Care Home: Butterhill House

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What the care home does well We found that Butterhill offers a genuine commitment to care with a competent, yet open and personable approach, which reflects the homeliness of a confident relationship between carer and those people using the service: "We had lots of questions about B`s care plan, and the extent of the help that she would receive, and got clear answers with reassurance". "I was made welcome and felt involved at all times". "Extremely happy with the staff and home". From examination of care records we established that there was an effective assessment, care planning and review of individual needs, which are meaningful and robust, in formulating a good standard of care. When we discussed the quality of care with those people using the service and visitors, it was made clear that they appreciated this highly personable attitude and approach to care. The housekeeping, catering and maintenance have all contribute to the team approach, and are recognised by the management for their efforts. We acknowledged the good working relationships that the home had with visiting professionals, such as General Practitioners and District Nurses. "Provides a friendly, safe environment for clients to live in. Responds quickly to their needs, and works well with District Nurses". "I am very happy with the standard of hygiene. Help given by the staff who seem well informed, and knowledgeable. Always supportive on home visits with doctors, which is commendable". People`s rights to live a meaningful life are central to the home`s aims and objectives. People are offered opportunities to exercise choice and control over their lives. We were impressed with the confidence and closeness within the Home and the mutual respect that prevailed. "A lovely home very relaxed, friendly, homely atmosphere". We considered that the overall management style demonstrated a solid approach in maintaining an environment conducive to the care of the elderly. There is a regular appraisal and review process of facilities and services, to maintain that environment by the senior care management and Providers. What has improved since the last inspection? We found an improvement in the assessment process, with relatives and those people who may be coming to the home, being more actively involved in the planning of care. We examined and confirmed that care files have been re-organised, to provide a more focused document. There have been improvements in encouraging people to participate in a variety group activities supervised by members of staff, and there are more opportunities to get involved in outings and social events. Our discussions with staff confirmed an improvement in the standards of staff morale, motivation and training, through sound management. There is evidence to show that the Manager has delegated tasks to senior carers, which has enhanced the quality of in depth service provided. Information gathered from the AQAA and discussed during our inspection found this to be true. What the care home could do better: We found an overall good quality of care and service that was not always evidenced through consistent record keeping. We advised that all records generated through the assessment process, care planning and review process are to be signed and dated by the assessor, to ensure accountability and audit of care. We felt that this approach applied in the recording of staff appointments and maintenance of staff records, to ensure a consistent and thorough approach to effective employment procedures. Butterhill has been recognized by us in achieving a very high standard of accommodation, and consider that the Registered Provider ensures a programme of renewal of the fabric, and decoration of the premises, to maintain that high standard of living for people. Attention should be given to ensure curtain screens with overhead tracked rails are provided for all double bedrooms, to maintain privacy for personal care. We found that there were some areas requiring attention to ensure the service complies with the requirements for fire safety and security, and that laminate posters be obtained to display clearly identifiable safety procedures for the handling of chemicals used in the home. We feel it appropriate to recommend that the medicines fidge be re-sited from the outside food store, and kept locked when not in use. That an audit take place on medicines stock held, to ensure that inappropriate stocks are removed from the home, which will facilitate a clearer management of medicine stocks. We also advise that the Controlled Drug `safe` be replaced with a wall mounted, `Rag bolted` metal cabinet, to ensure the secure storage of controlled drugs. Key inspection report Care homes for older people Name: Address: Butterhill House Butterhill House Butterhill Near Coppenhall Stafford ST18 9BU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Keith Jones     Date: 0 2 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Butterhill House Butterhill House Butterhill Near Coppenhall Stafford ST18 9BU 01785780380 01785780339 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Elms Residential Home Limited care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Age: Dementia (DE) age 55 and above. Physical disability (PD) age 55 and above. The maximum number of service users who can be accommodated is: 28 The regsitered 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: Dementia (DE) 28 Physical disability (PD) 28 Old age, not falling within any other category (OP) 28 Date of last inspection Brief description of the care home Butterhill House is a twenty-eight bedded care home for elderly people situated in the Coppenhall area of Stafford. The Home is located off a country lane, leading to Butterhill farm, in peaceful open countryside of outstanding beauty. The Home stands Care Homes for Older People Page 4 of 31 Over 65 0 28 0 28 0 28 Brief description of the care home in extensive mature grounds with attractive patio areas and mature gardens. The front aspect patio area overlooks a large lawn with an ornamental pool at the far end guarded with attractive wrought iron railings. There is limited parking on a circular gravel forecourt. Accommodation is located on the ground and first floor of the home offering both shared and single bedrooms, with a variety of en-suite facilities. Bathrooms and toilets are appropriately sited around the home, and offer a range of assisted facilities. The Home has three lounge areas for individuals to move around in as they wish. There is a large orangery that is used as a dining room, and for social events; this area is light, elegant and spacious. Secluded quiet rear walled patio areas have been created that are attractive and tranquil to sit in, with a raised garden overlooking pastureland. Rear ground floor bedrooms open onto this area and could have tables and chairs outside if people wished. Limited local amenities are to be found in Hyde Lea Village over a mile distant, and there is no public transport in the area. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We conducted this unannounced inspection with the Registered Care Manager and senior care staff on duty, whose input contributed to this report. Our inspection of the building allowed us free access to all areas and open discussion with people who use the service, relatives and staff. There were 27 people in residence on the day of our inspection. We looked at how care is being arranged and supported for a range of people with personal care needs. To do this we looked at (case tracked) three peoples files from admission referral to the present time, and three staff files were examined. We also looked at other information such as complaints, incidents, events and other professional reports. We took the opportunity to speak with a number of people who are using this service, relatives and members of staff, who took an active role in our inspection process, their input contributed to the subsequent report. We acknowledged receipt of the Annual Quality Assurance Assessment (AQAA), and two survey forms returned. We inspected a Care Homes for Older People Page 6 of 31 sample review of administrative procedures, practices and records, confirming consistent good practice and effective management. There followed a report feedback with the Registered Care Manager, in which we offered an evaluation of the inspection, indicating those recommendations resulting from the inspection. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? We found an improvement in the assessment process, with relatives and those people who may be coming to the home, being more actively involved in the planning of care. We examined and confirmed that care files have been re-organised, to provide a more focused document. There have been improvements in encouraging people to participate in a variety group activities supervised by members of staff, and there are more opportunities to get involved in outings and social events. Our discussions with staff confirmed an improvement in the standards of staff morale, motivation and training, through sound management. There is evidence to show that the Manager has delegated tasks to senior carers, which has enhanced the quality of in Care Homes for Older People Page 8 of 31 depth service provided. Information gathered from the AQAA and discussed during our inspection found this to be true. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of people who may use the service are appropriately assessed before they are offered a place. They and their relatives can be confident that the service will be able to meet their needs. Evidence: We examined the services Statement of Purpose and Service User Guide, and found them to provide an informative description of Butterhills aims, objectives, and the way it operated, and we acknowledged that the documents were presented to all enquirers. We confirmed that information concerning fees payable were included in the Service User Guide, and that it is produced in large print as and when necessary. We considered that an audio and pictorial version would help people to make an informed choice. It is stated in the AQAA, and we recognise, that the Statement of Purpose represent the foundation on which the home operates upon, offering those people who may use the service and their relatives the opportunity to make an informed choice about where to live. Care Homes for Older People Page 11 of 31 Evidence: Our examination of three peoples care records and plans, confirmed that each person had an individualised pre admission Assessment, and were invited to visit the home with family members, before any decision is made. We identified that the Care Manager or her deputy, at the point of reference, conducts the pre-admission assessment. We found that each record showed the attention to individuality, with the assessment formulating a care support plan, based on assessed, individual needs. This assessment is produced with the involvement of those people admitted and family, allowing them to have an influence in the direction of care. Following an assessment the assessor determines the suitability of the application in view of the facilities available, and at the capacity of the home, to manage the person and any special needs. Likewise people are informed of those facilities, and are encouraged to seek clarification concerning the general and specific services available for people who may use the service. We pointed out that these records are to be signed and dated by the assessor, in all cases. Comments we received from surveys and discussing with people on the day of inspection: We are satisfied with the terms and conditions at Butterhill, and our involvement. Quite happy with the home, and the care I always receive. We had lots of questions about Bs care plan, and the extent of the help that she would receive, and got clear answers with reassurance. A person we interviewed on the day said: I remember that the staff made me feel very welcome, and included me in everything that was being discussed. Evidence of contracts exchanged after admission was seen within care files. The contracts were clear, informative and gave an understanding of the terms and conditions of the residency. Comments received through our surveys: I dont remember, it was a long time ago. My daughter chose this home for me after looking around. No intermediate care took place in the home. Care Homes for Older People Page 12 of 31 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. A wide range of needs are addressed through the care planning process, meeting clear principles of respect, dignity and privacy towards people who use the service. Medicine administration systems are safe and secure. Evidence: Our examination of care records and case tracking showed a good quality process of assessment, with individual care plans developed for person admitted to the home. We found that the pre admission assessment represented the foundation for a well considered and detailed care planning process, including risk assessments for mobility and falls, tissue viability and nutrition. We recognise that peoples profiles offered an individual plan of care, based upon dependency assessment and activities of daily living. Each persons health, personal and social care needs were found to be appropriately assessed in an individual plan of care that is reviewed monthly, to reflect their changing needs and adapting care profiles, supported with an informative daily progress report. The AQAA stated and we confirmed that those people who use the service, families and friends are invited to participate in the care planning process, and established monitoring systems following a process of goals, care, and evaluation Care Homes for Older People Page 13 of 31 Evidence: of quality care plans. Our case tracking confirmed to us that specialist support and advice are sought as needed, with each person using the service having access to a local Doctor, Dentist, Optician, Chiropodist, and District Nurse as required. We consider that the strength of planned care lies within the frequency of the review process in monitoring and adapting care profiles. The Care Manager was advised to regulise reviews to monthly updates, and date and sign the review. We also advised to store accident records to care plans to comply with Data Protection Act requirements. Our cross referencing of accidents and events with care plans showed a connection of appraisal and review if needed. A purposeful daily report is maintained to control monitoring, and offer an account of care and service given. Risk assessments were carried out on an individual basis and frequently reviewed. Included in the care records were applications of established monitoring systems following a process of recognition and evaluation. Our observations showed that generally people using the service appeared to be content, comfortable and happy with their lifestyle, complimentary regarding the quality of their lives and the care they were receiving at Butterhill. Comments from surveys we received: To what could do better, there is nothing I can think of other than getting me moving and walking. Our personal care is well catered for with such as hairdressing, chiropody, manicures, periodical checks of eyes, hearing and even cleaning our specs. Ensures access to medical treatment whenever required, are sympathetic to difficulties arising from his dementia, very welcoming to visitors. We received comments from the District Nurses and General Practitioners who offer professional support to the home: Provides a friendly, safe environment for clients to live in. Responds quickly to their needs, and works well with District Nurses. Ongoing close working relationship with District Nurses means any ideas for improvement are shared at the time. Clients and staff appear happy. I am very happy with the standard of hygiene. Help given by the staff who seem well Care Homes for Older People Page 14 of 31 Evidence: informed, and knowledgeable. Helen clearly has a grasp of her residents needs and wishes. Always supportive on home visits with doctors, which is commendable. The administration of medicines adhered to procedures to maximise protection to people. We saw that storage was secure, although there was too much stock held as a result of consistent oversupplying; the Care Manager agreed to audit stocks with the supplying pharmacy. We looked at the controlled drug arrangements and found the safe was inadequate to meet regulation and will require a Rag bolted secure metal cabinet, attached to an adjacent wall. Random checks of medicine stocks against Medicines Administration Record (MAR) sheets confirmed a consistent and accurate administration. Records were seen to be complete and easy to follow through, with no observed breaches in the system. Self medication and risk assessment policies were seen to be satisfactory, with no one in at the time who wished to participate in the scheme. We confirmed that only senior care staff administer medication, all have received training in the Safe Handling of Medications. All three people being cases tracked were found to have appropriate medication. We found the medicines fridge is inappropriately placed in the outside food store, requiring resiting, and routinely kept locked. It is stated in the services Statement of Purpose and the AQAA, that independence, privacy and dignity are encouraged, with the full involvement of family in all matters concerning the well being of people. This was confirmed in our discussions with people who use the service. visitors and staff, and that relatives have freedom of visiting, which emphasised the importance of maintaining social contact. We looked at bedrooms presented to facilitate privacy for the individual, which included medical examinations and personal care procedures being performed in private. We were impressed with the confidence and closeness within the Home and the mutual respect that prevailed. Our discussion with visitors on the day was a fruitful exchange, with all being very complimentary of care: This home is a massive improvement on the last home she was in, the difference to her well being has been amazing. No problems with open visiting, and we were kept up to date on all matters that affected care. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples rights to live a meaningful life are central to the homes aims and objectives. People are offered opportunities to exercise choice and control over their lives. People are offered a healthy, well balanced diet. Evidence: We found the daily routine to be flexible, non institutionalised to accomodate peoples abilities and wants, offering choices for meal times, personal and social activities, including recognition of varied religious needs. Our discussions with people who use the service and staff, clearly identified a relaxed and informal atmosphere in which the peoples needs were respected, with the security that there are familiar events to the day they could relate to. We saw that peoples life histories are discussed and used as a basis for individualised social care, offering choice and support. Families and friends are actively encouraged to participate in the daily life of the home, with no restriction being placed on visiting times. During the course of the inspection we saw staff interact with people in a positive and polite manner. General comments received from people in the course of inspection, indicated an appreciation and involvement with the progress of their health and social status. The home states that it provides a variety of activities including bingo, quiz, skittle, ball games and Care Homes for Older People Page 16 of 31 Evidence: board games; exercise sessions, beauty therapy, walks and use of the garden, with care staff organizing events. Our discussions with people indicated a degree of routine events, although most people said they would like more activities and diversions: What the home does well is good overall care, regular good food and regular chats. More activities for residents. Arrange short trips for residents. We could do with some more activities, but appreciate that the carers all work very hard, and are a very pleasant crowd. It is stated in the Statement of Purpose and AQAA, that personal choice, dignity and self determination are respected in policy and action, which we found to be true. Those individuals rooms inspected showed a significant influence of personalisation in the inclusion of belongings, some furniture and general decor. Our inspection of the home demonstrated a degree of expressed individuality in most of the bedrooms inspected. Relatives and friends are encouraged to maintain social links as part of the planning of care. We found that the standards of catering offered a satisfactory service, to which those people we spoke with were highly complimentary of all aspects of quality. A menu, arranged by the cook on a weekly basis, offered a wholesome, varied and suitable choice. We observed a very pleasant lunch served during inspection, with choices available of faggots or cheese and potato pie, with optional preferences matched, served in a comfortable and exceptionally furnished dining room. The quality and quantity of the food offered on the day was observed to be of a good standard. People interviewed confirmed that that the quantity and quality food provided was good: What the home does well is good overall care, good food and regular chats. The meals are very good, excellent food. We saw that staff offered discreet assistance to those who required it. The choice of dining room, lounge or bedroom was at the discretion of people using the service. We confirmed that the cook knew each person using the service, and some of the relatives. We discussed diversity with the cook, who indicated an awareness in meeting individual needs; there were no special cultural needs at the time. Individual preferences were recorded in assessment and conveyed to the catering staff, who met Care Homes for Older People Page 17 of 31 Evidence: with, and discussed their requirements. The manager informed us that each individual is encouraged to be independent with regard to financial affairs with the assistance of their relatives. We found this to be true and saw that each person who wanted one has a lockable facility available in their rooms. The manager informed us that each individual is encouraged to be independent with regard to financial affairs with the assistance of their relatives. We found this to be true, and saw that a lockable drawer or cabinet was available in the bedrooms of each person who wanted one. We discussed with the manager the arrangements for handling small amounts of personal monies, and found that they were efficiently handled, and checked by the Registered Provider. Our discussions with people confirmed that individual spiritual persuasions, and individual diversity was seen to be respected. There are regular monthly Church of England services held, and a Roman Catholic priest attends on weekly basis. A Polish catholic priest attends a person living in the home on a regular arrangement. No other diverse religious needs were identified at the time of inspection. We were informed that relatives are welcome to stay as long as they liked in times of stress, including overnight stay. Our discussion with visitors on the day was a fruitful exchange, with all being very complimentary of care: No problems with open visiting, and we were kept up to date on all matters that affected care. Care Homes for Older People Page 18 of 31 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. The service has a meaningful complaints policy. People are given opportunities to freely express any concerns, and these are quickly responded to. People are protected from abuse, and their human rights are promoted. Evidence: We found that peoples legal rights are protected by the systems in place in the service to safeguard them, including their contract, the continual assessment of care planning and policies in place, for example, the complaints procedure, which we examined. We examined the complaints policy and found it appropriate, and up to date. There were a few minor concerns, which we feel would be better dealt with through a record of Concerns, Complaints and Safeguarding, to register peoples concerns in a meaningful and effective manner. From our talks with people who use the service, and staff, it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. We saw evidence in case tracking that people had received information on the procedure to complain, including reference to us. This process was evidenced through the Service User Guide, on examination and case tracking and discussion. We identified that there had been no complaints or allegations made to us directly since the last inspection. Comments we received from people who use the service, through the surveys returned: Care Homes for Older People Page 19 of 31 Evidence: General care and welfare of residents is good. Yes but havent really had the need. Ongoing close working relationship with District Nurses means any ideas for improvement are shared at the time. Our discussion with the Care Manager confirmed that there is satisfactory evidence of a protocol and response, to anyone reporting any form of abuse, to ensure effective handling of such an incident, and great emphasis is placed on staff training and raising abuse issues. The policy and procedure for handling issues of abuse was examined, and found to be appropriate. We examined three staff records to confirm that staff were suitably checked through Criminal Records Bureau (CRB), and Protection of Vulnerable Adult (POVA) disclosure. We found staff received training on abuse at induction, this includes the right to Whistle blowing, consistent with the Public Disclosure Act, 1998. Care Homes for Older People Page 20 of 31 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 provides a safe, well maintained, clean and comfortable environment for the people who use the service. Evidence: A tour of the Home verified that the premises were fit for purpose, clean warm and tidy, and being satisfactorily maintained. External car parking and grounds are spacious and well maintained. The open garden and patio offers a very pleasant area for fresh air and reflection. The state of repair and maintenance is generally very good, offering a comfortable, homely yet secure environment. External access is via a well maintained driveway from a country lane, set in beautiful pastoral countryside. Visitors and people who use the service take advantage of very attractive gardens and grounds; pathways were safe and recently attended to, after a harsh winter. A sheltered rear patio area has several areas in need of risk assessment, to ensure effective safety standards. We were informed that on admission the Care Manager assesses each individuals needs for equipment and necessary adaptations, we found this to be correct, and saw those facilities available throughout the Home, with suitable fittings of hand and grab rails, in adequate, well lit and airy corridors. Wheelchair access was satisfactory throughout the Home. All communal areas are of a high standard, offering social as well as private reflection, as the mood takes. The home provided three lounge areas Care Homes for Older People Page 21 of 31 Evidence: that were pleasantly decorated, providing essential furnishings and items to provide comfortable areas where people were able to interact, or to entertain their guests. The conservatory provided a superb dining area where people could experience the views of the surrounding grounds, although it can get very warm and would benefit from an air conditioning unit or fans in summertime. Toilets and bathrooms were located on both floors and were in close proximity to bedrooms and communal areas. Bedrooms were well maintained to meet peoples personal preferences. On inspection most bedrooms were highly personalised, displaying the persons own furniture, and personal belongings. Efforts had been made to provide a homely atmosphere, and the decor was found to be of a good standard. Some of the original white furniture is in need of renewal, especially sink surrounds which were generally inadequate throughout. It is the policy that on bedrooms becoming vacant that each room is reappraised for redecoration, as confirmed during the inspection. We found that the high standard of decor was beginning to show wear and tear, requiring timely intervention to maintain that standard. Double bedrooms have no provisions for privacy, requiring overhead curtain screening. Each bedroom has adequate space to assist with personal care and dressing assistance. A locked facility and lockable bedroom doors are made available on request, following suitable risk assessment. The nurse call alarm system was satisfactorily tested, and personal appliance tested (PAT) equipment, that is televisions, radios, where seen to be tested. The Care Manager expressed a willingness to meet any reasonable demand for special needs. People we spoke to during the course of the inspection expressed their general approval of their accommodation standards, which was complemented with the large number of personal items brought in to enhance the homeliness of their rooms. Corridors were seen to be free from obstruction, fitted to aid mobility and well lit to facilitate safe access throughout the Home. Wear and tear is evident in some corridor areas, especially towards the rear of the building. The housekeeping services in the home were seen by us to be of a high standard. The people spoken to generally remarked that they find the environment always very clean and fresh. To complement the presentation there were numerous floral and decorative displays. Comments we received from a survey we sent out before the inspection, and from people we talked with on the day: They do their best to make us feel at home. Our rooms are given a really personal touch with such colour schemes, bed clothes, and care of cloths. Laundry must be an ongoing nightmare, but well controlled. Care Homes for Older People Page 22 of 31 Evidence: Very much so, a very pleasant environment, its a lovely place in every way. A comfortable, friendly place to live, all comforts of home but with safety in mind. (District Nurse) The home achieves a high standard of cleanliness. The standard and presentation of all the toilets were generally of a good quality, clean, uncluttered and freshness, but needing some improvements in decor. All communal bathrooms were well equipped and of a high standard. Adequate attention has been given to ensure maximum privacy within risk assessed boundaries. Infection control is a feature within the staff induction and supervisory training programmes. We found the kitchen presentation showed satisfactory standards of cleanliness, and evidence of sound food hygiene practices. We found the laundry was well organised and equipped to a good standard, regulations were available, and would be enhanced with posters clearly displaying, and relevant to, solutions in use. We advised the discontinuation of maintaining a stock of communal clothing items. The external and internal environment was well maintained and secure. The Care Manager is to provide us with a development plan for 2009/10/11. Heating and ventilation were found to be satisfactory and lighting was domestic in style. Aids, adaptations and equipment were available throughout the Home. Fire equipment was inspected and seen to be serviced and up to date. However the fire report is in need of upgrading to meet changing circumstances. We found the fire door at the rear of the building to be unsecured, leading on to a risk assessed section of rear patio, and we found the cellar to have no smoke alarm, which is also used as a store for paints. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels ensure that suitably trained staff are provided to meet the needs of people who use the service. Recruitment processes are satisfactory, protecting the people who use the service from harm and abuse. Evidence: There were 27 people using the service on the day of inspection. Three weeks of duty rotas were examined, from the 11.05.09 through to 01.06.09. The consecutive duty rotas were examined, providing evidence that the home is suitably staffed in numbers, skills and qualifications to ensure the needs of people are met. On the day of inspection the staffing levels were: Morning shift 1 Senior Carer and 3 carers Afternoon shift 1 Senior Carer and 2 carers Night duty 1 Senior Carer and 1 carer We recognised that the Care Manager is supernumerary to the staffing roster. Flexible rostering with agreed overtime are used to accommodate shortfall due to sickness and absence; agency staff are not deployed. The Manager is supported by a team of Care Homes for Older People Page 24 of 31 Evidence: experienced senior carers and a satisfactory complement of care and support staff. The administrative, catering, domestic and laundry hours were determined and found to be appropriate for the size of the home and the needs of people. We were informed through the AQAA that some 70 of care staff have NVQ II or III, with all new staff scheduled to undertaking training. It was understood that a commitment to maintain this threshold has been resourced by the Provider. This was confirmed on examination of training records and speaking with staff. All new staff goes through a detailed induction process TOPPS designed, that will ensure that they are going to be the right person for the home. It is recognised that staff received a meaningful training programme, which is not reflected in the maintainence of records to confirm achievements and to compliment a thorough induction programme. We consider that the administration of training needs to be reviewed to ensure that all mandatory, and relevant specialist subjects are conducted in a timely schedule. We advised that the staff record be reviewed in the way information is organised and presented. We found that staff supervision is established as a routine practice, and that the Care Manager has been regarded as the only supervisor. It was agreed that a formal approach to a delegated process would be re introduced. The Provider and Care Manager have established, and continue to pursue a comprehensive procedure for interview, selection and appointment of staff, although there remains some inconsistencies in the records management. The Care Manager was advised to maintain a strict protocol of appointing staff and establishing a robust management of staff records. The thoroughness of staff selection has a significant effect upon the provision of care to ensure protection of people, and three staff were interviewed, confirming the policies in action. A member of staff we interviewed stated: It great working at Butterhill. The manager is very well regarded and we all love her way of managing the service and the staff. We respect her for her professionalism and her personality. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care team promote the health, safety and welfare of people using the service, and working practices are safe. People who use the service can be assured that the home is run in their interests, based on openness and respect. Evidence: The experienced Home Manager Helen Wiggs, has over the past two years demonstrated effectiveness in establishing a solid management foundation, implemented to achieve a good standard of set aims, objectives and care. She has been actively engaged in quality reviews and audits with the Registered Provider, following our last inspection and registration with us, meeting compliance to requirements, and addressing recommendations we made. She has achieved her NVQ Levels III and IV and Registered Managers Award (RMA) qualification. We observed an openness, professional and pleasing confidence in the interactions of staff, relatives and people who use the service, based on mutual trust and respect. Comments from those people we met in the course of inspection told us: Care Homes for Older People Page 26 of 31 Evidence: Provides a friendly, safe environment for clients to live in. Responds quickly to their needs, and works well with District Nurses. Helen operates an open door policy, whenever I wanted to talk she will come along and sits with me, which makes me feel better.. A lovely home very relaxed, friendly, homely atmosphere. . Through the inspection process we found appropriate risk assessments in place for people using the service, through care planning and monitoring, staff selection and of the general environment, these are up to date and accurate. Health and safety notices can be seen throughout the Home, although Chemicals safety notices (COSHH) should be prominent in areas of use and storage. We considered it appropriate to advise a further fire inspection to maintain the level of safety and security. An examination of administrative, monitoring, planning and care records showed to us that record keeping has not been consistent or up to date, especially on staff training and appointment schedules, and maintaining dating and signature ownership of record updates. Records inspected included surveys asking people who use the service their opinion, these are conducted annually. The Manager offered evidence of procedures and safe working practices including: restraint, Complaints, and missing persons procedure. The accident book was seen and found to be in order, with a regular analysis of trends and frequency. Our examination of those records showed an effective follow through of action taken, including a review of care plans if necessary. We were informed through the AQAA, and by the manager that financial arrangements are supervised and administered by the Registered Provider and care manager in respect of pocket money, comfort fund and petty cash management. We found the administration and management of the home to be efficient, uncomplicated, and sensitive to the needs of people. Care Homes for Older People Page 27 of 31 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 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 An audio and pictorial version of the Service User Guide would help people with poor eyesight to make an informed choice. That all records generated through the assessment process are to be signed and dated by the assessor, to ensure accountabiity and audit of care. That care plans are reviewed monthly to reflect changing needs and ensure that peoples health and well being are maintained. That all records generated through the care planning and review process are to be signed and dated by the assessor, to ensure accountabiity and audit of care. That accident forms, once completed are kept in care plans to reflect the outcome of events and influences on care, and to comply with the Data Prortection Act. That an audit take place on medicines stock held to ensure that inappropriate stocks are removed from the home, which will facilitate a clearer management of medicine stocks. 2 3 3 7 4 7 5 7 6 9 Care Homes for Older People Page 29 of 31 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 7 8 9 9 That the medicines fidge be re-sited from the outside food store, and kept locked when not in use. That the Controlled Drug safe be replaced with a wall mounted, Rag bolted metal cabinet, to ensure the secure storage of controlled drugs. A Concerns, Complaints and Allegation book be established to more effectively monitor incidents. That the Registered Provider ensures a programme of renewal of the fabric and decoration of the premesis, to maintain a high standard of living for people living in the home. That the building complies with the requirements for fire safety and security, in alarming the rear fire exit door, and fixing a smoke detector to the cellar. A further fire safety inspection is recommended. That renewal of old furniture and sink surrounds be undertaken to maintain a good standard of living accomodation for people in the home. That laminate posters be obtained to display clearly identifiable safety procedures for the handling of chemicals used in the home. Ensure curtain screens with overhead tracked rails for all double bedrooms, to maintain privacy for personal care. To discontinue the practice of maintaining a stock of communal clothing, to reduce the risk of cross infection. That the recording of staff appointments and maintenance of staff records be reviewed to ensure a consistent and thorough approach to effective employment procedures. That formal staff supervision and training records be kept up to date to reflect the quality of observed practice. That the Provider ensures that records are kept up to date to reflect the observed good standards of care and service presented to people. All records to apply the convention of dating and signing entries and updates. 9 10 16 19 11 19 12 24 13 25 14 15 16 25 26 29 17 18 30 37 Care Homes for Older People Page 30 of 31 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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