Care Home: Bonaer

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What the care home does well The home is very well managed and the registered providers have an open door policy. Staff, residents and visitors said the management team are all very approachable, they address issues promptly and the registered providers are present in the home each day. The home provides a warm, clean, safe environment for people using the service, staff and visitors. The grounds are accessible, well maintained and attractive. The registered providers continue to upgrade the decor and furnishings in the home and residents preferences are taken into consideration. Care is provided to a high standard and residents are only admitted following an assessment to ensure the home can meet their needs. Residents have an individual detailed care plan that is compiled with them or a representative. The care plans direct staff very well on the person centred care to be provided. Relevant risk assessments are undertaken to assure people`s safety. Care needs are reviewed each month to ensure the care plans are up to date. The home has achieved the Gold Standard Framework at a commended grade and staff told us it has enhanced people`s end of life care. Residents told us their end of life arrangements are discussed and it is a relief to know their wishes will be respected. Residents said their healthcare needs are met well and they have access to their doctor, optician, dentist and other professionals when required. People using the service told us they are very happy living at Bonaer and they said the staff are extremely kind and caring. They said they are treated as individuals and can do as they wish each day. Visitors told us the home is a happy friendly place and the care is to a high standard. There is a suitable, safe system in place for medications and the home has appropriate equipment for pressure relief and moving and handling. Activities take place in the home and outings are enjoyed; the home has it`s own transport. There are a large number of photographs displayed around the home showing residents, staff and relatives enjoying social events and activities. There are also displays of resident`s art work. There is a resident`s committee who discuss ideas and improvements for the home they also help with the organisation of events such as Christmas and the annual fete. Friends and family are very welcome in the home and residents can go out with them according to their wishes and ability. There are suitable systems for dealing with complaints and abuse. Staff and residents said they could easily approach the registered providers if they had a problem. Staff told us they try to respect people`s individuality at Bonaer and make the daily routines as flexible as possible. Residents said they can choose what they do each day, bedtimes are flexible and there are choices on the menu. Nutritious home cooking is provided and staff ensure that plenty of refreshments are available. Residents said the food is good and fresh produce is used. Recruitment procedures are robust and the documents required by legislation are held. Staff have a thorough induction programme and are supervised and appraised regularly. Sufficient skilled staff are on duty to ensure that resident`s needs are met. Staff were observed to interact well with residents in a very kind, relaxed manner during this inspection. The registered providers are committed to providing appropriate training for staff and a great deal was seen to be on offer. The deputy manager has taken on responsibility for staff training and is very enthusiastic about it. 77% of care staff are NVQ qualified and housekeeping and laundry staff are undertaking NVQ training appropriate to their roles. Quality assurance surveys take place annually and there and staff and resident`s meetings take place regularly. An informative newsletter is circulated to staff and residents bi-monthly. Some audits take place and significant event analysis takes place. The home has maintained the Investors in People Award for three years. Health and safety is promoted with relevant policies in place. Risk assessments have been undertaken for health and safety and fire to ensure people are kept safe. What has improved since the last inspection? The home has achieved the Gold Standard Framework, for end of life care, at a commended grade. They have discussed end of life wishes with residents and introduced advanced care plans. Staff told us that this has enhanced the end of life care for residents. They have maintained the Investors in People Award for three years. Significant event analysis takes place which investigates events and looks at continued improvements. Further decoration and refurbishment has taken place. This includes painting the outside of the building and the main lounge. New furniture has been provided in the lounges and the sun room. Individual care plans now include spiritual, cultural and medication needs. A deputy manager has been employed which the manager said has been very beneficial. She has taken on the responsibility for staff training and has supported and enabled the manager to concentrate more on management tasks. Training has greatly improved and packs have been purchased to assist staff training in house. What the care home could do better: Improve the handwritten instructions on the medicine administration record charts to ensure they are witnessed and signed by both members of staff. Provide formal medicines training for all care staff on induction to the home.Improve the activities provided to ensure continuity when the coordinator is away and improve the standard of record keeping for activities. Review the staffing levels in the evenings to make certain there are sufficient staff to meet people`s needs. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Bonaer 17 Station Hill Hayle Cornwall TR27 4NG     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: Diana Penrose     Date: 0 4 0 9 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 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Bonaer 17 Station Hill Hayle Cornwall TR27 4NG 01736752090 01736759681 bonaercarehome@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Anthony Joseph Metalle,Mrs Sarah Jayne Metalle care home 31 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability terminally ill Additional conditions: Date of last inspection Brief description of the care home Bonaer is situated next to Hayle railway station, which is very close to the local amenities. It is a big adapted house with an extension and a large conservatory. There is limited car parking space in the grounds but there is additional free parking nearby, on the roadside. The home provides residential and nursing care for up to thirty-one elderly people. The registration allows for seven people with a physical disability and the home also provides palliative care. Accommodation is on two floors with a shaft lift provided. There are hand washbasins Care Homes for Older People Page 4 of 29 Over 65 33 0 5 0 7 0 Brief description of the care home in all bedrooms and there are adequate toilet and bathing facilities. Meals are prepared in the kitchen on the ground floor and served in the three lounges or individual bedrooms if preferred. There is no dedicated dining room in the home but dining tables and chairs are provided in the lounges. To the front of the home there is a veranda and a garden with a large fishpond and seating that is accessible to residents. There is also a garden at the back of the home, which has been made accessible with a raised bed and greenhouse for residents use. The Registered Providers have owned the home since May 2003 and are still in the process of upgrading and refurbishing. They are very involved in the running of the home; Mrs Metalle is the Manager but also works as part of the nursing team. Qualified Nurses and Care Assistants provide care within a relaxed and friendly atmosphere. Information about the home is available in the form of a residents guide, which can be supplied to enquirers on request. A copy of most recent inspection report is available in the home. Fees range from 395 to 700 pounds per week; this information was supplied to the Commission during this inspection. Additional charges are made in respect of private healthcare provision, hairdressing and personal items such as newspapers, confectionary and toiletries. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: An inspector visited Bonaer Nursing Home on the 02 and 04 September 2009 and spent nine hours at the home. This was a key inspection and an unannounced visit. The purpose of the inspection was to ensure that the needs of people using the service are properly met, in accordance with good care practices and the laws regulating care homes. The focus was on ensuring that placements in the home result in good outcomes for people. All of the key standards were inspected. On the days of inspection 30 people were living in the home. The methods used to undertake the inspection were to meet with a number of residents, relatives, staff and the registered providers to gain their views on the services offered by Bonaer Nursing Home. Records, policies and procedures were examined and the inspector toured the building. The registered manager has returned a very detailed Annual Quality Assurance Assessment (AQAA), which has informed this inspection. Also surveys have Care Homes for Older People Page 6 of 29 been returned in respect of 6 residents, 4 staff and 2 healthcare professionals, these have also informed this inspection. This report summarises the findings of this inspection. The Registered Providers were away on the first day of this inspection; the Deputy Manager was in charge and very competent in running the home. Residents and relatives expressed great satisfaction with the standard of care and the services provided at the home. What the care home does well: The home is very well managed and the registered providers have an open door policy. Staff, residents and visitors said the management team are all very approachable, they address issues promptly and the registered providers are present in the home each day. The home provides a warm, clean, safe environment for people using the service, staff and visitors. The grounds are accessible, well maintained and attractive. The registered providers continue to upgrade the decor and furnishings in the home and residents preferences are taken into consideration. Care is provided to a high standard and residents are only admitted following an assessment to ensure the home can meet their needs. Residents have an individual detailed care plan that is compiled with them or a representative. The care plans direct staff very well on the person centred care to be provided. Relevant risk assessments are undertaken to assure peoples safety. Care needs are reviewed each month to ensure the care plans are up to date. The home has achieved the Gold Standard Framework at a commended grade and staff told us it has enhanced peoples end of life care. Residents told us their end of life arrangements are discussed and it is a relief to know their wishes will be respected. Residents said their healthcare needs are met well and they have access to their doctor, optician, dentist and other professionals when required. People using the service told us they are very happy living at Bonaer and they said the staff are extremely kind and caring. They said they are treated as individuals and can do as they wish each day. Visitors told us the home is a happy friendly place and the care is to a high standard. There is a suitable, safe system in place for medications and the home has appropriate equipment for pressure relief and moving and handling. Activities take place in the home and outings are enjoyed; the home has its own transport. There are a large number of photographs displayed around the home showing residents, staff and relatives enjoying social events and activities. There are also displays of residents art work. There is a residents committee who discuss ideas and improvements for the home they also help with the organisation of events such as Christmas and the annual fete. Friends and family are very welcome in the home and residents can go out with them according to their wishes and ability. There are suitable systems for dealing with complaints and abuse. Staff and residents said they could easily approach the registered providers if they had a problem. Staff told us they try to respect peoples individuality at Bonaer and make the daily routines as flexible as possible. Residents said they can choose what they do each day, bedtimes are flexible and there are choices on the menu. Nutritious home cooking is provided and staff ensure that plenty of refreshments are available. Residents said the food is good and fresh produce is used. Care Homes for Older People Page 8 of 29 Recruitment procedures are robust and the documents required by legislation are held. Staff have a thorough induction programme and are supervised and appraised regularly. Sufficient skilled staff are on duty to ensure that residents needs are met. Staff were observed to interact well with residents in a very kind, relaxed manner during this inspection. The registered providers are committed to providing appropriate training for staff and a great deal was seen to be on offer. The deputy manager has taken on responsibility for staff training and is very enthusiastic about it. 77 of care staff are NVQ qualified and housekeeping and laundry staff are undertaking NVQ training appropriate to their roles. Quality assurance surveys take place annually and there and staff and residents meetings take place regularly. An informative newsletter is circulated to staff and residents bi-monthly. Some audits take place and significant event analysis takes place. The home has maintained the Investors in People Award for three years. Health and safety is promoted with relevant policies in place. Risk assessments have been undertaken for health and safety and fire to ensure people are kept safe. What has improved since the last inspection? What they could do better: Improve the handwritten instructions on the medicine administration record charts to ensure they are witnessed and signed by both members of staff. Provide formal medicines training for all care staff on induction to the home. Care Homes for Older People Page 9 of 29 Improve the activities provided to ensure continuity when the coordinator is away and improve the standard of record keeping for activities. Review the staffing levels in the evenings to make certain there are sufficient staff to meet peoples needs. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are only admitted to the home following an assessment of their needs to ensure the home can provide suitable care. Evidence: The deputy manager showed us the care files of two people who had been admitted to the home in the past two months. The registered manager had completed one pre admission assessment on a specific form and it was in detail. The other was completed by the deputy manager on a sheet of A4 paper, it covered the nursing needs in detail but not all of the criteria in National Minimum Standard 3.3. The registered manager told us on the second day of this inspection that her deputy has been told about the form and will use this in future Information from Adult Social Care and hospital staff was seen in the care files. The deputy manager said that an individual plan of care is compiled from all of the assessment information gathered. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service feel their healthcare needs are very well met and their privacy and dignity is respected. Detailed care plans are generated for each person, they give excellent information and direction to staff on the care to be provided and there is a system for the use of medicines that assures residents are safeguarded. Evidence: We looked at three care files in detail, they held printed care plans that were very detailed and informed and directed staff in the care to be provided. The plans now include spiritual, cultural and medication needs. They have been signed by the resident or a representative and some have comments written on them or details added. The plans were reviewed monthly with a date and signature recorded; any changes were hand written on the plans. We saw that risk assessments included Waterlow scoring, nutrition, moving and handling, falls, Barthel, wounds and the use of bed rails. Daily records were seen and they were written by the nurses. The deputy manager showed us the records that are maintained by the care staff and she said they maintain them very well. She said the carers have responded well to training they are very observant and report to the nurses if they have any concerns. We were Care Homes for Older People Page 13 of 29 Evidence: told that people are asked their preferences in respect of the gender of care staff looking after them and it is incorporated in the care planning. People using the service told us that their healthcare needs are met and they have access to their doctor, optician, dentist or other professional when they need them. Staff said they have sufficient equipment for moving and handling purposes. We were told that pressure relieving mattresses, gel pads and cushions are provided where necessary and records were seen in the care files. Hospital style beds and electric beds were seen in use. We were told that specialist nurses and other professionals visit when required and the home has a good relationship with the local doctors surgery. The deputy manager said she has an interest in continence management and that another nurse has a special interest in wound care and they keep up to date on these subjects. We were told that mental capacity assessments had been undertaken and that no residents had deprivation of liberties authorisations. The home has achieved the Gold Standard Framework (GSF) accreditation at a commended grade. The registered manager told us that all staff were involved and a great deal of work was undertaken. She said they did more than was required for the award. She told us that residents have found it helpful talking about their end of life arrangements. One resident said I found it helpful to talk about my end of life care and knowing that I can stay at Bonaer for the rest of my life. A memorial garden has been developed in the grounds and provides a quiet area for people to sit. The deputy manager explained the medicines system. A monitored dosage system is used in the home although some packets have been issued for medicines prescribed as required to reduce the amount of wastage each month. We found that there were no specific care plans in place for people prescribed to have medicines administered, when required, or any directions on how to make an assessment if this medicine is required. This was discussed with the deputy manager and one of the nurses and a care plan format has now been devised. The records for receipt, administration and disposal were examined and were satisfactory. Handwritten instructions on the medicine administration record charts were not signed or witnessed and this was pointed out to the deputy manager who said she would address it with the nurses. We saw a suitable medicines policy, a copy of the handling of medicines guidelines for social care and suitable reference books that were available to staff. Patient information leaflets were seen in a file in the treatment room. We were told that there have been issues with supplies when prescriptions are changed mid month but this has been addressed. All medicines were Care Homes for Older People Page 14 of 29 Evidence: stored safely but the key was seen kept in the lock of the internal cupboard of the controlled drugs cupboard. On closer examination we found that it could not be removed. The deputy manager said she would ensure that this is removed or replaced and held safely. We were told that one person receiving residential care requires insulin and it is administered by the Community Nurses, their records were seen and the injection sites were recorded. Storage was appropriate and there was a detailed care plan in the residents file for managing her diabetes. The deputy manager said she was unaware of any formal medicines training for care staff on induction to the home but could easily ensure this was included. We observed residents privacy to be upheld during this inspection and saw information in the staff room regarding the privacy and dignity for staff to read. People told us they are treated with respect and their privacy is upheld at all times. Staff knocked on doors prior to opening them and shared rooms were provided with appropriate screening. One person said she has a do not disturb sign for her door and staff respect this. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities and social events take place, there is no programme and record keeping needs to be improved. Visitors are welcomed and residents are encouraged to live a life of their preference. Evidence: We were told that there is an activities coordinator employed for 18 hours per week but she has been on sick leave for a few weeks. There was no structured plan in place for the provision of activities in her absence and nothing taking place during this inspection. One carer told us that she had spent time with residents mainly providing manicures. The registered manager said she has picked scented flowers from the garden and cherry tomatoes for the residents and spends time chatting with them. She said these little things are not always perceived as activities. We were told that some games and the regular entertainments, which are frequent, continue to be enjoyed by residents. There were notices on a board informing people of the entertainers visits. These included Arts and Music for Health, various musicians and people with pat dogs. We also saw the activities file which listed things that normally take place for example painting, crafts, poetry, bingo, gardening, cooking and videos. A carer said that various religious services are held in the home and Care Homes for Older People Page 16 of 29 Evidence: people told us they can attend as they wish. A small confectionery shop was seen and a member of staff went out shopping during this inspection for toiletries for residents. The home has a vehicle for taking residents out but we were told there are limited staff authorised to drive it so it is not used as much as people would like. The registered manager said she has now been included on the insurance so she can take people out now. An annual fete is held at the home and people said they enjoyed this in June when the weather was good. The registered providers told us the home has adopted a donkey and he has visited the home; they said residents and staff enjoyed the visit. There were photographs all around the home of people enjoying various events and activities and there were displays of residents art work. Surveys told us that appropriate activities are always/usually on offer. Staff and professionals comments include Employ a few more staff to do more activities with residents, More activities for residents, not just sitting in their chairs all day sleeping, More activities for those that are able to participate. Provide more activities. The AQAA states that life histories are being compiled and they hope to introduce a method by which people dont feel they are just sitting around. The manager acknowledges this is an area for improvement. We saw records for each resident held in a file, they were dated and stated the activity attended. There were comments such as enjoyed the singing and so on but little else. The recording of more detail as to what people get out of the sessions and their emotional responses was discussed with the deputy manager. The records showed that activities were not attended regularly some records had gaps of several months and some no recordings since 2007. The most recent records seen were June 2009. We were told there is a residents committee who meet to discuss social events. A resident was knitting squares, which she said would be sewn together to make blankets; she said it keeps her fingers nimble. There is a library upstairs which provides a quiet room for meeting with visitors and so on, staff said this room is not used very often. There is a record of visitors to the home and there were visitors in the home during this inspection. Residents said they could receive visitors in private and at any time. Visitors told us they are always made welcome in the home and can call whenever they like. Residents told us there are suitable telephone arrangements in the home and they can have their own private line if they wish. Staff told us they try to make the daily routines as flexible as possible. People using the service said they choose when they get up and go to bed within reason; several Care Homes for Older People Page 17 of 29 Evidence: said they go to bed early. We were told that people start to go to bed at 17.30 which is helpful as there are only four staff in the evenings to put people to bed. People told us they choose what clothes to wear and how they spend their day. Several people said You do as you like here. People said their relatives visit and can bring their dogs in with them; there is a resident cat and a pet rabbit. Choices were seen on the menu and residents were observed to have a selection of meals at lunchtime. Residents rooms were personalised with their own belongings and furniture and one person said she chose the decor for her room. The maintenance man said that several residents have chosen the colours for their rooms. He said one person moved to a different room recently and has had his new room painted according to his wishes. Nutritional needs assessments were seen in the care files and we were shown records of peoples weight with specific diet information as required. Individual likes and dislikes were recorded and a sheet with peoples individual requirements was seen, this is given to the cooks so they are aware of peoples needs. The cook showed us a menu that was varied and nutritious. There was a choice of two lunchtime meals and a selection of hot and cold snacks at teatime. People using the service said the food is generally good. One said They have a lot to learn about making pasties and another said The stew had too much potato. Surveys told us that people usually/always enjoy the meals provided. Comments include The food is spot on, The food could be better, Teatime food is mostly sandwiches and soup, everyday the same thing, More fresh fruit and veg are needed and Perhaps a larger choice of breakfasts or lunch meals. The cook said that fresh vegetables are used and that all cakes are homemade. Plenty of fluids were observed to be available for residents in all areas with different sized beakers, straws and feeders for residents use. There were jugs of water or fruit squash in each bedroom. Meals were served in the lounges or individual bedrooms and appropriate assistance was observed. The AQAA states that training has been provided to care staff on the importance of diet, mouth care and swallowing difficulties. One survey commented A formal dining room would be nice but there is no space to extend. A dining table was seen in one lounge but staff said it was not used. Care Homes for Older People Page 18 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints procedure that ensures complaints are listened to and acted upon. Arrangements are in place for the protection of residents safeguarding them from harm or abuse. Evidence: We saw that the home has a satisfactory complaints policy and procedure. There has been one complaint to the home and none to the Commission since the last inspection. The records in the home show that the one complaint was dealt with and resolved. Thank you letters and cards are kept in the home. We saw an adult protection policy, a copy of the No Secrets document, the alerters flowchart and other leaflets about abuse, in a file in the staff room. We were told that in house training takes place as well as external sessions when available. The AQAA told us that housekeeping, laundry and maintenance staff have attended safeguarding training, as well as the carers. We were told that Mental Capacity Act training has taken place and some staff have attended Deprivation of Liberties training. There is a secure facility for the storage of money in the home. Residents said there are no barriers to raising concerns with the management. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, well maintained and free from offensive odours; the grounds are well maintained and attractive providing a pleasant safe environment for residents, staff and visitors. Evidence: The Inspector toured the building and the grounds. The home was warm, clean and homely with no offensive odours. The maintenance man told us that further decorating has taken place since the last inspection including the main lounge. Carpets and furniture have been replaced where necessary. He told us that the outside of the building had also been painted which was quite a job. He showed us his maintenance plan for this year which he is working through. The AQAA states that the registered providers hope to develop a couple of rooms to offer en suite facilities. They state that new furniture has been purchased for the lounges and sun room and this was seen during this inspection. The grounds were attractive and planted with colourful flowers. The memorial garden is at the front of the home, in a quiet spot there is a seat with a poem written on a plaque. The greenhouse at the back of the building contained tomato and lettuce plants. We were shown a new shed that has been purchased for storage purposes. People using the service told us they like to sit on the veranda at the front of the Care Homes for Older People Page 20 of 29 Evidence: home which has a sunshade for use if it gets too hot. All laundry is dealt with in house and residents said they are happy with the service. Hand-washing facilities were seen in all rooms with liquid soap and paper towels. Staff were observed wearing protective plastic aprons and gloves appropriately. Staff told us they have received infection control training. We were told that the laundry and housekeeping staff are undertaking NVQ level 2 training relevant to their roles. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment procedures are robust and there are sufficient staff employed who receive regular training to improve their knowledge and skills. Evidence: The registered manager told us there are no staff vacancies at the moment. We spoke to care staff who said that there is a nurse on duty at all times, sometimes there are two. They said that generally there are six care staff in the morning, three in the afternoon and evening and two at night. The rota confirmed these numbers. We were told that a team leader system has been introduced during the day and one team leader told us she is enjoying the role and the extra responsibility. Staff and residents told us that generally there are enough staff to meet peoples needs but some said there could be more in the evenings when people are being helped to get ready for bed. Some felt there could also be more in the afternoons especially while the activities coordinator is not around. Surveys gave varying opinions on the staffing availability one person commented It would help to have a staff member available to do the little things around the sitting areas - particularly at mealtimes - someone dedicated to this task is required. We were told that a carer is now allocated to be in the lounge at supper time. Staff seemed happy in their work and interacted well with people using the service and each other. Care Homes for Older People Page 22 of 29 Evidence: The figures provided in the AQAA document inform us that 77 of care staff have an NVQ either at level 2 or 3 and that three other staff are undertaking training. Copies of NVQ certificates were seen in staff files. Five staff files were inspected and recruitment procedures were thorough. Evidence that induction had taken place was missing from three files. Only one file contained a job description, the manager said these are kept in a separate file. CRB and POVA checks are undertaken prior to employment. The deputy manager told us she has been given responsibility for staff training and is enjoying this. We saw several training folders that she has developed and questionnaires on various topics such as dehydration, diabetes, Parkinsons Disease and Chronic Obstructive Pulmonary Disease. Staff told us about training sessions that have taken place in the home and externally. We were told the registered providers have invested in a training system from a reputable company and there are packs for several different subjects. The system enables staff to undertake training at their own pace and then undergo a test paper that is sent to the company for assessing. We saw some of the training materials. Staff told us the training provision is very good, one member of staff said they had great respect for the deputy manager and the work she has undertaken on staff training. The AQAA told us that the Skills for Care induction programme has been undertaken by all care staff and we were shown documentation during this inspection. The deputy manager showed us other induction documents that are also completed when staff first start work in the home. The home has achieved the Gold Standard Framework accreditation for palliative care and staff said they all had training which helped them to achieve this. Training records were seen which were up to date. Minor shortfalls were highlighted and the manager was addressing these. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager is competent and efficient in running the home; significant systems are in place to monitor and improve the service for residents and staff with awards being obtained. Health and safety is promoted and there is a system for managing peoples money that ensures their finances are safeguarded. Evidence: People using the service and staff told us the home is run extremely well and that the registered providers are present in the home every day. We were told that the owners are very open and can be approached easily. Staff said they are well supported and receive regular supervision. Surveys also told us that staff are supported well by the manager and a resident commented How very kind Sarah is to us all, she always listens to us and helps us if she can. One of the providers is the manager she is a registered general nurse and she has achieved the Registered Managers Award; she has seven years experience in the care homes sector. She said she keeps herself up to date on current issues by reading Care Homes for Older People Page 24 of 29 Evidence: relevant magazines and using the internet. She said the GSF work has kept her busy but with excellent results, she has subscribed to the end of life magazine which keeps her updated. She said she attends courses when she can and keeps up to date with statutory training in house. We saw a copy of the annual business plan in the staff room. We also saw a file of policies and a staff handbook that had recently been updated, these were in the staff room. We were told that an annual satisfaction questionnaire is distributed to residents and the results are collated. An action plan for the most recent survey was seen in the managers office. The AQAA states that the providers plan to survey the staff in future. Staff told us that they have meetings and minutes were seen that showed people can air their views. The manager said that management meetings also take place and the heads of each department attend. She said that each department is compiling their code of conduct. The maintenance man told us he is part of the residents committee and they meet four or five times a year. Minutes of the last meeting were seen, the manager said they aim for these meetings to be six weekly but they do vary, they are more frequent if a special event is coming up. A newsletter was seen in the staff room and was very informative, it included the annual survey results, the Gold Standard Framework (GSF) achievement, adverts including the residents baking day on Mondays and other stories and contributions. The registered manager has completed an Annual Quality Assurance Assessment (AQAA) for the Commission in excellent detail and returned it within the agreed timescale. Evidence provided in the AQAA has been verified during this inspection. The home has continued to maintain the Investors in People Award. The AQAA states that there are plans to undertake a complete audit of all services. From this the manager will develop regular audits. The manager showed us a file that contained the analysis of significant events and action plans were included. This is excellent practice and to be commended. We were shown the system for the handling of residents money. There is a safekeeping policy with a form for residents to sign as agreeing to the policy. We were told that two people deal with their own money and relatives deal with most of the other residents money. Mr Metalle is responsible for dealing with personal monies held for residents in the home and he is appointee for one person, her money is kept in a separate bank account. We were told that one of the nurses is appointee for another person. Cash was seen in separate envelopes and held in the safe and the money for one person was checked and was correct according to the records. Records were seen that Care Homes for Older People Page 25 of 29 Evidence: detailed all transactions and the corresponding receipts were seen. The registered provider said he would number the receipts in future for ease of auditing. Double signatures were recorded on the sheets. We saw a health and safety policy for the home. We were told the fire risk assessment had been undertaken and approved by the fire authority. The fire safety procedure was seen and checks were in place and seen recorded in the fire file. The AQAA details relevant service checks and the dates they were undertaken; all were up to date. The environmental health officer visited on 02 September 2009 and the report was excellent. Catering staff told us they had undertaken food hygiene training; one at intermediate level. Accident reporting complies with data protection and there is an audit system in place. The manager reports accidents and incidents to the Care Quality Commission appropriately, according to regulation 37. The home does not have many accidents an average of around four per month. Staff said they attend statutory training regularly and the deputy manager said she is ensuring this is kept up to date. She said that at the moment first aid and food hygiene training is taking place. A training matrix was seen and showed that most statutory training was up to date. A few gaps had been highlighted by the manager who said she was addressing these. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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