Care Home: Boscombe Lodge

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What the care home does well The vast majority of the feedback received about Boscombe Lodge has been positive. People made favourable comments such as, "I am extremely pleased with and grateful for the care my relative receives at Boscombe Lodge," "Boscombe Lodge is an exceptional home. I visited numerous homes before Boscombe Lodge and none compared," "Boscombe Lodge is a place of excellence," and, "Completely tends to the needs of my relative in a kind and compassionate way." When people are considering moving into Boscombe Lodge they know that through assessment and discussion they will be helped to decide if it is the right place and suitable for them. When people move into the home management and staff will continue to make every effort to find out about people`s needs and preferences so that these can be identified, planned for and met. People can feel confident that aspects of their care needs such as medical care, and the management of their medicines will be well and safely managed. People living at the home told us that they were always treated with respect and dignity. People will always able to welcome their visitors so that they can maintain contact with friends and family. People said that they enjoyed the food provided by the home. They are offered choice and their individual needs and preferences are respected. Boscombe Lodge benefits from having a stable management and reasonably stable staff team. This provides people with consistency of care and approach. What has improved since the last inspection? It has been three years since we carried out a site visit at Boscombe Lodge. Since that time the home has continued to develop procedures and practices. Activities have developed providing people for more opportunities for occupation and stimulation. Menus have been developed to provide people with greater choice. The premises have continued to be well maintained. For example the heating system in the home has recently been upgraded to provide a more constant temperature for people. Equipment had been provided to meet individual needs. What the care home could do better: The home is operating to a good standard and people are very happy with the service they are receiving. There are areas where development could continue such as more detailed assessments of people`s occupational needs and more use of the local community. The AQAA identified areas where the home hopes to continue with improvements such as developing the garden area, encouraging more resident involvement, and further developing end of life care and staff knowledge. Key inspection report Care homes for older people Name: Address: Boscombe Lodge 65 Boscombe Road Southend On Sea Essex SS2 5JD     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Vicky Dutton     Date: 1 1 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Boscombe Lodge 65 Boscombe Road Southend On Sea Essex SS2 5JD 01702603444 01702603377 boscombelodge@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Boscombe Care Homes Limited care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Nursing and personal care for service users who are over the age of 65 years not to exceed 30. The Registered Manager should complete a course equivalent to NVQ Level 4 in Management by 2007. To provide nursing and personal care to one service user who is under the age of 65 years and who is known to the CSCI. Date of last inspection Brief description of the care home Boscombe Lodge is an established care home which provides both personal and nursing care for up to thirty older people of whom. Up to six people living in the home may have dementia. The home is situated in a residential area and has been extended to provide additional places and facilities for the provision of care for older people. Residents accommodation and communal areas are situated on two floors, with a Care Homes for Older People Page 4 of 30 Over 65 6 30 0 0 Brief description of the care home passenger lift provided for assisted access. A secluded garden is provided to the rear of the property. The premises are situated within relatively close proximity to both local, main shopping and other civic amenities. All bedrooms have private en suite shower and w.c. Four bedrooms are shared and the rest are for single occupancy. A limited parking area is available to the front of the property. All prospective residents are provided with a Statement of Purpose and Service User Guide with up to date information of the home. Fees range from £439.00 to £625.00 per week and there are additional charges for hairdressing, chiropodist, taxis, luxury toiletries and sundries. A brochure is also available. The most recent inspection report is made available to people. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key site visit. At this visit we (CQC), considered how well the home meets the needs of the people living there, how staff and management work to provide good outcomes for people, and how people are helped to have a lifestyle that is acceptable to them. We spent seven and a half hours at Boscombe Lodge. We looked around the premises to see if it was pleasant and safe for people. We viewed some care records, staff records, medication records and other documentation to see how well these aspects of care and running the home are managed. Time was spent talking to, observing and interacting with people living at the home, and talking to relatives, management and staff. The homes Annual Quality Assurance Assessment (AQAA) was sent in to us when we asked for it. The AQAA is a self assessment tool that providers are required by Law to Care Homes for Older People Page 6 of 30 complete. The AQAA tells us how management feel they are performing against the National Minimum Standards and how they can evidence this. The AQAA for Boscombe Lodge was completed by the manager. It was adequately completed, gave us all the information we asked for and helped us in our assessment of the home. Before the site visit a selection of surveys had been sent to the home for distribution to residents, relatives, involved professionals and staff. We received responses from seven people living in the home, four visiting professionals, ten staff and six relatives. The views expressed at the site visit and in survey responses have been incorporated into this report where appropriate. We were assisted at the site visit by the manager, nursing manager and other members of the staff team. Feedback on findings was provided throughout the inspection. The opportunity for discussion or clarification was given. We would like to thank the staff team, residents, relatives and visiting professionals for their help throughout the inspection process. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The home is operating to a good standard and people are very happy with the service they are receiving. There are areas where development could continue such as more detailed assessments of peoples occupational needs and more use of the local community. The AQAA identified areas where the home hopes to continue with improvements such as developing the garden area, encouraging more resident involvement, and further Care Homes for Older People Page 8 of 30 developing end of life care and staff knowledge. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can feel confident that they will be given assistance and information, and have their needs assessed to ensure that the home will be suitable for them. Evidence: We saw that the home had a Statement of Purpose and Service Users Guide in place. We noted that these were also available in Braille format. It was explained that when people are thinking about moving into Boscombe Lodge they are given A comprehensive pack of information. Files containing the Service Users Guide and Statement of Purpose were also available in peoples rooms so that they could refer to them at any time after they moved into the home. On seven residents surveys received everyone felt that they had been given sufficient information about the home to help them to make a decision. Relatives spoken with confirmed that they visited the home and felt that they had been given good information. People spoken with confirmed that the deputy manager at the home had visited Care Homes for Older People Page 11 of 30 Evidence: them/their relative to assess their needs before they moved into the home. Some people knew the home from previous experience. One person said, I knew the home very well as they had cared very well for my [relative.] When I needed care I asked if they had any vacancies. We looked at the files of two people who had recently moved into the home and saw that pre-admission assessments had been undertaken that provided a good basis for understanding peoples care and other needs, and begin planning their care. One person completing a survey felt that the admission experience had not been positive, and that they had not felt welcomed. Other people spoken with however felt that the home could not have done more to make them feel welcomed and settle. One person said, It was very strange when I first came here, but the staff were good and I soon felt at home. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can feel confident that they will receive good and consistent care that meets their individual needs in ways that they would wish. Evidence: Many people living at Boscombe Lodge were able to express their views about the care and support they receive. People said, The staff are very caring and help me with everything I need, and You get everything you need. One person gave examples of how staff supported them in meeting their specific individual needs and mentioned the key worker system in operation at the home. One person said, I am looked after like a prince/ess. On surveys everyone felt that they always received the care and support that they needed. Management and staff spoken with had a good awareness of peoples individual needs, and were observed to support people in their preferred individual routines. Staff have undertaken training in delivering person centered care. People looked comfortable and well cared for. One person said, My [relative] is always clean and tidy, hair combed, dressed appropriately etc. Always warm and well cared for. Another person liked it that the staff took the trouble to make sure peoples clothes were always well matched. Care Homes for Older People Page 13 of 30 Evidence: To see how well peoples care is planned for and arranged so that staff are aware of peoples needs and meet them in an individual way we looked at four peoples care records in some detail. We found care plans to be comprehensive and to cover the issues identified in the pre-admission assessment. Care plans provide staff with good information to enable them to care for people in ways that they prefer. Care plans were person centered and detailed peoples needs, and actions required to meet these needs, under various headings. These included Eating and drinking, social and psychological, personal hygiene, mobility and communication. Other areas such as behaviour were also covered as needed to reflect individual needs. Although one person felt that they were not consulted about their relatives needs or care plan it seems that this is unusual. We saw that as far as possible residents or their families had been involved in agreeing care plans, and had signed to acknowledge this. One person said, I am regularly informed of any changes in [relatives] health or care plan. Other people confirmed that they were consulted on their wishes and needs. A daily living assessment is completed with the resident to assist this process and identify their individual needs and wishes. Assessment comments also indicated peoples involvement. For example, Explained to X and their relative about the risk of falls and the actions we need to take to prevent this. From discussion and records looked at, people receive good health care at Boscombe Lodge. People told us that they were always able to see a doctor when they needed to. We saw that assessments had been undertaken in relation to key areas such as tissue viability, nutrition and falls. Areas of risk such as the use of bed rails and moving and handling had also been assessed. Where assessments indicated a level of risk we saw that specialist equipment such as mattresses or beds were quickly put into place. Records showed that people access appropriate health care professionals such as speech and language, physiotherapists, general practitioners and other specialisms to meet their individual needs. We received feedback on surveys from three visiting professionals to the home. Responses to questions and comments were positive such as, Residents are very well cared for and always very clean, They care for people and provide additional service and resources to meet the residents needs, and The care and nursing staff are well trained. They are very co-operative, and always discuss any issues of concern. They are very helpful. During the year we (CQC) have also received two letters of praise about the home. One reported that their relative had been admitted to the home with badly ulcerated legs. They said, The nurses did such a good job in caring for their legs that one had recovered really well and was bandage free, and the other was much better. This was praised by the tissue viability nurse at Southend Hospital. Training records showed us some staff have completed training in relevant health care areas such as respiratory conditions, Care Homes for Older People Page 14 of 30 Evidence: nutrition and PEG feeding, Parkinsons disease, catheter care and caring for people affected by stroke. This will increase staffs knowledge and understanding of these areas enabling them to deliver good care. No one living at Boscombe Lodge currently manages their own medication. We looked at systems in place to see if this aspect of peoples care was managed in a safe and effective way. Medication is always administered by trained staff. The nursing manager confirmed that medication training had been undertaken by staff. This was confirmed through the training matrix. It was identified that further training was planned for the near future to highlight medication management for people with swallowing difficulties. We saw that the medication area was clean and well organised. All expected records and procedures were in place. Good records are maintained and the system is regularly audited to identify any errors or issues. No anomalies or errors were noted on the records sampled. During the day staff were observed to be respectful to people and responsive to their needs. Privacy was maintained when personal care tasks were being carried out. One person told us, The staff are always most respectful. I get embarrassed about some things, but they always reassure me and tell me not to worry as it is their job. A letter of praise said, X was well cared for and treated with dignity at all times. Although not fully assessed we saw that peoples end of life needs had been discussed and their wishes recorded. Trained staff and some care staff have been trained in palliative care. This is to be developed further through training from the Marie Curie Foundation and the introduction of the Liverpool end of life care pathway planned for the near future. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have opportunities to have a fulfilling lifestyle, maintain contact with friends and family and enjoy good food. Evidence: During the site visit we spoke to many residents and a number of visitors. People felt that they made choices in their daily lives. People felt that their individual choices were listened to and respected. For example one person told us that they preferred to have a main meal in the evening rather than lunch time and this was arranged. Care plans viewed identified peoples preferred rising and retiring times. When care plans identified preferences such as what drinks people like, when they like to rise we noted that this had been adhered to in practice. People are able to go where they wish and bring in personal possessions to make them feel at home. The home employs an activity co-ordinator. They appeared on the rota as working from 13.00 to 16.00 each day but the manager said that they actually work up to 30 hours a week as they will come in earlier or stay later, undertake evening activities etc. Members of the providers family who are directors in the Company also now work in the home to provide residents with activity and support. A number of people at Boscombe Lodge prefer to remain in their rooms. We saw from records and Care Homes for Older People Page 16 of 30 Evidence: observations that people are offered company and activity. Care files included a social history sheet that provided basic details of peoples history and interests, and an activities assessment to identify any preferences or wishes. This could be developed especially in the case of people who have dementia care needs. Activities undertaken are recorded. There is not a structured programme of activity in place. Activities are offered to suit peoples views or preferences on the day. However there are some regular events such as Fridays Happy Hour and Tuesday Bingo. Talking books are used. An aromatherapist visits the home twice a week for anyone wishing to use this service. Periodic entertainers visit, and special events take place throughout the year. For example Egyptian dancers and on the weekend following the site visit a Donkey Derby was planned with relatives and friends invited. A relative told us, They always encourage X to join in with activities etc. but respect their wish not to participate if they choose. Most people seemed happy with the level and range of activity offered. On surveys seven residents said that there were always activities arranged that they could take part in. Minutes of a recent residents/relatives meetings said, Most of the residents commented on how Happy they are with all the activities being carried out at the home. The activity co-ordinator said that they had plenty of equipment such as games and craft materials available. We saw that people enjoyed having newspapers, knitting, and listening to the radio. One person told us that there was a regular church service at the home, and that they had their own individual arrangements in place to meet their spiritual needs. People are able to enjoy having visitors at any time. We saw that people were made welcome, offered refreshment and that they had a good relationship with management and staff. A letter received by us said, We are warmly greeted with a smile when we enter from a nurse, the cook, the cleaner, the nursing staff, manager or owner depending on who is nearest the door. These small things are very important. We were given a cup of tea or coffee every time we visited X which we could do at any time or any day. Feedback on the food provided at the home was positive. People said, The food here is good, Home cooked and very nice, and I have no complaints about the food. The home operate a four weekly rotating menu, with a choice being offered for each meal. People said that they are asked what they would like and given a choice. On the day of the site visit we saw that breakfast was prepared or cooked to peoples individual preferences. Lunch on the day of the site visit looked appetising and plentiful. It was well presented and people said that it was nice. Staff offered people appropriate assistance. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for safely through practice in the home. Evidence: The home has a clear complaints procedure in place that is easy to understand. The complaints procedure is on display for people and available to refer to in information folders in their rooms. On surveys and in discussion people said that they knew how to raise any concerns. One person said, The owner is always available to talk to. Another person said, The home listens and acts promptly if there is a problem. The AQAA said that two complaints had been made over the previous year. We were aware of both of them as they had both been referred and managed under safeguarding procedures. The home were co-operative in investigations and worked with Social Services in establishing the facts in each case. Staff training records and staff spoken with confirmed that training in safeguarding had been undertaken. We saw that good information was available so that staff knew all the contact details necessary, and had access to the appropriate forms to use if an incident occurred. The home have their own policies and procedures in place relating to safeguarding vulnerable adults. We saw that staff handbooks relating to safeguarding produced by the local authority were also available. Although not currently a particular issue at Boscombe Lodge we saw that staff had received training in managing challenging behaviour and that care plans reflected Care Homes for Older People Page 18 of 30 Evidence: peoples behavioural needs. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean and pleasant home. Evidence: Boscombe Lodge is an adapted and extended older property. Accommodation for residents is on two levels with access provided via a shaft lift or stairs. There is a central garden for people to enjoy. There are a number of communal areas available. The home is conveniently situated for access to local amenities and the town centre. The home is well maintained and decorated, with people being offered choices in this area. A recent residents meeting minutes said, A redecorations programme is going around. All residents will be asked by X the maintenance staff about the choice of colour they would like in their rooms. The home has four shared rooms and the rest are single. All rooms have an en suite facility. People using shared rooms said that they did not mind this and were happy with arrangements. People said that they were happy with the accommodation provided and made comments such as, The home is always bright and clean, The home is warm and comfortable, and The home is clean and beautifully furnished. On the AQAA and in discussion with the manager it was clear that management are keen to maintain high standards of accommodation with any issues arising being attended to promptly. Care Homes for Older People Page 20 of 30 Evidence: Suitable bathrooms and shower rooms were available which provide different options for peoples bathing needs. We saw that suitable equipment to meet peoples needs is available, with appropriate moving and handling equipment and specialist beds and mattresses being in use where needed. Signage in the home is adequate and and would offer people who have cognitive impairments some assistance with orientation. On the day of the site visit the home generally seemed fresh and clean. One person said, The home is always clean and never smelly. There is a suitable laundry area available. Staff have been trained in infection control so that they are aware of good practice that will keep people safe. Communication difficulties however made it difficult to establish the scope of knowledge and understanding of the person working in the laundry area. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported for by caring and well trained staff. Evidence: We received positive comments about staff working at Boscombe Lodge. The staff do their utmost to ensure that my [relative] and other residents needs are met, The staff are very friendly and helpful, The staff are like an extended family, [the provider] and staff are marvellous and always ready to help, and The staff are all lovely were some of the comments made. Staff surveys received, discussion and observation showed that staff are positive about their role and felt that there was good teamwork. Staff said, The home always make sure that the residents needs are met to make sure that they feel happy safe and comfortable. The home is accommodating and makes people feel important, and, The home looks after residents needs, it is a lovely home where I have worked for many years. Staff turnover at the home is relatively low with many staff having worked there for a number of years. Agency staff are not used at Boscombe Lodge. This means residents can have a sense of stability and receive care and support from people that they know and are familiar with. On the day of inspection twenty nine people were being accommodated. We looked at staffing rotas and saw that staffing levels were being maintained at seven care staff and a trained nurse during the morning, four or five care staff and a trained nurse Care Homes for Older People Page 22 of 30 Evidence: during the afternoon evening and two care staff and a trained nurse at night. As identified from recent staff meeting minutes from February, this is a recent change. [The manager] explained that they will be increasing the staffing level from six carers to seven carers during the peak hours to improve the service provided to service users. The managers hours are supernumerary. The nursing manager also has supernumerary hours to complete supervision and other tasks. Additional support and hours are provided for domestic, laundry, catering and residents activities. During the site visit there were generally staff around in the communal areas to monitor, interact with, and assist people. When we used a call bell to gain assistance for a resident this was responded to reasonably promptly. People spoken with felt that staffing was sufficient to meet their needs. Only one person on a survey felt that, Sometimes staff numbers seem to be at a bare minimum and therefore response times to day to day needs are slow. Another person said that on one occasion it had taken fifteen minutes for someone to answer the door to them. So that people receive care from a well trained workforce it is recommended that at least 50 of a homes care staff achieve a National Vocational Qualification (NVQ) in care at level two or above. Information provided on the AQAA and discussed at the site visit indicated that out of 16 care staff ten currently hold an NVQ, and some of these have recently completed this at level three. Of the remaining six staff we were told that three have recently completed NVQ at level two and are awaiting confirmation and certificates. The remaining three staff will be starting their NVQ course in the near future. The home have therefore achieved over the 50 basic target, and show a commitment to maintaining a well trained workforce. The previous inspection found that recruitment procedures and practice at Boscombe Lodge were satisfactory and protected residents. We looked at the files of one member of staff who had been most recently started work at Boscombe Lodge to ensure that good practice was being maintained. We saw that all proper checks had been undertaken. POVA first, and Criminal Records Bureau checks had been undertaken, references taken up and proof of identification sought. Minutes of a recent resident/relatives meeting showed that the home are open to involving people in this process. X informed all residents about new recruitment taking place and asked the residents if they would like to join in on the interviews which will be taking place in the next few weeks. On ten staff surveys received people said that their recruitment was carried out fairly and thoroughly. On staff surveys everyone said that their induction covered the things they needed to know very well. We saw from staff files that induction processes are in place to ensure that staff have a good initial introduction to the home during their first four Care Homes for Older People Page 23 of 30 Evidence: days. They also undertake a range of training and undertake Skills for Care Common Induction Standards through a workbook. On Surveys and in discussion staff made positive responses to questions about training saying that training offered gave them the skills that they needed. One said, The home always makes sure that their employees undergo training. We saw that staff have individual training profiles in place. Those sampled, and a training matrix viewed, indicated that staff have undertaken a good range of training including dementia care, person centered care, and palliative care to support them in their role. On surveys and in discussion relatives felt that staff had the right skills for the job. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe and well managed home. Evidence: The owner of Boscombe Lodge is also the registered manager. They are experienced and have appropriate qualifications. The manager is supported by the nursing manager who undertakes much of the day to day running and organisation of Boscombe Lodge. People made positive comments about the management of the home and felt that they were friendly and approachable. One person said, Attention is always given to any queries. Management are always available when needed. This gives me great peace of mind. Another person said, The home is managed and run very efficiently but unobtrusively. It still feels like home. Residents told us that the manager always talks to them and listens to what they have to say. Minutes of a recent residents meeting said, X said that [the manager] visits them on a daily basis and that they are really happy with the way [the manager] listens to them. X commented that the boss man always comes to see them and that they are really happy. Staff said, Management are easy to approach and talk to and are always Care Homes for Older People Page 25 of 30 Evidence: available, and, Management have a superb relationship with staff. When we visited the home was well organised, and all the information needed to undertake the inspection was readily available. Discussion and information viewed at this inspection showed that the manager is aware of things happening in the home and proactive in dealing with issues when they arise. People commented that Boscombe Lodge, Is a very happy home, always has a lovely atmosphere for the residents and staff alike, and, I have been welcomed as part of Boscombe Lodge family. They make a huge effort to host events for residents, their families and staff which makes for a really friendly and positive atmosphere. The provider has strategies in place to ensure that the quality of the service is kept under review and that people have the opportunity to express their views about the service. We saw that regular staff meetings and residents meetings take place. The provider undertakes regular quality reviews of the service. At Boscombe Lodge surveys are sent out twice a year to residents and other people involved with the service. We saw that the latest one of these had taken place in January/February this year with a comprehensive report of results having been produced. Responses to surveys had been very positive. The AQAA was completed by the manager. The AQAA was adequately completed and showed us that management know what they need to do better, and how they can continue to improve the service for the benefit of residents. People can feel confident that if they or their families ask the home to help them look after their personal monies, this will be done in a way that safeguards their interests. Monies checked were correct, with receipts in place for all transactions. Records viewed showed that staff receive regular supervision to support them in their roles. Annual appraisals are also undertaken. The AQAA completed identified that systems and services within the home are monitored and maintained. A sample of records looked at confirmed this. A partial tour of the premises showed that the home seemed well organised and safe. We did however notice that sluices and the laundry area were open. As the home is registered to provide some dementia care this could present a hazard for people. The provider undertook to rectify this, and following the site visit confirmed that these areas had now been made secure. When the fire service last visited the home in November 2008 they found everything to be in order. A local fire risk assessment was seen to be in place. Fire records were well maintained. Systems are tested weekly, and fire drills are carried out to ensure Care Homes for Older People Page 26 of 30 Evidence: that staff know what to do in an emergency. The last environmental health officers visit in February this year found that very good standards of food hygiene were being maintained and awarded the home a four star rating. Training records showed that staff are kept up to date in core areas such as moving and handling, health and safety and food hygiene. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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