set by Skills to Care was identified. A concerted effort is being made to provide staff with statutory and service specific training. There is an ongoing NVQ programme and at the time of the inspection four care staff had achieved NVQ Level 2 qualifications in care or health and social care and one had attained NVQ Level 3. Three staff were working towards attaining NVQ Level 2 and two were working toward NVQ Level 3. Care Homes for Older People Page 22 of 27 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. The home is effectively managed and overall is run in the best interests of people using services. Their financial interests are safeguarded and mostly their health safety and welfare is promoted and protected. Evidence: This is a family business in which family members are actively involved on a day to day basis in the homes management and operation. The registered provider is a qualified nurse and visits most days. She takes an active role in the homes operation and sometimes covers nurse absences. The registered manager has management qualification at graduate level. It was suggested he consider obtaining the new Leadership and Management Award qualification. The home has a strong senior team of nurses. These include a matron with delegated responsibility for clinical care, supported by a deputy matron. Both are mental health nurses and have extensive relevant nursing and management experience. They lead and direct clinical and personal care and provide staff with good leadership. Care Homes for Older People Page 23 of 27 Evidence: The home does not manage the finances of any people using its services. Additional costs incurred are invoiced to their relatives or representatives with responsibility for payment of fees. Quality assurance systems exist. The provider and manager and the senior management team are in constant contact with people using services and their visitors. This enables a prompt response to feedback warranting improvement or change. Survey feedback from relatives and discussions with visitors confirmed they feel comfortable in approaching management and are listened to. Annual quality assurance surveys are sent to relatives by the home. Those sampled demonstrated good levels of service satisfaction. Routine maintenance and services checks are carried out. Recommendations from a recent fire safety audit by the Surrey Fire and Rescue Service had resulted in additional fire evacuation equipment being purchased. Staff had recently received fire training from a specialist trainer. It is intended that use of this equipment will be demonstrated at the next fire training session and the evacuation procedures will then incorporate use of this equipment. Records examined included a sample of policies and procedures which had been recently reviewed and were of a good standard. Also the fire risk assessment and maintenance records. The gas certificate needs renewal and this is planned to coincide with completion of the new extension. Areas for further development include quality monitoring systems which would be enhanced by use of quality audits. The need to reinstate regular monitoring of hot water temperatures was agreed. Also for radiator covers to be fitted in the two bedrooms identified and a risk assessment carried out for the person occupying the bedroom with a balcony. The home manager must ensure notification of all information we must be told about. This includes all safeguarding adults allegations and pressure sores in accordance with the CQC guidance. Care planning should be more holistic and social care provision needs review. Care Homes for Older People Page 24 of 27 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 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 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). 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