Care Home: Bradbury Home

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What the care home does well The vast majority of the feedback received about Bradbury Home has been positive. People made favourable comments such as, "I have visited a number of homes in the last six weeks and Bradbury Home is the best," and, "On the whole the care provided is very good. Kindness is shown and understanding of an elderly person`s situation," When people are considering moving into Bradbury Home they know that through assessment and discussion they will be helped to decide if it is the right place and suitable for them. 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. Most people said that they enjoyed the food provided by the home. They are offered choice and their individual needs and preferences are respected. People`s spiritual and pastoral needs are very well catered for and there are daily opportunities for worship. The accommodation provided at Bradbury Home is good. People`s rooms are spacious and comfortable. What has improved since the last inspection? The home has made good progress over the last year. There is now a stable management team in place. The management team are working together to continue to improve and develop the service. Much of the building has been refurbished. New decoration and furnishings have improved the environment for residents. The garden area has also been improved to provide a pleasant space for residents to enjoy. The needs of people with dementia are being recognised to a greater degree with signage being developed and life story work being undertaken. Activities have continued to develop and people now have more opportunities for activity and engagement. Care planning at the home has improved and would now give staff adequate information to enable them to support residents. What the care home could do better: Although care planning has improved there are still issues that need to be addressed. this is so that people can be assured that their care is planned in a person centered way, that takes into account all of their needs and preferences. People should be involved in planning their care.The management team have made good progress in moving the staff team towards a more person centred and activity based approach to care. From one survey received and comments in meeting minutes, work is still needed to fully achieve this cultural shift. Staff training has been ongoing, but there are still some shortfalls in core training. Staff would also benefit from training in additional areas such as conditions of old age. Key inspection report Care homes for older people Name: Address: Bradbury Home 2 Roots Hall Drive Southend on Sea Essex SS2 6DA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Vicky Dutton     Date: 1 3 0 4 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 29 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 29 Information about the care home Name of care home: Address: Bradbury Home 2 Roots Hall Drive Southend on Sea Essex SS2 6DA 01702435838 01702435877 lawrence.taylor@salvationarmy.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Salvation Army UK Territory Name of registered manager (if applicable) Mr Lawrence Taylor Type of registration: Number of places registered: care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Number of service users for whom personal care is to be provided must not exceed 36 (total number not to exceed thirty six) Personal care to be provided to no more than 10 service users with dementia over the age of 65 years of age (total not to exceed ten) Personal care to be provided to no more that 36 older people over the 65 years of age (total not to exceed thirty six) Date of last inspection Brief description of the care home Bradbury Home is a purpose built premises which opened in May 1992. It is owned and managed by the Salvation Army. Accommodation is provided over three floors that are accessed by a shaft lift. There are thirty two single rooms and two double rooms. All rooms are en suite. The first and second floors have lounge areas and an attached Care Homes for Older People Page 4 of 29 0 3 0 4 2 0 0 9 0 0 Over 65 10 36 Brief description of the care home kitchenette, where people could prepare their own snacks and drinks. One of these areas is used as a quiet contemplation and prayer area, and the other is set up as a space where activities can take place. On the ground floor there is one large lounge area for people to use. Meals are served in a pleasant dining room that overlooks the garden. There is a hairdressing room and a treatment room so that people can meet with nurses, chiropodists and other health professionals in private. The garden has patio areas and seating. Ramps allow access for those residents who use wheelchairs. The garden is secure. A staff room with lockers and a kitchenette is also provided. A statement of Purpose is available that sets out what the home aims to provide. Information booklets are available to people who are interested in using the service. It was confirmed that the current fees at the home are £515.00 per week. There are additional charges for chiropody, hairdressing, and other personal requirements. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: 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 at Bradbury Home. 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 complete. The AQAA tells us how management feel they are performing against the Care Homes for Older People Page 6 of 29 National Minimum Standards and how they can evidence this. The AQAA for Bradbury Home 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, one visiting professional, three staff and four 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 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 29 What the care home does well: What has improved since the last inspection? What they could do better: Although care planning has improved there are still issues that need to be addressed. this is so that people can be assured that their care is planned in a person centered way, that takes into account all of their needs and preferences. People should be involved in planning their care. Care Homes for Older People Page 8 of 29 The management team have made good progress in moving the staff team towards a more person centred and activity based approach to care. From one survey received and comments in meeting minutes, work is still needed to fully achieve this cultural shift. Staff training has been ongoing, but there are still some shortfalls in core training. Staff would also benefit from training in additional areas such as conditions of old age. 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 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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 a Welcome to Bradbury Home document in place. The Statement of Purpose had recently been reviewed. The Welcome to Bradbury Home was easy to read and contained some pictures to make it colourful and aid understanding. The manager confirmed that people are given written information about the home. People spoken with confirmed that they or their families had visited the home before they had moved in. On six residents surveys received everyone said that they had received enough information about the home before they made the decision to move in. We looked at the files of two people who had recently moved into the home. These showed us that detailed pre-admission assessments had been undertaken. These Care Homes for Older People Page 11 of 29 Evidence: provided a good basis for understanding peoples care and other needs, and begin planning their care. We also saw that if someone from the home has a spell in hospital, that their needs are re-assessed before their return to ensure that the home is still suitable to meet their needs. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience 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 receive good care that meets their individual needs and preferences. Evidence: When we visited Bradbury Home people looked comfortable and well cared for. On seven surveys received people told us that they always received the care and support that they needed and that staff were always available to them. A number of people living at Bradbury Home 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, I can do most things for myself but the staff are always there if I need them. Relatives also felt that the care was good and made comments such as, The physical needs of residents are well catered for, On the whole the care provided is very good with kindness and understanding shown, and, They put the needs of the residents first. Management and staff spoken with had a good awareness of peoples individual needs, and were observed to support people in their preferred individual routines. Care Homes for Older People Page 13 of 29 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. Care planning at the home has been an area of poor performance at the home for some time, and there are still areas that need to be improved. At this visit however information was more detailed and better coordinated. Care plans in place would enable staff to find the information they needed, be aware of peoples needs, and provide appropriate support to a degree. On surveys staff felt that ways of sharing information about residents usually worked well. The current systems in use however are overly complex and involve huge amounts of work for staff. Information is held in different places with a Needs Assessment and Care Plan book, a Care Plan Diary book, and daily records all held separately, with some duplication. This does not help to provide a joined up approach to care. Care plans would benefit from providing more detail. Comments such as Requires the assistance of two carers for bathing and all personal care for someone who is unable to express their needs is not adequate. The home are working hard to develop a person centered approach to care. This needs to be reflected in care planning, which should include details of peoples preferences and routines. Although the manager said that staff try to involve people in their care planning, there was little evidence to support this. Recent managers meeting minutes said, Can we keep driving home the importance of the residents involvement in care planning. The manager is fully aware of the difficulties and limitations presented by the current care planning system. Other options have not been explored or developed as the provider has been intending to introduce an electronic care assessment and planning tool. This has now been awaited for some time. On surveys all seven people said that they always received the medical support that they needed. From discussion and records looked at, people receive good health care at Bradbury Home. We saw that the Needs Assessment and Care Plan book provided robust assessments for all aspects of peoples needs such as tissue viability, nutrition and mental health. Nutrition records are maintained and peoples weight monitored. Risk assessments were in place relating to falls, moving and handling and other aspects of care. Records showed that people access appropriate health care professionals such as general practitioners, the district nursing team, continence teams and other specialisms to meet their individual needs. Opticians and a chiropodist visit the home on a regular basis. We received one survey response back from a visiting professional to the home. Responses to all of our questions were answered with the most positive response. Training records showed us a few staff have completed training in relevant health care areas such as palliative care, pressure area care and Parkinsons disease. This will increase staffs knowledge and understanding of these areas enabling them to deliver better care. Care Homes for Older People Page 14 of 29 Evidence: No one living at Bradbury Home 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. Staff spoken with told us that they had undertaken training in administering medicines. This was confirmed through the training matrix, but the dates identified showed that staff may benefit from having update training to ensure that their skills and practice are up to date. Although one person undertook medication training last year, most staffs training dates from 2007 or 2008. We saw that the medication area was clean and well organised. All expected records and procedures were in place but there were some consistency issues. PRN protocols were not always in place for medicines to be taken on an as and when required basis, (PRN.) Handwritten entries were not always checked and countersigned by a second member of staff to provide a failsafe and good audit trail. Sometimes medication was prescribed to be taken on a regular basis but was being used on a PRN basis. This should be agreed the persons doctor and the instructions changed accordingly. 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. Staff at the home have undertaken/or are currently undertaking dignity in care training to raise their awareness and increase their skills. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have opportunities to have a fulfilling lifestyle, maintain contact with friends and family and enjoy good food. Evidence: Bradbury Home has a lively feel, and there are opportunities for people to be involved in different activities. On surveys there was a varied response in relation to activities with people saying that they were always, usually or sometimes avaialble. One person told us that, There is a good range of activities on offer, while another said, We could do with more entertainment. One member of staff is currently taking a lead role in arranging activities. Care staff are becoming more used to seeing this aspect of care as part of their role. One member of staff told us, Its the bit I love the best and very important. However there may still be a way to go in educating all staff. At a staff meeting in January this year the manager raised that there were too few activities taking place. Staff responded that residents wanted to sleep and were not interested. Under a new scheme two young people will soon be working at the home and involved in providing activity and engagement for residents. A monthly programme of activities is posted which includes things such as quiz time, vitalize (an exercise programme) bowling, reminiscence, film club, Bradbury Choir and other events. A mobile library visits the home. A strength of Bradbury Home is the Care Homes for Older People Page 16 of 29 Evidence: opportunities people have for spiritual fulfilment and support. A daily prayer meeting is held as well as a Sunday service. People can also be involved in Home League meetings each week. Two people told us that they particularly enjoyed this as they used to lead their own home league groups when living in the community. A Chaplin is employed at the home for twenty hours each week to provide pastoral care and support to residents and their families as needed. Assessments and planning in relation to peoples individual occupational needs are not well developed within the current care planning system. Since the previous inspection however the home have started to develop life story books with residents who have dementia. When completed these will provide staff with useful insights and information about residents that may help stimulate communication, and give ideas for activity. The manager told us of plans for the future for example a reminiscence room is to be developed and sensory equipment ordered. People are still able to feel a part of the local community. One person told us that they had just enjoyed going to the over 60s club. A member of staff was heard offering to take a resident to the park or shops. Another member of staff told us about taking a resident to an exhibition. The home has their own minibus to help get people out and about. It is hoped that trips out will be a regular feature during the summer months. Information on advocacy services was available so that people can know where to go for independent support and advice if they wish to do so. The Welcome to Bradbury Home booklet also includes useful contact details for people such as the Citizens Advice Bureau. It is clear that the wish of the home is for people to retain their rights as citizens. Minutes of a recent management meeting said, As we race towards an election can we please ensure that all residents have the power to vote either by taking them to the polling station or claiming a postal vote if they wish. this is very important as they are still a part of the community and entitled to vote. People are able to enjoy having visitors at any time. We saw that people were made welcome, and that they had a good relationship with management and staff. We saw that a number of people had their own telephones in their rooms to help them to keep in touch with their friends and family. Feedback on the food provided at the home was varied but more positive than negative. On surveys two people said that they always enjoyed the meals, four that they usually did and one that they sometimes did. People said, The food is really good, good food, There is a good choice of menu, and, I have no complaints about the food at all. Others felt that, Sometimes the food is a little ordinary, We need more fresh greens, and, The meat can be tough and sometimes a bit Care Homes for Older People Page 17 of 29 Evidence: tasteless. People agreed that they are offered choices, but have to choose their menu the day before. The home operate a four weekly rotating menu, with a choice being offered for each meal. We saw that a good range of foods are offered. People have the opportunity to feedback about the food through a comments book that is available, as well as directly and through residents meetings. As the catering operation at the home is contracted out the administrator holds regular meetings with the contractor to try and address any issues. Lunch on the day of the site visit looked appetising and plentiful. Bradbury Home provides a very pleasant dining area for people with tables very nicely laid and presented. Where people needed assistance this was done in a sensitive manner by staff. Care Homes for Older People Page 18 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 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. The Local Authorities Complaints and Comments procedure is also available for people. On surveys and in discussion people said that they knew who to talk to if they had any concerns, and knew how to make a formal complaint. When we looked at complaints records we saw that no complaints had been recorded in the previous year. The folder did however contain lots of compliments about the service. No safeguarding concerns have been raised about the service in the previous year. Staff training records and staff spoken with confirmed that training in safeguarding had been undertaken. We saw that appropriate procedures and information was available so that staff knew what to do and who to contact if an incident occurred. One person told us, I feel safe and secure here. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a pleasant and comfortable home. Evidence: Bradbury Home is purpose built with accommodation provided over three floors. Access to all areas is provided by a passenger lift. There are both bedrooms and communal accommodation on each floor. Since the previous inspection work to refurbish the ground and first floor have been completed, with all areas redecorated, new dining and lounge furnishings on the ground floor and new flooring. The home is looking bright and comfortable. The garden has been further developed to provide a pleasant space for people to use. Bradbury Home provides spacious accommodation and good facilities for people. All bedrooms are roomy and have an en suite facility. There is a hairdressers room, a treatment room and a range of assisted baths and shower areas available. Peoples rooms viewed where homely, personalised and pleasant. There are spacious and pleasant lounge areas on each floor. Bradbury Home is registered to provide dementia care. When undertaking the refurbishment the manager was careful to consider the impact of this for residents. Each floor is decorated in a different colour with contrasting doors. Memory boxes have been put in place to help people to identify their rooms. Some signage has been developed, and the manager showed us further signage that is about to be ordered to carry on developing this aspect. Care Homes for Older People Page 20 of 29 Evidence: As with catering the domestic and laundry operation at Bradbury Home is contracted out to an external provider. On the day of the sire visit the home appeared clean and was odour free. On surveys people said that the home was always fresh and clean. People said, The servicing of my room is excellent, There are high standards of cleanliness throughout, and The home is clean and fresh throughout. The home has a suitable laundry area which has just been provided with all new equipment. Both the laundry person and domestic staff spoken with were knowledgeable and confirmed that they had undertaken appropriate training. We saw from the training matrix that staff had undertaken training in infection control, and good practice was observed during the day. Care Homes for Older People Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by caring and well trained staff. Evidence: We received positive comments about staff working at Bradbury Home. The staff care very well for my [relative], Kindness and compassion comes through, They show kindness and understanding of an elderly persons situation, and Very friendly and welcoming staff, were some of the comments made. Surveys, discussion and observation showed that most staff are positive about their role. Staff said, We try to meet the needs and welfare of all the residents. The residents wishes come first, and, I really enjoy working at Bradbury and have learnt a lot since starting here. Another member of staff felt that the home had made a huge amount of progress in the previous year, and that things were now, Much better. Staff turnover at the home has been relatively high with six staff having left in the previous year. The AQAA, completed in February this year, told us that in the previous three months 123 shifts had been covered by agency staff. These issues will not help in providing residents with consistent care from staff that they are familiar with. The manager said, and rotas viewed confirmed that the use of agency staff has recently reduced due to recruitment and changes in rota patterns. On the day of inspection twenty five people were being accommodated. We looked at staffing rotas and saw that staffing levels were being maintained at five care staff and Care Homes for Older People Page 22 of 29 Evidence: a senior during the morning, four or five care staff and a senior during the afternoon evening and two staff at night. The managers hours are supernumerary. Additional support and hours are provided for domestic, laundry, catering and administration and pastoral care. During the site visit there were generally staff around in the communal areas to monitor, interact with, and assist people. People spoken with felt that staffing was sufficient to meet their needs. Only one person on a survey felt that, More time could be given to talking with and engaging with residents. I am unimpressed by care workers completing notes and journals, reports etc. when call bells continue to ring. While staffing appears to be sufficient to meet the current level of needs at the home this will need to be monitored and increased as current vacancies at the home are filled. In particular night staffing levels need to be monitored as two staff to cover three floors may not provide people with the care and speed of response to meet their needs. 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 18 care staff eleven currently hold an NVQ. From training information seen a further four staff are currently undertaking NVQs. Two staff who already have an NVQ at level two are undertaking their level three. The home have therefore achieved slightly 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 Bradbury Home were satisfactory and protected residents. We looked at the files of two members of staff who had most recently started work at Bradbury Home to ensure that good practice was being maintained. We saw that all proper checks had been undertaken. ISA first checks had been undertaken and Criminal Records Bureau checks applied for and later received. References had been taken up and proof of identification sought. On three staff surveys people said that their recruitment was carried out thoroughly, with all checks having been completed. On three staff surveys there were various opinions as to if their induction had covered the things they needed to know in order to do the job. Very well, mostly and not at all were the responses given. This is important as staff need to develop good knowledge and skills in working with residents from the start of their employment. We saw from staff files that a basic induction checklist is used, and that staff complete a range of initial in house training. Staff then go on to complete Skills for Care core induction standards. We saw that one person had not started these yet, although they had been working at the home for three months. It was explained that in this case the Care Homes for Older People Page 23 of 29 Evidence: persons probation period was to be completed before Skills for Care Standards were commenced. Other staff had Skills for Care induction standards identified as completed on the training matrix. On Surveys and in discussion staff made positive responses to questions about training saying that training offered gave them the skills that they needed. Training records sampled and a training matrix viewed indicated that staff have undertaken a good range of basic training including dementia care. However training in conditions relating to old age and other aspects could be improved as this seems limited. For example no staff have undertaken training in sensory awareness. The manager said that the Chaplin is planning to deliver training in Death and Dying in the near future. Care Homes for Older People Page 24 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience 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 safe and well managed home. Evidence: Bradbury Home has an experienced and qualified manager in post. They are currently going through their registration process with us (CQC.) Since the previous inspection the management team at the home has bedded down, and now seems to provide a cohesive approach to managing the home. People made positive comments about the management of the home and said, The general management is good, and You can always talk to the manager. When we visited the home was well organised, and all the information needed to undertake the inspection was readily available. Discussion observation and information viewed at this inspection showed that the manager has a good awareness of and rapport with residents, is aware of things happening in the home and proactive in dealing with issues when they arise. 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 and give feedback about the service. We saw that regular residents, relatives and management meetings take Care Homes for Older People Page 25 of 29 Evidence: place. Staff meetings take place on a periodic basis. One person told us, Residents are listened to, we have a residents meeting. The provider undertakes quality reviews of the service. This last took place in November 2009. A report of results was produced and was available for people to view. We saw that quality surveys had just been distributed, and that some had been returned. Responses on these were positive about the service. To comply with Regulations a senior person in the organisation undertakes a formal visit to the home once a month. We saw that these visits are undertaken and include talking to people about the service. The home maintain a Quality Assurance folder which includes monitoring and audit tools for different aspects of the home. Some of these had not yet been used. The AQAA was completed by the manager. The AQAA was satisfactorily 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. 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. One person reported that, The home has good safety precautions. When the fire service last visited the home in January this year they found everything to be satisfactory. 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 that staff know what to do in an emergency. The last environmental health officers visit in November 2009 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 moving and handling but that in other core areas such as health and safety and food hygiene gaps in training need to be addressed to ensure that staff have the knowledge ans skills required to deliver safe care. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 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. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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