Care Home: Boston House

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What the care home does well The service did lots of things very well. These included the following: People`s needs were assessed before they moved in. This meant that they knew that their needs could be met. People and their relatives were pleased with the service. One person`s relative commented that the service had a, "clear set up and sense of purpose", and added that there was, "very much a focus on rehabilitation from the start". The care plans we saw were clear and detailed and gave staff the information they needed to take into account people`s wishes and preferences when supporting them. Staff had a good understanding of the way in which people`s choices, privacy and dignity could be maintained. We observed that all interactions between staff and people using the service were sensitive and respectful and we saw that the service had a strong focus on maintaining confidentiality and privacy. People were happy with the food served. Comments included, "the food is lovely", and I`m really enjoying the food". One person`s relative said that the manager was, "very responsive to complaints". Another person said that they, "would feel confident enough to go to the office if I was not happy with anything I saw". A third person said, "I could quite happily talk to the manager about anything". The arrangements for safeguarding people were good. The GP said that they had, "never seen anything that they weren`t happy about". One person using the service talked about feeling safe and secure in the home and being confident to raise any concerns. This person concluded,"I feel safe, oh yes". The home was decorated and furnished to a high standard and there was evidence of ongoing maintenance and refurbishment. Staff were well supported by management and provided with an induction, good access to a wide range of training, and regular supervision and appraisal. This meant that they in turn were able to support the people using the service. People were happy with the staff. Comments included that they were, "very helpful, kind and understanding". "very friendly", "they`ve helped me a lot" and, "they welcome you". The GP said that, "the staff on the ground were excellent", and that, "staff morale was good". Without exception, the comments about the manager from people who use the service, their relatives, health care professionals, the management team and the staff team were very positive. She was described as "approachable", able to, "sort problems out", and was said to ask people`s views. One health care professional said that the manager was,"very particular about doing things right", "very well up on what`s going on and all the regulations and standards", and was, "very good at organizing, but also had very good personal skills and is approachable to all staff". The GP concluded that the multi disciplinary health and social care staff had a teamwork approach and, "management are key to the way the place runs". What has improved since the last inspection? Some improvements to practice that was already good were made since the last inspection. These included the following: The garden areas had been significantly refurbished to provide very pleasant and enclosed areas for people to enjoy. The way that people were supported to take their medication had improved by addressing a requirement made by our pharmacist inspector. What the care home could do better: There were three things that we felt the service could do better. These were as follows: While staff demonstrated a caring and committed attitude to the protection of vulnerable adults and had received training, they were not all clear on the practical steps they should take in certain circumstances. They needed further guidance on the possible scenarios they may be faced with and the practical steps they would need to take to protect a person. The way that staff were deployed across the three units needed to be reviewed in the light of people`s comments about not always been able to see a member of staff on the unit they were living on. While overall, fire safety arrangements were good, the manager needed to make sure that all fire safety checks were always completed consistently. When discussing the above issues, we were reassured by the manager`s commitment to make any necessary improvements in the best interests of people using the service. Key inspection report Care homes for older people Name: Address: Boston House Broadway Street Hathershaw Oldham OL8 1XR     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: Helen Dempster     Date: 3 0 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Boston House Broadway Street Hathershaw Oldham OL8 1XR 01617703769 01616651039 pat.judge@oldham.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Oldham M.B.C. Name of registered manager (if applicable) Mrs Donna Michelle Paul Type of registration: Number of places registered: care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following service of category only: Care home only - PC. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other categlory - Code OP. Dementia - Code DE (maximum number of places: 5) Physical disability - Code PD. The maximum number of service users who can be accommodated is: 29 Date of last inspection Brief description of the care home Boston House is a purpose built Local Authority Home, situated three miles from Oldham town centre and close to local amenities and public transport. The service provides short stay and intermediate care to people. The home is divided into three Care Homes for Older People Page 4 of 28 Over 65 0 29 0 5 0 29 2 0 0 7 2 0 0 9 Brief description of the care home units, each unit having a lounge, kitchen and dining area with bedrooms situated off the units. The intermediate unit has a specially adapted kitchen and equipment for rehabilitation purposes. All bedrooms are single occupancy and are larger than the minimum space requirements. There are no en-suite facilities, however there are numerous toilets and bathrooms situated close to service users bedrooms and lounges. Four rooms have doors into adjoining rooms, which can be converted into doubles for service users to share if they wish. The home provides appropriate aids and adaptations in order to maintain service users independence. Boston House has level access throughout the building onto secure garden areas.Fees charged are £370.00. Information about the service can be obtained from the service user guide, which is a booklet that provides information about what people can expect from the service. Information can also be obtained from the manager, either in person or by telephone. Care Homes for Older People Page 5 of 28 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 key unannounced inspection included a site visit. The manager and staff at the home did not know that the visit was going to take place. In May 2009, an Annual Service Review (ASR) was done, as part of the lead up to this inspection. This involved the manager filling in an annual quality assurance assessment (AQAA), and people who use the service and staff filling in surveys to tell us their views of the home. We then considered this information, and all the other information we had received about the service, so that we could decide when we needed to visit the home to do a key inspection. The outcomes for people who used the service at that time were good. This reassured us that people at the home continued to be happy with the way they were supported at the home and that they continued to receive a good service and this helped us to plan the timing of this inspection. Prior to this inspection, we sent surveys out again to people who use the service and staff so they could tell us what they thought about the service. We did not receive any completed surveys. We asked the manager of the service to complete an AQAA again. This form gave the manager the Care Homes for Older People Page 6 of 28 opportunity to tell us what they feel they do well, what they needed to do better and what had changed since the last key inspection and ASR. This helps us to determine if the management of the service see the service they provide in the same way that we see it. The form was well completed and the manager was able to tell us what plans there were to develop the service. We have quoted some key information from the AQAA in this report. All of the key inspection standards were assessed at the site visit and information was taken from various sources. This included observing care practices, talking with people who use the service, their relatives, the manager and management team, the visiting GP, a senior manager , a nurse delivering training to staff, a visiting lay clergy member from a local church and members of the staff team. Three people were looked at in detail to learn about their experience of the service from when they first used it to the present-day. A selection of records were looked at, including medication records, training records and care records. Throughout this report we use the terms, us, and, we, and our, when we are talking about the Care Quality Commission. Care Homes for Older People Page 7 of 28 What the care home does well: The service did lots of things very well. These included the following: Peoples needs were assessed before they moved in. This meant that they knew that their needs could be met. People and their relatives were pleased with the service. One persons relative commented that the service had a, clear set up and sense of purpose, and added that there was, very much a focus on rehabilitation from the start. The care plans we saw were clear and detailed and gave staff the information they needed to take into account peoples wishes and preferences when supporting them. Staff had a good understanding of the way in which peoples choices, privacy and dignity could be maintained. We observed that all interactions between staff and people using the service were sensitive and respectful and we saw that the service had a strong focus on maintaining confidentiality and privacy. People were happy with the food served. Comments included, the food is lovely, and Im really enjoying the food. One persons relative said that the manager was, very responsive to complaints. Another person said that they, would feel confident enough to go to the office if I was not happy with anything I saw. A third person said, I could quite happily talk to the manager about anything. The arrangements for safeguarding people were good. The GP said that they had, never seen anything that they werent happy about. One person using the service talked about feeling safe and secure in the home and being confident to raise any concerns. This person concluded,I feel safe, oh yes. The home was decorated and furnished to a high standard and there was evidence of ongoing maintenance and refurbishment. Staff were well supported by management and provided with an induction, good access to a wide range of training, and regular supervision and appraisal. This meant that they in turn were able to support the people using the service. People were happy with the staff. Comments included that they were, very helpful, kind and understanding. very friendly, theyve helped me a lot and, they welcome you. The GP said that, the staff on the ground were excellent, and that, staff morale was good. Without exception, the comments about the manager from people who use the service, their relatives, health care professionals, the management team and the staff team were very positive. She was described as approachable, able to, sort problems out, and was said to ask peoples views. One health care professional said that the manager was,very particular about doing things right, very well up on whats going on and all the regulations and standards, and was, very good at organizing, but also had very Care Homes for Older People Page 8 of 28 good personal skills and is approachable to all staff. The GP concluded that the multi disciplinary health and social care staff had a teamwork approach and, management are key to the way the place runs. What has improved since the last inspection? What they could do better: 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 28 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 28 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 had their needs assessed before using the service, so they knew that their needs could be met. Evidence: In the AQAA the manager stated, we ensure that service users are not admitted to Boston House without an in-depth needs assessment carried out by a professional, identifying the individuals needs, and areas of concern. To find out whether this was the case, we looked at a range of documents and we looked carefully at the care provided to three people from the point of their admission to the present time. We also talked to people using the service and staff. Boston House is divided into three wings, where people receive the specific care which they require. The Intermediate Care Wing accommodates people for up to 6 weeks and these people received care from a range of healthcare professionals, including an occupational therapist and physiotherapist, with access to good facilities to promote Care Homes for Older People Page 11 of 28 Evidence: their independence. Many of these people had been admitted from hospital for a period of rehabilitation to enable them to return home. The Transitional Care Wing accommodates people for up to 6 weeks, many of whom had been admitted from hospital. In many cases, these people had been assessed as needing longer term support, and preparations for their discharge, including completing work/adaptations at their home address, was taking place. The Short Term Care/Respite Care Wing accommodates people for planned stays to enable their carers to rest, or for emergency admissions for a variety of reasons. Stays on this wing tended to range from one week to 8 weeks. However, we were told that on some occasions, this stay can be longer depending on individual circumstances. We saw that each person had a full assessment, which involved all the relevant health care professionals, and the persons social worker, before they were admitted to the home. Since the previous inspection, the managers of the services run by Oldham Borough Council see these assessments during weekly meetings. This enables them to agree the most appropriate placement for the person while at the same time considering the impact of the dependency levels of all the people already accommodated at the service. This ensures that the manager is fully aware of an individuals needs and can make a decision as to whether they can meet that persons needs before the admission takes place. We were told that on the day of admission, staff at the home obtain further information about the persons needs and preferences. Once people are admitted, the Boston House staff use the pre admission assessments, and their own observations and assessments, to complete the care plan and risk assessments. We saw that the assessment process is ongoing throughout the persons stay at the service. People and their relatives said that they were pleased with the service. One persons relative commented that the service had a, clear set up and sense of purpose, and added that there was,very much a focus on rehabilitation from the start. Care Homes for Older People Page 12 of 28 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. Peoples health and personal care needs were met in the way they preferred, with consideration for their best interests and with respect for their privacy and dignity. Evidence: In the AQAA the manager stated, we provide and maintain the personal care of each individual service user, promoting their independence when and where ever possible, at all times ensuring that the service users privacy and dignity are respected . To find out whether this was the case, we looked at a range of documents and we looked carefully at the care provided to three people from the point of their admission to the present time. We also talked to people using the service, the manager and staff. The care plans we saw were clear and detailed and gave staff the information they needed to take into account peoples wishes and preferences when supporting them. Each care plan focused on what people could do independently and what staff needed to do to enable further independence. There were lots of details of peoples health care needs, including their medical history and what staff needed to do to support Care Homes for Older People Page 13 of 28 Evidence: them to maintain their health. Examples included good assessments and care plans concerning nutritional needs, maintaining healthy skin, mobility etc. We saw that staff were offered a range of training on health care issues which helped them to support people to maintain their healthcare needs. Examples included training in moving and handling and infection control. We talked to the GP, who together with a partner in their practice, provided care to the people on the intermediate and transitional wings. This GP explained that they often provided care to people on the short stay wing as well, because the service was sometimes located outside their own GPs catchment area. We saw evidence which suggested that this resulted in people having continuity of care, provided by a GP who was familiar with their care needs and was working as part of a team of health care and social care workers on a weekly basis in the best interests of people using the service. As the GP and his partner visited the home five times weekly, this meant that the homes staff, occupational therapists, and physiotherapists were able to bring any health care concerns to the GPs attention and obtain a timely response and treatment. This is good for people using the service. The GP talked about the benefits of the staff being able to keep health care professionals well-informed about the way that people were coping with their rehabilitation, their personal care needs, any worries and anxieties they may have and how they were interacting with others. We concluded that the consistent teamwork approach between health and social care staff, including each group of staff being represented in all meetings concerning people, meant that peoples health and social care needs were well met. The GP told us that the, communication system works really well, and that verbal communication was also very good. We saw that records of peoples progress were made every day, and often several times per day. We observed that equipment and various aids and adaptations were provided to encourage maximum independence. Despite this, the home retained its homely and domestic setting. We also observed the involvement of peoples relatives and carers in their care. One example was a relative washing a persons hair, as was their preference. We saw that staff supported and encouraged this involvement. The staff we talked to had a good understanding of the way in which peoples choices, privacy and dignity could be maintained. We observed that all interactions between staff and people using the service were sensitive and respectful. Care Homes for Older People Page 14 of 28 Evidence: We saw that the service had a strong focus on maintaining confidentiality and privacy. One example was clear policies about staff respecting people and ensuring that their practice did not include talking about people, including inadvertently talking about individuals they worked with when using internet/ social networks in their personal lives. People who use the service and their relatives were pleased with the way staff maintained peoples privacy and dignity. One persons relatives said that the staff were, respectful of dignity. Another persons relative described the way that staff were very sensitive when their relative was distressed by a symptom of their illness. This relative said that staff were, very helpful, kind and understanding. Relatives were also pleased with the treatment received. One relative said that, the rehabilitation treatment is excellent, and that their relative had, made great progress here. The way that people were supported to take their medication was assessed by the Care Quality Commissions Pharmacist Inspector who judged practice at the home to be good. We saw evidence to demonstrate that a requirement made by the Pharmacist Inspector had been addressed. The GP told us that to address this requirement they had reviewed their prescribing practice to make sure that staff had very precise instructions on the administration of medication. Care Homes for Older People Page 15 of 28 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 benefit from choices to enable them to exercise day to day control over their lives and enjoy the food of their choice. Evidence: In the AQAA the manager stated, routines are flexible and residents are encouraged to make informed choices and to maintain links with family, friends and carers. Meals are varied and nutritional and cater for varying dietary and cultural needs. To find out whether this was the case, we talked to people, the manager and staff, saw meals being served and looked at the programme of activities. We saw that in order that peoples individual needs and preferences could be established, staff completed a, preference sheet, when people were admitted to find out about their likes and dislikes and normal routines. An activities coordinator travels around the services run by Oldham Council. This member of staff offered a variety of activities, including baking, crafts etc. Recent events held included a St Patricks and St Georges Day Social and a Summer Fayre. The manager said that forthcoming events included a Halloween Afternoon and Christmas activities. Care Homes for Older People Page 16 of 28 Evidence: A medical student visiting the home told us that the home was, really nice, had a,nice atmosphere, that, everyone was friendly, and that, people look occupied. This person concluded that, theres always something going on. We also talked to a visiting lay assistant from a local church who visited the home on a monthly basis to provide Holy Communion. This person said that the home had a, very open atmosphere, and that they were always made welcome. People were happy with the food served. Comments included, the food is lovely, and Im really enjoying the food. We saw that the cooks were committed to providing people with food that met their cultural needs and preferences. One cook said that the manager had responded quickly to their request for training in meeting the dietary needs of one person recently admitted to the service. Care Homes for Older People Page 17 of 28 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 were confident that the manager and staff would listen to their concerns and staff commitment to the protection of vulnerable adults ensured that people were safeguarded from abuse. Evidence: In the AQAA the manager stated, on admission service users are given written information on the homes complaints representation procedure should they wish to make a compliment or complaint The manager added that the service has improved in the last 12 months by providing staff with training in the protection of vulnerable adults (POVA) and ensuring that this topic is included in supervision and meetings as appropriate. To see if this was the case, we looked at policies, procedures and records and talked to people, the manager and the staff. We saw that the service has a complaints procedure and maintained records concerning the outcomes of complaints. One persons relative said that the manager was, very responsive to complaints. Another person said that they, would feel confident enough to go to the office if I was not happy with anything I saw. A third person said, I could quite happily talk to the manager about anything. A copy of the procedure concerning the protection of vulnerable adults (POVA) was readily available and staff had received training in its implementation. We talked to Care Homes for Older People Page 18 of 28 Evidence: three members of staff and asked them how they would respond to a scenario where an allegation of abuse was made to them personally. All three staff demonstrated a caring and committed attitude to the protection of vulnerable adults. However, they were not all clear on the practical steps they should take in certain circumstances. We discussed this with the manager and it was recommended that staff received further guidance on the possible scenarios they may be faced with and the practical steps they would need to take. We asked the GP about safeguarding people at the service. The GP said that they had, never seen anything that they werent happy about. One person using the service talked about feeling safe and secure in the home and being confident to raise any concerns. This person concluded,I feel safe, oh yes. Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefited from a warm, clean, safe, well equipped and well maintained environment. Evidence: In the AQAA the manager stated, all areas of the building are well maintained, homely and clean. The manager added that improvements in the last 12 months included redecorating nine bedrooms, having new carpets fitted in four bedrooms, installing a new ventilation system in the kitchen and refurbishment of two bathrooms/toilets. To see if this was the case we looked around the home, looked at records, including fire safety records, and we talked to people, the manager, and the staff. The environment is designed to provide three separate group living areas, each with its own lounge, dining room and kitchen area. We saw that this enabled people to enjoy some independence, including making a drink or snack in the kitchen area. The home was decorated and furnished to a high standard and there was evidence of ongoing maintenance and refurbishment . Bedrooms did not have ensuite facilities, however plenty of toilets and bathrooms were located close to bedrooms and communal areas. Bedrooms were fitted with Care Homes for Older People Page 20 of 28 Evidence: locks, and lockable cupboards were available for people to store their personal effects and/or medication. The intermediate wing has a specially adapted kitchen which was used to enable people to maintain some independence with normal domestic tasks, as they would need to do when they returned home. This included using a washing machine, dryer, fridge etc. Many rooms had wide doors to enable wheelchair access. Some hoist systems, including ceiling mounted tracking systems, had been installed in some rooms. Since the last inspection, the garden areas had been significantly refurbished to provide very pleasant and enclosed areas for people to enjoy. People expressed satisfaction with the environment. One person said that they were, surprised by how nice the room was and that you have your own room. Another persons relative talked about being, pleasantly surprised, by the environment and concluded that, The environment was very pleasant, very clean. Care Homes for Older People Page 21 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who used the service benefited from support provided by experienced and committed staff who they trusted. Evidence: In the AQAA the manager stated, the recruitment process is thorough and based on equal opportunities and ensuring the protection of service users. Staff are trained and competent to do their job and 87.5 of the current staff team have attained a National Vocational Qualification (NVQ). To see if this was the case we looked at staff files, training records and the recruitment procedure and we talked to people, the manager, and the staff. The manager said that she conducted interviews for potential staff. However, much of the recruitment procedure was completed by the Human Resources Department of Oldham Council. We talked to three staff about the recruitment procedure and they all confirmed that they did not work alone with vulnerable people until suitable references and a Criminal Records Bureau (CRB) check were obtained. When looking at training records and when talking to staff, we saw that staff were provided with an induction, had good access to a wide range of training, and had regular supervision and appraisal. Most of the staff held a National Vocational Qualification (NVQ). This exceeds the standard that 50 of staff hold this Care Homes for Older People Page 22 of 28 Evidence: qualification. Staff talked about management being approachable and supportive. We looked at the way that staff were deployed to meet the needs of people using the service. At the time of the visit, we were told that Oldham Council were reviewing staffing levels to make them more flexible across the various residential services. This had some advantages. In particular, this meant that only staff employed by Oldham Council would be used, rather than agency staff, to provide continuity of staffing for people. However, staff we spoke to were concerned about staffing levels. We were told that minimum staffing levels were three care staff and a manager. As the service is spread across three units, this meant that when staff were helping to care for a person who needed two members of staff to support them, there would not be a staff member on one of the units. People using the service, and the relative of a person, told us that sometimes, they could not see a member of staff, especially when staff were taking their meal breaks, and that this bothered them. We observed that this was the case during the evening. This was discussed with the manager on duty who explained that all staff meal breaks were paid breaks, so that they were expected to be available should they be needed. When taking meal breaks, staff members sat in the main hallway, so people on the units would not be able to see them. We explained that people using the service and a relative had expressed concerns about not being able to see staff on the units and we recommended that the management team discuss and review the deployment of staff in the light of these comments. People were happy with the staff. Comments included that they were,very friendly, theyve helped me a lot, they welcome you. The GP said that, the staff on the ground were excellent, and that, staff morale was good. Care Homes for Older People Page 23 of 28 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 and their relatives were confident that the manager ran the home in the best interests of people who live there and that their safety and welfare were promoted. Evidence: In the AQAA the manager stated that she had, continued to participate in ongoing training to aid her professional development and has kept up to date with all current policies and procedures. The manager added that, all maintenance and safety checks have been completed in accordance with best practice. To see if this was the case we looked at records and spoke to people, the manager and staff. A new manager had been registered in July 2009. The manager was the former assistant manager of the home and therefore was familiar with the service. Her qualifications included a City and Guilds in Community Care and a range of NVQ qualifications. The manager was about to study towards the Registered Managers Award. Without exception, the comments about the manager from people who use the service, their relatives, health care professionals, the management team and the staff Care Homes for Older People Page 24 of 28 Evidence: team were very positive. She was described as, approachable, able to, sort problems out, and was said to ask peoples views. One health care professional said that the manager was,very particular about doing things right, very well up on whats going on and all the regulations and standards and was, very good at organising, but also had very good personal skills and is approachable to all staff. The GP concluded that the multi diciplinary health and social care staff had a teamwork approach and, management are key to the way the place runs. The service has good quality assurance arrangements, which included giving each person on discharge a, customer satisfaction survey. We saw that the outcomes of these surveys were collated so that the comments could be acted upon. The manager explained that the service holds money on behalf of five people using the service. There was a safe to store valuables, and each person had a lockable unit in their room. The manager explained that all bills/fees for the service were dealt with centrally by the Finances Department of Oldham Council. Overall, fire safety arrangements were good. However, while some fire safety checks were completed regularly, the manager needed to make sure that checks that should be completed on a weekly basis, including the check of the fire bell and means of escape, were always consistently completed every week. Care Homes for Older People Page 25 of 28 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 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 18 It is strongly recommended that the manager ensures that all staff are confident with, and have a full understanding of, the practical steps they would need to take should an allegation of abuse be made to them personally. This is necessary so that people are always safeguarded. It is strongly recommended that the manager reviews arrangements for the deployment of staff across the three units in the light of the comments of people using the service. This is necessary in order that people are reassured by seeing staff on the unit to meet their needs at all times. It is strongly recommended that the manager monitors the fire safety checks to ensure that checks that should be completed on a weekly basis are always completed consistently. This is necessary to ensure peoples safety. 2 27 3 38 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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