Care Home: Cheney House

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What the care home does well Detailed information within the pre admission assessment on the health, social and emotional needs of people, ensures that people continue to receive care according to their needs. Some people using the service lack the capacity to fully understand the needs of their care, particularly for some living with advanced dementia. In such instances the care plans gave specific instruction for staff to follow. Having detailed information within the care plans, promotes continuity of care and approach, and ensures the staff are in no doubt as to how peoples health and social care is to be provided. The home seeks to link in with peoples individual cultural, social, religious and recreational interests. Information is available within the care plans on previous occupations, family links, hobbies and interests, past and present. Risk assessments are completed for pressure area care, nutrition, mobility, moving and handling and falls. People assessed as being `at risk`, had information within their risk assessments on the actions taken to address and reduce risks to a minimum. People have access to support and advice from health and social care professionals. Peoples medications are well managed. What has improved since the last inspection? The registered provider has demonstrated a high commitment to work with heath and social care professionals, commissioners and regulators on improving the quality of the service and driving up standards of care. A significant amount of work has taken place on improving the quality of the information and instruction within the care plans and risk assessment, this has made these essential documents more individualised and `person centered`. People using the service and their representatives are fully involved in care planning meetings which take place regularly. Assessment of Mental Capacity (MCA) and Deprivation of Liberty (DoLS) having been carried out for individuals, the outcomes of the assessments link in with the aims and objectives of the individual care plans. This ensures that people are appropriately supported in exercising their right to make their own decisions and in taking risks according to their level of capacity and understanding. Systems have been set in place to ensure that complaints are acted upon appropriately and fully investigated. Regulation 37 notifications are forwarded to CQC on significant events that impact on the health, safety and welfare of people using the service. In addition Nothants Commissioning Unit are kept informed and where required referrals are made to the Local Authority Safeguarding Team.There has been a commitment to ensure that staff receive training appropriate to their roles and responsibilities. A training matrix has been implemented, in order to plan and manage staff training. Much work has taken place since the last key inspection to improve on the environment both structurally and cosmetically, some of the bedrooms and communal areas had been redecorated, colour schemes had been chosen by the people using the service. Non slip flooring has replaced the carpets in the large lounge and the corridors on the ground and first floor. The Bannister near the entrance lobby had been heightened to improve safety. A maintenance worker has been appointed this ensures that ongoing building upkeep and weekly/monthly maintenance checks to the water, heating, fire and electrical systems is carried out. The home has recently set up a health and safety committee which will feed into the Health and safety audits that are carried out every six months. Weekly quality monitoring forms have been put in place, these steps have had a significant impact on improving the overall safety and quality of the environment. New divan beds have been purchased, which they are compatible with the use of bed rails (should a person require these to be in use). The home had recently purchased a set of sit on scales which ensure that all people using the service have the opportunity to have their weight gains and losses monitored. Consultation and negotiation has taken place with people who prefer to spend time in their rooms to relocate to ground floor rooms. This enables greater opportunity for staff to keep in regular touch with people within their rooms, balancing their need for privacy with their needs for social interaction and safety. An administration assistant has been appointed to assist with day to day admin duties, this allows the manager to be more accessible to people using the service, visitors and staff. What the care home could do better: The appointment of a dedicated activity person would give greater opportunity for people to engage in activities of their choice. The contact details of the local authority safeguarding team, the commissioning unit and CQC should be made available for people to contact should they feel their concern or complaint is not responded to appropriately by the provider. Key inspection report Care homes for older people Name: Address: Cheney House Rectory Lane Middleton Cheney Banbury Oxon OX17 2NZ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Irene Miller     Date: 1 3 0 5 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 30 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 30 Information about the care home Name of care home: Address: Cheney House Rectory Lane Middleton Cheney Banbury Oxon OX17 2NZ 01295710494 01295712784 cheney@regalcarehomes.com www.regalcarehomes.com Regal Care Homes Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: No person falling within the category of DE(E) may be admitted into Cheney House where there are 34 service users who fall within the category of DE(E) already accommodated within the home. No person falling within the category of OP may be admitted into Cheney House where there are 34 service users who fall within the category of OP already accommodated within the home. Date of last inspection Brief description of the care home Cheney House is a care home providing personal care and accommodation to thirtyfour older people who may have a dementia related illness. Regal Care Homes Ltd are the Registered Providers of the home. The home is located in the village of Middleton Care Homes for Older People Page 4 of 30 Over 65 34 34 0 0 Brief description of the care home Cheney and is set within its own grounds. The building was a former rectory and is a listed building. There are nineteen single bedrooms of which nine have en-suite toilet facilities. Of the eight bedrooms, which are shared by two people, two have en-suite facilities. Middleton Cheney has amenities such as three churches, shops, post office, chemist, doctors surgery and three public houses. The village is on a bus route to the town of Banbury, which is approximately three miles away. The fees at the time of this inspection range between GBP350 to GBP550 per week, the fee is dependant on whether residents are funded by the local authority or by private arrangement. The service user guide gives details on the difference in fees and how they are set dependent upon the care and support required and type of bedroom facilities chosen. The fees include accommodation, personal care, meals, laundry and some activities and entertainment. Chiropody and hairdressing services can be arranged and are charged separately. Other costs would include clothing, dry cleaning, some outings and toiletries. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of all inspections undertaken by the Care Quality Commission are based upon seeking the outcomes for people using the service and their views of the services provided. This visit was unannounced and focused on the key standards under the National Minimum Standards and the Care Standards Act 2000 for homes providing care for older people. The Care Quality Commission received a regulation 37 notification from Cheney House in November 2009 informing that of a number of people using the service had acquiring serious pressure ulcers. This prompted a full review of the care afforded to people using the service identified at this risk, namely people who were physically frail, immobile and nutritionally compromised. The Care Quality Commission, Northampton local Authority Safeguarding Team and Northampton County Councils Commissioning Care Homes for Older People Page 6 of 30 Department were involved with the review. Several meetings took place with the Registered Provider of Regal Care Ltd during which the serious concerns were discussed and a temporary ban was placed on new admissions into the home. This allowed the provider time to fully investigate the reasons for the drop in the quality of care provided at Cheney House and to enable a plan of action to be put in place to ensure that all people remaining at the service were safe and their needs met. The provider kept all of the agencies informed on the actions taken to address the pressure area care concerns and on the treatment and progress of those people who had acquired pressure ulcers. At this inspection we looked through written information available on peoples care, such as the individual care plans (a care plan sets out how the home aims to meet the individual personal, healthcare, social and spiritual needs of people using the service). Due to communication difficulties, some people using the service were unable to give verbal feedback on the care they receive at the home. Observations of care practices and discussions with people using the service where possible gave an indication on the quality of the service provided at Cheney House. Records in relation to the homes management and administration systems, quality assurance, staffing and general policies and procedures were viewed. Prior to this visit we sent out to the provider an Annual Quality Assurance Assessment (AQAA) this document allows the provider to supply us with information on how they view their own performance, such as what they do well, what they could do better and plans for future improvements. The AQAA was returned to us within the timescale set, and gave an insight into how the home is managed and quality assessed. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? The registered provider has demonstrated a high commitment to work with heath and social care professionals, commissioners and regulators on improving the quality of the service and driving up standards of care. A significant amount of work has taken place on improving the quality of the information and instruction within the care plans and risk assessment, this has made these essential documents more individualised and person centered. People using the service and their representatives are fully involved in care planning meetings which take place regularly. Assessment of Mental Capacity (MCA) and Deprivation of Liberty (DoLS) having been carried out for individuals, the outcomes of the assessments link in with the aims and objectives of the individual care plans. This ensures that people are appropriately supported in exercising their right to make their own decisions and in taking risks according to their level of capacity and understanding. Systems have been set in place to ensure that complaints are acted upon appropriately and fully investigated. Regulation 37 notifications are forwarded to CQC on significant events that impact on the health, safety and welfare of people using the service. In addition Nothants Commissioning Unit are kept informed and where required referrals are made to the Local Authority Safeguarding Team. Care Homes for Older People Page 8 of 30 There has been a commitment to ensure that staff receive training appropriate to their roles and responsibilities. A training matrix has been implemented, in order to plan and manage staff training. Much work has taken place since the last key inspection to improve on the environment both structurally and cosmetically, some of the bedrooms and communal areas had been redecorated, colour schemes had been chosen by the people using the service. Non slip flooring has replaced the carpets in the large lounge and the corridors on the ground and first floor. The Bannister near the entrance lobby had been heightened to improve safety. A maintenance worker has been appointed this ensures that ongoing building upkeep and weekly/monthly maintenance checks to the water, heating, fire and electrical systems is carried out. The home has recently set up a health and safety committee which will feed into the Health and safety audits that are carried out every six months. Weekly quality monitoring forms have been put in place, these steps have had a significant impact on improving the overall safety and quality of the environment. New divan beds have been purchased, which they are compatible with the use of bed rails (should a person require these to be in use). The home had recently purchased a set of sit on scales which ensure that all people using the service have the opportunity to have their weight gains and losses monitored. Consultation and negotiation has taken place with people who prefer to spend time in their rooms to relocate to ground floor rooms. This enables greater opportunity for staff to keep in regular touch with people within their rooms, balancing their need for privacy with their needs for social interaction and safety. An administration assistant has been appointed to assist with day to day admin duties, this allows the manager to be more accessible to people using the service, visitors and staff. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 9 of 30 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 30 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. Detailed information within the pre admission assessment ensures that the needs of people using the service are identified and can be met. Evidence: No changes have taken place to the registration categories of this service since the last key inspection. The homes Statement of Purpose, provides information on the management of the home and qualifications of staff and the Service User Guide, provides information on the range of services provided at the home and within the local community. Both these documents are made available to prospective residents and their representatives. We looked at the pre admission assessment documentation within peoples care files. There was detailed information available to demonstrate that the home had carried out a full assessment of peoples health, social and emotional needs prior to them moving into the home. The information gained from the pre admission assessment Care Homes for Older People Page 12 of 30 Evidence: was transferred into the individual care plans, this ensures that people continue to receive the care according to their needs. Additional information was available within the care files from the placing authorities. This combined information ensures that needs are known and therefore an informed decision to be made as to whether needs can be fully met by the home. Care Homes for Older People Page 13 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Detailed information within the care plans and risk assessments ensures that people receive personalised care according to their individual needs. Evidence: We were informed by the manager during the visit that work had taken place on developing the care plans to be more individualised and person centered. The care plans and risk assessment viewed evidenced that much work has taken place on improving the quality of the information and instruction within these documents. We were informed that care planning meetings take place regularly and with the individual and their representatives. There was evidence within the care plans viewed of this involvement and in discussion with a visitor this was also verbally confirmed. Within the care plans viewed there was evidence of assessment of Mental Capacity (MCA) and Deprivation of Liberty (DoLS) having been carried out for individuals, the outcomes of the assessments link in with the aims and objectives of the individual care plans. This ensures that people are appropriately supported in making their own Care Homes for Older People Page 14 of 30 Evidence: decisions and in taking risks according to their level of capacity and understanding. Some people using the service lack the capacity to fully understand the needs of their care, particularly for some living with advanced dementia. In such instances the care plans gave specific instruction for staff to follow. Having detailed information within the care plans, promotes continuity of care and approach, and ensures the staff are in no doubt as to how peoples health and personal care is to be provided. Risk assessments are completed for pressure area care, nutrition, mobility, moving and handling and falls. People who were assessed to be at risk, had appropriate action taken to address and reduce the risks to a minimum. Nutritional assessments were available within the care plans, the assessments identify people at risk of being nutritionally compromised. Some people have swallowing difficulties and there were records of the involvement of a speech and language therapist (SALT) in their care. People identified as at risk of not receiving sufficient dietary and fluid intake have their food and fluid intakes closely monitored and this is recorded in their food journals. The home had recently purchased a new set of sit on scales which ensure that all people using the service have the opportunity to have their weight gains and losses monitored. Falls risk assessments identified people at risk of falls, and the care plans address how the risks were to be minimised to an acceptable level. We were informed that new divan beds had recently been purchased, which they are compatible with the use of bed rails should a person require these to be in use. On the day of inspection a visiting district nurse was carrying out a review of each person who requires the use of bed rails to assess the need and the suitability of this equipment for the individuals. The Care Quality Commission received a regulation 37 notification from Cheney House in November 2009 informing that of a number of people using the service had acquiring serious pressure ulcers. This prompted a full review of the care afforded to people using the service identified at this risk, namely people who were physically frail, immobile and nutritionally compromised. The Care Quality Commission, Northampton local Authority Safeguarding Team and Northampton County Councils Commissioning Department were involved with the review. Several meetings took place with the Registered Provider of Regal Care Ltd during which the serious concerns were discussed and a temporary ban was placed on new admissions into the home. This allowed the provider time to fully investigate the reasons for the drop in the quality of care provided at Cheney House and to enable a Care Homes for Older People Page 15 of 30 Evidence: plan of action to be put in place to ensure that all people remaining at the service were safe and their needs met. The provider kept all of the agencies informed on the actions taken to address the pressure area care concerns and on the treatment and progress of those people who had acquired pressure ulcers. We were informed at the time of this inspection that only one person residing at the home was receiving treatment for a pressure ulcer, this person was frail and immobile and spends most of their time in bed and short periods sitting out in the main lounge. We viewed the pressure area care plan for this person which gave specific instruction on how their pressure care needs were to be be met, the appropriate pressure relieving equipment was seen to be in use for this person, and for others identified at risk of developing pressure ulcers, pressure relieving mattresses and cushions were available in both the bedrooms and in the lounge. There was evidence of regular involvement of the district nurse in providing treatment and records were available of when people are repositioned in bed to reduce the pressure to areas of the body, (turn charts), to reduce the risk of people at risk of developing pressure ulcers. People using the service have access to see their general practitioner and to other treatment and support from health and social care professionals who visit the home. The company medication policy is made available to staff on their induction training and staff sign to say they have been made aware of the policy. The medication storage and administration systems were sample checked and these were seen to be well managed, no controlled drugs were in use at the time of inspection. Staff who have the responsibility of administering medication had received appropriate training. The medication stock and administration charts (MAR) are audited on a weekly basis, by the manager and also checked by the Area Manager when conducting monthly unannounced monitoring visits (regulation 26 visits) to the home. During the visit we observed staff interacting with people using the service, we observed staff to enable people to exercise their rights to choice, dignity and independence. Staff were observed speaking to people with respect and calling people by their preferred name. Some people choose to spend time in their rooms, in discussion with the manager we were informed that through consultation and negotiation, some people had relocated to ground floor rooms. This enables greater opportunity for staff to keep in regular touch with people within their rooms, balancing their need for privacy with their needs Care Homes for Older People Page 16 of 30 Evidence: for social interaction and safety. Care Homes for Older People Page 17 of 30 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. In general peoples individual and social needs are being met. Although the appointment of a person to oversee this area would enhance this element of care. Evidence: The care plans viewed had information on peoples individual cultural, social, religious and recreational interests, previous occupations, family links, hobbies and interests, past and present. For people with limited verbal communication there was information on how the person best communicates their needs. At present no activity person is employed at the home, we were informed that this is a post that the company are actively seeking to appoint. Feedback from surveys returned to CQC prior to this inspection indicate that this is an area where people feel could be better improved. We were informed by the manager that at present day to day activities are being carried out by care staff and that outside entertainers visit the home to provide musical entertainment. The following comments in relation to activities were received via the surveys returned to CQC , improve on activities; therefore improve on the moral of the residents and staff. The home could improve on activities for people with dementia as they need Care Homes for Older People Page 18 of 30 Evidence: constant stimulation, I think the home is trying to address this problem. The Annual Quality Assurance Assessment (AQAA) identifies that an area for further improvement is for activities to be more diverse and structured and to incorporate more outside events. During the visit we observed staff during the course of their duties, to spend time responding to people to stop and chat with individuals. The homes menu has recently been reviewed, and menus have been further developed to include pictures to enable people to choose what they wish to eat for there meals. Visitors are welcomed into the Home and invited to share a meal with their relative whenever they wish, one relative spoken with said that they visit their wife every afternoon and spend time helping her with her meals. The person said that this is something practical they could do as verbal communication with his wife was now very limited. Care Homes for Older People Page 19 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be assured that any concerns or complaints they have are listened to and acted upon. Evidence: Since the last key inspection CQC have received two complaints and one safeguarding concern about the service. As previously mentioned in the health and personal care section of this report the safeguarding concern prompted a full review of the management of pressure area care provided by the service. A copy of the complaints procedure is available within the homes Statement of Purpose and the Service User Guide documents. These documents are located within the main front lobby of the home. Feedback sheets are made available within the front entrance for people to write down any concerns, compliments or complaints about the service and a secure box is available for internal posting direct to the manager. Feedback from the most recent quality assurance survey was available within the front entrance. The contact details of the Area Manager for Regal Care is on display within the front entrance, should people feel their complaints are not responded to appropriately they have a right to contact either the Local Authority Safeguarding Team, Northants Commissioning Unit or CQC directly, therefore the contact details for these agencies Care Homes for Older People Page 20 of 30 Evidence: should also be made available. Records of compliments, concerns and complaints were viewed which evidenced that the provider takes listens and takes action on these, there was details of the complaint, investigation and outcomes. Staff have received training on the Safeguarding of Vulnerable Adults (SoVA), the Mental Capacity Act (MCA) and Deprivation of Liberty (DoLS). In discussion with staff they were able to demonstrate they are aware of the procedures to follow should they suspect or witness any acts of abuse. Advocacy services can be arranged through Age Concern, and people who wish to vote are supported in doing so through the use of the postal vote scheme. We were informed through information supplied in the Annual Quality Assurance Assessment (AQAA) that 90 of the staff are trained in a National Vocational Qualification (NVQ) level 2 or 3 in which modules cover issues surrounding what constitutes abuse and abuse reporting procedures. Care Homes for Older People Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is safe and comfortable and meets the needs of the people using the service. Evidence: A tour of the building was conducted during which we sample checked some bedrooms, bathrooms, W.Cs and the communal areas, kitchen and laundry facilities were viewed. Much work has taken place since the last key inspection to improve on the environment some bedrooms and communal areas had been redecorated, we were informed that the colour schemes had been chosen by people using the service. Non slip flooring has replaced the carpets in large lounge and the corridors on the ground and first floor. The Bannister near the front entrance had been hightened for improved safety. A maintenance worker has been appointed this ensures that ongoing building upkeep and weekly/monthly maintenance checks to the water, heating, fire and electrical systems is carried out. The home has recently set up a health and safety committee which will feed into the Care Homes for Older People Page 22 of 30 Evidence: Health and safety audits that are carried out every six months. Weekly quality monitoring forms have been put in place, these steps have had a significant impact on improving the overall safety and quality of the environment. Cross infection training is provided for all staff, personal protective equipment was available within the bedrooms and the bathrooms/WCs and hand sanitiser was available at the front entrance of the home and within the entrance to the main kitchen. Care Homes for Older People Page 23 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are cared for by staff that are appropriately trained to meet their needs. Evidence: We looked at the recruitment files of two new staff employed at the home and there was evidence of the necessary pre employment checks being carried out prior to the staff taking up post at the home. These included checks with the Independent Safeguarding Authority (ISA), previously known as POVA, the Criminal Records Bureau (CRB), and two written references. We were informed that no staff take up employment at the home until a full CRB clearance has been obtained. The company has signed up with an E-Learning provider which enables staff to complete training modules on line. Training is available for staff to achieve a national Vocational Qualification (NVQ) levels 2 and 3 in care, catering and cleaning, 90 of the staff are either NVQ trained or undertaking an NVQ qualification. New staff are inducted into their post over three days, during which they are supernumerary to the staffing levels, and are assigned to a senior member of staff as a mentor, who oversees the induction. Records were available on staff training to include dementia care, moving and Care Homes for Older People Page 24 of 30 Evidence: handling, fire safety, food safety, pressure area care, nutrition, continence management, infection control, palliative care, health and safety and control of substances hazardous to heath (CoSHH). All senior staff have attended First aid training and staff responsible for the administration of medication have undertaken medication training. Care Homes for Older People Page 25 of 30 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. Te home is run in the best interests of people using the service. Evidence: Standard 31 relates specifically to the role of registered manager therefore this standard has not been fully assessed. The management arrangements are considered critical in the quality of care and in safeguarding the health and welfare of people who use the service and are therefore reported on in that context. The current manager advised that she started work at Cheney House as the interim Manager in November 2008. She has previous experience of managing a care home and confirmed that as of 1st April 2010 she would be taking up a permanent managers post at Cheney House, she confirmed that she is to submit an application for registration to the Care Quality Commission without delay. Time was spent during the inspection with the manager assessing compliance with the requirements issued following the last key inspection. Much work has taken place in Care Homes for Older People Page 26 of 30 Evidence: meeting the requirements and in improving the overall quality of the service. Records were available of quality audits, the manager and the company area manager self assess the systems in place to ensure that high quality of care is consistently provided. The registered provider has demonstrated a high commitment to work with heath and social care professionals, commissioners and regulators in improving the quality of the service and driving up standards of care. An administration assistant has been appointed to take on some of the day to administration duties, this enables the manager to be more accessible throughout the home. Feedback from relatives has been positive in that they feel they can contact the manager at any time. The administration assistant holds the responsibility for dealing with financial transactions relating to individuals, small amounts of cash held on behalf of people using the service were sample checked and seen to be in good order, supported with records of transactions and receipts. Care Homes for Older People Page 27 of 30 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 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 16 The contact details of the local authority safeguarding team, the commissioning unit and CQC should be made available for people to contact should they feel their concern or complaint is not responded to appropriately by the provider. Care Homes for Older People Page 29 of 30 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. 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