Care Home: Chelmsford Nursing Home

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What the care home does well Chelmsford Nursing Home is a new purpose built care home that has been built on the same site and adjacent to the former Chelmsford Nursing Home and provides residential and nursing care for older people and those with a diagnosis of dementia. The accommodation is well appointed, well decorated and well equipped for residents` comfort, safety and to promote independence. The premises are clean with good infection control standards in place. The assessment process is robust. Comprehensive information is provided to potential residents who are encouraged to view the service prior to making a decision. Standards of customer care are good and efforts are made by management and staff to ensure residents and their representatives` needs are met throughout the process. Standards of care planning are thorough, are based on person centred care and are regularly monitored and reviewed. Healthcare access is good. All residents are registered with a local GP who attends regularly and there is good monitoring of healthcare needs with prompt referral. The organisation aims to provide excellence in all aspects of care including end of life care and dementia care. Staff are specially trained in these areas to ensure these objectives are met and residents experience good quality outcomes. The home employs a full time activities coordinator and a varied programme of social and therapeutic activities are offered. The home has a snoozelum room that is very well fitted with fibre optics and strobe lighting, used as therapy for residents displaying aggression/anxiety. Relatives/visitors were welcomed into the home. The quality assurance programme is under development and regular audits are planned both internally and from a compliance team within the organisation. What has improved since the last inspection? This is the first inspection of this service. What the care home could do better: Some issues were identified with recording of medication and one requirement has been made with regard to this. Key inspection report Care homes for older people Name: Address: Chelmsford Nursing Home Howe Green East Hanningford Road Chelmsford CM2 7TP     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: Diana Green     Date: 2 6 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Chelmsford Nursing Home Howe Green East Hanningford Road Chelmsford CM2 7TP 01245472430 01245472428 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: European Care (Danbury) Ltd care home 64 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 64 The registered person may provide the following categories of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Physical Disability - Code PD Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Chelmsford Nursing Home provides nursing and personal care for up to 64 older people. The home can offer specialised care for people who have a physical disability and those with dementia. The home is purpose built and accommodation is provided on three floors accessible by stairs and lifts. There are 64 single en-suite bedrooms provided on the ground and first floor with separate dining rooms, bathrooms; shower Care Homes for Older People Page 4 of 28 Over 65 0 64 0 64 0 64 Brief description of the care home rooms, sluice rooms and clinical rooms. The third floor comprises administrative and staff facilities. Communal space is provided on all floors with one lounge and an adjoining dining room, both on the ground floor. All areas are wheelchair accessible. Chelmsford Nursing Home is set in a rural location in Howe Green approximately 3miles south east of Chelmsford. There is car parking for visitors at the front of the home. The registered manager of the home is Mrs Kay Farrell. The ranges of weekly fees as advised on 2nd February 2010 are £600 to £981. Additional charges apply for hairdressing, chiropody, newspapers and magazines. CQC inspection reports can be obtained from the home, or via the CQC internet website www.cqc.org.uk Care Homes for Older People Page 5 of 28 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: This was the first inspection of the service. The quality rating for this service is 2 star. This means that people who use this service experience good quality outcomes. This unannounced inspection took place on 26th November 2009. All of the Key National Minimum Standards (NMS) for Older People, and the intended outcomes, were assessed in relation to this service during the inspection. This report has been written using accumulated evidence gathered prior to and during the site visit. This includes the Annual Quality Assurance Assessment (AQAA), which is required by law to be completed by the service and is a self assessment that focuses on how well outcomes are being met for people using the service. Care Homes for Older People Page 6 of 28 The inspection process included reviewing documents required under the Care Home Regulations. A number of records were looked at in relation to residents, staff recruitment and training, staff rotas and policies and procedures. Time was spent talking to residents, their relatives, staff and the manager. The manager and staff were welcoming and helpful throughout the inspection. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. 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 28 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 28 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. Prospective residents can be assured they will be provided with sufficient information to enable them to make a decision about moving into the home and will have an assessment before admission to ensure their needs can be met. Evidence: The home had a statement of purpose and service user guide that met regulatory requirements. The statement of purpose and certificate of registration were seen on display in the entrance of the home together with key information for prospective residents and their representatives. Three residents who completed surveys told us they had received sufficient information to enable them to make a decision prior to moving into the home. The admission procedures were discussed with the manager of the home. Prospective residents and /or their relatives were encouraged to visit the home and view the accommodation. We were informed that wherever possible assessments were Care Homes for Older People Page 10 of 28 Evidence: undertaken either in the persons own home, care home or hospital. Referrals were accepted by telephone and information on care needs obtained including a copy of the community care assessment provided by the social worker. A pre-admission assessment was undertaken using a pre-assessment form as a prompt to discuss care needs. Residents were received into the home on a trial basis. Information was used following admission to complete a full assessment and care plan. Four residents care plans were viewed during the visit to the service. All included a detailed pre-admission assessment form that provided key information on the residents care needs from which a care plan could be developed. The home does not provide intermediate care. Care Homes for Older People Page 11 of 28 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. Residents health and personal care needs are well met through robust care planning and regular monitoring of care practices. The standards for administration of medicines are in the main good; closer monitoring of record keeping will ensure these standards are maintained. Evidence: Four residents care records were viewed during the site visit. All four contained a preadmission assessment detailing the residents care needs that had been undertaken prior to admission. Care plans were seen for maintaining a safe environment, communication, breathing, eating and drinking, elimination, washing and dressing, thermo-regulation, mobilisation, sleeping, death and dying etc. All were reviewed monthly to include changing needs. All four files viewed contained very detailed care plans that provided clear guidance to staff when providing care to meet individual residents needs and had been signed by the resident confirming their agreement to their care. A life history named Getting to Know You was provided to each resident on admission with a request to complete as much information as possible with the help of their relative if needed. Information received enabled care staff to have a Care Homes for Older People Page 12 of 28 Evidence: greater understanding of the resident and their life experiences and to assist them to personalise their care. Risk assessments were seen for risks associated with residents handling, risk of falls, skin integrity, use of bed rails, pain, agitation etc. All had been regularly reviewed. Daily statements of well being were recorded for both day and night enabling staff working between shifts to be kept informed of the residents changing needs. A relative spoken with during the visit to the service said they had seen the care plan and told us that the care was very good and staff were professional in their approach with residents. Residents access to healthcare services was discussed with the manager and confirmed from the care records. The home had a contract with a local GP practice who attended weekly and on request. One residents care records viewed during the visit to the home confirmed they had received visits from their GP, dietician, chiropodist and social worker. Another relative who completed a survey told us my x and all the family are delighted with the care that x receives. A third relative told us the service does most things to a high standard and cares for the patients very well. The medication systems were discussed with the manager of the home and the storage inspected. Medication was stored in a walk in cupboard, wall cupboards and controlled drugs cabinet located in the locked medication room on the first floor of the home. Three lockable trolleys were used for medication rounds. The home had a medication policy and procedures for staff guidance and information on medicines was also available for staff and seen in the medication room. Medication was supplied from a local supplying pharmacy in monitored dosage systems and individual containers. There were appropriate procedures for the receipt and disposal of medication available and these were seen to be well adhered to. Medication was given by registered nurses and a list of staff signatures and initials was held to enable appropriate follow up in the event of an adverse incident. Room temperatures were recorded and monitored to ensure medicines were stored within safe recommended levels (maximum 25 degrees centigrade). Drug refrigerator temperatures were also monitored and recorded to ensure the safe storage of medicines requiring cold storage. The medication storage and medicines administration records for three residents were examined. Records were completed accurately and in full and all medication was available as prescribed. The Controlled Drugs (CD) storage met requirements and a CD register was in use. Records were completed accurately and confirmed by two staff signatures. However the name of the pharmacy but not the address was recorded in the register on receipt and disposal of CD drugs as required. Three medicine bottles did not have the date of opening recorded and one medicine had been changed to four times daily but the instruction had not been changed on the Medicines administration sheet (MAR sheet). The training records confirmed that all registered nurses had undertaken medication Care Homes for Older People Page 13 of 28 Evidence: handling training. We were informed that the supplying pharmacist undertook regular medication audits. A relative spoken with during the visit to the service told us that their loved ones medication had been reviewed by the GP and they were now receiving less medication and had responded well. Staff were observed to be friendly and relaxed in their conversations with residents. A relative told us that staff are very respectful to all. Residents personal care was observed to be provided in private. Rooms included personal items of furniture and lockable facilities for storage of valuable and medication in the event that a resident chose to self medicate. The aims and objectives of the home were viewed and were seen to be comprehensive and included good detail of how the privacy and dignity of residents would be respected. Care Homes for Older People Page 14 of 28 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. Residents are assured their daily lives will be enhanced by a varied programme of social and therapeutic activities that meet their cultural expectations and they will receive a well-balanced and nutritious diet with choices acommodated. Visitors are warmly welcomed into the home. Evidence: The homes activities were discussed with the manager and records were inspected. A full time activities coordinator was employed to organise activities and provide group and individual activities for residents supported by care staff. We were informed that the activities coordinator had recently undertaken training in the provision of therapeutic activities. On admission residents are requested to complete with their family and staff and a personal history file. This includes their family tree, details of their work and life experience and includes photographs taken during their lives. The information is used to inform their person centred care plan. The activities programme included monthly entertainment, weekly seated exercise sessions to music and a private physiotherapist also attended two to three times per week to aid mobility and flexibility. The AQAA informed us that the home provided daily activities, weekly minibus trips and monthly get together with families providing buffets and entertainment. The manager said that garden parties had been held during the summer and there Care Homes for Older People Page 15 of 28 Evidence: were also plans to provide a sensory garden for residents. During the tour of the premises photographs were seen showing some of the social activities/ events arranged. A programme of planned activities in large print was seen displayed on the wall in the lounge and large screen televisions were provided in lounges so that residents with sight impairment could see more easily. The activities room was stocked with a large and varied range of equipment. The sensory room was viewed and was well equipped with strobe lighting and mirrors etc. We were informed that there is a policy for use of the sensory room and that residents have an assessment prior to using the facilities which are used to calm residents mood and behaviour. Adjacent to the laundry there is a hairdressing room with hairdressing sinks with flexible shower heads and shelving, which was observed to be locked when not in use. We were informed that a church service is held monthly with representatives from various faiths attending to give communion weekly. Activities records were seen for four residents. These detailed the activities taken part in such as music, reading, walks in the garden, Holy Communion, time spent in the sensory room, optician and hairdressing. The records included very detailed comments about the outcome for the resident of each activity showing that staff were monitoring the benefit for residents. The homes visiting policy was included in the statement of purpose. A visitors book was seen and confirmed that visitors came into the home at various times during the day, evening and weekends. Several visitors were observed visiting the home. A relative told us they could visit at anytime, could see their loved one in private and always felt welcome. During the visit to the home residents were observed to be mainly in the lounge/ dining area where small tables were pleasantly laid for lunch. Some residents had chosen to eat in the small lounge of the home. It was evident from observation and inspection of records that choices were accommodated in how residents spent their day, whether they took part in activities or chose to have a rest in their rooms following lunch. Residents rooms were seen to be personalised with their own belongings (photos, pictures, ornaments etc.) that provided a very homely environment. Information on advocacy services was included in the statement of purpose for residents information should they wish to seek their advice or support. The lunchtime meal was observed being served to residents from a heated trolley. The meal comprised a choice of home made chicken soup, faggots in tomato sauce, sausages, or cheese and potato pie served with potatoes, cabbage and turnip and followed by a desert of gooseberry pie and cream or strawberry sponge cake. Drinks were served with the meal and were also noted to be provided during the day. Residents records viewed confirmed that a nutritional risk assessment was Care Homes for Older People Page 16 of 28 Evidence: undertaken on admission to the home and weights monitored with nutritional supplements provided as needed ensuring that residents did not lose weight unduly. The care records confirmed that specialist diets were catered for and advice obtained from a dietician where needed. A resident who completed a survey told us the food is good and relative also told us the food is very good. The kitchen is located on the ground floor of the premises but was not fully inspected on this occasion. However it was seen to be large and exceptionally well fitted with modern equipment. A recent environmental health inspection was reported to have found the facilities to be satisfactory. Care Homes for Older People Page 17 of 28 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. Robust policies, procedures and practices assure residents that their complaints will be listened to and acted upon and they will be protected from harm or abuse. Evidence: The home had a complaints procedure that was included in the statement of purpose and service user guide and was seen on display in the home. We were informed that a total of five complaints had been received by the home since registration for the service. The record of complaints was viewed and confirmed that complaints were fully investigated in line with the homes procedures. All residents and their relatives who completed surveys confirmed they were aware of the complaints procedure and who to speak to if they had a concern. The home had safeguarding procedures in place and the records confirmed that all staff had received updated training in safeguarding adults. The home had detailed policy and procedures for safeguarding adults and the manager confirmed that the Essex safeguarding procedures were available for staff guidance in the event of needing to refer an allegation. A whistle blowing policy was also available to support staff should they witness an allegation of abuse. A copy of the training matrix was provided and confirmed that regular updated safeguarding adults training is provided for care staff to ensure they are aware of the procedures to be followed in the event of an allegation being made. There had been one safeguard alert made by the service that was appropriately investigated in line with procedures. The homes recruitment Care Homes for Older People Page 18 of 28 Evidence: procedures were inspected and were confirmed to protect residents by ensuring all relevant checks were undertaken prior to appointment. Care Homes for Older People Page 19 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are assured that they will have a clean, comfortable, well maintained and homely environment that promotes their independence and is very well equipped for their comfort and safety. Evidence: A tour of the premises was made during the visit to the home. The entrance to the home was secure with a door entry system in place. The building comprised three floors accessible by stairs and lifts. The ground and first floor included thirty two single en-suite bedrooms on each floor with separate dining rooms, bathrooms, shower rooms, sluice rooms and clinical rooms etc. The third floor comprised administrative and staff facilities. Several residents rooms, communal rooms, bathrooms, a shower room, medication room, sluice room, activities rooms. The sensory room and laundry were viewed. The premises were clean with no odorous smells and were well furnished, decorated and equipped to a high standard. The second floor offers training facilities, meeting rooms, storage rooms, a visitors overnight room, a staff room, a staff changing room, including lockers and showering facilities. The staff rest room contains a small kitchenette for the preparation of drinks and snacks. On this floor there is also a second managers office. The home had large gardens to the rear of the home that were mainly laid to lawn with a raised garden that was accessible by ramps and steps. The perimeter of the grounds has been secured through fencing. We were informed that a sensory garden was also to be established with pathways for Care Homes for Older People Page 20 of 28 Evidence: wheelchair access. Records viewed during the visit to the home confirmed that systems were in place to ensure the building complied with the requirements of the local fire and environmental health department. Two lifts, keypad protected, provide access to all floors. There are also stairways to all floors that are also keypad protected. There were grab rails throughout corridors with aids in bathrooms and toilets to meet the mobility needs of residents. The nurse call system is a state of the art digital version, with corridor alarms and control panels. There is a small triangular light above each door, which flashes red when a call is made and turns green when a member of staff is in the room assisting the resident. The system is provided throughout the home with wall, overhead and corded call buttons, to suit the needs of each area/resident. The home had a high number of profiling beds to meet residents needs. A range of specialist pressure relief equipment was available to meet the needs of individual residents. This included individual slings for hoists to be used for residents with mobility needs. The home was clean with no malodorous smells evident. A relative told that the home is always clean. Systems were in place to ensure staff had personal protective clothing for use when providing personal care. Hand washing facilities (liquid soap and paper towels) were provided throughout to ensure care staff had appropriate equipment to safely provide personal care. The laundry room was viewed and was clean and well organised with shelving, individual boxes and hanging rails to enable staff to organise the sorting and return of residents laundry to the rightful owner. There were two washing machines fitted and two driers all in working order. Both washing machines had sluice facilities (able to wash at 65 degrees centigrade for a minimum of 10 minutes) to minimise the risk of infection. A relative who completed a survey told us there are high standards of cleanliness everywhere and another told us the home provides a clean and modern environment. A relative spoken with during the visit to the home confirmed they were satisfied with the standard of laundry. Staff were observed wearing protective clothing when serving meals and residents were also provided with protection as needed to ensure their clothing did not become unnecessarily stained with food. The laundry is on the ground floor with in/out door arrangement for clean and dirty laundry. There are two industrial washing machines and two industrial tumble dryers with an industrial sheet ironer. Care Homes for Older People Page 21 of 28 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. Residents are assured they will be cared for by skilled and caring staff that are robustly recruited, employed in sufficient numbers and are well trained. Evidence: There were twenty-nine residents at the home. We were informed that in addition to the manager there were two registered nurses and six care staff on duty. Night staffing levels comprised one registered nurse and three care assistants. Recruitment of staff was ongoing and the manager said that staffing levels would increase to accommodate the number and dependency of residents admitted to the home. During the visit to the home, residents were observed to be well cared for indicating that staffing levels were appropriate for their needs. Feedback from relatives also confirmed this: staff are attentive and helpful in many ways and very caring, friendly, professional staff...provide...a high standard of personal care. Ancillary staff were observed to be provided in sufficient numbers to ensure the smooth running of the laundry, kitchen and domestic duties. The duty rota was seen and confirmed the staffing levels were as discussed. We were informed that the home employed a total of twenty-two care staff of which eight had an NVQ level 2 qualifications or above. This is below the 50 needed to meet the recommended standard. However it is acknowledged that this is a developing service and a further nine staff were also in the process of undertaking Care Homes for Older People Page 22 of 28 Evidence: NVQ level 2 training. During the visit to the home the recruitment files for three recently employed staff were viewed. All files included evidence that the relevant checks (CRB, two satisfactory references, identification etc.) were undertaken prior to appointment. We were informed that a copy of the General Social Care Council (GSCC) Code of Practice was given to all new staff on appointment to ensure they were aware of their responsibilities as a care worker. The files also included staff contract/terms and conditions detailing their legal rights of employment. The records confirmed that all new care staff were registered to undertake Skills for Care induction and this was also confirmed from the personal files seen. The training programme was discussed with the manager and records viewed. A copy of the training matrix was provided. This comprised a rolling programme of mandatory training (health and safety, manual handling, fire safety, food hygiene, first aid and dementia). Regular updated training was also provided for infection control, dementia, safeguarding adults and specific training to meets individual needs, for example incontinence, challenging behaviour, etc. The training records for the same three staff were viewed and confirmed that since appointment they had received training in manual handling, safeguarding adults, fire safety, health and safety. We were informed that all staff had received a six-hour dementia-training programme and further training in dementia care was planned. Care Homes for Older People Page 23 of 28 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. Residents are assured the home is well managed, operates in their best interests and their health, safety and welfare is safeguarded. Evidence: The manager is an experienced registered nurse and care home manager and had been employed at the home prior to registration of the service. Staff who completed surveys told us the home works well as a team. All members of the staff and management are willing to help each other. From observation and an inspection of records, the home appeared to be well managed. The homes quality assurance policy and procedures were discussed with the manager. The organisation had a corporate quality assurance programme in operation that had not yet been fully implemented in the home. This comprised a range of quality audits including care planning, medication and health and safety. We were informed by the manager that the service consulted with staff, residents and their representatives. This was also confirmed during the visit to the service where minutes were viewed for Care Homes for Older People Page 24 of 28 Evidence: staff meetings (care staff, training coordinators and kitchen staff) and residents and relatives. The home had a comprehensive range of policies and procedures in place for staff guidance that had been regularly reviewed ensuring they met with up to date legislation and best practice guidance. The arrangements for handling residents monies were discussed with the manager. Neither the manager nor her representative was appointee for any resident. No resident managed their own financial affairs. All residents had a relative or representative to manage their finances on their behalf. All expenses, for example hairdressing and chiropody were paid for by the home and invoiced. The home had a health and safety policy and procedures in place for staff guidance. The records confirmed that staff had attended health and safety training following appointment. Evidence of a sample of records viewed showed that there were systems in place to ensure the servicing of equipment (hoists, sling etc.) and utilities and there was evidence of appropriate weekly and monthly internal checks being carried out (e.g. checks on fire equipment, fire alarms and emergency lighting etc.). Care Homes for Older People Page 25 of 28 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 26 of 28 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 1. The date of opening must 10/02/2010 be recorded on the medication container. 2. Changes in medication must be recorded on the MAR sheet and confirmed by date and the signature of the person making the change. This is to ensure residents receive their medication as prescribed and are safeguarded. 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 27 of 28 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 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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