Care Home: Brookvale House

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What the care home does well The home provides a range of activities for service users which meet their needs, the activities are flexible and are provided by an outside provider and also by staff from within the home. Residents we spoke with told us that they were happy with the activities provided and comments included; I can join in when I want or just sit and watch, I enjoy playing bingo and watching TV another resident told us that they liked painting and we observed this person painting in their room. Residents are supported to be involved as much as possible in day to day running of the home and they are offered choices to enable them to be as independent as possible, there was good information in care plans about residents choice. We observed staff interacting with service users and we saw that people are treated with respect and their right to dignity maintained. Those service users we spoke to told us that staff listen and act on what they say. The home employs staff who have obtained recognised qualifications and they are provided with training to meet residents needs and the home exceeds the national minimum standards for staff with over 50% having achieved a minimum of NVQ2. The service has robust recruitment procedures in place and staff only start work at the home once all recruitment checks have been undertaken and this provides protection for service users. What has improved since the last inspection? There were no requirements or recommendations made as a result of the last visit to the service and we were informed that care plans have been revised and improved to provide better outcomes for residents. The homes completed AQAA told us that Brookvale House has developed a structured training program in partnership with an external provider. A calendar of training is displayed to staff well in advance of upcoming sessions. As part of the Brookvale Health care team staff can access the training schedule for all eight homes within the group, giving them an increased choice of opportunities and venues to attend training. The importance of regular training is communicated to the entire staffing team. The laundry at the home has new washing machines and tumble driers and a number of residents rooms have been redecorated. What the care home could do better: We have made one requirement as a result of this visit and other points, which need to be addressed to help improve the service provided for residents are contained within the main body of the report. We found that at present people who needed insulin to manage their diabetes did not have a clear plan of care to provide staff with the information they needed to fully support these residents. The home must ensure that service users are provided with a detailed plan of care to meet their assessed needs and currently the lack of clear care plans for service users who are insulin dependant places them at possible risk. Key inspection report Care homes for older people Name: Address: Brookvale House 4 Brookvale Road Portswood Southampton Hampshire SO17 1QL     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: Mick Gough     Date: 1 8 0 8 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 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) 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 29 Information about the care home Name of care home: Address: Brookvale House 4 Brookvale Road Portswood Southampton Hampshire SO17 1QL 02380322541 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): yasmin.somji@brookvalehealthcare.co.uk Brookvale Homes Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 35 The registered person may provide the following category/ies of service 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 category - OP Dementia - DE Mental Disorder, excluding learning disability or dementia - MD Physical disability - PD Date of last inspection Care Homes for Older People Page 4 of 29 Over 65 0 0 35 0 35 35 0 35 Brief description of the care home Brookvale house is a care home for older people and is registerd with the Care Quality Commission to provide accomodation for up to 35 older people and for people who have a mental disorder or who have dementia. The home is owned by Brookvale Homes Ltd group. Accommodation is arranged over two floors with a passenger lift affording access to rooms on the first floor. All rooms except one are for single occupancy and a number have en suite facilities. Staffing is provided 24 hours a day, including the provision of waking night staff. The home is situated in a residential area of Southampton, close to the shops and local amenities of Portswood. There is an enclosed garden and patio area to the rear with seating for use of residents. There is an off road car park to the front, from which there is ramped access into the home via the front door. 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 report details the evaluation of the quality of the service provided at Brookvale House and takes into account the accumulated evidence of the activity at the home since the last key inspection which was carried out in August 2007 and also the last Annual Service Review which was carried out in August 2008. We also took into account the homes Annual Quality Assurance Assessment (AQAA), which arrived when we asked for it and was completed satisfactorily. The AQAA is a self assessment tool that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Included in the inspection was an unannounced site visit to the home, which was conducted on the 18 August 2009 between 1000 and 1400. For this visit we involved 10 users of the service and 5 members of staff who we spoke with on the day of the visit and this provided us with information about the home we also had the opportunity to speak with two visitors to the home. Care Homes for Older People Page 6 of 29 Other evidence for this report was obtained from reading and inspecting records, including pre admission assessments, plans of care, medication records training and recruitment records and records relating to health and safety and quality assurance. We also looked at how the agency deals with any complaints and issues regarding the protection of vulnerable adults. We looked at some of the homes policies and procedures and throughout our time in the home we also observed the interaction between staff and users of the service. We were assisted throughout the visit by the acting manager of the service and also the director of nursing who is employed by the organisation. The home is registered to provide support for 35 residents and at the time of the inspection there were 31 people living at the home. 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: We have made one requirement as a result of this visit and other points, which need to be addressed to help improve the service provided for residents are contained within the main body of the report. We found that at present people who needed insulin to manage their diabetes did not have a clear plan of care to provide staff with the information they needed to fully support these residents. The home must ensure that service users are provided with a detailed plan of care to meet their assessed needs and currently the lack of clear care plans for service users who are insulin dependant places them at possible risk. Care Homes for Older People Page 8 of 29 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. Potential new residents have a needs assessment undertaken prior to moving into the home and this allows the home, the resident and their representatives to see if the home can meet the residents needs. The home does not provide intermediate care. Evidence: We looked at the homes Statement of Purpose and this gave clear information about the services provided at the home and we were informed that a copy is available for all potential new services users and their representatives. A copy of the statement of purpose was kept in the entrance hall of the home together with a copy of the most recent inspection report. The homes completed AQAA told us pre admission assessments for all prospective residents are carried out by the manager and or a senior member of staff whenever Care Homes for Older People Page 11 of 29 Evidence: possible. Prospective residents and their relatives friends are always encouraged to visit the home. If they have further questions concerns they are encouraged to ring (without appointment) and the manager will help them as much as possible. Initial admission then commences with a four week trial. We looked at pre admission assessments for 4 users of the service and we found that the pre admission assessment had information regarding communication, eating and drinking, elimination, hygiene, likes and dislikes, how the person likes to spend their day, mobility, sleep and rest, family contacts and friends and safe environment. Other assessments seen contained similar information. We were informed that the manager or deputy goes out and conducts assessments before anyone moves into the home and residents are invited to come to the home, look around and stay for a meal and this enables them to make an informed decision on whether or not to move in, this also enable the home to see that they can meet the residents needs. All new service users are offered a trial placement. 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. The health, personal and social care needs of residents are contained in an individual plan of care, which generally gives good information on what care is needed, however the lack of clear plans of care for people who are insulin dependant puts them at risk. Service users are supported to access all relevant health care professionals and the health care needs of residents are met. The home has medication policies and procedures in place, however the lack of clear information regarding how staff support residents with their insulin does not always protect residents. Evidence: We looked at care plans for 4 residents and these contained good information for staff on the care needs of residents, staff who we spoke with told us that the care plans have been improved and were much better than before and that they were simple and easy to follow. The care plans we looked at had information on how residents liked to spend their day and there was information on what residents could do for themselves Care Homes for Older People Page 13 of 29 Evidence: and where they needed support, one plan seen said - needs help with washing and dressing and went on to tell staff what the person could do for themselves and told staff that the person needed help with buttons, another told staff how the person needed to be supported when brushing their teeth. This information helps ensure that residents received the type and level of support they require. Daily recording was carried out but recording stated - all care given and fine today and this did not always provide good evidence of care delivery. We discussed this with the acting manager who told us that she would address this issue. One of the service users we case tracked had diabetes, which is controlled by insulin, however there was not a care plan in place for this to provide staff with clear guidance on how the person needed to be supported, there was however information in the medication records regarding blood glucose monitoring and insulin administration but clear information should be included in a plan of care to ensure that the resident was fully protected. All care plans that we looked at contained risk assessments for any identified risk, there was information on the risk, degree of risk and also information on how to minimise any risk, these were generally well completed but one seen did not give staff clear information on what they should do to minimise risks, for example the risk assessment told staff that if the person was showing signs of aggression they should allow the person to have some space but did not give staff guidance on what they should do if the person did not calm down. All care plans seen had mental capacity assessments carried out by the home and the acting manager told us that if the home felt that anyone lacked capacity they would get professional advice to establish the facts and get appropriate support to protect the persons interests. Service users at the home are registered with 5 different GP surgeries and have a number of different GPs. Dental checks are conducted at local surgeries in the community and the home has a visiting optician service who also carry out hearing assessment and can provide appropriate support if necessary. The home has a visiting chiropodist who calls at the home and community nurses also visit the home as and when required. Some residents have the support of community psychiatric nurses to monitor and manage their mental health. We saw records of various health care appointments undertaken by residents and the homes completed AQAA told us that all residents are supported to access health services and that they are escorted to appointments by a familiar member of staff or relative if required. The home uses a monitored dose medication system and this is supplied to the home by a local community pharmacist. We looked at medication administration records and Care Homes for Older People Page 14 of 29 Evidence: these showed that residents are getting their medication as prescribed. We found no gaps in the records and all staff who administer medication have received training. Medication was seen to be stored appropriately and controlled drugs were kept secure. Two residents at the home have diabetes that is controlled by insulin and these residents administer their own insulin via a pen injection system. Staff provide some support with this and sign to witness that the residents have taken their insulin. The home had a locked fridge for the storage of insulin and temperatures were recorded. The homes completed AQAA told us that there is a robust medication policy in place and medication is audited annually by a community pharmacist, the system is also audited informally on a daily basis and also on a weekly basis by the manager. However the lack of a clear plan of care for residents who require support with their insulin puts them at risk. Throughout our visit staff were seen to behave appropriately with residents and we observed staff interacting with residents and using their preferred form of address. Staff were seen to knock on residents doors before entering and residents spoken to confirmed that staff treat them with dignity and respect. Comments from residents included; the staff are always kind, they do a wonderful job and they always treat me well. Staff told us that they get on well with residents and that their privacy and dignity is always respected. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a range of activities for residents, which are provided flexibly to meet their expectations and their religious and recreational needs are met. Residents are able to maintain contact with family and friends and visitors are welcome at any time. Residents are supported to exercise choice and control over their lives as much as possible and they are provided with a balanced diet in pleasant surroundings at time convenient to them. Evidence: The home uses an outside activities organisation to provide activities twice per week and at other times care staff are allocated the task of organising activities for residents. Activities are displayed on a notice board and these include, sing alongs, board games, bingo, ball games, armchair exercise, reminiscence sessions, arts and crafts, quizes, TV, films and music. Individual and group activities are provided and the home recently had a garden party and we saw photographs of residents singing and dancing and generally enjoying themselves. There are regular visiting entertainers and on the day of the visit we saw one member of staff giving residents a manicure. People we spoke with told us that they were very happy with the activities provided, there are two lounges, one with a TV and another quiet lounge where people could just relax in peace and quiet. We spoke with people in both lounges and they told us Care Homes for Older People Page 16 of 29 Evidence: that they could make their own decisions on whether to be involved with activities or not. We spoke with one residents who enjoyed painting and he was painting in his room and told us that he was very happy at the home. All residents have a social care plan and this details their interests and hobbies and also their likes and dislikes. The home maintains records of activities and this gave information on the activities provided, who took part and also provided evidence when residents choose not to be involved. We were told by the acting manager that the home would support people to continue their chosen religious or cultural activities. There are visiting church services and two residents who like to go to church regularly are supported to do so. Care plans seen contained life histories that provides information about a persons previous social and leisure activities and this enabled staff to offer appropriate activities to each person. We spoke with staff who told us that they enjoyed organising activities and that they try to encourage people to be involved in any activities but would respect their wishes if they decided not to participate. Observations during the visit and discussions with care staff indicated that people are provided with opportunities for choice and that choices are respected, this means that people are free to make their own decisions whenever possible. We observed people being offered choices regarding where they wanted to spend their time, some in their rooms, some watching TV and some just sitting relaxing. People spoken with confirmed that they are given choices and these are respected. We saw in care plans evidence that people are offered choice and there was information on peoples preferred times of getting up and going to bed and also evidence that some people disliked showers and preferred baths. The home maintains a visitors book and this showed that people feel able to visit at any reasonable time. We spoke with two visitors to the home who told us that they are always made welcome and confirmed that they could visit whenever they wanted. The home operates a four week rolling menu and this is changed seasonally. We spoke with the cook who told us that breakfast was usually cereals and toast but people could have a cooked breakfast if they wanted. Lunch time is the main meal of the day and on the day of the visit the main meal was Chicken in white wine with fresh vegetables, the cook told us that someone goes round to inform residents of the main choice and alternatives are made available. On the day of the visit everyone had the main choice. Supper is normally a snack type meal such as cheese pie, sandwich or soup and residents are free to ask for whatever they like. The kitchen is open 24 hours a day and staff are able to make snacks and sandwiches for residents at anytime. We saw staff supporting residents with drinks throughout the day and those residents we spoke with told us that they always/usually liked the meals provided at Care Homes for Older People Page 17 of 29 Evidence: the home and confirmed that if they did not like something, then the home would provide an alternative for them. Records within care plans included weight charts and nutritional assessments. 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. There is a simple, clear and accessible complaints procedure, which includes timescales for the process and any complaints are logged and responded to appropriately. The home has policies and procedures regarding adult protection and these help protect service users from any form of abuse Evidence: The homes complaints procedure was seen on display in the hallway and this contained all of the required information including timescales to respond to any complaints. Evidence recorded within the homes complaints log demonstrated that peoples complaints are recorded and taken seriously. There was evidence that complaints are fully investigated and action taken to resolve issues. We spoke with residents living at the home and they told us that if they had any concerns they would speak to a member of staff and they told us they were confident that any concerns would be quickly sorted out. 2 visitors to the home who we spoke with confirmed that they knew who they needed to speak to if they had any concerns. The homes completed AQAA told us that there had been 2 complaints in the last 12 months and these were both recorded in the homes complaints log and were satisfactorily resolved. The home has policies and procedures regarding the protection of vulnerable adults and there is a whistle blowing policy. All staff files that we looked at showed that staff have received training in the protection of vulnerable adults and refresher training is Care Homes for Older People Page 19 of 29 Evidence: also made available. Those staff spoken with confirmed that they had received training and were aware of their responsibilities in this area. The homes completed AQAA told us that there had been 2 safeguarding referrals made in the past 12 months and records showed that these had been appropriately reported to the relevant authorities by the home. Currently there is one ongoing adult protection issue being investigated and the home has co operated fully to help ensure that people are kept safe. Care Homes for Older People Page 20 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. Residents live in a safe and well-maintained environment and have access to comfortable indoor and outdoor facilities. residents have the specialist equipment they require to maximise their independence and the home was clean, pleasant and hygienic and free from offensive odours. Evidence: During the visit to the home we looked around all the communal areas of the home including bathrooms, toilets, lounges/ dining rooms as well as a number of bedrooms. We also looked at the kitchen, laundry area and garden. All areas of the home we visited were clean and furniture and fixtures were of good quality and in a good state of repair. We spoke to domestic staff who told us that they are provided with the equipment they need to keep the home clean and free from offensive odours. Service users who we spoke with told us that they were happy with their accommodation, comments included, its very nice here, the staff keep it very clean and I am very happy living here. Visitors told us that the home was kept clean and that their relatives were happy at the home. Staff told us that there was lots of space in the communal areas and this gave residents the opportunity to relax in private or get together with other residents. We saw that some of the residents bedrooms had been personalised and we were told that residents are encouraged to bring in personal items. This means that people are living in clean pleasant environment which meets their needs. Care Homes for Older People Page 21 of 29 Evidence: We looked at the homes laundry area and this is fitted with industrial washing machines and tumble driers and the home employs a dedicated laundry person. There are clear procedures for washing any soiled items and these are washed separately and at suitable temperatures to help prevent the spread of infection. The laundry had easily cleanable surfaces and there were hand washing facilities available. We saw that there was a number of alcohol gel dispensers around the home and all bathrooms had hand washing facilities to help prevent the spread of infection. Care Homes for Older People Page 22 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a mix of staff that has a range of skills and qualifications to enable them to provide the support that residents require and there were sufficient numbers of staff on duty to meet the needs of residents. The homes recruitment policy and practice supports and protects residents and they benefit from a staff team that are suitably qualified and have received sufficient training to meet the needs of residents. Evidence: Staff morale was good and there was a good rapport between residents and staff. The homes staff rota was examined and this showed that the home provides 1 senior staff member plus 4 carers between 0800 to 2000. Between 2000 to 0800 there is 1 senior staff member and 2 carers awake throughout the night. In addition to care staff there is a manager who works flexibly throughout the week and currently the companys director of nursing is also working 40 hours per week at the home to provide advice and support for the acting manager. The home also employs a maintenance man who works full time, 2 cooks, a kitchen assistant, 1 laundry assistant and 2 domestic staff members who work alongside the care staff to provide domestic support. We discussed staffing numbers with the homes acting manager and the director of nursing and we were told that they felt that staffing levels were sufficient. Service users we spoke with told us that there were always staff around and one person told us, if I ring Care Homes for Older People Page 23 of 29 Evidence: my call bell someone always comes quickly. Staff spoken with told us that they felt that staffing levels were fine. The home employs a total of 19 care staff and 16 have achieved a minimum of NVQ level 2. Domestic staff have also obtained National Vocational qualifications and this exceeds the national minimum standards of having 50 of staff training to a minimum of NVQ level 2 or equivalent and this ensures that residents are supported by suitably qualified staff. The home has policies and procedures in place with regard to recruitment and staff recruitment records were inspected for 3 staff members. All file we saw contained; application form, interview notes, 2 references, Criminal Record Beaure and Protection of Vulnerable Adults checks, proof of address, passport, photo and medical questionnaire. Staff spoken with told us that their recruitment procedure was comprehensive and the homes completed AQAA told us that the home operates a thorough and robust recruitment process. From the recruitment records we saw on the day of the visit we were able to confirm this and the homes recruitment practice helps to ensure that only suitable people are employed at the home. Staff training records that were contained in personal files showed that staff have completed training in; fire, medication, moving and handling, first aid, adult protection, food hygiene, infection control, challenging behaviour, dementia care, skin care, nutrition as well as health and safety and COSHH. Staff spoken to confirmed that they receive regular training and they were confident that they could meet the needs of service users. The director of nursing told us that training is sourced from a number of different outside training organisations as well as in house training. The home has a good induction procedure which is based on the skills for care common induction standards and there is an in house induction to cover procedures within the home. The comprehensive training that staff receive ensures that residents are supported by qualified, competent and trained staff. 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. There is an effective management system and it is run in the residents best interests. However the home does not currently have a registered manager of the home. The financial interests of residents are protected by the homes policies and procedures and the health, safety and welfare of residents and staff are promoted and protected. Evidence: The homes registered manager resigned from her post in June 2009 and since this time the deputy manager has been carrying out the day to day management of the home. She is currently undertaking her NVQ4 in care and told us that she also intends to obtain a management award. The organisation employs a nursing officer to provide advice and support to all of the care homes in the group and she has been working full time at the home for the past few months to provide advice and support for the acting manager. We spoke with one of the directors of the parent company and he told us that the home is looking to appoint a new manager in the near future. The home sends out questionaires to service users, relatives, staff and other Care Homes for Older People Page 25 of 29 Evidence: interested parties twice a year to obtain their views on how the home is meeting peoples needs. Questionaires are collated and responses are displayed at the home. We saw the results of a recent survey of relatives and these were generally positive about the home, however when dissatisfaction was noted the home posted the action they intended to take to resolve any problems. The home conducts regular staff meetings and staff we spoke with told us that these were positive meetings and gave them a chance to voice their views and opinions and that the management listen to what they say. Currently the home does not hold any service user meetings and when we asked residents if they felt that these would be of benefit, no one expressed any interest in having residents meetings. Regular regulation 26 visits are carried out in line with the regulations and staff receive regular supervision and have annual appraisals. The home does not manage any service users personal finances, they do however hold some personal spending money for residents to pay for chiropody, hairdresser etc. Residents money is held secure at the home in separate wallets and there are clear receipts of all transaction and this provides a clear audit trail to protect residents. We checked the balances for 2 service users and these were found to be correct. and the policies and procedures regarding personal finance protects service users. We looked at the health and safety arrangements at the home and found that all required servicing and testing of equipment had taken place, we saw the gas safety certificate, certificates for fixed hoists, passenger lift and bath hoists, certificates for private electrical equipment and also the homes fixed wiring and these were all in date. There was thermostatic controls on all hot water outlets and this provided protection for service users. The homes fire log book showed that all required testing was carried out and there was an up to date fire risk assessment for the building. 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 1 7 15 The registered provider must ensure that all service users have a written plan of care as to how the service users needs in respect of their health and welfare are to be met, especially with regard to those residents who are insulin dependant. This will ensure that all staff have the information the need to provide the correct support to residents. 30/09/2009 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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