Care Home: Cathedral View Nursing Home

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What the care home does well The service provides a comfortable homely environment that is very clean and well maintained for people using the service, staff and visitors. There is ample sitting and dining space and suitable washing and toilet facilities. Good measures are in place for the prevention of infection. There are beautiful spacious grounds that are accessible to the people using the service, with seating areas outside. There is a very friendly welcoming atmosphere and the people using the service say they are happy living in the home. They say there are enough staff and they are very kind and caring. Visiting Health Professionals say the home has a multi cultural background of staff and therefore shows that the organisation recognizes equality and diversity not only in job opportunities but also to individuals who are patients in the home. They also say that the staff support family members as well as the client creating a family welcoming atmosphere, which encourages communication and confidence for everyone. Information about the service is available in the home and provided to people who enquire about the home. People are only admitted following an assessment to ensure the home can meet their needs. Prospective resident`s and their family are invited to visit the home prior to any decisions being made to live there. On admission each person has a written care plan detailing their individual requirements; this directs staff on how best to meet their needs. For those who lack capacity, individual assessments have been undertaken and people`s best interests considered in respect of any deprivation of liberties. A specific care plan format has been developed in consultation with the department of adult social care and is comprehensive. Care plans are compiled with the resident or their representative, reviewed regularly and signed. Several risk assessments are undertaken to enhance peoples care. People using the service said their healthcare needs are met and specialist healthcare professionals visit the home when required. Appropriate equipment is provided for pressure relief and moving and handling purposes. There is a suitable system for medications and registered nurses administer all medicines. Everyone spoken with said the care is very good and they are happy living in the home. They said they are treated with respect and dignity and their privacy is upheld at all times. They also said their individual preferences are respected and they can choose what they do each day. People using the service are able to maintain contact with their family and friends as they wish. Visitors are welcome in the home and some residents go out with their families. A range of activities are on offer in the home and people can join in as they wish, some said they stay in their rooms and this is accepted. Staff said they do try to spend time on a one-to-one basis with residents. Life histories are on file to help staff improve their interaction with people using the service. Nutritional needs are assessed and special diets are catered for. The food served is to a good standard with homemade cooking, fresh fruit and vegetables. Comments aboutthe food were positive. There have been no complaints but there is a system in place that ensures complaints are dealt with promptly and records are kept. There is a suitable policy for the prevention of abuse and staff receive appropriate training. Residents said they feel safe in the home. There have been no abuse issues in the home. There is a robust recruitment policy and procedure. Residents said that staff are kind and caring and there are enough of them to meet their needs. 65% of care staff have an NVQ qualification in care. The training records show that staff receive regular training relevant to the job. The Registered Manager is a Registered Mental Nurse and a competent manager. The matron is a Registered General Nurse and has managed the home for 6 years. Both have achieved the Registered Managers Award. Staff and residents spoke highly of them both and said the home is very well run. They said they are approachable and work well as a team. The management endeavour to ensure that working practices are safe. Relevant service checks take place as required and are up to date. Excellent fire evacuation procedures are in place. What has improved since the last inspection? The statement of purpose has been reviewed and updated. New carpets have been fitted in all lounges and corridors and new furniture has been purchased for some rooms. New pressure relieving comfortable chairs have been purchased for communal areas. A new wet room shower facility and a hairdressing salon have been provided since the last inspection. An administrator has been employed to assist with the paperwork and maintain the records. Some policies have been reviewed and updated. The care planning system has greatly improved and the plans give much more direction to staff on how care is to be provided. For those who lack capacity, individual assessments have been undertaken and people`s best interests considered in respect of any deprivation of liberties. A specific care plan format has been developed in consultation with the department of adult social care. The fire evacuation procedure has been developed and includes individual evacuation plans for each person using the service. What the care home could do better: Feedback was given to the registered manager and the matron throughout this inspection and they agreed to address any issues raised. Where risk assessments have a scoring system the details should be included in the care plans with appropriate instruction for staff to follow.Activities could be further reviewed to ensure people s needs are met. Individual activity sheets for each person detailing their involvement and emotional reactions would provide evidence that activities are appropriate and fulfil people`s preferences. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Cathedral View Nursing Home Kenwyn Church Road Truro Cornwall TR1 3DR     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: User doesnt belongs to any group     Date: 3 0 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Cathedral View Nursing Home Kenwyn Church Road Truro Cornwall TR1 3DR 01872222132 01872222132. cathedralview.res@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Cathedral View Limited care home 26 Number of places (if applicable): Under 65 Over 65 26 0 0 old age, not falling within any other category physical disability terminally ill Additional conditions: 0 26 26 Service users to include up to 26 adults aged over 65 with a physical disability (PD) Service users to include up to 26 adults of old age (OP) Service users to include up to 26 adults with a terminal illness (TI) Total number of service users not to exceed a maximum of 26 Date of last inspection Brief description of the care home Cathedral View Limited owns two registered care homes, Cathedral View Residential Home and Cathedral View Nursing Home. Both homes are located on the same site, close to the centre of Truro with good transport links into the town and surrounding areas. Mrs Lynde Gilbert is the Registered Manager for both homes and has a Registered Mental Nurse qualification and the Registered Managers Award. Mrs Victoria Parsons is Care Homes for Older People Page 4 of 27 Brief description of the care home the Matron and has a Registered General Nurse qualification and the Registered Managers Award. She manages the nursing home on a day-to-day basis. Cathedral View Nursing Home is registered to accommodate 26 elderly residents in need of personal and nursing care, some may have a physical disability. The home provides single bedrooms for the majority of residents although six rooms are registered for shared accommodation. Bedrooms are situated on two floors and there is a shaft lift. There are two lounges and a large dining room for residents use. All facilities are accessible for those who may have limited mobility or in need of specialist equipment such as wheelchairs. There are extensive accessible gardens and there is sufficient parking outside the home for staff and visitors. Suitably qualified and experienced staff provide care in a relaxed and friendly atmosphere. Suitable activities take place each day organised by an activities coordinator. Information about the home is available in the form of a statement of purpose, residents guide, and colour brochure, which can be supplied to enquirers on request. A copy of the most recent inspection report is available in the home. Fees range from 675 to 950 pounds per week; this information was supplied to the Commission on the day of inspection. Additional charges are made in respect of private healthcare provision, hairdressing and personal items such as newspapers, confectionary and toiletries. Care Homes for Older People Page 5 of 27 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: An inspector visited Cathedral View Nursing Home on the 30 April 2009 and spent six hours at the home. This was a key inspection and an unannounced visit. The purpose of the inspection was to ensure that people s needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus was on ensuring that placements in the home result in good outcomes for people. On the day of inspection 26 residents were living in the home. The methods used to undertake the inspection were to meet with a number of people using the service, relatives, staff, matron and the registered manager to gain their views on the services offered by the home. Records, policies and procedures were examined and the inspector toured the building. Completed surveys received from six residents, four staff Care Homes for Older People Page 6 of 27 and three external healthcare professionals who visit the home informed this inspection. The manager has returned a completed Annual Quality Assurance Assessment (AQAA), which has also been taken into consideration. This report summarises the findings of this inspection. People using the service are highly satisfied with the care and services provided at the home. What the care home does well: The service provides a comfortable homely environment that is very clean and well maintained for people using the service, staff and visitors. There is ample sitting and dining space and suitable washing and toilet facilities. Good measures are in place for the prevention of infection. There are beautiful spacious grounds that are accessible to the people using the service, with seating areas outside. There is a very friendly welcoming atmosphere and the people using the service say they are happy living in the home. They say there are enough staff and they are very kind and caring. Visiting Health Professionals say the home has a multi cultural background of staff and therefore shows that the organisation recognizes equality and diversity not only in job opportunities but also to individuals who are patients in the home. They also say that the staff support family members as well as the client creating a family welcoming atmosphere, which encourages communication and confidence for everyone. Information about the service is available in the home and provided to people who enquire about the home. People are only admitted following an assessment to ensure the home can meet their needs. Prospective residents and their family are invited to visit the home prior to any decisions being made to live there. On admission each person has a written care plan detailing their individual requirements; this directs staff on how best to meet their needs. For those who lack capacity, individual assessments have been undertaken and peoples best interests considered in respect of any deprivation of liberties. A specific care plan format has been developed in consultation with the department of adult social care and is comprehensive. Care plans are compiled with the resident or their representative, reviewed regularly and signed. Several risk assessments are undertaken to enhance peoples care. People using the service said their healthcare needs are met and specialist healthcare professionals visit the home when required. Appropriate equipment is provided for pressure relief and moving and handling purposes. There is a suitable system for medications and registered nurses administer all medicines. Everyone spoken with said the care is very good and they are happy living in the home. They said they are treated with respect and dignity and their privacy is upheld at all times. They also said their individual preferences are respected and they can choose what they do each day. People using the service are able to maintain contact with their family and friends as they wish. Visitors are welcome in the home and some residents go out with their families. A range of activities are on offer in the home and people can join in as they wish, some said they stay in their rooms and this is accepted. Staff said they do try to spend time on a one-to-one basis with residents. Life histories are on file to help staff improve their interaction with people using the service. Nutritional needs are assessed and special diets are catered for. The food served is to a good standard with homemade cooking, fresh fruit and vegetables. Comments about Care Homes for Older People Page 8 of 27 the food were positive. There have been no complaints but there is a system in place that ensures complaints are dealt with promptly and records are kept. There is a suitable policy for the prevention of abuse and staff receive appropriate training. Residents said they feel safe in the home. There have been no abuse issues in the home. There is a robust recruitment policy and procedure. Residents said that staff are kind and caring and there are enough of them to meet their needs. 65 of care staff have an NVQ qualification in care. The training records show that staff receive regular training relevant to the job. The Registered Manager is a Registered Mental Nurse and a competent manager. The matron is a Registered General Nurse and has managed the home for 6 years. Both have achieved the Registered Managers Award. Staff and residents spoke highly of them both and said the home is very well run. They said they are approachable and work well as a team. The management endeavour to ensure that working practices are safe. Relevant service checks take place as required and are up to date. Excellent fire evacuation procedures are in place. What has improved since the last inspection? What they could do better: Feedback was given to the registered manager and the matron throughout this inspection and they agreed to address any issues raised. Where risk assessments have a scoring system the details should be included in the care plans with appropriate instruction for staff to follow. Care Homes for Older People Page 9 of 27 Activities could be further reviewed to ensure people s needs are met. Individual activity sheets for each person detailing their involvement and emotional reactions would provide evidence that activities are appropriate and fulfil peoples preferences. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. 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 27 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 27 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. Appropriate information is given to prospective residents enabling them to make an informed choice as to where to live. Residents are only admitted to the home following an assessment of their needs to ensure the home can provide suitable care. Evidence: The home has a suitable statement of purpose and residents guide. There is also a colour brochure with photographs of the home and grounds. The documents have recently been updated. The AQAA states that the home could offer a statement of purpose in Braille or a different language if the need arose. It also states that a web site is being looked into to give people more accessible information about the home. The registered manager said that prospective residents and their relatives are encouraged to visit the home before deciding it is the right one. The registered manager and the matron usually visit prospective residents together to undertake an Care Homes for Older People Page 12 of 27 Evidence: assessment of needs. This is recorded on specific forms, which were seen and were completed appropriately. Information from social workers or hospital nurses is included where appropriate. This home does not provide intermediate care. Care Homes for Older People Page 13 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person using the service has a written care plan that clearly directs staff to ensure that all healthcare needs are met. There is an appropriate system for the use of medicines that safeguards the people using the service. Evidence: Each person using the service has an individual written care plan and three were inspected. For those who lack capacity, individual assessments have been undertaken and peoples best interests considered in respect of any deprivation of liberties. A specific care plan format has been developed in consultation with the department of adult social care and is comprehensive. The care plans inspected were very detailed and include health, personal care, social needs, religious needs and end of life wishes. They inform and direct staff on the individual care to be provided. They have been compiled with the resident and signed by them or their representative. Regular monthly reviews take place and are documented. Life histories are included with information provided by the resident and Care Homes for Older People Page 14 of 27 Evidence: their family. Where risk assessments have a scoring system the details need to be included in the care plan with appropriate instruction for staff to follow. This was discussed with the registered manager during the inspection of the residential home and is being addressed. There is a lot of useful information in the residents files including, records of health professional s visits, risk assessments, body maps and next of kin holiday dates. Daily event records are maintained and those seen were informative. People spoken with said their healthcare needs are met very well and they have access to their GP and other professionals when required. The matron said that links with specialist healthcare professionals is very good and some of the nurses have special interests and link with the external services. There is a very good amount of moving and handling and pressure relieving equipment provided. Care practice was observed to be appropriate during the inspection and carried out in a calm, efficient manner. Residents said their personal care is carried out as they wish it to be and they had no concerns at all about the staff. Everyone spoken with said the staff are friendly, kind and very caring. There is a policy and system in place for the use of medicines in the home that has been reviewed since the last inspection. There is also a homely remedies policy and a list approved and signed by a doctor. A copy of the handling of medicines in social care document and other reference books are available to staff. There is a monitored dose system used and only registered nurses administer medicines. No residents are selfadministering at the moment. Records are kept of all medicines received and disposed of and no gaps were seen on the administration charts. Basic medicines training has been formally included in the induction programme for care staff. The storage of all medicines is safe and secure including controlled drugs and those requiring refrigeration. Staff were observed to uphold peoples privacy during this inspection and knocked on doors before entering. People said they receive their post unopened and the telephone arrangements are good. Peoples preferences in respect of the gender of care staff providing personal care is recorded in the care files. People spoken with said they are treated with respect and their privacy is respected at all times. Care Homes for Older People Page 15 of 27 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. Staff encourage residents to socialise and join in activities, visitors are welcome and efforts are made to ensure that residents choices and preferences are respected so they can live a life that suits them. Evidence: Activities are organised by an activities co-ordinator, but these are not every day. A list of forthcoming events was seen on a notice board. Activities include Holy Communion, quizzes, chair exercises, sing songs, poetry, skittles and reminiscence. Trips out are arranged when the weather is good and people said they enjoy these. Entertainers visit sometimes and people said a lot went on at Christmas time. Several people said they enjoy the Music for Health visits. No activities were taking place during the inspection, some people were in the lounge with the television on which seemed to be controlled by one individual. One woman showed the inspector her crochet and puzzle books she enjoys. Some people felt there could be more activities provided and one CSCI survey from a resident said We could do with more activities. Health professional surveys also included these comments The day-to-day routine could be enhanced with more activities both inside and outside the home, It would be nice if they had something to look forward to instead of just another same old Care Homes for Older People Page 16 of 27 Evidence: day and More regular activities for clients needed. The manger assured us that they have tried to provide what people want and have consulted the residents on this. However she will persevere until they get it right. The AQAA states that there has been an increase in staffing levels to give more individual time to people using the service, for example for manicures and nail painting. The management acknowledge they could still improve on the one to one activities provided. Records of the people attending activities are kept and there are some details regarding activities in the daily event records. Individual sheets for each person that detail their involvement and emotional reactions are to be developed to evidence that activities are appropriate and fulfil peoples preferences. People using the service said they could receive visitors in private and at any time. Visitors spoken with said they are always made welcome in the home and they are always offered a cup of tea. People said they choose what they do each day. They said they decide when to get up and go to bed, what clothes they wear and whether to stay in their room or go to the lounge. One person prefers to sit in an area away from the television and this is respected. We were told there is no time limit for breakfast but other meals are more structured to a time. Peoples rooms were personalised with their own belongings and furniture. One person controls her own money and goes out to a cash point machine when she needs to. There is a six-week menu displayed on the dining room tables and some menus were seen in people s rooms. Everyone spoken with said there are choices every day. Nutritional needs assessments were seen in the care files and the matron said that special diets are catered for. She said eleven people have liquefied meals and the speech and language therapist has assessed them all. Everyone spoken with said the food is very good. Fresh vegetables and fruit are included daily. Snacks and drinks are available between meals; water or juice was seen accessible to all residents. Meals are cooked in the kitchen on the ground floor and served in the dining room or peoples individual bedroom if they prefer. The cook said she has undertaken Intermediate Food Hygiene training and other kitchen staff basic Food Hygiene training. Comments from CSCI surveys include Its hard to tell the beef from the lamb, I like the sweet and sour and The food is varied and a menu is provided. Care Homes for Older People Page 17 of 27 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 home has a satisfactory complaints procedure that ensures complaints are listened to and acted upon. Arrangements are in place for the protection of residents safeguarding them from harm or abuse. Evidence: The home has a suitable complaints policy and a method for recording complaints. There have been no complaints to the home or the Commission since the last inspection. People using the service said there are no barriers to raising concerns with the staff or the management. CSCI surveys show that people know the complaints procedure and feel confident they will be listened to. Thank you letters and cards are kept and there are many. The abuse policy is appropriate and includes local authority procedures. Staff said they have received training regarding abuse and the records confirmed this. The home has been involved in the production of an abuse training DVD that they are using as part of their training. There have been no safeguarding issues at the home. Care Homes for Older People Page 18 of 27 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 and grounds are very well maintained providing a safe environment for residents, staff and visitors. The home is comfortable, clean with no offensive odours, making it a pleasant place for residents to live in. Evidence: The property is well maintained and appears to be safe. It is comfortable, warm, homely and very clean with no offensive odours. Furnishings and decoration are to a good standard and refurbishment is ongoing. The AQAA states that new carpets have been fitted in all lounges and corridors and new furniture has been purchased for some rooms. New pressure relieving comfortable chairs have been purchased for communal areas. We were shown a new wet room shower facility and a hairdressing salon that have been provided since the last inspection. The property has beautiful extensive gardens that are very well maintained and people using the service can access these. Some residents spoke about going out into the grounds when the weather is good. The laundry facilities are suitable with four washers and one large drier. There is a sluice on each floor with washer disinfectors. Protective clothing is supplied for staff and they were seen wearing aprons and gloves. Hand washing facilities for staff are Care Homes for Older People Page 19 of 27 Evidence: good and alcohol hand cleansing gel is provided. There are relevant policies in place for infection control. CSCI postal surveys from people using the service say the home is always clean and comments include The carpets are clean and there is no smell and There is a high standard of cleanliness and the home is maintained well. Staff say The home provides a clean and safe working environment for staff and All relevant equipment is supplied and well maintained. Care Homes for Older People Page 20 of 27 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. There are suitable staffing levels for the number of residents and 65 of care staff hold NVQ qualifications. Recruitment procedures are robust and staff receive regular training to update their skills, this helps to safeguard people using the service. Evidence: The matron said that staffing levels are adjusted according to the dependency of people living in the home. There is a qualified nurse on duty at all times and sometimes two nurses in the mornings. There are on average six carers in the mornings, three in the afternoons until 16.30 when another comes in until 21.30. There is one nurse and one carer awake overnight. The registered manager and matron are on duty during the week and on call at all times. Staff said they feel there are enough staff and the team works well. Staff surveys say Obviously sometimes people go off sick or have holidays, but we all chip in and help and Usually needs are met but there are times when the home is busier for no specific reason. Resident surveys say staff are always or usually available, one resident commented Sometimes they do not have enough time. During this inspection people using the service said there are enough staff and they attend to them promptly. They said the staff are very kind and care for them well. A very good rapport between residents staff and management was observed. Care Homes for Older People Page 21 of 27 Evidence: 65 of care staff are qualified to at least NVQ level 2 in care with six of these at level 3. Other care staff are studying for a qualification. There is a recruitment policy and the home operates an equal opportunities policy. Four staff files were inspected and all of them contained the documents required by legislation with relevant employment checks included to ensure people are safe to work with vulnerable people. A form has been devised to show who is responsible for the supervision of staff between receipt of a POVA first check and the full CRB disclosure being received. Staff are issued with terms and conditions of employment and an appropriate job description. There is an induction programme for new staff that complies with the skills for care standards. The induction pack includes the in-house induction checklist and the GSCC code of practice. Care staff are enrolled onto NVQ training following induction. We were told that training needs are identified during the interview process for new staff, at annual appraisals and during supervision or staff meetings. The administrator holds a training matrix held on her computer that shows that statutory training for staff is up to date and that a significant amount of other training takes place. Packs supplied by a training company are used for some training. The matron is qualified to provide the in house moving and handling training. One of the nurses is trained to provide resuscitation training and a session was taking place during this inspection. We were told that external agencies, specialist nurses and medical representatives come to the home to provide training sometimes. There were notices displayed advertising abuse, first aid and moving and handling training. Certificates for training attended were seen in the staff files. Care Homes for Older People Page 22 of 27 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 registered manager and matron are competent in running the home and systems are in place to monitor and improve the service for residents and staff. An appropriate system is in place for managing peoples monies and training and safety checks are undertaken to ensure the health, safety and welfare of residents, staff and visitors. Evidence: The registered manager is a Registered Mental Nurse with 30 years experience and 25 years at Cathedral View; she is very competent in running the two homes. The matron is a Registered General Nurse and has managed this home for 6 years; she has worked in the home for 15 years. Both have achieved the Registered Managers Award. They both said they attend all statutory training updates and read the nursing press to keep up to date on current issues relevant to the client group. The manager and matron have recently attended training on the Mental Capacity Act and Deprivation of Liberty Safeguards. The matron said she is qualified to train staff with the packs used in the home and has received training in first aid and equality and Care Homes for Older People Page 23 of 27 Evidence: diversity in the past year. Staff and residents spoke very highly of the owners, registered manager and matron. CSCI staff surveys show that staff feel supported in their work. Comments include If we have problems to discuss the matron and manager are always available, The matron of the home has regular 1:1 meetings and We have regular staff meetings. An annual quality assurance survey takes place with residents, relatives and external stakeholders. The results of the most recent survey were seen and they are very positive in all areas. The manager said that the results are compared year on year with an aim to improving the services provided. Resident, relative and staff meetings take place regularly and the minutes show that people can air their views and actions are taken. We were told that the owners of the home visit regularly and meet with staff and residents. The manager completed her Annual Quality Assurance Assessment (AQAA) in detail and returned it to the Commission within the allotted timescale. There is a policy for the safekeeping of residents money in the welcome pack. There is one resident who deals with her own money and a lockable facility is provided. Money is held for residents for toiletries and hairdressing and so on, it is held in a noninterest account and records are kept for all transactions. Receipts are kept for all purchases. No cash is held in the home for residents, there is petty cash for day-today requirements. Power of attorney details are recorded. The management team endeavour to ensure that working practices are safe and there is satisfactory evidence that appropriate health and safety and fire precautions are in place. Health and safety and fire risk assessments have been undertaken and relevant service checks take place, certificates show that these are up to date. A very comprehensive fire evacuation procedure file was seen with individual evacuation plans for each person using the service. A copy of the individual plans are also held in their room. This is excellent practice. Asbestos and Legionella testing have recently taken place. Fly screens have been fitted to kitchen windows and the door as discussed at the last inspection. The last environmental health officers report from October 2008 was satisfactory. Care Homes for Older People Page 24 of 27 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 25 of 27 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 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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