Care Home: Bushell House

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What the care home does well The Trustees and the manager lead the continued development of the high standard of the home, both in the environment, and in the way care is provided at the home. People living at the home are given choices, and are helped to maintain their usual daily routines as much as possible. Assessments of need and care plans provide person-centred information for staff, enabling them to know how best to look after each individual. The residents surveys returned to us told us that they always received the care and support they needed. `They care for the residents. Very clean place. Very good food`. stated one resident. Staff we spoke to had a good understanding of residents needs, and we saw good interaction between the staff and the residents living at the home. Staff attend various training courses, and 87% of them hold NVQ qualifications. Staffing levels are kept at a good level to provide more opportunity for 1:1 time with residents. The home has a relaxed and friendly atmosphere, and the furnishings are very homely and comfortable. Bedrooms are attractive, with warm fabrics and cosy features. The addition of many personal belongings makes them all individual. Residents told us that there are some activities organised that they could take part in if they wish, and talked about bingo and crafts sessions. They told us how they liked to go for short walks in the garden or in the village. The manager was aware of the need to develop the activities available for people in the home, and plans were in place to use the recently formed League of Friends for Bushell House to help do this. Personal interests are taken into consideration, and one resident who enjoyed jigsaws had a large table set up in one of the lounges for them to continue with the ongoing puzzle when they wished. A dedicated cook plans and prepares meals, and all of the residents we spoke to told us they enjoyed the food at the home. Meetings with residents are held to discuss any problems, or take on board any suggestions for things such as meals, activities, or decor. The manager told us that the approach in the home is open, and they try to encourage staff to discuss issues, and residents to chat freely and express opinions. All of the residents we spoke to were satisfied with the way they were looked after, and could not think of anything they would like done differently. The home hold the Investors In People (IIP) award, showing a commitment to the development of staff, and the home also holds the Residential and Domiciliary care Benchmarking (RDB) accreditation, for quality assurance. The recent Environmental Health inspection concluded with a five star award for the food hygiene systems and practice in the home. A relative we spoke to told us `I really wanted to make an official comment, to let you know how wonderful this place is. Without the tender loving care of these care staff my mother would not have been able to carry on. I say that about every member of staff in the home`. `Good all round care` stated one resident. T The manager told us `Our aim is to provide a high quality service, in a warm, caring, safe and homely environment. The ethos at Bushell House is to ensure that people are seen as unique and individual with an emphasis on treating people with the dignity and respect they deserve`. The manager told us of the plans in place to develop staff and the care provision in the home, and to continually monitor the service as a whole. What has improved since the last inspection? Medication procedures have been developed by staff wearing a red tabard when they are administering medication, to try and prevent others interrupting them and possibly causing errors to be made. Two members of staff have attended the Lancashire County Council Train the Trainer course, enabling them to present training to the staff team. A League of Friends of Bushell House has been recently set up. It is envisaged the members will help with social activities, and also help to organise a planned activities programme. The manager and the Trustees are continually maintaining the home, and have made improvements to the lighting and the surface on the main driveway to make it safer and easier for people to access with walking aids. What the care home could do better: We discussed with the manager areas we had noted minor issues with. These were areas such as needing a clear signature of agreement with the care to be provided, ensuring reviews of care are formally carried out monthly and development of the activities programme. We made no requirements or recommendations around these, as it was clear that the manager had already noted the issues and was in the process of addressing them appropriately. The manager told us about how `There is room for improvement in any organisation`, and how there would be constant monitoring and reviewing of the service, involving residents, relatives and staff, in order to continually provide a good quality of life for the residents. `I am perfectly happy with the arrangements`. stated a resident. Key inspection report Care homes for older people Name: Address: Bushell House Mill Lane Goosnargh Preston Lancashire PR3 2BJ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jennifer Hughes     Date: 1 1 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Bushell House Mill Lane Goosnargh Preston Lancashire PR3 2BJ 01772865225 01772865503 mail@bushellhouse.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Trustees Of Bushell House Name of registered manager (if applicable) Mrs Susan Jones Type of registration: Number of places registered: care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - Code 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 - Code OP The maximum number of service users who can be accommodated is: 31 Date of last inspection Brief description of the care home Bushells House, a Georgian grade 2 listed building, is situated in the rural village of Goosnargh, with easy access to transport links. There is no car park, but parking is available in the roads around it. It is large, luxurious and set in a beautiful garden, where residents can walk, or just sit and enjoy the fresh air. The home provides personal care to a maximum of 31 service users of both sexes. It is Care Homes for Older People Page 4 of 30 Over 65 31 0 Brief description of the care home well equipped to suit the needs of its residents. For example there is a passenger lift, assisted baths, hoists, grab rails and ramps. There are several communal rooms including the library, upstairs lounge and dining room. All the individual rooms are for single occupancy and are large and very well appointed; many have en suite facilities. Toilets and bathrooms are conveniently situated. There is a varied seasonal menu in place, and dietary needs and snacks are also catered for. There are activities organised for those who wish to join in. Trained care staff are provided over 24 hours, every day of the year. A brochure and Service User Guide provide information about the home, and are available from the manager. At March 2010, the fees ranged from £386.50 to £470.00 a week, dependent on need. Further details are available from the manager. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unnannounced visit to the home, in that neither the Trustees nor the manager were aware that it was to take place. The site visit was part of the key inspection of the home. A key inspection takes place over a period of time, and involves gathering and analysing written information, as well as visiting the home. The length of the visit was for 6 hours. Every year the registered persons are asked to provide us (Commission for Quality Care, CQC) with written information about the quality of the service they provide. We use this information, in part, to focus our assessment activity. This document is called the Annual Quality Assurance Assessment (AQAA). Surveys were sent and received from residents and staff of the home. Care Homes for Older People Page 6 of 30 During the site visit staff records and resident care records were viewed, alongside policies and procedures of the home. The manager and management team, residents and relatives, and care staff were spoken to, and their responses are reflected in the body of this report. A tour of the home was made, viewing lounges, dining room, bedrooms and bathrooms. Everyone was friendly and cooperative during the visit. Care Homes for Older People Page 7 of 30 What the care home does well: The Trustees and the manager lead the continued development of the high standard of the home, both in the environment, and in the way care is provided at the home. People living at the home are given choices, and are helped to maintain their usual daily routines as much as possible. Assessments of need and care plans provide person-centred information for staff, enabling them to know how best to look after each individual. The residents surveys returned to us told us that they always received the care and support they needed. They care for the residents. Very clean place. Very good food. stated one resident. Staff we spoke to had a good understanding of residents needs, and we saw good interaction between the staff and the residents living at the home. Staff attend various training courses, and 87 of them hold NVQ qualifications. Staffing levels are kept at a good level to provide more opportunity for 1:1 time with residents. The home has a relaxed and friendly atmosphere, and the furnishings are very homely and comfortable. Bedrooms are attractive, with warm fabrics and cosy features. The addition of many personal belongings makes them all individual. Residents told us that there are some activities organised that they could take part in if they wish, and talked about bingo and crafts sessions. They told us how they liked to go for short walks in the garden or in the village. The manager was aware of the need to develop the activities available for people in the home, and plans were in place to use the recently formed League of Friends for Bushell House to help do this. Personal interests are taken into consideration, and one resident who enjoyed jigsaws had a large table set up in one of the lounges for them to continue with the ongoing puzzle when they wished. A dedicated cook plans and prepares meals, and all of the residents we spoke to told us they enjoyed the food at the home. Meetings with residents are held to discuss any problems, or take on board any suggestions for things such as meals, activities, or decor. The manager told us that the approach in the home is open, and they try to encourage staff to discuss issues, and residents to chat freely and express opinions. All of the residents we spoke to were satisfied with the way they were looked after, and could not think of anything they would like done differently. The home hold the Investors In People (IIP) award, showing a commitment to the development of staff, and the home also holds the Residential and Domiciliary care Benchmarking (RDB) accreditation, for quality assurance. The recent Environmental Health inspection concluded with a five star award for the food hygiene systems and practice in the home. A relative we spoke to told us I really wanted to make an official comment, to let you Care Homes for Older People Page 8 of 30 know how wonderful this place is. Without the tender loving care of these care staff my mother would not have been able to carry on. I say that about every member of staff in the home. Good all round care stated one resident. T The manager told us Our aim is to provide a high quality service, in a warm, caring, safe and homely environment. The ethos at Bushell House is to ensure that people are seen as unique and individual with an emphasis on treating people with the dignity and respect they deserve. The manager told us of the plans in place to develop staff and the care provision in the home, and to continually monitor the service as a whole. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. 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. Clear information is provided, which enables people to make an informed decision about the home. The assessment that is carried out for all residents means that a service is provided that is tailored to an individuals needs and preferences. Evidence: The home provides very clear information about the service it provides in the form of a Service User Guide and a brochure that contain information that clearly details who owns and manages the home, and what services the home provides. There is detail on what people who live there can expect from the day to day running of the home, and the staff who will look after them. Most of the residents told us that they knew about the home before they moved in, with some arrangements being made by family members. My relatives chose this home as I was at that time in hospital and could not have travelled around to inspect homes as they did. I have no regrets about their choice, stated one resident. The manager told us the information would be made available in different formats for people if needed, such as large print or another Care Homes for Older People Page 12 of 30 Evidence: language. We viewed the individual records of three residents we randomly selected. There is a set procedure for admitting someone to the home, and all of the files held preadmission assessments carried out by members of the management team. We found that the assessments held information about all aspects of the physical, social and psychological care of the individuals. The assessments made sure that the individual needs were identified, and the home could meet those needs. We advised there should be a signature confirming agreement with the needs assessment from the new service user, as well as the one from the staff member carrying out the assessment. However it was clear that liaison with the service user and family does take place, as we saw that short reports are completed around their individual perception of the admission, how they felt about it, and what they wanted from it. Following admission we saw that a plan of care for each individual was devised from the assessment that had been carried out, and this had been signed in agreement by the resident or their relative, as well as staff of the home. Staff told us that they were always given up to date information about the care needs of people they support, and were able to view the assessments the manager had made for more information. They were able to tell us about the needs of residents, and how to meet those needs. Staff told us that they felt the communication systems in the home were very good. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of residents are well met in this home. Evidence: Care plans are written records that describe the care that is given to each resident. We noted that the care plan format at the home prompted comprehensive information and were very structured. The files we viewed held some good person centred information about residents and the care they required, noting the little things that are important to individuals. The plans identified the areas of need for each person, with good instructions for staff on what they must do to meet that need. We saw that reviews of the care provided were carried out, with additional guidance for staff if there were any changes. The records were titled as reviewed Monthly or more frequent, and we noted that this often was not the case, with some being carried out two monthly. The manager confirmed they should be on a monthly basis, and was producing a record for each file to prompt staff when the review was to be done. Care Homes for Older People Page 14 of 30 Evidence: We also noted the use of body maps to identify any skin marks. The staff need to ensure these are kept up to date to show the residents present circumstances. Staff we spoke to could tell us what each persons needs were, and the best way to care for that person. We saw clear and informative daily notes were made by staff for each resident, which gave a good picture of each persons life in the home. The manager was aware of the requirements of the Mental Capacity Act 2005, and the deprivation of liberty safeguards, and had used good assessments to conclude that at present no residents lack the capacity to make decisions in the home. Appropriate aids and adaptations are assessed for by professionals, and available in the home for those residents who need them. Assessments are made of any risk to the residents, with action for staff to take to reduce that risk. It was clear from the records that health professionals had regular contact with the residents when needed, and during this inspection visit a GP was present, making his regular weekly visit to the home. A chiropodist also called in to treat several residents. We saw residents being treated with respect, and heard staff chatting with residents who clearly felt able to say how they felt and what they wanted. Staff spoken to said they enjoyed working at the home, with one commenting The home does its best to cater for all its residents. The home has a relaxing ambience, relatives and friends that visit their family enjoy visiting and usually come at morning coffee or afternoon tea and we always offer refreshments. We looked at a sample of medication records and stock. A designated treatment room holds the secure storage of all medication, and records were clear and up to date. One member of the management team is the designated person in charge of medication procedures. All staff involved with administering medication have attended appropriate training. Patient Information Leaflets were available for the medication in the home, and staff were aware of administering at the correct time of day, and before or after meals, as per instructions. The home follow the good practice of staff wearing a red tabard when administering medication, to try and avoid these staff being interrupted so as to minimise the risk of error. Care Homes for Older People Page 15 of 30 Evidence: The manager told us of the close link between the home and the local pharmacist, who ensures staff are aware of the use of any new medication they supply. We saw regular audits and records of receipts and returns of medication. 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. Residents daily lives and social activities are well catered for, and people benefit from living in a home that tries to continually develop to provide people with opportunities to live lives that are fulfilled. Evidence: The individual care plans we saw included information on each persons life history, their religious needs, and what hobbies and activities they preferred. Residents told us that there are some activities organised that they can take part in if they wish. They told us about playing bingo and having a craft session, about gentle exercise sessions, armchair line-dancing and having their nails and hair done. We viewed the activities records, which noted the activities taking place and who had participated, although there were no records for the previous few weeks. The manager told us the activities organiser was due to retire, causing the plans and records to be incomplete. She told us about the plans to really develop the activities programme through the new League of Friends that had been set up. This group of people could help to organise the programme, and the funding for it. The members could also help out with social activities and act as volunteers if assistance was ever needed on outings. Care Homes for Older People Page 17 of 30 Evidence: Responses to surveys sent to residents were varied when asked about activities. In answer to what the home does well, one said Planned activities to join in when desired and another said Outings of various kinds are arranged for those able to take part, places of interest, country tours, seaside resorts, with another stating Could provide more activities. Overall responses said that activities were usually organised for people to join in with if they wished. We did note that the lifestyle in the home was very flexible, and residents are welcome to choose what they wish to do. The manager said that she was aware that some people did not wish to join in with organised events. A few residents enjoy walking around the village, or visiting relatives and friends. There is a computer in the library available for residents, and a large well maintained garden area with seating and a summer house to enjoy. We saw staff helping individual residents to do what they wished to do, whether it was going for a walk around the garden, buying a can of hairspray, or writing a card to a relative. There are good links with the local community, and there have been visits from the local schoolchildren to chat with residents about their past. There are regular weekly visits from the local vicar to provide communion for those who wish to partake. Annual Founders Day provides a church service for all residents, families and friends, followed by a sherry reception and buffet lunch. Birthdays and other events are always celebrated. The home operate a four weekly seasonal menu, and the manager told us an alternative would be offered if a resident did not want the main meal. Residents told us they are asked which dish they would like for their main meal each day. On the day of this visit the choice was steak and dumpling casserole, or cumberland sausage with potatoes, broccoli and carrots, followed by fruit cheesecake and cream. Cups of tea and coffee were also served. The meals are served by staff in the welcoming and elegant dining room, with large windows overlooking the adjacent fields. Tables were well set and positioned around the room for easy access.Some residents preferred to eat in their room, where staff made sure their meals were provided efficiently over the meal time session. Staff confirmed the home Provides good fresh food. Fresh meat from a butcher, fresh fish and fresh vegetables. Residents told us about Good quality food, well cooked and adequate for my needs and very good food. We saw that the residents have meetings with the cook and are able to give direct feedback on their likes and dislikes. Care Homes for Older People Page 18 of 30 Evidence: The cook discussed the different dietary needs of people with us, and how she catered for them. A recent visit from the Environmental Health Department awarded the home a five star rating for their kitchen standards. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents benefit by being supported and protected. Evidence: There is a complaints procedure in place, and a book in which to record any complaints which come to the managers attention. There are copies of the procedure available in the entrance of the home, and in information about the home given to residents. We saw clear records of three concerns raised by residents, and saw that the manager had formally dealt with the issues professionally, and to the satisfaction of the people concerned. All of the residents we spoke to said that they knew how to make a complaint, and what they would do. Id tell any of the staff here if I didnt like something, said one resident. Responses in surveys also told us that they knew who to speak to if they were unhappy, and all but one person knew how to make a formal complaint. The manager told us that they use any information from feedback, or concerns raised, positively, in order to further improve the service. She told us about the open door management style she operates, and all of the staff and residents spoken to told us they always felt able to speak to any of the management team. We saw that staff had attended training about abuse awareness, or safeguarding. Safeguarding procedures must be in place in all homes, and must be followed if it is Care Homes for Older People Page 20 of 30 Evidence: suspected that a resident has been the victim of any kind of abuse. We spoke to staff on duty, and found they had a good understanding of the procedures. 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 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 very well maintained environment, which provides aids and equipment to meet the care needs of the residents. It is a very pleasant, safe and homely place to live. Evidence: The home is a large, Georgian, grade 2 listed building, and both internally and externally is maintained to a high standard. A partially enclosed garden area at the front of the home has been very well maintained, and residents enjoy having a walk around it , or sitting in it in the better weather, enjoying the fresh air and watching the world go by. The front driveway has recently been resurfaced, and low level lighting installed, making it safer and more accessible for people who use walking aids. We toured the home, and saw that all of the home was very clean, tidy and fresh. Domestic staff have set routines to follow to keep the home to a good standard of hygiene. Surveys returned from residents told us that the home was always fresh and clean. We found the home was comfortably warm when we visited. The home is always anxious to see that all residents are kept warm, all rooms are double glazed and centrally heated, extra heaters are available if needed, stated a resident. Care Homes for Older People Page 22 of 30 Evidence: We saw the bedrooms of several of the residents, and found them to be decorated to a high standard, very comfortable, welcoming, and containing many personal possessions. Residents are also encouraged to use as much of their own furniture in their room as they wish. All of the residents we spoke to liked their rooms very much, and liked having their own private space to stay in when they wished. The residents told us that they are able to have a key to their own room and to the front door of the home, following a risk assessment to ensure there are no concerns around this. The communal rooms, made up of a dining room and large library/lounge on the ground floor and a large lounge on the first floor, were bright and airy, and very comfortably furnished. Pianos were in each lounge, and the manager confirmed that residents were welcome to play them if they were able. A pay phone was available for residents, although most of them had their own phone in their rooms. Residents and visitors with mobility problems are helped to get around the home with the use of handrails, ramps and a passenger lift. Aids and adaptations are also in place to help with toiletting and bathing needs. There are appropriate numbers of toilets and bathing facilities for those residents without en-suite facilities. The laundry room was clean and tidy, with good systems in use. Policies and procedures were in place for the prevention of cross infection. There is an ongoing programme in place for refurbishment and decoration, and a handy man deals with any minor repairs and general maintenance. 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. The home is properly staffed, which means that the residents are supported by sufficient numbers of trained and well-motivated staff. Evidence: Two staff files were selected, and we saw there is a recruitment procedure in place showing that the necessary recruitment checks are carried out to ensure the protection of residents. References, POVA 1st checks and Criminal Records Bureau (CRB) disclosures had been received for all staff working at the home. Clear records were held throughout the recruitment process. All new staff are given comprehensive induction training, when they are given guidance and information on their terms and conditions, and working practices in the home. The staff we spoke to confirmed that they felt their induction covered very well what they needed to know to do the job. The manager confirmed that new staff work their first two weeks at the home as supernumerary members of the staff team, to ensure they are more familiar with the procedures and the residents in the home before working without close support. We saw that most of the staff at the home were long term employees, so offering continuity of care. Care Homes for Older People Page 24 of 30 Evidence: The home trains all its staff to the highest possible level, commented a staff member. Staff told us about training they have received, finding it relevant to their role, and helping them to understand and meet the individual needs of people. The trustees and the manager are committed to staff training, and the manager told us in information sent to us that 13 of the 15 staff (87 ) have obtained National Vocational Qualifications (NVQ) in care. She told us that when the present staff complete the course, there will be eight of the staff holding NVQ level 3 in care, and five holding NVQ Level 4 in care. Records showed a variety of training that staff have attended, for example covering food hygiene, abuse awareness, medication awareness, health and safety, moving and handling, dementia, catheter care, infection control, continence, and nutrition. The manager told us how she constantly looks for training for staff to develop her staff team. The home hold the Investors In People Award, showing a commitment to developing staff. The staff rota we saw showed that there is always a good level of care staff on duty to meet the needs of the residents, as well as the manager, assistant managers and senior staff, domestics, and the cook when she is on duty. Staff told us that they felt well supported with regular contact with the manager. Its a team of staff here and we all work together to make sure people are looked after. There are good communication systems used in the home, and the manager is very easy to talk to, said one staff member. I love working here. I feel really supported by the manager. I just feel proud to work here, and to be able to tell people I work here, said another. Friendly service always. said a resident. 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 manager leads a team of staff who work to make sure people who live at the home are as safe and comfortable as possible. Their aim is to continually improve services and so provide a good quality of life for residents. Evidence: Bushell House is a charitable organisation and is governed by a board of Trustees. The registered manager for the home has over 30 years experience in caring services, and has been manager at this home for the last eight years. Her qualifications include the Registered Managers Award (RMA), and the Institute of Leadership and Management (ILM) Level 5 Diploma in Management. The manager and staff told us that there is an open door approach to management in the home, and we saw staff and residents calling into the office freely and easily chatting with the manager and the management team. A staff comment about the home in a survey was It provides the residents with a large comfortable home giving them all the privacy, dignity and independence they need or require at all times. Care Homes for Older People Page 26 of 30 Evidence: A resident said about the home, Always endeavours to provide a comfortable and homely feeling. We found residents are encouraged to be involved with the running of the home, and their suggestions and comments in the annual surveys help the manager to identify areas that may be changed to suit people living at the home more. Meetings are held with residents and the manager, which also may involve the cook, to help make sure residents are getting meals they like or would prefer. We also saw minutes of staff meetings with the manager, ensuring there is good communication within the entire staff group. The manager said Generally, we try to do whatever the residents want, large or small. For example, one resident wanted a Do Not Disturb sign, so we provided one for her. A communication book to pass on daily information about residents, and a shift handover session, ensures all staff on duty are up to date with events in the home. We saw that staff receive supervision sessions from the manager, and annual appraisals, which identify any problems or training needs. We saw that the home follows strict procedures regarding residents finances, and where needed maintain good records and receipts, and good liaison with relatives. We saw that the home holds both the RDB (Residential and Domiciliary care Benchmarking) and IIP (Investors In People) awards, which are external quality assurance accreditations. Records show that maintenance and servicing checks of equipment were up to date and correct. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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