Care Home: Burton Closes Hall Nursing Home

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What the care home does well People are suitably informed about the home and their needs are effectively accounted for in accordance with their best interests Peoples health and personal care needs are well met and acccounted for in an inclusive manner. People rights to respect, dignity and privacy are well promoted. People are well supported to make choices about their daily lives in accordance with their individual capacities and also to maintain contact with their families and friends. People are provided with food that they enjoy and which suits their needs and preferences. People may be confident that the home will take any complaints or concerns they raise seroiusly and listen and act on these. There are suitable systems in place to promote peoples protection from harm and abuse. The home is comfortable and welcoming, warm and well lit. It continues to be kept generally safe, clean, well maintained and equipped and suits peoples needs People can be assured that they will receive care and support from staff that are effectively recruited, inducted, trained and deployed in their best interests. The home is very competently managed and run in peoples best interests and their health, safety and welfare is well promoted and protected. We received many positive comments about service identified under the relevant outcome sections of this report. Examples of these include, `The nursing and medical care is very good.` `Any problems are soon addressed.` `Excellent nursing care, with affection.` `I am spoilt rotten and very happy here.` `I choose my daily living routines and staff always ask first before acting.` `The meals are wonderful.` `There is a choice of menu and we are always asked what we want and where we want to eat it.` Our expert concluded from her visit to the home and discussions with people, that they are encouraged to have choice, independence and control over their lives with the support of staff and family where needed. She also stated that she was very impressed with the standard of support available to people and felt the Orangery Unit for the Young Physically disabled to be an excellent example of independant living within a resident home complex. What has improved since the last inspection? We did not make any legal requirements at our last key inspection in 2007. The service is proactive in ensuring their own continuous self monitoring using an objective quality assurance and effective management monitoring systems involving serivce users. With an internal audit of the service that takes place at least annually. They told us in our AQAA about improvements they have made over the last twelve months and also improvements that they are actively working on. These are detailed under the relevant outcome sections of this report and include, Development of the availability and format of their key service information for people. Development of the format for recording peoples individual needs assessment and care planning records and person centred approaches to care. Implementing the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguarding 2009. Development of activities for people and also the sensory stimulation and orientation of people accommodated in the dementia unit. Ensuring ongoing environmental upgrading, repair and renewal by way of an identified programme. Recruitment of more experienced staff, together with a review of staff skill mix and promoting ongoing staff development by way of staff training and development plans. Ongoing review of the homes operational policies and procedures, with implementation of new and revised where necessary. What the care home could do better: The service is able to demonstate their philosophy as one of continuous self monitoring and development. They have robust management and monitoring systems in place, know what they need to do to improve and consistently strive to do so. We made one requirement and recommendation relating to specified infection control equipment and procedures, which the manager assured us would be addressed. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Burton Closes Hall Nursing Home Haddon Road Bakewell Derbyshire DE45 1BG     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Richards     Date: 1 6 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Burton Closes Hall Nursing Home Haddon Road Bakewell Derbyshire DE45 1BG 01629814076 01629814078 burtoncloseshall@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Hill Care Limited care home 58 Number of places (if applicable): Under 65 Over 65 26 51 0 dementia old age, not falling within any other category physical disability Additional conditions: 0 0 7 The named resident (category YA/PD) may continue to be accommodated in Room 5 in the Hall Unit as previously agreed provided the total number of residents in that unit does not exceed 25. This agreement is not transferable to any other resident than the person named. Up to 25 older persons (OP) with nursing in the Hall Unit. Up to 26 older persons (OP) and elderly, dementia (DE(E) personal care only in the House Unit. Up to 7 younger adults with physical disability (PD) in the Orangery Unit. Date of last inspection Brief description of the care home Burton Closes Hall Nursing Home provides nursing and personal care and support for up to 47 older persons and 5 younger adults with physical disabilities. The home is of substantial character and is organised within three separate units in accordance with the category and needs of service users, being young physically disabled, older people Care Homes for Older People Page 4 of 30 Brief description of the care home with nursing care needs and people with dementia and personal care needs. Each unit has communal lounge and dining space, together with adequate bathing and toilet facilities. With the exception of four shared rooms, the care complex provides all single room accommodation, the majority of which have en suite toilets and wash hand basins or showers. Each unit also has a kitchenette area in which drinks and snacks can be prepared. There are centralised kitchen and laundry facilities. A range of equipment is provided to assist service users with mobility, both individual and communal. A shaft lift is provided in the home and there is ramped access to an outdoor courtyard, with seating areas. There are also extensive gardens, including a central courtyard, with seating, which are well maintained. Service users receive care and support from a team of Registered Nurses, care and hotel services staff. The deployment of nurses and care staff is in accordance with the category of the three service user groups accommodated. The range of fees charged per week, which are correct as at the date of this inspection are 353.92 pounds to 2,200 pounds. These are set in accordance with individually assessed needs and service provision. And may include for those eligible, individually agreed funding via local authority and primary care trusts. The above fees do not include personal toiletries and hairdressing, newspapers, private chiropody and transport. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 stars. This means the people who use the service experience excellent) quality outcomes. The focus of our inspection is on outcomes for people who live in the home and their views on the service provided. The inspection process looks at the providers ability to meet regulatory requirements and national minimum standards. Our inspections also focus on any aspects of the service that need further development. We looked at all the information we have received, or asked for, since the last key inspection. This included: the annual quality assurance assessment , or AQAA that was sent to us by the service. The AQAA is a self assessment that focuses on how well Care Homes for Older People Page 6 of 30 outcomes are being met for people using the service. It also has some numerical information about the service; surveys returned to us by people using the service and from other people with an interest in there; information we have about how the service has managed any complaints; what the service has told us about things that have happened - these are called notifications and are a legal requirement; the previous key inspection and the results of any other visits we have made to the service in the last 12 months; relevant information from other organisations; and what other people have told us about the service. The inspection visit of 16 July 2009 included assessing compliance with previous requirements made and the meeting of key national minimum standards. We sent out 25 surveys to people living in the home and their representatives and received 14 responses. We sent out 10 surveys to staff who work there and received 9 responses. There were 56 people accommodated in the home on the day of the inspection visit, including 5 on the Orangery, Young Physically Disabled unit and 21 in the dementia care unit. The remainder receive and are accommodated in nursing care unit. People who live in the home, visitors and staff were spoken with during the visit. We were assisted by the registered manager and other key staff in the home. (Some people were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff). Case tracking was used during our visit where we looked more closely at the quality of care and services received by 3 people living in the home. We did this by speaking to them and/or their relatives, observation, reading their care records, and talking to staff. We also invited an Expert by Experience to assist us. Our Expert focused their visited in the Orangery Physically Disabled Unit, where she spent time speaking with people who live there, staff and their families or representatives as available. Her focus was to look at the quality of life experienced by people living there and to look at how their rights, including choice, independence, dignity, privacy, respect and inclusion are promoted. All of the above was done with consideration to the diversity needs of people accommodated at the home. At the time of our visit all people accommodated were of British White, Christian based religion, both male and female. What the care home does well: People are suitably informed about the home and their needs are effectively accounted for in accordance with their best interests Peoples health and personal care needs are well met and acccounted for in an inclusive manner. People rights to respect, dignity and privacy are well promoted. People are well supported to make choices about their daily lives in accordance with their individual capacities and also to maintain contact with their families and friends. People are provided with food that they enjoy and which suits their needs and preferences. People may be confident that the home will take any complaints or concerns they raise seroiusly and listen and act on these. There are suitable systems in place to promote peoples protection from harm and abuse. The home is comfortable and welcoming, warm and well lit. It continues to be kept generally safe, clean, well maintained and equipped and suits peoples needs People can be assured that they will receive care and support from staff that are effectively recruited, inducted, trained and deployed in their best interests. The home is very competently managed and run in peoples best interests and their health, safety and welfare is well promoted and protected. We received many positive comments about service identified under the relevant outcome sections of this report. Examples of these include, The nursing and medical care is very good. Any problems are soon addressed. Excellent nursing care, with affection. I am spoilt rotten and very happy here. I choose my daily living routines and staff always ask first before acting. The meals are wonderful. There is a choice of menu and we are always asked what we want and where we want to eat it. Our expert concluded from her visit to the home and discussions with people, that they are encouraged to have choice, independence and control over their lives with the support of staff and family where needed. She also stated that she was very impressed with the standard of support available to people and felt the Orangery Unit for the Young Physically disabled to be an excellent example of independant living within a resident home complex. Care Homes for Older People Page 8 of 30 What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Older People Page 9 of 30 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are suitably informed about the home and their needs are effectively assessed and accounted for in accordance with their best interests. Evidence: In the AQAA, the home told us they ensure people are well supported and informed throughout their admission there and that their needs are effectively accounted for. They told us about some key improvements they have made. These include the provision of their key service information in standard and alternative formats, including large print and audio format. Together with the review and development of their format used for recording peoples needs assessment and care plans. They also tell us that they aim to continuously review there practises here and where necessary improve these in accordance with recognised national standards. At this inspection people told us that they received the information they needed to Care Homes for Older People Page 12 of 30 Evidence: assist them in choosing to live at the home, including individual written terms and conditions. We saw that the format used to assess and record peoples individual needs had been reviewed and further developed since our last key inspection. Providing comprehensive and person centred information, with any risks to peoples safety clearly accounted for. With one particular area of development relating to peoples recreational and social activity needs. One service user that our Expert by Experience spoke with had chosen to have written details of their agreed care needs in their own room along with their care plan for their own reference. Plans were in hand to introduce a standardised needs assessment format to fully account for peoples mental capacity, in accordance with the priniciples of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards 2009. However, for one person case tracked we found advanced decisions regarding their care and treatment, including End of Life wishes were fully recorded in accordance with the those principles. Staff told us that they are always given up to date information about the needs of the people they support and care for. Discussions with staff on duty told us that they were wholly conversant with these. People told us they had opportunity to visit the home before they moved there. Care Homes for Older People Page 13 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are well met based in an inclusive manner. Peoples rights to respect, dignity and privacy are well promoted. Evidence: In our AQAA the home told us they continue to ensure peoples health and personal care needs are met from a person centred approach, providing the necessary aids and equipment to assist them where necessary. They told us that they ensure safe and suitable systems for the management and handling of peoples medicines and pride themselves in maintaining a ongoing nil pressure ulcer incidence. They also told us about improvements they were making to their care planning format. At this inspection people told us they receive the care and support they need, including medical care, and that staff listen and act on what they say. We received many positive comments from people, which included, Care Homes for Older People Page 14 of 30 Evidence: The nursing and medical care is very good. Any problems are soon addressed. Excellent nursing care, with affection. Our Expert spoke with some of the younger adults with physical disabilities about staff approaches to their personal care and support. She received all positive feedback from people and one person told her that staff are always very respectful and maintain their dignity. We looked at the results of a recent satisfaction survey conducted by the home with people who use the service, or who have an interest there. Part of the survey looked at peoples satisfaction with their health and personal care and staff approaches with them. Both of these areas scored one hundred percent. Again with many positive written comments made by people, including one person who said, the care is excellent and thorough. We saw that peoples care plans were formulated in accordance with their risk assessed needs and had recorded evidence of their regular review. They were person centred and detailed the required care interventions for staff to follow. We saw how the standard and format of these was being developed, including in respect of accounting for peoples Mental Capacity, dementia care needs, social and daily living needs and End of Life care. Care plans were also reflective of recognised practise standards concerned with the care of older people. One person told our expert that she was provided with a copy of her own care plan, which she kept in her own room for reference. Inputs from outside health and social care professionals were accounted for, including for the purposes of routine health screening and monitoring. Staff were seen to be sensitive in their approaches with people and were conversant with peoples needs and required care interventions. Feedback from staff also told us that they aim to promote an environment where people are respected and valued as individuals with care tailored to peoples abilities and capacities. We found the arrangements for the ordering, receipt, storage, administration and disposal of peoples medicines to be in accordance with safe and recognised practise. With arrangements in place to ensure that staff responsible for these receive suitable and regular training. We saw examples of regular quality auditing of medicines systems is conducted by the home to confirm that their comprehensive policy guidance for these is put into practise. Care Homes for Older People Page 15 of 30 Evidence: At the time of our visit, there was no person who had chosen to retain and administer their own medicines. However, there is suitable policy guidance and a risk assessment procedure in place should any person wish to do so. Care Homes for Older People Page 16 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are well supported to make choices about their daily lives in accordance with their individual capacities and to maintain contacts with their families and friends. People are provided with food that they enjoy and which suits their needs and preferences. Evidence: In our AQAA the home described a range of activities for people provide and told us they aim to promote flexible daily living routines for them in accordance with their choices. They told us about some developments and changes they had made. These included the appointment of an activities co ordinator. Securing more regular outside entertainers to come into the home and in promoting links for people to the local community, including regular visits made by some to the local church hall and luncheon club. Also by reviewing dining arrangements and menus with people. Together with some environmental developments in the Dementia care unit, including providing reminiscence and quiet rooms and sensory stimulation provision there. Their key aim for improvement over the coming months focuses on specific staff Care Homes for Older People Page 17 of 30 Evidence: training to assist in broadening the scope of activities provision for people with dementia. At this inspection people surveyed told us that there are always or usually activities that they can join and that they always or usually enjoy the food provided. We saw during our visit that the activities coordinator had brought in pet rabbits for some people to see and touch. People engaged in a number of one to one activities, including crafts. We also saw activities information, food menus and photographs of residents engaging in activities displayed around the home. Written care plans that we saw on the dementia care unit included detailed activities and occupational plans for people, which were person centred. They reflected individuals choices and capacities and also included domestic chores that some people liked to engage in. For example one person chose to regularly help in table setting and their bedroom tidying. Our expert spoke with three people accommodated in the Orangery Young Disabled Unit. One person had gone out to a day service. Another residents there said they were spoilt rotten and very happy there. All said they chose their daily living routines and that staff always ask first before acting. Another person there told us that staff support her to go out shopping when she wishes. A third person said that staff respected their quieter chosen lifestyle, rather than joining in large group activities. Staff in the dementia care unit told us about how they were assisting and supporting one person to move to a more independent living facility in the local community. Including helping them to develop their independent living skills to assist them in this. People also told us that there are frequent activities and trips out and were looking forward to a seaside theme day which was planned and soon to be held in the outside courtyard area with peoples friends and families invited. People said they can have visitors when they choose and maintain contacts with their families and friends. Some told us about residents and relative meetings that are now held where people are consulted about life in the home. One relative who lives away, told us how the home helps them to keep in touch, by email and photographs. People gave very good feedback about the quality and choice of food provided. One person told our Expert, Care Homes for Older People Page 18 of 30 Evidence: The meals are wonderful. There is a choice of menu and we are always asked what we want and where we want to eat it. Lunches served at our visit were well presented and appealing and people were assisted in accordance with their needs. Our expert concluded from her visit to the home and discussions with people, that they are encouraged to have choice, independence and control over their lives with the support of staff and family where needed. She also stated that she was very impressed with the standard of support available to people and felt the Orangery Unit for the Young Physically disabled to be an excellent example of independant living within a resident home complex. Care Homes for Older People Page 19 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People may be confident that the home will take any complaints or concerns they raise seroiusly and listen and act on these. There are suitable systems in place to promote peoples protection from harm and abuse. Evidence: In our AQAA the home told us how they promote peoples rights to complain and protect them from harm and abuse. They also told us that they have not received any complaints made directly to them about their service within the last twelve months. The Commission has received one complaint about the service. Part of this was passed to social services for them to investigate via joint agency safeguarding procedures. This was not substantiated. The provider of the service investigated the other issues raised by the complainant, which related to the provision of equipment and infection control maters. These were not substantiated by them. We saw that the complaints procedure is provided in large print format and openly displayed in the home. Information about how to complain can also be found the the homes service guide. Care Homes for Older People Page 20 of 30 Evidence: The home had consulted with people by way of a satisfaction survey conducted in May 2009 to see if they knew who to speak with if unhappy and how to make a formal complaint. We saw that many positive responses were received from people who said they who knew who to speak to if they wanted to complain and were confident in the homes capacity to act on what they say. Although some people indicated they were not sure as to the formal complaints procedure. The manager told us that in order to address this, copies of the complaints procedure were sent out to all peoples relatives and given to people in their own rooms. At this inspection all people that we spoke with knew how to complain and who to speak with if unhappy. Staff spoken with told us they receive training and regular updates in recognising abuse and the procedures to follow in the event of any suspicion or witnessing of the abuse of a service user. They also told us about written policy and procedural guidance in place for this. We saw that there are comprehensive policies and procedures in place for staff to follow in respect of dealing with aggression and for the management and handling of service users monies. Care Homes for Older People Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is comfortable and welcoming, warm and well lit. It continues to be kept overall safe, clean, well maintained and equipped and suits peoples needs. Evidence: In our AQAA the home told us that they continue to ensure the home is safe, suitably equipped and well maintained. With a continuous operational programme for he ongoing renewal and repair of the home, with specified areas of redecoration and refurbishment detailed. They also told us there is an infection control action plan in place, including to ensure that all staff undertake infection control training. At this inspection all people spoken with and surveyed, except one, told us that the home is always kept fresh and clean. The latter told us in a written survey that it usually is, although made a general written comment that it could be improved. Our expert found the home to have a relaxed atmosphere and the Orangery Unit to be clean, bright and accessible. All of the rooms there have en suite facilities and there is a communal kitchen area where residents and their visitors can make drinks and snacks. She also saw that all peoples bedrooms had their own TVs and seating area Care Homes for Older People Page 22 of 30 Evidence: and are decorated to their personal tastes with their own personal possesions. One resident had recently chosen to move to a different bedroom, which had been redecorated to her choice. In the dementia care unit, we saw a range of aids and methods to assist people in their orientation. A themed 1940s reminiscence room had also been provided since our last key inspection there. The manager advised us that formal consideration was being given to the possibility for significant environmental redevelopment of the dementia care unit, with the aim of creating a more open and spacious environment for people accommodated there. We found the private and communal accommodation used by people living in the dementia care and nursing units to be well decorated, furnished and equipped. However, we did observe waste bins located in communal handwashing areas around the home to be open type, with no lids. Therefore not of a suitable type to promote best infection control. We also saw that improvements could be made in respect of the cleaning of hoisting equipment and discussed the same with the manager. The manager advised that the home periodically undertakes an infection control audit of the home as part of their quality assurance and monitoring systems. The overall score for the most recent audit was 92 percent. An action plan was in place, which included the review of the homes infection control policy and procedures to be undertaken. The manager also provided us with information about visits from outside authorities. Including the Health and Safety Officer who visited in December 2008. The Environmental Health Officer had inspected the homes kitchen facilities in May 2009, with a report awarding a four star outcome. The Fire Officer from the local Fire Authority also undertook their inspection of the premises on the day of our inspection visit. Care Homes for Older People Page 23 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that they will receive care and support from staff that are effectively recruited, inducted, trained and deployed in their best interests. Evidence: In the AQAA the home described a comprehensive and effective approach to staff recruitment, induction, training and deployment. They told us about some improvements they have made, which include the recruitment of more experienced staff and also developments in staff training. They said they are working to ensure that all staff undertake dementia care training and that they aim to develop a bank of casual staff to cover for staff sickness and absences. Additional information that they gave us in the AQAA tells us that they have a stable staff group with a suitable skill, gender and cultural mix. With all staff having achieved at least an NVQ level 2 and some with level 3. Except three staff who are in the process of undertaking this. At this inspection all people told us that staff are always or usually available when they need them and that they listen and act on what they say. We received numerous positive comments about staff, including, Care Homes for Older People Page 24 of 30 Evidence: Staff are to be applauded for their care and attitude. Staff are always kind, friendly and approachable. You are never made to feel a nuisance. Our father couldnt be in better hands. Staff described suitable arrangements for their recruitment, induction, training and deployment. Records that we examined reflected the same. Feedback that we obtained from staff demonstrated their enthusiasm and commitment to their role. With an ethos of person centred thinking and reflective practise. Training materials had been sourced for staff training to be undertaken in the Mental Capacity Act 2005 and Deprivations of Liberty Safeguards 2009. Care Homes for Older People Page 25 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is very competently managed in peoples best interests and their health, safety and welfare well promoted and protected. Evidence: In our AQAA the home told us that they regularly consult with people about their service. That they aim for continuous improvement and development using a formally established quality assurance and monitoring system covering all aspects of their service. They told us about areas of policy development, including revised approaches to health and safety risk assessment processes. They also confirmed the most recent dates for the servicing and maintenance of equipment in the home, which are satisfactory. At this inspection we found the home continues to be managed in an organised and professional manner. Staff told us that they received the support they need. That the Care Homes for Older People Page 26 of 30 Evidence: manager regularly meets with them to discuss how they are working and that the ways information is shared about people that staff support and care for works well. We also found there are clear lines of accountability in the home and with external management. With twenty four hour additional senior oncall management support. Staff were clear about their role and responsibilities. We looked at the the findings from the homes most recent satisfaction surveys conducted with residents and their representatives during May 2009. These showed us that peoples satisfaction with care and meals they received, the cleanliness of the home and staff approachability scored 100 percent. With activities provision scoring 95 percent. We also saw a record of action taken to address matters arising from those surveys, including a review of laundry systems and ensuring that all people are provided with a copy of the homes complaints procedure. We saw that that records are kept of the regular quality auditing and review of the service, including action plans arising from those. We also found all records concerning confidential information about service users to be kept securely and safely. With suitable systems and arrangements in place for the handling and safekeeping of peoples monies. Staff told us about satisfactory arrangements for safe working practises, including by way of staff training and instruction, provision of necessary equipment and necessary policy and procedural guidance for them to follow. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 26 13 Waste bins in communal 30/09/2009 hand washing areas must be fully occlusive. So as to promote best infection control practise concerned with waste disposal. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 26 The home should consult with the local PCT infection control nurse to ensure that approaches to quality assurance and auditing of infection control systems in the home concur with best practise. A review of deep cleaning schedules should be undertaken to ensure these include the cleaning of equipment, including hoisting equipment. 2 26 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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