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Care Home: Chaxhill Hall

  • Chaxhill Hall Chaxhill Nr Westbury-on-Severn Glos GL14 1QW
  • Tel: 01452760717
  • Fax: 01452760717
  • Planned feature Advertise here!

Chaxhill Hall Care Home is situated alongside the main A48 trunk road between Gloucester and Westbury upon Severn. It is an adapted Victorian house and the accommodation consists of thirty-two single and two double rooms, twenty-two of which have en suite facilities. Communal facilities consist of three large lounges, two on the ground floor and one on the first floor, and two dining rooms. The first floor is accessed by a passenger lift. There is a garden and patio area for people to enjoy in the fine weather. Car parking is available at the front of the building. The home does 0 not have a copy of their Statement of Purpose or Service Users Guide on display. Copies of the homes complaints procedure are in each person`s room and displayed on the notice board in the main entrance. The fees for this home are from 380.00 pounds to 600.00 pounds per week depending on the needs of the person. Additional charges that are not included in the fees are for hairdressing, chiropody and toiletries.

  • Latitude: 51.826000213623
    Longitude: -2.3819999694824
  • Manager: Mrs Portia Lea Brown
  • Price p/w: ~
  • UK
  • Total Capacity: 36
  • Type: Care home only
  • Provider: Mrs Francesca Beverley Whitehouse,Mr Peter Albert Whitehouse
  • Ownership: Private
  • Care Home ID: 4346
Residents Needs:
Old age, not falling within any other category

Latest Inspection

This is the latest available inspection report for this service, carried out on 11th February 2010. CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

For extracts, read the latest CQC inspection for Chaxhill Hall.

What the care home does well Senior staff assess people before admission to help ensure that the home can meet their needs. A letter of confirmation, that the home can meet their needs, is usually sent to people prior to admission. People have their needs met and have the support of healthcare professionals when required. Most people and their friends and relatives were pleased with the care provided in the home. We observed people being treated with dignity and respect, and most people told us that they liked living in the home. One person told us that sometimes staff are in a hurry. Friends and relatives were complimentary about the home. There was a cheerful atmosphere in the lounge and friendly conversations between the people living in the home, the staff and the visitors. The home provides a variety of food for people to choose from at each meal, and people told us that they enjoy the meals provided in the home. The staff are well trained, and updates to their training were planned. The home`s thorough recruitment procedures help to protect the vulnerable people accommodated. The home has a quality assurance system where people, relatives and healthcare professionals complete regular surveys, and the results are given out at staff and residents meetings. Any concerns raised are discussed individually with people. Changes have been made as a results of conducting surveys, for example; improved decoration and activities. What has improved since the last inspection? Medication is more safely stored and weekly audits are completed. Additional risk assessments have been completed in the care plans, and a new more person centred care planning system has been accessed for completion soon. One lounge downstairs and the entrance hall have been decorated, and a large lounge upstairs was almost complete, which will provide a large attractive quiet room for people to enjoy. The care staff have completed a lot of training, to include the Protection Of Vulnerable Adults (POVA) training, to help ensure that staff can recognise any abuse and know what to do. The home has a new passenger lift providing good access to both floors. A full-time maintenance man has been employed to help ensure that all issues are dealt with as soon as possible, and that decoration can be gradually improved throughout the home. There is a new decking area in the garden providing a safe place for people to sit. The activity co-ordinator works three days each week and has developed a programme of activities for people to choose from, and has completed an `Activities Co-ordinator` training.The senior carer had set up a training file with Gloucestershire Skills for Care. We looked at the file for mandatory training and it was very well set up with copies of the staff certificates. Ninety percent of staff have NVQ level 2 or above. The home also has two dementia care link workers and ninety percent of the staff have completed a dementia awareness course. Health and safety has improved, which helps to ensure that people live in a safe home. What the care home could do better: Medication management has improved, as we had previously made requirements at the last inspection. There remains a need for further improvement to help ensure that medication is managed safely at all times. The care plans are currently not detailed enough, however, the staff have started to improve the system to help ensure that all needs have appropriate actions and goals recorded. Several rooms in the home have been refurbished, this should continue as planned to help ensure that the home meets the required standard and that people live in a comfortable home and are respected. The laundry room requires some attention to promote infection control. Key inspection report Care homes for older people Name: Address: Chaxhill Hall Chaxhill Hall Chaxhill Nr Westbury-on-Severn Glos GL14 1QW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kathryn Silvey     Date: 1 1 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Chaxhill Hall Chaxhill Hall Chaxhill Nr Westbury-on-Severn Glos GL14 1QW 01452760717 01452760717 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Francesca Beverley Whitehouse,Mr Peter Albert Whitehouse Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: To add a total of 3 beds to be used for service users between the ages of 55yrs 65yrs. Date of last inspection Brief description of the care home Chaxhill Hall Care Home is situated alongside the main A48 trunk road between Gloucester and Westbury upon Severn. It is an adapted Victorian house and the accommodation consists of thirty-two single and two double rooms, twenty-two of which have en suite facilities. Communal facilities consist of three large lounges, two on the ground floor and one on the first floor, and two dining rooms. The first floor is accessed by a passenger lift. There is a garden and patio area for people to enjoy in the fine weather. Car parking is available at the front of the building. The home does Care Homes for Older People Page 4 of 31 0 Over 65 36 Brief description of the care home not have a copy of their Statement of Purpose or Service Users Guide on display. Copies of the homes complaints procedure are in each persons room and displayed on the notice board in the main entrance. The fees for this home are from 380.00 pounds to 600.00 pounds per week depending on the needs of the person. Additional charges that are not included in the fees are for hairdressing, chiropody and toiletries. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This key inspection took place during one day with one inspector. We spoke to many people living in the home, their family or friends, the staff, and the manager. We received completed surveys from one relative and four care staff. A number of records were looked at including care plans, risk assessments, health and medication records. The care records of two people were looked at in detail this time as we also looked at care records in October 2009. We also looked at the communal areas, the kitchen, the laundry and some bedrooms. The staff were observed engaging with people living in the home. Care Homes for Older People Page 6 of 31 The registered manager returned The Care Quality Commissions (CQC) Annual Quality Assurance Assessment (AQAA), this is a self-assessment about the home and is a legal requirement. We completed a random inspection in October 2009 to follow up a number of requirements from the last key inspection in February 2009. Several requirements were found to have been completed at the random inspection, and one new requirement was made. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? Medication is more safely stored and weekly audits are completed. Additional risk assessments have been completed in the care plans, and a new more person centred care planning system has been accessed for completion soon. One lounge downstairs and the entrance hall have been decorated, and a large lounge upstairs was almost complete, which will provide a large attractive quiet room for people to enjoy. The care staff have completed a lot of training, to include the Protection Of Vulnerable Adults (POVA) training, to help ensure that staff can recognise any abuse and know what to do. The home has a new passenger lift providing good access to both floors. A full-time maintenance man has been employed to help ensure that all issues are dealt with as soon as possible, and that decoration can be gradually improved throughout the home. There is a new decking area in the garden providing a safe place for people to sit. The activity co-ordinator works three days each week and has developed a programme of activities for people to choose from, and has completed an Activities Co-ordinator training. Care Homes for Older People Page 8 of 31 The senior carer had set up a training file with Gloucestershire Skills for Care. We looked at the file for mandatory training and it was very well set up with copies of the staff certificates. Ninety percent of staff have NVQ level 2 or above. The home also has two dementia care link workers and ninety percent of the staff have completed a dementia awareness course. Health and safety has improved, which helps to ensure that people live in a safe home. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Senior staff assess people before a planned admission to the home to help ensure that peoples needs can be met, and a letter of confirmation is sent to them. Evidence: We looked at the records for two recent admissions to the home. A pre-admission assessment had been completed with a lot of detailed information about the person, which included medication and whether there was a risk of falls. There was an example of a proforma letter sent to the person before admission to confirm that the home is able to meet their needs. A copy of the actual letter sent was not available. We looked at the information available for a recent emergency admission to the home, and a care plan had been provided by the Community Adult Care Directorate (CACD). The home also keeps a record of telephone conversations with healthcare professionals. Soon after the emergency admission the home had completed a care plan, and there were detailed daily records. Care Homes for Older People Page 11 of 31 Evidence: Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person has a care plan, that is regularly reviewed, which includes risk assesments and the support of healthcare professional when required. There is room for improvement in the records, which the manager has identified and will be completed soon. Medication management and practice have improved, however, some additional improvements are required to help ensure safe administration at all times. Evidence: The home has a simple care planning system that is being updated to a computerised new format, which we looked at. The new system will address each persons individual needs, with actions for staff to complete and goals to be achieved. This will be an improvement and should be completed for all care plans, to help ensure that the care plans are more person centred. We looked at two care plans in detail to include the medication records. One care plan identified continence care needs, and that support was required for the installation of Care Homes for Older People Page 13 of 31 Evidence: eyedrops. The daily records were informative and the care plan was due for the first review. The CACD review was due in February 2010. We looked at another care plan that had a completed nutritional assessment tool and monthly weight chart. This person had been referred to a dietitian, and food and fluid intake and output charts had been completed. We also spoke to the relatives who were complimentary about the care provided in the home and knew about their mothers care plan. The relatives told us that their mother had lived at the home for ten years and that they knew about her weight and had seen the chart. The care plans seen had manual handling, falls and pressure ulcer risk assessments completed. People are weighed monthly, or more often when required, to help identify a risk of malnutrition. We were informed that specific risk assessments are completed when required. The home did not require any support from healthcare professionals for pressure ulcers care. We looked at medication management to include requirements made by us at previous inspections. The medication storage was secure and organised. The medication cabinet was bolted to the wall, however, the staff were uncertain that the Controlled Drug (CD) cabinet inside was also bolted to the wall, as required. There were no CDs stored. The staff see the medicine prescriptions before ordering the medication from the pharmacy, we looked at the records. All medication entering the home is initialed on the record by two care staff. There should be a photographs of all people on the medication records. The medication administration records (MAR) had any allergies noted and were complete. There were no gaps in staff administration records and the staff were using the correct codes for anomalies. There should be a complete staff signature, not a initial, when handwritten transcribed medication is added to a MAR. As we had previously required this, we looked at a completed record in a bedroom with regard to the application of skin cream, which is good practice. However, the record should indicate how much cream must be applied each time. The skin cream application was also recorded on the MAR. We looked at a simple protocol for as required Haloperidol that required some improvement, to include maximum dose in twentyfour hours, how long to use the medication for, and when to inform the doctor. We found protocols in the care plans Care Homes for Older People Page 14 of 31 Evidence: for two as required medication, an aperient and an analgesic. One as required analgesia, Co-codamol, should have had a protocol for staff to follow. We recommend that a copy of the as required protocols are kept with the MAR. We completed a spot check audit where one tablet was missing, the container was dated when opened, however, the staff thought that the container was dated but not used on the first day of opening, which would account for the tablet. Care should be taken to date the container when it is opened and used. We looked at the homes weekly medication audit, which included looking at management generally and completing a random spot check of individual records. We recommend that instead of completing a random check all medication is individually audited in rotation to include a tablet count. We checked when night sedation was being administered, and the earliest time was 20:00 hrs. We were told that the doctor usually completes an annual medication review. The homes medication policy review was incomplete and needs to be finished as soon as possible. We discussed this with the manager and the senior carer responsible for medication. We recommend that The Royal Pharmaceutical Societys guidance for medication administration in care homes be obtained from the Internet as a reference. An updated medication reference should also be obtained. We observed medication administration, and recommend that the medication trolley is taken to each dining room at lunch time to avoid medication being taken long distances, away from the MAR, in an individual pot. The MAR should be with the medication at the point of administration to help ensure that staff do not inadvertently give the medication to the wrong person, should they become distracted. The senior staff that administer medication will be completing an update to their medication training through Skills for Care on 3rd March 2010. We spoke to several people, their friends and relatives in the lounge, they told us they liked living in the home and the staff were nice. One person told us that sometimes staff are in a hurry. Friends and relatives were complimentary about the home. There was a cheerful atmosphere in the lounge between staff and everyone, where we observed people were being treated with dignity and respect. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to spend their day how they choose, and can join in with organised activities if they wish. The home provides a variety of food for people to choose from and special diets when required. Evidence: The activity co-ordinator works three days each week and a programme of activities was displayd in the hall, which for the following two weeks included; a singalong, watching a film, making cakes, exercises in both lounges, reminiscence - war time, coffee morning, bingo and one to one activities. The activity co-ordinator has started compiling social histories about people. There are no organised activities when the hairdresser comes as most people are preoccupied. There is sometimes a quiz at the weekends. People told us they had enough to do, and that they went out sometimes. One person would have liked to go out more often. Religious services take place in the home, and one person told us they attend a day centre regularly. Care Homes for Older People Page 16 of 31 Evidence: We spoke to relatives and they told us there were enough activities with singing and music, which they had seen as they visit twice a week. They also told us about a trip to Weston-super-Mare, and that staff had put on a Pantomime. We looked at the menus, there were a variety of meals to choose from. We observed lunch being served from a hot trolley, where people choose what they want on the day. The lunch was served in both dining rooms and was hot and well presented with portions to suit individual tastes, and staff were available to help people. We also observed supper being served in a calm and relaxed atmosphere. The staff also dealt with an emergency during supper in a professional manner to avoid anyone being disturbed too much. Special diets can be provided, and supplementary food drinks are also used when required to improve nutritional intake. We were told that the Environmental Health Officer (EHO) had required that the kitchen had an additional handwashing basin, which has been provided. The homes rating with Environmental Health has improved, however, as there is no dishwaher in the home it cannot improve further. We spoke to several people in the one lounge and two people in their bedrooms, and all were complimemtary about the food provided. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home investigated a recent complaint well and takes complaints seriously. People are safeguarded from abuse by the homes well trained staff and the policies and procedures the home has that support them. Evidence: The home has a complaints procedure, and the people we spoke to knew whom to contact should they have a complaint. We looked at how the home had investigated a recent complaint from a relative. The relative had also complained to CACD. We looked at the records and the homes reply, which was well documented and included relevant information. We also looked at the outcome of the last safeguarding referral, where the home had implemented improvements to the care plan regarding a persons weight loss, and referred the person to the dietitian. A record is kept of all conversations with health and social care professionals. The manager informed us that all the staff, including herself while on maternity leave, had completed safeguarding of vulnerable adults (SOVA) training on 23/11/09. The staff also have an Alerters guide to refer to. The home has a safeguarding procedure, which includes whistle blowing so that staff know whom to inform and what to do should they witness any form of abuse in the home. Care Homes for Older People Page 18 of 31 Evidence: The home is planning that additional staff complete the Deprivation of Liberty Safeguards training. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home maintenance has improved to help ensure that people are safe, and the refurbishment and decoration of the home continues to improve. The home was generally clean and free from any offensive odours. Evidence: We looked around the communal areas and a sample of bedrooms. The bedroom fire door we noticed propped during the recent random inspection remained propped open. The manager agreed to order a Dorguard device to enable the door to close when the fire bell is activated, as the person likes her door open all the time. The domestic cleaning trolley is no longer stored in the bathroom. We spoke to the cleaner who was using the trolley and she told us it is locked away. She also told us she has completed infection control training. We looked in the laundry, which needed cleaning and a new impervious floor covering. One tumble dryer was not working and was going to be repaired. We recommend that the laundry has an infection control policy posted there to inform all staff about the correct procedure. We looked in the kitchen, which was clean and well organised. The new lounge upstairs was being decorated and looked really light and spacious, the Care Homes for Older People Page 20 of 31 Evidence: plan was for it to be a quieter room without a television. The home will then have two lounges on the ground floor and one upstairs, and two dining rooms on the ground floor. The staff use one dining room for staff handovers, and for writing care plans, which is unacceptable as visitors and people living in the home may like to use it. Staff sometimes use the same room for breaks, which should be staggered to ensure there are enough staff in the home to meet peoples needs and answer call bells etc. There is no business plan for completing the refurbishment, however, many rooms have been decorated already. There is a new passenger lift to improve access for people between floors. All radiators have guards and windows are restricted to improve safety. The manager told us the bathrooms are all due for renovation soon. One has a new sliding door to improve access. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are currently sufficient staff to meet people needs and the manager reviews the situation when dependency levels change. Ancillary staff help support the care team to meet peoples needs. The staff are well trained and updates to their training are planned. The homes recruitment procedures help to protect the vulnerable people accommodated. Evidence: We looked at the staff duty rota, and the manager told us that should dependency levels change the rota is reviewed to meet peoples needs. There were thirtytwo people accommodated and the rota told us that from 8:00 until 14:00 hours there are five care staff plus the manager on duty, from 14:00 until 22:00hrs there are four care staff to include a senior carer, and the manager is on duty until 16:00 hours. Each weekday there are two domestic cleaners and one each weekend day, there is a cook daily from 8:00 - 15:00, a laundry person Monday to Friday, an activity person three days each week and a maintenance person five days each week. During the night from 22:00 - 8:00 there are two staff on duty. The manager lives on the premises and is on call. The staff rarely complete a fourteen hour shift now, and when they do it is to cover sickness. Night staff prepare Care Homes for Older People Page 22 of 31 Evidence: vegetables in the morning to avoid them being in water all night, we had concerns about this procedure at the last inspection. The training in the home has improved. We spoke to a senior carer who is in charge of organising the training in the home. He was completing a Level 3 medication award with Warwickshire college and had been the deputy manager while the manager was on maternity leave. The senior carer had worked in a nursing home previously, and has trained the staff in the home in oral care. The senior carer had set up a training file with Gloucestershire Skills for Care. We looked at the file for mandatory training and it was very well set up with copies of the staff certificates. Ninety percent of staff have completed NVQ level 2 or above training. We were provided with a matrix of all mandatory training provided in 2009, which included the expiry dates for all courses. Eight staff had completed Mental Capacity Act and Deprivation of Liberty Safeguards training, seven staff had completed medication training and the majority of staff had completed manual handling, infection control, first aid, POVA/SOVA, food hygiene, and health and safety awareness training. The home has two dementia care link workers and ninety percent of the staff have completed a dementia awareness course. We looked at one staff file and photocopies of all training were in the file. The activity co-ordinator has completed an Activities Co-ordinator training, which was a two week course. The people in the home would benefit from the co-ordinator being on duty for additional days each week. Senior care staff take on more responsibility to include; planning person centred care; nutritional tool assessments and weighing people and reviewing the care plans. We looked at two recruitment records of staff employed since the last inspection, and all relevant CRBs. The records were complete with two references and good interview notes. We had four completed staff surveys returned to us and and all but one told us they were given the correct training. All the staff told us that the manager gives them regular support and time to discuss how they are working. We received the following comments from the staff about what the home does well; we care about our service users and it is homely, provide good quality care, looking after the residents and everything. The staff also told us that the home could provide better communication, and that more refurbishment should be completed. Care Homes for Older People Page 23 of 31 Evidence: A relative commented that the staff keep residents clean and tidy and arrange for the doctor to visit when necessary. However, the relative would also like to see more staff so that they have time to sit and chat with people during tea breaks, and be available generally without relatives having to look for help when it is needed. Staff breaks should be staggered to ensure there are enough staff in the home to meet peoples needs and answer call bells. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is well qualified and experienced and has a team of well trained staff that know their responsibilities. The home has an effective quality assurance system where changes are made as a result of peoples comments. Health and safety has improved and is well managed in the home with the help of an outside agency. Evidence: The manager Portia Brown has just returned from maternity leave, she has completed a Registered Manager Award (RMA), NVQ level 4 in care and has 8 years experience caring for older people with more than three years as the homes assistant manager. The manager has applied to become the homes registered manager. The manager is on duty four days each week and is on call at other times, the deputy manager is fulltime and has NVQ level 4 in care and a Leadership Management Award. Care Homes for Older People Page 25 of 31 Evidence: There are five senior carers, four have the NVQ level 3 in health and social care award and one has NVQ level 2. The manager completed the AQAA for us after the inspection day as we had not asked for it before. We appreciate that this was completed quickly for us and that next time more detail could be added to provide us with more information about the service. We looked at the supervision procedures for staff, and this has been sustained. The regulation 26 visit records were complete for January 2010. Two staff check peoples personal monies and sign the record to help protect everyone. We looked at the residents meeting record as part of the homes quality assurance, and nineteen people attended. The record told us that people wanted more variety for the teatime menu and ideas were given, e.g. salad, trifle, corned beef hash. All the people said they liked breakfast and that they were happy with the activities, and loved the quiz they had one weekend. Quality assurance surveys had been sent out to people twice since the last key inspection, and had also included relatives and doctors. We looked at the results collated for the June 2009 survey and recommend that the actions taken are also recorded. The manager told us that the results are conveyed to staff at their meetings, and that any concerns raised by people are discussed individually with them. At the residents meetings concerns are discussed to include the surveys results and what actions the home has taken. Since the last survey result where fourteen people told the manager that decoration was average, the decoration of the home has progressed. Two people said the activities were poor and the manager told us that this has improved with the new activity person. Survey are due to be sent out again soon, we recommend that more space is provided for people to write a comment. All the requirements and recommendations from last key inspection are complete with the exception of the medication procedure review, and some additional information for as required medication. An outside agency supports the manager with the homes health and safety management, and visits the home every six months. Currently there are no health and safety matters outstanding. The manager is completing the Induction for Managers training through Skills for Care Homes for Older People Page 26 of 31 Evidence: Care, completing three hours each week for thirteen weeks. As mentioned in the environment section of this report the manager agreed to provide a Dorguard device on a bedroom door to improve fire safety for everyone in the home. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Improve the protocols for as 30/04/2010 required medication to provide additional detailed guidance for care staff to follow. This will help ensure that the protocols include the maximum dose to be given in 24 hours and how long the medication can be given before the doctor is informed to ensure safe medication administration at all times. 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 7 We recommend that the new comprehensive care planning system is completed. This will help ensure that detailed and specific person centred care plans are available to meet people needs well. We recommend that the MARs are with the medication at the point of administration to avoid errors. Page 29 of 31 2 8 Care Homes for Older People 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 3 9 We recommend that all handwritten transcribed medication records are signed, and that any alterations to a medication dosage, relayed from a doctor, are signed by two staff. We recommend that the amount of skin cream to be applied each time is also recorded on the MAR. We recommend that the review of the homes medication ploicy and procedures is complered and that a copy of The Royal Pharmaceutical Society guidance be obtained for reference. We recommend a more detailed medication audit be completed to include regular individual tablet counts. We recommend that the care staff do not use the communal rooms for completing care records. We recommend that the laundry room is thoroughly cleaned and that impervious floor covering is provideed to help promote infection control. We recommend that care staff stagger their breaks to help ensure that staff are available at all time to meet peoples needs. We recommend that the actions taken, as a result of quality assurance procedures, are recorded. 4 5 9 9 6 7 8 9 19 26 9 27 10 33 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!

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