Care Home: Cedar Court Care Home

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What the care home does well Each person has a detailed and comprehensive care plan, which have been based on recognised good practice tools. People and their representatives are consulted about their care plans.Comments received from people and their representatives about the care and support provided by the home included:"The home looks after me well"; "Its a good place to live in" and "Good nursing staff"."Excellent standard of Care". "The nursing care is excellent`;"The home provides the care and attention my relative requires and generally I am satisfied with the care and attention my relative receives and believe they are in the best home available". The service provides a wide range of meaningful therapeutic,recreational, social and leisure activities. People living in the service and their representatives spoke positively about this service including, "I am particularly grateful to the activities organiser who has done a great deal to improve my relatives morale"; "The entertainment manager in particular does a very good job"; "The home provides entertainment, trips out and social evenings"; "The home provides good activities" and "Good activities are run by the coordinator". The service provides a good standard of accommodation , which is well maintained , furnished , cleaned to a good standard and is accessible to people throughout . Since out last inspection a "Tea Cups" Tearoom has been provided, which is available for people and their relatives to use, where they can help themselves to a range of teas and coffees. Staff are supported to undertake training and development including, National Vocational Qualifications ensuring that the needs of people living in the service are met. There is an experienced manager in post who has implemented a range of quality monitoring audits and self assessment tools. What has improved since the last inspection? Information sampled during this visit indicated that care plan reviews are carried out in consultation with people who use the service and/or their representatives. improvement was seen in the recording of daily records. What the care home could do better: It is recommended that the service maintains copies of quality assurance feedback surveys in the service to be made available for inspection. Key inspection report Care homes for older people Name: Address: Cedar Court Care Home Elmbridge Road Cranleigh Surrey GU6 8TR     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lisa Johnson     Date: 0 8 1 2 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 32 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 32 Information about the care home Name of care home: Address: Cedar Court Care Home Elmbridge Road Cranleigh Surrey GU6 8TR 01483275191 01483276594 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Cedar Court (Cranleigh) Care Limited Name of registered manager (if applicable) Mrs Jean Bishop Type of registration: Number of places registered: care home 57 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 57. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home The service is a purpose-built nursing home, which can accommodate up to 57 service users with residential and nursing needs over two floors. The home is well equipped and, for example, it has its own hairdressing salon. All rooms at the home are single occupancy with en-suite facilities. The home is close to Elmbridge Village and is set in Care Homes for Older People Page 4 of 32 Over 65 0 57 57 0 Brief description of the care home a semi rural location with views of countryside from most windows. The grounds have been well thought out to give sitting areas and have been landscaped. There is plenty of off road parking available. Fees range form £810 (Residential care) to £900 (Nursing care) Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced site visit was part of a key inspection. We arrived at 9.am and left at 6.20pm. Information was provided to us by the service prior to this visit in the Annual Quality Assurance Assessment (AQAA). This is a self assessment that focuses on how well outcomes are being met for people using the service. We received the AQAA by the expected date, which was clear and gave us all the information we asked for. Reference is made to this assessment in this report. During this visit we met with six people who live in the service and discussion took place with the registered manager and five members of staff . We received eight surveys from people who live in the service, four were received from relatives and we also received a survey from a health and social care professional. Care Homes for Older People Page 6 of 32 During this visit we looked at the arrangements for activities, meals and staff interaction. We sampled staff recruitment, and training records, care plans, risk assessments complaint records, quality assurance systems, medication administration practises , health and safety records and sampled policies and procedures. We also reviewed other information that we have received since our previous including notifications. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 32 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 32 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 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective people considering the service as a place to live are provided with the information they need to know to enable them to make an informed choice about the suitability of the home as a place to live. Peoples needs are assessed prior to admission ensuring that the home will be able to meet them. The service does not provide intermediate care. Evidence: The service provides people and/or their representatives with a brochure that includes their statement of purpose and service user guide, which details all of the up to date information about the service and what it is able to provide. We were informed that this information can be provided in alternative formats if this is required. Information supplied in the AQAA says that previous inspection reports completed by the Commission are also brought to peoples attention. At the time of this visit the previous inspection report was also seen in the homes reception area. Eight out of twelve surveys received from people living in the service and their relatives said that Care Homes for Older People Page 11 of 32 Evidence: they had received enough information about the service to help them decide whether this was the right home for them to move in to. Information supplied in the AQAA states that prospective people and their families/representatives are able to visit the service prior to an assessment being undertaken and some people decide to stay for lunch. The service carries out pre admission assessments ensuring that they will be able to meet peoples needs. An appointment is made to see all prospective people in hospital, home or other current placement where a social and health care needs assessment iscarried out. During this visit we sampled the pre admission documentation with covered health, social, emotional, cognitive, daily living, social skills, cultural and religious needs. Where referrals are received from the local authority information is obtained and reviewed during the homes assessment. The service also gathers information from other health care care professionals including, General Practitioner, district nurses and other specialist nurses and teams. Care Homes for Older People Page 12 of 32 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. Peoples health and personal care needs are outlined in a plan of care.Peoples health care needs are met and their privacy and dignity is respected. People are protected by the homes medication administration procedures ensuring their safety. Evidence: Care plans are compiled based on full needs assessments covering, physical, personal,dementia assessment criteria, social, choice,cultural and religious needs. During this visit we sampled four peoples care plans that were based on recognised good practise and also the Gold Standards Framework. This system enables the service to support and manage peoples and relatives long term goals, expectations and peoples choices, which we saw evidence of. During this visit we sampled four peoples care plans, which were well structured, comprehensive and provided clear details how peoples needs were to be supported and met. Care plans are reviewed four weeks after admission and then six monthly. Information seen demonstrated that care plan reviews were regularly reviewed, up to date and that consultation takes place with people and their representatives . Care Homes for Older People Page 13 of 32 Evidence: Seven out of eight people surveyed said that they always or usually receive the care and support that they need. One person said sometimes. Four relatives surveyed said that they are always kept up to date with important issues affecting their relative and the service usually gives the support or care they need. People are appointed a named registered nurse, although a relative surveyed said that would like an appointed key worker as a point of contact. Peoples preferred name of address and likes and dislikes were recorded. Daily records were maintained and were generally detailed, although making reference to each identified goal would make this clearer. The service has implemented a wide range of assessments including, mental health issues, tissue viability, moving and handling and risk of falls. Information seen demonstrated that nutritional assessments were carried out and that peoples weights were regularly monitored. These assessments are regularly reviewed and updated, although one persons assessments need updating, which was brought to the manager, who said that they would follow this up. Eight people said the home makes sure that they receive the medical care they need. Comments included, The home shows reasonable flexibility to meet my personal requirements but could improve by providing more physio. The home looks after me well; Its a good place to live in and Good nursing staff. During this visit a relative told us that the service provides an excellent standard of Care. Feedback received from relative surveys included, The nursing care is excellent, they always keep me informed; The home provides the care and attention my relative requires and generally I am satisfied with the care and attention my relative receives and believe they are in the best home available. The service maintains links with a range of health and social care professionals including, continence nurse, psychiatry for older persons, community psychiatric nurses, Parkinsons specialist nurse, physiotherapy, general practitioner,dentist and chiropodist. The home also receives visits from a hospital rehabilitation service, McMillan team and the Alzheimers society. Health care interventions and health care professional appointments were outlined in peoples care plans. We were told that one person chose to keep their previous chiropodist who visits the service. A health care professional surveyed said, that peoples social and health care needs are usually properly monitored, reviewed and met by the service and that the service seeks advice and acts on it to meet peoples needs. The service provides a happy and Care Homes for Older People Page 14 of 32 Evidence: safe environment for all their residents. Information provided to us and seen during this visit confirms that staff receive of training ensuring that they are able to meet peoples needs including dementia awareness. At the time of these visit people were observed to be clean, well presented and appropriately dressed. Peoples privacy was maintained when carrying out personal care. Through out this visit we observed staff to be respectful, caring and attentive towards people. People told us during this visit that staff were kind, caring and friendly. A person surveyed said,its a nice place to live. People are provided with call bells if they require assistance. A person surveyed, said that on several occasions when visiting the call bell has been out of their relatives reach, which they have brought to the attention of staff. During this visit we observed two peoples call bells that been appropriately placed for them to access. During this visit we looked at the systems in place for the administration of medicine in one of the living units. Medication was stored and locked away safely.Medication policies and procedures were in place and staff receive medication training. A list is maintained of staff that are trained to administer medication and photographs of people were available for identification. The home has purchased a syringe driver to ensure timely administration of palliative care medication. Records were maintained for fridge temperatures containing medication and controlled medication was stored and recorded appropriately. Quantities of medication received by the home were recorded. We sampled some peoples medication administration records, which were maintained in good order and contained no gaps. Regular medication audits take place to monitor any errors and practise. Any errors that have occurred have been proactively reported and appropriate action and follow up has taken place. We were informed that peoples ability to self medicate is assessed. Currently there are no people living in the service that are self administering their medication . Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples preferences, social, cultural, diverse ,religious and recreational interests and needs are met. People maintain contact with their family , friends , representatives and the local community. People are supported to exercise choice over their lives and are provided with varied and well balanced meals. Evidence: The service is demonstrating that they provide and support people to participate in a range of meaningful recreational,therapeutic, leisure and social activities, which meets their needs, choices and preferences. Information about peoples life histories and their likes and dislikes is obtained and the activities coordinator completes records to evidence their participation in activities. There is a weekly activities schedule,which is displayed in each lounge, notice board and a copy is provided to people living in the service every week. Before any activity takes place the activity coordinator approaches people to remind them about what activities are taking place. At the time of this visit a musical event was taking place and in the afternoon some people left the service to attend an external social activity. The range of activities include, cognitive stimulation therapy, brain training, reminiscence, reflexology , exercise, visiting entertainers , arts and crafts, pat dog visits and gardening, where Care Homes for Older People Page 16 of 32 Evidence: some people have helped with planting flowers and shrubs of their choice. The home benefits from two large film screens where film shows are provided. People have access to the internet in their rooms and the service provides people with their own television with inbuilt music channels. A hairdresser, library and shop trolley also attend the home. Peoples religious needs are respected with visits from clergy and communion services taking place. A local church visited the home to carry out a remembrance day service. The home benefits from having their own wheelchair accessible vehicle and employs a driver. A range of external outings have taken place to the local town centre, market, museums, garden centres, theatre trips and places of interest. We were told that all people living in the service are provided with the opportunity to participate in outings. Some people choose to attend external day services or local clubs such as choir, art, bingo and bridge clubs. Due to their needs one person is supported on a one to one basis and member of staff supporting them at the time of this visit told us that they support them to participate in playing golf and bowling.The service has six volunteers who visit the service on a regular basis who assist in carrying out some activities. Information supplied in the AQAA states that the service has links and contacts with the library, the British legion, age concern, National Association for Providers of Activities (NAPA) The activities coordinator has trained in cognitive stimulation therapy for specialist dementia care and completed dementia training awareness to increase their understanding of how to support people and develop their communication skills.The activities coordinator has been presented with a support worker of the year award by Surrey Care Association. During this visit the activities coordinator was seen visiting some people who stay in their rooms,which is included in the activities schedule. We were informed that the home is planning to increase their activity schedule and to provide for extra out of hours provision at evenings and at weekends. A number of positive comments were received during discussion with people and from surveys received about the activities coordinator and the programme provided including, I am particularly grateful to the activities organiser who has done a great deal to improve my relatives morale; The entertainment manager in particular does a very good job; The home provides entertainment, trips out and social evenings; Care Homes for Older People Page 17 of 32 Evidence: The home provides good activities; Good activities run by the coordinator. One person said that they would like more activities in the summer. The service operates an opening visiting policy and relatives and friends are able to take meals.Monthly social events are arranged to include families are friends and are also invited to accompany their relatives on outings. During this visit we saw a range of toys for children to play with when they visit. Birthdays and anniversaries are celebrated.The manager has converted one of the upstairs rooms into Teacup Tearoom ,which provides another area for people to socialise and where they are able to help themselves to a range of coffee and teas. The service also holds relative support meetings. The service provides opportunities for people to make suggestions including, activity planning, which is included in the residents committee meetings enabling them to suggest or add any activities of what they would like to see on the programme. People have set up their own residents fund and hold their own bazaars and sales where they sell their crafts. The home provides a news letter, which provides up to date information about developments in the home. We were informed that one person wishes to to bake cakes and arrangements are being made for this person to do this in the kitchen. Information is offered on advocacy, which the service arranged for a person and people are able to bring any favourite possessions and furniture into the home, which we saw in their bedrooms. The service provides a seasonal, four weekly menu, which was varied, well balanced, provided choice. The catering manager visits people each day and asks for feedback or special requests. Specialised diets are catered for and a cooked breakfast is available if people choose to have this. The homes menus were seen on display, however it would be beneficial for them to be displayed on the tables to make these more accessible to people. In the evening one person could not remember what they had ordered and wished for an alternative, which a member of catering staff accommodated. Discussion took place with the manager about the current meal pre ordering systems whether they meet the needs of people with dementia. Afternoon tea was served with home made pastries . The chef told us about a gourmet evening, which was held . Discussion with people and from surveys received were mainly positive about the meals. Two people said the food was Excellent.Two people told us during this visit some meals are better then others and one person commented, I would like the menu changed. Another person said, Individual diets could be better. Care Homes for Older People Page 18 of 32 Evidence: The main meal is served at lunch time by the chef in the dining rooms. The meal was well presented using fresh ingredients. The lunch time meal was provided in an unrushed and relaxed atmosphere, although it was observed that staff interaction and seating arrangements could be improved for two people who require support with eating to increase interaction, which was limited with staff . This matter was discussed with the manager during this visit. The manager has identified that they wish to continue to improve and develop the dining experience so as not to provide sameness and repetition. Nutrition For Older Persons and dining with dignity training has been included in next years training programme. Care Homes for Older People Page 19 of 32 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. If people have concerns they know how to complain and they are safeguarded from abuse. Evidence: The service has a complaints procedure in place, which is available in the statement of purpose and service user guide and is also available in the reception. Information supplied in the AQAA states that the service listens to peoples concerns and their relatives are encouraged to raise concerns and suggestions. Three people living in the service said that they were aware of the homes complaints procedure and knew whom they would speak to if they had any concerns. Ten out of twelve people and relatives surveyed also confirmed this. Three relatives surveyed said that the home has responded appropriately if they or their relative using the service has raised any concerns. Information supplied in the AQAA stated that the service has received nine complaints in the last year. The manager maintains a recording system to log any complaints received and the outcomes of investigation.This was demonstrated by records sampled during this visit. Safeguarding vulnerable adults from abuse procedures were available including, the local authority multi agency procedure. In the last year six matters have been promptly referred by the service following the local authority safeguarding vulnerable adults from abuse procedures. Three matters resulted in further investigation, which have now been completed. One matter, which had been identified by the manager had Care Homes for Older People Page 20 of 32 Evidence: not been promptly referred in their absence . However the manager took immediate steps and action to report this matter when this came to their attention informing both the Commission and the local authority. Staff training records sampled confirmed that they receive safeguarding training, which was also confirmed by three members of staff spoken with during this visit. Two members of staff spoken with were aware of the procedures should they ever witness or be made aware of any incident where the safety of a person is compromised. The service has robust staff recruitment procedures in place, which is also includes volunteers ensuring the safety of people living in the service. The manager has re booked training for more of their staff to attend challenging behaviour management especially for those working with dementia care to ensure that they are able to respond appropriately. Care Homes for Older People Page 21 of 32 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. People live in a home that is safe, comfortable, homely and clean. Evidence: The service is purpose built and provides a good standard of accommodation which is safe, well maintained and provides comfortable and homely surroundings for people to live in. Accommodation is situated over two floors, with each having two sitting rooms and a dining room. The service also provides a hairdressing salon. The service was observed to be tastefully furnished and arrangements are in place for maintenance and refurbishment. Over the last year some redecoration has taken place.There is well maintained, accessible gardens for people to enjoy in the summer and in the last year raised flower beds have been installed.The service is planning to continue to improve the gardens by providing plants that appeal to the senses and also the provision of a summer house and bandstand for summer entertainment During this visit we observed some wheelchairs being stored under a staircase, which could cause an obstruction, this matter was brought to the attention of the manager at the time of this visit. The home is disability friendly and accessible through out and a lift is available, hand, rails are provided, call bells are in place and assisted bathrooms are provided. Care Homes for Older People Page 22 of 32 Evidence: Bedrooms were observed to be comfortable and personalised and they were all provided with en suite facilities. We were informed that people will be able to choose their preferred colour schemes for their bedrooms. At the time of this visit the home was observed to be cleaned to a good standard and was hygienic. The home has infection control procedures in place based on good practise guidance and all staff receive infection control training. Surveys received from people living in the service and their representatives stated that the home is always clean and fresh. Care Homes for Older People Page 23 of 32 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. People using the service are supported by staff that are competent and trained to meet their needs and they are protected by the homes recruitment policies and practises ensuring their safety and welfare. Evidence: At the time of this visit each floor was headed by a registered nurse who was supported by five carers in the morning and three carers in the afternoon. At night time there is a night supervisor, a senior carer on each shift and two care staff. The service has recognised that a another floating person would be beneficial in the evening and night. Due to the location of the home staff recruitment has been difficult. However two staff houses have now been purchased, which has assisted with this process. Occasional use of agency is made, particularly registered nurses, although this is starting to improve.The manager is aiming to achieve a core bank system of trained staff to provide additional cover when it is required. The service is also supported by an activity coordinator catering, housekeeping and an administration member of staff. Seven people surveyed said that staff are usually available when they need them , which was also confirmed during discussion with people at the time of this visit, although two people said sometimes there is delays. A person surveyed commented, Care Homes for Older People Page 24 of 32 Evidence: The home could be quicker answering the bell. Comments received from three relatives included, On several occasions the response call button has been slow; Perhaps a higher ratio of carers residents could be improved. Another person said that staffing levels are not as high as at weekends. This matter was discussed with the manager who said that the same nursing and care staff levels are provided at the weekends as weekdays. A member of staff stated that staffing could be improved New staff that are employed receive induction training and any new staff that do not have past experience of working in care follow the Skills for Care induction standards, which they are expected to complete before their six month probationary period ends.Discussion with three members of staff also confirmed this. Information supplied in the AQAA states that out of thirty three care staff employed nineteen have obtained National Vocational Qualifications (Level 2) or above. The manager is an NVQ assessor and staff are encouraged to complete these qualifications in health and social care. We were informed that more staff are completing NVQ(Level 3).Senior team members have been booked on NVQ courses in team leadership and management. The staff training schedule and personal files sampled demonstrated that they receive both statutory and specialist training ensuring that they are able to meet and support the needs of people living in the service.The manager has identified in the AQAA a range of further planned specialist training, which is to be provided in the new year to enhance staff skills further. Staff have personal development plans in place and training is provided by the organisation,which takes place both internally and externally. Staff are made aware of equality and diversity through induction and made aware of the organisations policies and procedures. Forthcoming training will be provided to assist staff to understand the English culture and traditions to reflect current peoples experiences. Systems are in place for staff appraisals and supervision. Staff recruitment follows an equal opportunities policy. People are supported by a staff team that are mixed ethnicity.The organisation has recruitment procedures in place.During this visit four members of staff personal files sampled demonstrated that the required information is obtained including, a fully completed application form,two written references,protection of vulnerable Adult first check (POVA) and criminal records bureau check (CRB). The manager maintains personal identification numbers for staff that are qualified registered nurses with the nursing and midwifery council (NMC)to ensure that they are fit to practise. Care Homes for Older People Page 25 of 32 Evidence: The service receives regular trained staff from an agency, although a record of their employment checks conducted by the agency were not available at this time. Since this visit we have been informed that these are being held by the deputy manager so as to be available for out of hours checks to be made where neccessary. Care Homes for Older People Page 26 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run in the best interests of people living there . Peoples financial interests are safeguarded and their wellbeing, health and safety is protected. Evidence: There is an experienced registered manager in post who has worked in the company for five years. The manager is a registered general nurse and registered mental health nurse who has had previous experience of working with older people with mental health needs as a community psychiatric nurse. The manager is currently in the process of making an application to complete a certificate in management studies. The manager has demonstrated that they keep up to date with developments and research to enhance clinical practice. The manager is also supported by a deputy, senior nurse and night supervisor and all departments have team leaders in place.The home holds regular staff meetings. Four members of staff spoken with said that they were happy working in the home. A member of staff surveyed said, The managers door is always open and the staff Care Homes for Older People Page 27 of 32 Evidence: normally work well as a team and encouraged to speak up and undertake training. A person living in the service and a relative said, There is a very good management team and The manager is always accessible. At the time of this visit the service provided a relaxed, happy and welcoming atmosphere and throughout this visit the manager was observed to have an open and accessible approach with people living in the service, visitors and staff. The manager was observed to make time to visit a person who had requested to see them. The manager receives twelve hourly reports from each floor, which covers all aspects of the home, which we sampled during this visit, which assists them to keep on top of the day to day running of the service and to follow up any issues that my have arisen. The manager provided us with a detailed and comprehensive AQAA, which details the improvements that the service has made and future developments that they have identified. Information supplied in the AQAA and evidence seen at the time of this visit confirms that the manager has a good understanding about the importance of equality and diversity. Monthly quality monitoring visits are carried by the organisation, which were available for viewing, which were clear and detailed. There are self assessment systems and internal audits as well to monitor performance which we sampled during this visit. The service holds a residents committee on a six weekly - two monthly basis, which are minuted and a copy is provided to residents and some representatives who attend on peoples behalf.The meeting provides people with the opportunity to comment and make suggestions. During this visit we sampled some of these minutes, which confirmed that these meetings take place. We were informed that annual feedback surveys are provided to people,their relatives, other stakeholders and staff to gain their views. However these were not available for viewing at the time of this visit as they had been sent to the services head office, which the manager has requested for analysis. It is recommended that copies are maintained in the home to be available for inspection. We were able to sample to compliments book which was available in the reception, that contained a number of positive comments. The service does not handle monies on peoples behalf and invoicing systems are used for purchases such as hairdressing which is managed by the companys head office. The manager and staff training records sampled indicated that they have received Care Homes for Older People Page 28 of 32 Evidence: deprivation of liberty safeguards training and the manager has a good knowledge and understanding of this. There has been one person subject to deprivation of liberty safeguarding authorisation, but this has now ceased. Records sampled for this person demonstrated that the correct procedures had been followed and that liaison had taken place with the deprivation of liberty safeguarding team. Good systems are in place to ensure the welfare and safety of people living in the service. Staff receive regular training in health and safety, moving and handling, fire safety first aid and infection control. The company has a quality control policy and regular health and safety audits and checks are are carried out. Systems are in place for monitoring water temperatures and certificates and records sampled confirmed that regular servicing and maintenance of equipment is up to date. In the last year the home has received a food safety inspection,that was satisfactory and from the fire authority. Accident and incident records were maintained and the service notifies the Commission of matters that we need to be informed about required by the legislation. Care Homes for Older People Page 29 of 32 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 30 of 32 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 33 It is recommended that the service maintains copies of quality assurance feedback surveys to be available for inspection. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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