Care Home: Chantry House Residential And Nursing Home

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What the care home does well People were provided with a clean, well maintained and homely environment to live in. The home was attractively decorated and furnished and there were attractive and secured gardens that people could enjoy. People were provided with a good range of activities that they could participate in if they chose to. People were provided with a balanced and healthy diet. There were some good areas of practice and training identified, which ensured that people that lived at the home were safeguarded. Comments made in the health professional survey included `my colleagues and I in (the area office) have been impressed by the commitment of manager and staff to provide a caring and professional home for our customers`. Comments in the staff surveys included `provide pleasant, homely surroundings for the residents. Make visitors feel welcome. Provide excellent training opportunities. The management are swift to deal with problems or potential problems. They hold a lot of meetings (full staff meetings, unit meetings and supervisions etc.) so staff have opportunities to have their say if they want to. The food is brill!` What has improved since the last inspection? The care plans had been updated and they detailed the support that people required and preferred to meet their assessed needs. The medication processes had improved and there were regular audits undertaken which ensured that people were provided with their prescribed medication. What the care home could do better: The interaction between people that lived at the home and staff was very good, however, there were some interaction observed which was not so good. The issues were reported to a senior staff member who dealt with them immediately and the manager was spoken with the day after the inspection and they assured us that the issues were dealt with. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Chantry House Residential And Nursing Home Chantry Road Saxmundham Suffolk IP17 1DJ     The quality rating for this care home is:   two star good 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: Julie Small     Date: 2 2 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 33 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 33 Information about the care home Name of care home: Address: Chantry House Residential And Nursing Home Chantry Road Saxmundham Suffolk IP17 1DJ 01728603377 01728605645 kats.sheldrake@anchor.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Anchor Trust care home 24 Number of places (if applicable): Under 65 Over 65 24 1 8 dementia learning disability mental disorder, excluding learning disability or dementia Additional conditions: 24 0 8 1 Chantry House may also care for one service user (as named in the letter from the Commission for Social Care Inspection to Mr John Ellis dated 11th May 2005) who is elderly and who has both a learning disability and dementia, falling in the registration categories of LD E, DE, E. Date of last inspection Brief description of the care home Chantry House is a registered care home, which provides nursing and residential care for up to 24 older people with mental health needs. The home is owned by Anchor Homes, a non profit making organisation, who provide care, support and housing to older people throughout the country. Chantry House is situated in the market town of Saxmundham and is close to all local amenities. Saxmundham is served by a local bus and train service and is a short distance from the main A12. The town is surrounded by open countryside and is a short drive from the Suffolk Coast. Care Homes for Older People Page 4 of 33 Brief description of the care home Chantry House opened in 1993 and is a purpose built resource, which is set back from the road and is surrounded by landscaped gardens. There is a large car parking area to the front of the building. The accommodation is in three units, two on the ground floor and one on the first floor. Rooms are all single occupancy and have en suite facilities. Each unit has a lounge/dining room with a kitchenette used to serve meals brought from the main kitchen. At this inspection the fees for the home were received from the adminstrator were £922.20 week per week. They do not cover the cost of items such as toiletries, hairdressing and newspapers. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The unannounced inspection took place Wednesday 22nd April 2009 from 10:00 to 17:00. The inspection was a key inspection, which focused on the core standards relating to older people and was undertaken by regulatory inspector Julie Small. The report has been written using accumulated evidence gained prior to and during the inspection. During the inspection four staff recruitment records and staff training records were viewed. The care records of four people that lived at the home were tracked. Further records viewed are detailed in the main body of this report. Observation of work practice was undertaken and ten staff members and five people who lived at the home were spoken with. Care Homes for Older People Page 6 of 33 Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was sent to the home, which was returned to us in the required timescales. Staff, health professional and service user surveys were also sent to the home. Three staff, two service user and one health professional surveys were returned to us. 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 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 8 of 33 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 9 of 33 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. People who use the service can expect to have their needs assessed prior to them moving into the home, to be assured that their needs will be met and to be provided with the opportunity to visit the home to help them to decide if they wish to move in. The home does not provide an intermediate service. Evidence: The care records of four people were viewed and each held a detailed needs assessment, which had been undertaken by a member of the homes management team before they moved into the home. The assessments included details of peoples personal care needs, medical history, mental health and mobility. The AQAA stated pre-admission assessment pro-forma action taken prior to admission utilising the information gleaned to ensure identified need is met from time of admission and all assessors have recognised qualifications to enable qualitative Care Homes for Older People Page 10 of 33 Evidence: assessment. Peoples records also held local authority needs assessments for those who were local authority customers. A detailed baseline assessment was undertaken when people had moved into the home, care plans and risk assessments were in place which showed how their assessed needs were met. The assessment records showed where people had been invited to the home for visits before they had made decisions to move in. A person that was spoken with told us that they visited the home before they had moved in, which gave them the opportunity to decide if they liked it. Two service user surveys said that they had received enough information about the home before they moved in so that they could decide if it was the right place for them. The AQAA stated pre-admission visits facilitated where possible with resident and their family. Care Homes for Older People Page 11 of 33 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. People can expect that their assessed needs are set out in an individual care plan, that their health needs are met and to be protected by the homes medication procedures. Evidence: Since the last inspection the care plans had been updated and reviewed. The care plans of four people were viewed which were detailed and clearly showed the support that each person required and preferred to meet their assessed needs. The details in the care plans included peoples personal care support, choices in their daily lives, night care routines, mobility and communication. The care plans were signed by each person to show that they had been consulted with about their care plans and where people were unable to sign their name, this was clearly documented. Each care plan included detailed risk assessments, which identified the assessed risks and methods of minimising the risks in peoples lives. The risk assessments included smoking cigarettes, mobility, personal evacuation plan, skin viability, aggression, continence and malnutrition universal screening tool. The care plans and risk Care Homes for Older People Page 12 of 33 Evidence: assessments were regularly updated to reflect peoples changing needs and preferences. Daily records that were maintained clearly showed peoples progress, support that they had been provided with, staff observations and choices that they had made each day. The care plans were kept in the unit in which each person lived, which provided access to the care staff that supported the people. Two staff members that were spoken with told us that the care plans were detailed and clearly explained the support that people should be provided with. The staff survey asked if they were provided with up to date information about the needs of the people that they supported. Two answered always and one answered never and commented not as much as we could, as a care home assistant I find that the office does not like to share information. The survey asked if the ways that they passed information about people between staff worked well. Two answered usually and one answered sometimes. The AQAA stated residents needs are clearly outlined in their service user plan. Changing needs are documented through a daily recording system, explicit review and evaluation processes. Specific preferences on choice of male and female carers are outlined in care plan. Two service user surveys said that they always received the care and support that they needed. Each persons care plan held a detailed end of life plan, which clearly identified peoples wishes at the time of death. The plan included details of their funeral arrangements, where their will could be located and who should be contacted at the point of their death or illness. Several thank you cards and letters were viewed from relatives of people who had lived at the home, thanking the staff at the home for the support that they had provided to their relative at the time of their death. The activities co-ordinator showed us an album, which they were working on, which included photographs and memories of people who had died, which provided people who lived at the home the opportunity to view the album. The AQAA stated end of life care been a focus in Anchor for the last 2 years and staff trained from our home with changes in practice implemented i.e. end of life specific care planning, seminars on bereavement grief and mourning and dispelling the myths of death. Funerals arranged by home for residents without families including memorial Care Homes for Older People Page 13 of 33 Evidence: services for residents at the home, conducted by the local ministers. Facilities in place for relatives of residents to stay with them. End of life wishes, pre care planning undertaken sensitively at the right time for the resident. Peoples care records clearly showed the medical support that they had been provided with. The outcomes from medical appointments, such as from their doctor, were clearly identified. Two service user surveys said that they always were provided with the medical support that they needed. The health professional survey said that the home always sought advice and acted upon it to manage and improve peoples health care needs and commented refers to GP (general practitioner) proactively. The survey said that the care staff always had the right skills and experience to support peoples social and health care needs and commented my experience of observing staff (both actively and discretely) is that the staff are very customer focussed and treat each customer as individuals. The AQAA stated a choice of G.P is offered to residents, however most are happy to accept the G.P, care offered at the local Saxmundham practice. We would, however, attempt to facilitate another G.P. if the resident requested this. Each persons care plan that were viewed included a detailed medication care plan, which showed their needs and preferences with the administration of their prescribed medication. A copy of each medication care plan was included in the MAR (medication administration records) charts, which provided easy access to the staff that were administrating the medication. Nursing staff were responsible for the administration of medication and the training records that were viewed showed that they had been provided with medication training. Since the last inspection there had been an improvement in the medication processes. There were regular weekly, daily and monthly medication audits which were viewed. The records clearly showed where improvements and problems had been identified and acted upon in a timely manner. There were also records of regular audits that had been undertaken by the local pharmacist. The MAR (medication administration records) charts of four people were viewed and it was noted that all medication was accounted for. Since the last inspection there had been an improvement of the recording of variable dose medication. The records clearly indicated where different doses of medication, such as PRN (as required) medication was administered, for example if people had taken one or two pain relief tablets. The medication procedures were viewed and they clearly showed the arrangements for the safe storage, handling, administration and recording of medication. Care Homes for Older People Page 14 of 33 Evidence: Part of the lunch time medication round was observed in one unit and it was noted that the medication was stored in MDS (monitored dosage system) blister packs in a secure trolley. The AQAA stated robust medication polices and procedures in place, including regular medication audits. Shift changeover checking of MAR sheets, nightly audit of all MAR sheets. CDs are kept in line with national legislation. Medication alerts sent out regularly. Lead nurse for medication with associate link nurse. Regular pharmacists audits, pharmacists reviews of residents medication and home practice in medication administration. Recording sheets for all variable dose medications including PRN prescriptions. The health professional survey said that people were always supported to manage their own medication or manage it correctly where this was not possible and commented my customer has advanced dementia and medication is managed correctly. Staff were observed to respect peoples privacy during the inspection, which included knocking on bedroom and bathroom doors before entering. There were some areas of excellent interaction between staff and people that lived at the home, particularly during the afternoon shift, which showed that people were treated with respect. Two staff members supported a person to move to a more comfortable position in their chair. They used the hoist in an appropriate and safe manner and they clearly explained their actions to the person and constantly reassured them throughout the process. A person was supported to sit outside to enjoy the fine weather, a staff member was observed to be attentive to their needs regarding if they were cold and if they wanted to return to the lounge. The person used non verbal communication and it was noted that the staff member were observant to their communication methods. We observed two incidents of not so good practice from staff members, for example a staff member had made an agreement to undertake an activity with a person, which was undermined by another staff member and this resulted in the person becoming upset. When we challenged the staff about their cause of the upset to the person, one staff member said I cant get into trouble I am following the care plan. We reported the incidents to the nurse in charge and they acted immediately to ensure that they were resolved. We spoke with the manager by telephone the day after the inspection and they assured us that they had arranged a supervision with the staff member where they would be advised of the appropriateness of their behaviour. The care plan was viewed and it was noted that the staff member had not been flexible in their approach, which was clearly identified in their care plan. Care Homes for Older People Page 15 of 33 Evidence: The AQAA stated policies and procedures to instruct staff of the rights of the individual. Values training for all staff. Person centred training available from in-house team. The health professional survey said that peoples privacy and dignity was always respected. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to be provided with activities that are of interest to them, to be supported to maintain the contacts that they choose to and to be provided with a balanced and healthy diet. Evidence: People were supported to maintain contacts with people that they chose to. Peoples care plans clearly detailed the contacts that they chose to maintain and their preferred methods of contact. During the inspection several people were observed to enjoy visits from their relatives and friends and it was noted that the staff welcomed them into the home. People that were spoken with confirmed that their relatives were always made welcome. The AQAA stated open visiting - relatives welcome to use all areas within the home, residents families are able to book a meal at any time to enjoy with residents and remembrance day and service users birthday parties arranged for residents with families and friends encouraged to attend. People were provided with an activities programme which was of interest to them that Care Homes for Older People Page 17 of 33 Evidence: they could choose to participate in. The minutes from meeting for relatives and people that lived at the home were viewed, which was undertaken January 2008, where the activities provision and plans for the future were discussed. There were two activities co-ordinators employed at the home and one was spoken with during the inspection. They showed us well detailed records that were maintained regarding the activities that people participated in, the observations of the coordinator, peoples progress and detailed risk assessments that identified the methods of minimising risks such as with using glue, using scissors and participating in activities. They told us that they liaised with the care staff if they had identified any issues with people during activities. The co-ordinator was undertaking activities with people regarding their life story and memories in areas such as their wedding day, which included photographs. They had also implemented a magazine, which identified the news in the home which was called Chantry Chatter. There were photographs of people that had been printed in sepia style, where people had dressed up in jewellery, hats and scarves. The co-ordinator told us that people had enjoyed dressing up and seeing themselves in old style photographs. Further activities included chair exercises, games, arts and crafts, decorating candles and lampshades and making bakeless cakes. It was noted that there were several arts and crafts items displayed in the activities room, which included dried leaf displays and Easter pictures, which one person proudly showed us as their art work. The activities co-ordinator told us about themed activities that they were undertaking, which included the opportunities for people to learn about different countries and to try their foods. During the afternoon of the inspection people were observed to be enjoying the sunshine outside, chatting to staff and each other and singing along to the music that was playing in the homes communal lounge. There were two cats that lived at the home and we observed people stroking and talking to them. People that were spoken with told us that there were a good range of activities that they could participate in and one person told us that they felt that some of the activities were childish. Two service user surveys said that there were always activities that they could participate in. It was noted that there was an attractive sensory garden which people could enjoy, which included raised flower beds. The minutes from a residents meeting that were viewed stated that they were planning to arrange a gardening group for people who wished to join in. The chef told us about a dignity in dementia training programme which they were undertaking with two care staff and a nurse. They said that they were working on a project to work with people to enjoy the gardens and their senses, such Care Homes for Older People Page 18 of 33 Evidence: as listening and looking at the birds, smelling the grass and flowers and enjoying the sensory garden. The AQAA stated social interaction/activities are outlined in service user plans, and the weekly programme of events is displayed in each lounge and in the entrance to the home, resident meaningful occupation with care staff i.e. shopping trips, outings and Church group visits monthly for songs of praise, seasonal services, holy communion services, memorial services. People were provided with a balanced diet and it was noted that there was fresh fruit and a range of drinks that people could help themselves to in the communal lounges. Staff were observed to provide people with a choice of hot drinks throughout the day of the inspection. The meal provision in the home continued to be of an excellent quality. There was a set menu and people could make alternative choices if they did not want what was on the menu. The chef was spoken with and showed us a new menu which they were due to implement, which provided increased menu choices. The chef had a good knowledge of peoples dietary requirements and regularly liaised with nursing staff to ensure that peoples changing needs were met, such as if peoples condition required a softer diet. People were provided with a choice of food to be provided for their birthday tea. A tick box document, which had recently been completed by a person was viewed for their birthday tea, which included their choice of jelly, sandwiches, ice cream and a birthday cake. The chef made chutney, jam, wine, bread and cured bacon themselves. During the inspection people were observed to enjoy a lunch of meat curry, which smelled and looked appetising. It was noted that there was little left on peoples plates. In one lounge two people were observed to be supported to eat their meals by two staff members. The staff were observed to speak to the people and talk to them about what was on their plate and if they were enjoying their food. In another lounge two people were also observed to be assisted by two staff members. The staff were observed to participate in a discussion with each other and the hairdresser, who was standing behind one of the people. The people were not involved by the staff in their discussion, however, one staff member told a person that they were doing well in the middle of their conversation. The nurse in charge was informed of what we had observed at the end of the inspection and the manager was informed by telephone the day after the inspection and they assured us that staff were advised about how they were to support people during meals and that the staff would be spoken with. People that were spoken with told us that they enjoyed the food and the home and that they were always provided with enough to eat. The service user survey asked if they enjoyed the meals at the home, one answered always and one answered always. Care Homes for Older People Page 19 of 33 Evidence: The AQAA stated choices available at all meal times including timing which can be flexible. Choice of snacks on offer on all units. Cultural and health needs assessed and provided for as required. Care Homes for Older People Page 20 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect that their complaints will be listened to and to be protected from abuse. Evidence: Peoples complaints were listened to and acted upon. The homes complaints, comments and compliments book was viewed and it was noted that complaints that were received were investigated and responded to in a timely manner. There were several letters and cards from peoples relatives, which thanked the staff at the home for the support and care that they had provided. The AQAA stated complaints and feedback is actively welcomed, as a mechanism to improve service provision. Robust complaint process are in place and documented in the Statement of Purpose, notice boards, leaflets, Service User Guide. Documentation process for all complaints and fixed response times with action taken. There is open door policy for management access. Staff that were spoken with and three staff surveys said that they knew what actions to take if a person wished to make a complaint about the service that they were provided with. People that lived at the home that were spoken with and two service user surveys said that they knew how to make a complaint. A health professional survey said that concerns had always been responded to appropriately and Care Homes for Older People Page 21 of 33 Evidence: commented for example, a customer transferred from another home for whom there were serious concerns, was referred to new GP for urgent visit - very observant staff. The care records of the person above were viewed and it was noted that there was some very good practice regarding the safeguarding of the person. There were body charts in place and it was noted that a safeguarding referral was made in a timely manner. Staff that were spoken with said that they had been provided with safeguarding training and they were aware of their roles and responsibilities in safeguarding people that lived at the home. Training records that were viewed showed that staff were provided with safeguarding training and they were provided with information about their responsibilities in the homes safeguarding policy and procedure and the local authority safeguarding guidelines. The minutes from a staff meeting February 2009 were viewed, which showed that the staff had discussed safeguarding, they had undertook group work regarding various aspects of abuse and they had discussed the acceptance of gifts policy. The AQAA stated the safeguarding of vulnerable adult process is in place and outlined in a policy. There is alert training, safeguarding and whistle blowing training for all staff and is an on-going process as recruitment takes place. Care Homes for Older People Page 22 of 33 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 who use this service can expect to be provided with a safe, clean, hygienic and well maintained environment to live in. Evidence: People were provided with a clean, homely and well maintained environment to live in. A tour of the building was undertaken and it was noted that the home was attractively furnished and decorated and that there were no unpleasant smells. During the inspection people were observed to use the communal lounges in the home and they enjoyed the sunshine in the afternoon in the homes attractive and secure gardens. The AQAA stated the home is welcoming and provides a clean homely environment with music, flowers, plants and two home cats. Special areas in the home, home focus is on creating an therapeutic environment. We have good quality facilities which have been specifically designed. Residents can personalise rooms to their own taste. There are small group areas throughout the home. Chantry House is built to a special design for dementia mental health units. There were grab rails in all the communal areas such as the lounges, halls and bathrooms, which ensured that the environment was accessible to the people who lived there. There were signs on peoples bedroom doors which assisted them to find Care Homes for Older People Page 23 of 33 Evidence: their bedrooms, for example, one person told us that they liked listening to one particular singer and it was noted that a picture of the artist was on their bedroom door. People who lived at the home that were spoken with told us that they were comfortable living at the home. Two service user surveys said that the home was always fresh and clean. The laundry was viewed, which was clean and tidy and provided two washing and two drying machines. A staff member who was working in the laundry was spoken with and they had a good understanding of infection control procedures. They told us that they had been provided with infection control training, which was confirmed in the training records that were viewed. The risks of cross infection was minimised by the provision of hand wash liquid and disposable paper towels in bathrooms, the kitchen and bathrooms. Staff were observed to wear protective clothing and gloves when they were working with food, in the laundry and supporting people with their personal care. Staff were provided with information of the methods of how to minimise cross in infection in the homes infection control procedures and in the Department of Health infection control guidance policy. The records of monthly infection control audits were viewed, which showed that the procedures and processes were regularly monitored to ensure that people were safeguarded. The AQAA stated infection control procedures policy and audit process in place. Hand washing promoted at all times. Training in infection control takes place at induction. Protective equipment is supplied and used as required. Care Homes for Older People Page 24 of 33 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 who use the service can expect to be supported by staff who are trained to meet their needs and to be protected by the homes recruitment procedures. Evidence: The staff rota was viewed and it showed that the home was staffed throughout each twenty four hour period. We were informed that there was one part time carer vacancy and that the manager had planned to interview for the post the week after the inspection. The AQAA stated appropriate staffing levels and limited use of agency staff where possible. Staff spoken with told us that they felt that there were sufficient staff to meet the needs of people that lived at the home. It was noted that call bells were answered promptly and that staff were attentive to the needs of people. There were staff available in each of the homes units to ensure that people were provided with support if they needed it. Three people told us that there were enough staff at the home and two people said that there were enough staff but sometimes they had to wait before their call bells were answered. The home had almost met the target of at least 50 staff to have achieved a minimum of NVQ (National Vocational Qualification) level 2 as identified in the National Care Homes for Older People Page 25 of 33 Evidence: Minimum Standards relating to older people. The AQAA said that there were twenty nine care staff and that twelve had achieved an NVQ award. However, they were working towards increasing the NVQ qualifications of staff in the home. The AQAA stated comprehensive NVQ 2 training programme, with assessors four in post, three further currently undertaking A1 (assessors) award and that they had improved in the last twelve months we have increased levels of staff with NVQ qualifications and staff training to NVQ level. We have increased number of NVQ assessors in the home and training of new assessors. Staff were provided with the training that they needed to meet the needs of people that lived at the home. The staff training records were viewed, which included a training matrix and training certificates. The training that was provided to staff included dementia, manual handling, dignity in dementia, medication, safeguarding, health and safety, dining with dignity, food hygiene, service user plans and COSHH (control of substances hazardous to health). There was further training booked for the next month, which included understanding behaviour and Deprivation of Liberty. Staff that were spoken with told us that they were provided with a good training programme which enabled them to meet peoples needs. Three staff surveys said that they were provided with training which was relevant to their role, helped them to meet peoples needs and that kept them up to date with new ways of working. The AQAA stated variety of training programmes available including. Anchor general courses, specific courses, council and PCT courses as well as externally purchased individual training to meet residents needs. Newly appointed staff were provided with an induction which included the Common Induction Standards. Two staff members that were spoken with confirmed that they had been provided with an induction course and that it was informative, they also told us that they undertook floater shifts before they worked alone. The floater shifts were in addition to the usual two care staff on each unit and the new staff shadowed more experienced care and nursing staff. The staff survey asked if the induction covered everything that they needed to know when they started. Two answered very well and one answered mostly and one commented I was supported very well during induction, managers were approachable and helpful, colleagues were equally supportive. The AQAA stated robust induction training. Probationary periods are in place for all staff. The records of four of the most newly recruited staff were viewed and it was noted Care Homes for Older People Page 26 of 33 Evidence: that the appropriate checks had been undertaken which ensured that people were protected by the homes recruitment procedures. Each of the records held their work history, identification, interview questions and answers, two written references and POVAfirst (protection of vulnerable adults) checks. Two of the staff records held CRB (Criminal Records Bureau) checks. The CRB checks had been applied for for the other two staff members and they were supervised when working until their CRB was received. The administrator informed us that one of the CRB checks had been dispatched to the home on the day of the inspection when they had looked on the CRB web site. Three staff surveys said that CRB checks and references were checked before they started working at the home. The AQAA stated we have robust recruitment procedures in place supported by a recruitment team. Clear job profiles and adverts with formal interview process. Care Homes for Older People Page 27 of 33 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. People who use the service can expect the home to be run in their best interests, to have their financial interests safeguarded and to have their health, safety and welfare protected. Evidence: The home was managed by a person who was fit to be in charge. Since the last key inspection the homes manager was successful in the CSCI (Commission for Social Care Inspection) registered manager application process. The AQAA stated registered managers qualifications which are RGN & RMN, BTEC National Business and Finance, NQV Assessor. The manager was attending a training course at the time of the inspection, which showed that they updated their knowledge. It was noted that the AQAA was returned to us within the required timescales and it provided good detail, which identified the planned improvements to the home. The AQAA identified areas which had been Care Homes for Older People Page 28 of 33 Evidence: improved on in the last twelve months which included improvements in all monitoring systems including audits, supervision, training records. New service user plans, all in place. New assessment tools. Policies and procedures now in home reviewed and all updated and introduced a self assessment manual to the home, linked to the minimum standards and KLORAs (key lines of regulatory assessment). There were good quality assurance processes that were undertaken, which showed that the running of the home was regularly audited and monitored. The regular audit records of health and safety, infection control, service user care plans and medication were viewed. The reports of monthly Regulation 26 visits were viewed and it was noted that staff, visitors and people that lived at the home were provided with the opportunity to express their views about the home. People were further provided with the opportunity to share their views about the service that they were provided with in regular satisfaction questionnaires. A staff member told us that if there were issues identified in the questionnaires they were acted upon. Peoples financial interests were safeguarded. The records of spending money of four people that lived at the home were viewed, which included a clear record of their financial transactions, receipts and an ongoing balance of their money. Peoples health, safety and well being was promoted. The minutes of regular health and safety meetings were viewed, which identified the regular health and safety checks that were undertaken, including fire safety, risk assessments and environmental checks. The records of temperature checks were viewed for freezers, refrigerators, food trolley and water. Certificates of services and checks were viewed, which included the lift, hoists, electrical appliances and gas safety. The fire safety records were viewed, which included a fire risk assessment, personal evacuation plans for each person that lived at the home and regular fire safety checks, which showed that people were safeguarded in case of a fire. There were risk assessments in place which identified the methods of minimising risks in the home, which included back care, electrical safety, falls, food and infection control. Staff were provided with information about how they should work in a safe manner in the homes health and safety procedures and other publications such as Department of Health COSHH and infection control guidelines, which were available in the office. Staff training records showed that staff had been provided with food hygiene, manual handling, health and safety and medication training (for those who were responsible for administering medication). Care Homes for Older People Page 29 of 33 Care Homes for Older People Page 30 of 33 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 31 of 33 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 32 of 33 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 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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