Care Home: Cherry Tree Lodge Private Retirement Home Ltd

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What the care home does well The home presented with a warm, friendly atmosphere and the staff were seen to interact well with the residents. Relaxed relationships were evident between the staff and residents and there was plenty of laughter during the day. A number of staff have worked at the home for a long time and they know the residents very well. Residents spoken with referred to the home being one big family. Other comments included, "Very good staff","It is real home" and "They can`t do anything better." We observed the staff helping the residents with different tasks and this was carried out in a supportive manner. Residents were being encouraged to maintain their independence and the home does have equipment, such as, bath aids and walk in showers to help them achieve this safely and in comfort. Although we recommend some improvements be made to the way in which staff record the care and support they give, it was evident that the residents were receiving care according to individual need. It was also being given in a way that the resident preferred, thus respecting their choice and wishes. Staff interviewed were knowledgeable regarding the residents` individual needs and also their routine, likes and dislikes. This is important for providing person centred care. The routine was seen as flexible, for example, time of meals, getting up in the morning or retiring at night. Residents are offered a good choice of of hot and cold meals at breakfast, lunch, tea and supper time. Organic produce is sought, as the owner feels the nutritional value for the residents is much better for them and also that organic foods taste better. Residents spoken with said how much they enjoyed their meals and their comments included, "Nothing is too much trouble for the chef", "Lovely food" and "First class." The chef confirmed that there is no set budget for food and that the owner only likes the best for the residents. A committed staff team work at the home and there is a good management structure in place to support them and the residents. The staff receive training in safe working practices and other courses relevant to the older person. Training helps to make sure the staff have the skills and knowledge to care for the residents safely. The staff can also refer to the home`s policies and procedures, as they provide guidance on how to work in accordance with current legislation to help protect people. Staff interviewed said they enjoyed working at the home, as they felt valued and supported. Work is being undertaken to redecorate and refurbish the bedrooms. A number have been completed and the furnishings and fittings are attractive. The bedrooms are individually decorated and attention is paid to ensuring colours match. A resident said, "My room is just perfect." What has improved since the last inspection? This was not assessed, as this is the first inspection of the service since the change in registration. What the care home could do better: The Service User Guide and Statement of Purpose should be updated to include the correct address and telephone number of the Commission. These details should also be included in the home`s complaint policy and procedure, so that people can make easy contact with us if they so wish. Staff are now receiving training in respect of the Deprivation of Liberty Safeguards, which have been introduced under the Mental Capacity Act 2005. These safeguards have been introduced for people who many need additional protection when they cannot make their own decisions about their care or treatment. We discussed the need to assess people`s mental capacity at the point of admission to the home. This helps to ensure that a person`s ability to make a judgment about moving in to the home is recorded. It also assists with daily care decisions once admitted. We would recommend that the manager and staff review this and ensure that such assessments are built into the admission and ongoing assessment process. Residents can give their own medicines. They must however, have a plan to support them to give their own medicines safely. This will identify the support the staff need to give to them to ensure their health and well being. Risk assessments for residents who wish to give their own medicines should be reviewed. This will help to ensure the resident and staff are aware of the risks involved and that the resident is still able to undertake this practice without placing themself at risk. Staff receive training in how to administer medicines. The competency of staff in handling medicines should be formally assessed to help make sure they have the necessary skills to do it safely. A risk assessment for the use of bed rails should be completed with the resident and/or their relative. This will help to ensure they are aware of why they are being used and for the staff to minmise the risks to ensure they are used correctly and safely. Daily records completed by the staff in respect of the resident`s plan of care and their daily activities should be recorded in their own care file. This will help to ensure the staff have all the information they need to help provide person centred care. We also found that on occasions the staff do not complete a daily record about the resident. Again, we would recommend this, to show the residents have received care and support in accordance with their plan of care. The manager agreed to undertake this. Key inspection report Care homes for older people Name: Address: Cherry Tree Lodge Private Retirement Home Ltd 40-42 Knowsley Road Southport Merseyside PR9 0HW     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: Claire Lee     Date: 1 7 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 27 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 27 Information about the care home Name of care home: Address: Cherry Tree Lodge Private Retirement Home Ltd 40-42 Knowsley Road Southport Merseyside PR9 0HW 01704534699 01704501237 cherrytreelodge@talktalk.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Cherry Tree Lodge Private Retirement Home Ltd The registered provider is responsible for running the service care home 24 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 24 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category, - Code OP Date of last inspection Brief description of the care home Cherry Tree Lodge is a care home, providing personal care for 24 older people. The home changed to a limited company on 26th January 2010. The home is privately Care Homes for Older People Page 4 of 27 Over 65 24 0 0 0 Brief description of the care home owned by Mr Gerald Ferguson and he is also the registered manager. Cherry Tree Lodge is situated near the promenade and with easy access to the town centre. There is plenty of communal space for the residents and the bedrooms have ensuite facilities. Residents have the use of a call bell when they require assistance from the staff. The weekly fee for accommodation ranges from 452.82 pounds to 552.44 pounds. Care Homes for Older People Page 5 of 27 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: A site visit took place as part of the inspection and this was carried out for a duration of one day for approximately seven hours. Information for this inspection was gathered in a number of different ways. This included an unannounced site visit where time was spent reading care, staff and service records and also looking at different areas of the building. All of the key standards were inspected and other standards we felt were relevant. Although the home was previously registered by us in January 2010, it became a limited company. An inspection was therefore carried out, as it is rated as a new service. Case tracking was used as part of the site visit. This involves looking at the support a resident gets from the manager and staff including their care plans, medication, money and accommodation. Two residents were case tracked, however this was not carried out to the detriment of other residents who also took part in the inspection process. Care Homes for Older People Page 6 of 27 Time was spent meeting with residents and staff to gain their opinions of the overall service. A number of comments from interviews with staff and residents have been included in the report. An AQAA (annual quality assurance assessment) was completed for the key inspection. For reference, the AQAA comprises of two self-questionnaires that focus on the outcomes for people. The self-assessment provides information as to how the manager and staff are meeting the needs of the current residents and a data set that gives basic facts and figures about the service, including staff numbers and training. The AQAA was completed to a very good standard and some information from it is included in the report. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: The Service User Guide and Statement of Purpose should be updated to include the correct address and telephone number of the Commission. These details should also be Care Homes for Older People Page 8 of 27 included in the homes complaint policy and procedure, so that people can make easy contact with us if they so wish. Staff are now receiving training in respect of the Deprivation of Liberty Safeguards, which have been introduced under the Mental Capacity Act 2005. These safeguards have been introduced for people who many need additional protection when they cannot make their own decisions about their care or treatment. We discussed the need to assess peoples mental capacity at the point of admission to the home. This helps to ensure that a persons ability to make a judgment about moving in to the home is recorded. It also assists with daily care decisions once admitted. We would recommend that the manager and staff review this and ensure that such assessments are built into the admission and ongoing assessment process. Residents can give their own medicines. They must however, have a plan to support them to give their own medicines safely. This will identify the support the staff need to give to them to ensure their health and well being. Risk assessments for residents who wish to give their own medicines should be reviewed. This will help to ensure the resident and staff are aware of the risks involved and that the resident is still able to undertake this practice without placing themself at risk. Staff receive training in how to administer medicines. The competency of staff in handling medicines should be formally assessed to help make sure they have the necessary skills to do it safely. A risk assessment for the use of bed rails should be completed with the resident and/or their relative. This will help to ensure they are aware of why they are being used and for the staff to minmise the risks to ensure they are used correctly and safely. Daily records completed by the staff in respect of the residents plan of care and their daily activities should be recorded in their own care file. This will help to ensure the staff have all the information they need to help provide person centred care. We also found that on occasions the staff do not complete a daily record about the resident. Again, we would recommend this, to show the residents have received care and support in accordance with their plan of care. The manager agreed to undertake this. 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 27 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 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given information and have their needs assessed before deciding to move into the home, so they know that they know they will receive the care and support they require. Evidence: People wishing to visit the home are provided with documents called a Service User Guide and Statement of Purpose. These give details about the home and the care and support they will receive from the staff. Both documents were in the main hall for everyone to see. We would recommend that the documents are updated with our address and telephone number, so that people can easily contact us if they wish. The manager confirmed that the Service User Guide and Statement of Purpose are also given to prospective residents and their families as part of a welcome pack. A resident confirmed that the staff had been very informative when they moved in and that everything was as he expected. Care Homes for Older People Page 11 of 27 Evidence: We discussed the admission process with the manager and we looked at an assessment for a resident who had recently been admitted. This involved looking back through their records to check that their care need requirements were properly assessed before they decided to move in. This has to be done to make sure the home is the right place for them to live. The residents records showed their care need requirements were fully assessed. The assessment was detailed and covered areas of the persons life, such as health and personal care, mobility, communication, diet, sleep and social background. Staff are now receiving training in respect of the Deprivation of Liberty Safeguards, which have been introduced under the Mental Capacity Act 2005. These safeguards have been introduced for people who many need additional protection when they cannot make their own decisions about their care or treatment. We discussed the need to assess peoples mental capacity at the point of admission to the home. This helps to ensure that a persons ability to make a judgment about moving in to the home is recorded. It also assists with daily care decisions once admitted. We would recommend that the manager and staff review this and ensure that such assessments are built into the admission and ongoing assessment process. Intermediate Care is not provided by the home. Care Homes for Older People Page 12 of 27 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. Arrangements must be put into place to help ensure people can mange their own medicines safely. Evidence: The AQAA reported, the home fully respects the rights of the individuals in the subject of health, care and medication. To see how this is achieved we looked at a number of residents care documents. Residents had an individual care file and this had written information relating to their health and social care needs. As part of the case tracking process, we looked at their care files. This was done to make sure the residents care needs had been set out in a care plan and that their needs were being met. One care file included a plan of care and staff had been provided with clear information about how to meet the persons identified needs. Information about the residents preferred routines with regards to their health and personal care was also available. The other care file lacked detail in respect of a plan of care, however the staff had recorded the care needs when completing a care review. The staff are introducing new care documents and advice was given regarding their use, as staff were a little unclear on how best to record the care and support they provide. The care manager completed Care Homes for Older People Page 13 of 27 Evidence: the plan of care for this resident at the time of the site visit. The care reviews were recorded in good detail with the involvement of the resident and/or their relative. We also saw good evidence of contact with external professionals and the district nurse team visit the home regularly to offer clinical advice and support. This helps to keep the residents in good health. A staff member said, I would always tell the manager if a resident was unwell. Risk assessments were part of each of the residents care plans. Risk assessments had been carried out for a particular task or activity, which posed a risk to the resident or staff. This helps to minimise the risk of harm to them. We advised the manager to complete a risk assessment for the use of bed rails and this should be completed with the resident and/or their relative. This will help to ensure they are aware of why they are being used and for the staff to minmise the risks to ensure they are used correctly and safely. Staff had recorded the care and support they provided, however we feel the way in which this is carried out could be improved. This is discussed further under Standard 37 (Record Keeping) of this report. We looked at medicine management in the home. We checked the stocks and records of several people and found clear, accurate records of medicines received into the home, given to people and disposed of. We saw evidence that staff had received medicine training, however there were no formal written assessments of staff competence including watching staff handle and administer medicines. We recommend this be undertaken to help ensure they give out medicines safely to the residents. Residents can look after their own medicines if they so wish and we looked at how people were supported to do this. Two people that were looking after their own medicines did not have a plan of care to evidence how the staff provide this support for them to carry out this practice safely. We saw risk assessments, though these need to be reviewed to ensure the resident and staff are aware of the risks involved and that the resident is still able to undertake this practice without placing themself at risk. The AQAA reported, all residents are treated with respect and their dignity upheld. We saw that the staff were polite and helpful towards the residents when helping them with different tasks. A resident said, The girls are great and always there. Staff were seen to encourage the residents to maintain their independence and they were on hand to help as needed. Staff were seen to knock on private doors before entering and using the residents preferred name, as a mark of respect to them. Care Homes for Older People Page 14 of 27 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. Social activities and meals are well managed and provide daily variation and interest for people living in the home. Evidence: There was a pleasant, friendly atmosphere in the home and we saw good interaction between the residents and the staff. There was plenty of laughter and a number of residents were taking part in a game of bingo with the activities organiser. The AQAA reported, the home has a daily written activity plan for each month. We saw this plan, which enables the residents to take part in a number of events and activities. A monthly newsletter is also produced, which sets out different social arrangements. Residents interviewed said they were more than happy with the social aspect of the home. In house activities are arranged such as, music, quizzes, bingo, birthday parties, films and a gardening club. Residents can also purchase items from the homes mobile shop. Visitors are welcome at any time and residents are encouraged to go out each day. A resident confirmed how much they enjoyed taking walks around the town and marine lake. Another resident had gone out for a family party. Care Homes for Older People Page 15 of 27 Evidence: Residents can choose how to spend their day and their wishes were respected. We noted this in respect of choice of meals, times of getting up or retiring at night. These details were recorded in the residents care files and residents interviewed said the staff made sure they were able to follow their preferred routine. Organic produce is now sought for the residents meals and the chef confirmed that the quality of the produce purchased was very good. The chef said there was plenty of fresh fruit and vegetables available and all meals were freshly prepared and cooked. This was seen at the time of the site visit. The AQAA reported, the secret of a good diet are in the ingredients and residents spoken confirmed how much they enjoyed the meals. Their comments included, First class, Lovely selection and Like home cooking. Residents also benefit from having their water purified to help their general health and well being. We looked at the menu and this offered a good choice of hot and cold nutritious meals prepared at different times of the day. Residents can have a cooked breakfast or ask for a lighter alternative at lunch time if they wish. Food stocks were plentiful and the residents have fresh fruit provided each day to help ensure they receive their five a day. The majority of residents attend the dining room for their meals and lunch was seen as a social occasion when everyone got together. The dining room tables were attractively laid and this included small flower arrangements. Residents can take their meals in their own room if preferred. Care Homes for Older People Page 16 of 27 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 were protected by the complaints and safeguarding procedures, which were understood by the staff. Evidence: The AQAA told us that that the home had not received any complaints and this was confirmed when we looked at the complaint log. The manager said that if a concern or complaint was received, then it would be investigated according to the homes complaint policy and procedure. We looked at this document and would recommend it contain our address and telephone number, so that people have easy access to this information should they wish to contact us. Details of this policy and procedure were also seen in the Service User Guide/Service User Handbook. Residents spoken with said they were happy with arrangements in the home. Their comments included, I would tell the girls if I was worried and I would speak up. We saw evidence of an abuse and whistle blowing policy and staff interviewed were able to describe the different types of abuse and how to report an alleged incident. They also confirmed that they receive training to safeguard people they care for. The local authority adult protection procedure was available for staff to refer to and the contact details for reporting allegations were displayed in the lounge. This helps to ensure that any possible problems that arise are dealt with openly to protect people from harm. The AQAA reported that there have been no adult protection referrals for investigation. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in suitably, adapted, clean, comfortable and pleasant surroundings. Evidence: When looking round the home we found that it was clean, well maintained and decorated to a good standard. Work is currently underway to provide new furniture, carpets and fittings in the bedrooms, in accordance with what the residents would like. The AQAA told us that the owner is developing the second floor to accommodate four residents and this includes a bedroom with a full ensuite. We spent time with the residents in the lounge and they said there was plenty of space for them to have a period of quiet time, to meet their visitors or sit with other people. The lounge had comfortable armchairs and a large wide screen TV for easy viewing. There is a small conservatory/sun lounge and also a dining room. We looked at a number of bedrooms and these were decorated with individual colour schemes and matching drapes and bed linen. Residents had brought items in from home to make their rooms feel homely and cosy. A resident said, I love my room. We noted that when decorating the bedrooms, the owner has tried to retain the original features, which gives the home its character. The bathrooms are equipped with bath aids, including walk in showers to help the residents bathe safely and in comfort. Staff were checking the temperature of the hot Care Homes for Older People Page 18 of 27 Evidence: water prior to bathing residents to make sure it was at a safe temperature for them. The AQAA told us that staff are compliant with ensuring good standards of infection control and staff receive training to help ensure they minimise the risks associated with poor hygiene. There are no domestic staff employed, these duties are undertaken by the care staff. Areas seen were clean, tidy and hygienic and the staff had access to gloves, aprons and hand gel when dealing with soiled products. We discussed the maintenance of the grounds and we were advised that the patio area at the rear will be developed once all the internal work has been completed. Residents are able to sit out in the front garden. CCTV cameras are in operation externally and they do not compromise the privacy of the residents. Care Homes for Older People Page 19 of 27 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 receive care and support from staff that they like and who have the skills to support them correctly. Evidence: There were sufficient numbers of staff to care for the nineteen residents accommodated. The registered manager, a manager, a care manager and three care staff were on duty at the time of our visit. At night there is one carer and a person who sleeps in and is on call. Also on duty was the cook and maintenance men who were refurbishing a bedroom with the owner/registered manager. Six staff members are assigned a senior role and they help to oversee the care and management of the service. The staff have a key worker role, this gives them extra responsibilities for a number of task for the residents, such as shopping or helping to tidy their room. A staff member said this enabled them to get to know the residents very well. Interviews with the residents confirmed that they were happy with the care and support they were receiving. A resident said, It is just like one big home. The AQAA reported, the service offers a robust recruitment policy. To evidence this we looked at staff files for two new employees. We found the necessary recruitment Care Homes for Older People Page 20 of 27 Evidence: checks had been done. Each file had an application form, medical questionnaire, two or more references and a police check. We were shown evidence of induction material for the home and also for the Skills for Care Induction, which is a formal introduction into care. This helps to ensure the staff are aware of their role in care and what is expected from them. The AQAA reported that all staff, except for one member, have an NVQ in Care at Level 3 and five managers have an NVQ in Management at Level 4. This demonstrates a good commitment to learning and staff development. We looked at staff training files and these showed that the staff receive regular training in safe working areas, such as moving and handling, first aid, food hygiene, infection control and health and safety. Other training includes, abuse awareness, risk management, equality and diversity and the Mental Capacity Act 2005. These are all relevant to the care of the older person and help to ensure the staff have the skills and knowledge to undertake their work safely. The staff members spoken with confirmed that training courses were readily available and that they were well trained. Care Homes for Older People Page 21 of 27 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 home is well managed on a day to day basis. This helps to ensure that the home is run in the residents best interests and that there are appropriate procedures in place to maintain their health and safety. Evidence: The owner, Mr Gerald Ferguson remains the registered manager. Mr Ferguson is supported by a team of staff and managers who are appointed as heads of department. For example, care, catering, general manager and administration of the home. The AQAA reported, all residents benefit from a well managed service and the residents and staff spoken with confirmed this. Staff also said that Mr Ferguson welcomed new ideas and initiatives to continually improve the service. The staff team are committed to ensuring the quality of the service is maintained to a good standard. They fully recognise the importance of a quality assurance system in order to ascertain whether residents, relatives/representatives and health and social Care Homes for Older People Page 22 of 27 Evidence: care professionals are happy with the standard of care. In order to achieve this they use an external company who undertake a review of the service each year. This involves distributing questionnaires to find out what they think of the home. The residents can also attend meetings in the home and we saw the staff talking with them throughout the day to make sure everything was satisfactory for them. The administrator oversees the handling of residents monies. We looked at a number of financial records and these were well maintained to help protect the residents financial interests. The staff are supervised as they go about their daily tasks and they all meet with their respective manager on a formal basis. A staff member confirmed that these meetings take place regularly. This helps to ensure they give good standards of care to the residents and and assists with their professional development. We saw that accidents had been recorded, for example, if a resident falls and the impact it has had on their health. This helps to monitor their general health and well being. The home has a comprehensive range of policies and procedures to promote and protect both residents and staff members health and safety. These are subject to regular review to ensure they are in accordance with current legislation. Staff use a communication book for recording personal care. We would recommend that information in respect of the residents plan of care and their daily activities be recorded in the residents own care file. This will help to ensure the staff have all the information they need in to help provide person centred care. There is a risk that information may be lost or not conveyed to the staff if recorded in different places. We also found that on occasions the staff do not complete a daily record about the resident. Again, we would recommend this is undertaken, to show the residents have received care and support in accordance with their plan of care. The manager agreed to implement this. The maintenance records for services and equipment, such as gas, electric and fire detection demonstrated that the appropriate service contracts were in place. This was also confirmed in the AQAA. Fire detection records showed us that the fire alarms were tested weekly and emergency lighting each month. These contracts and safety checks help to protect the people who use the service. The staff training files we looked at also confirmed that the staff receive fire prevention training, so they know how to act in the event of a fire. Care Homes for Older People Page 23 of 27 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 24 of 27 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 Residents must have a plan 20/06/2010 to support them to give their own medicines This will help to ensure they can undertake this practice safely to ensure their health and well being. 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 1 The Service User Guide and Statement of Purpose should contain the Commissions telephone number and address, so people can easily contact us if they so wish. A risk assessment for the use of bed rails should be completed with the resident and/or their relative. This will help to ensure they are aware of why they are being used and for the staff to minmise the risks to ensure they are used correctly and safely. The competency of staff in handling medicines should be formally assessed to help make sure they have the necessary skills to do it safely. 2 8 3 9 Care Homes for Older People Page 25 of 27 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 Risk assessments for residents who wish to give their own medicines should be reviewed. This will help to ensure the resident and staff are aware of the risks involved and that the resident is still able to undertake this practice with out placing themself at risk. 4 37 Daily records completed by the staff in respect of the residents plan of care and their daily activities should be recorded in their own care file. This will help to ensure the staff have all the information they need to help provide person centred care. We also found that on occasions the staff do not complete a daily record about the resident. Again, we would recommend this, to show the residents have received care and support in accordance with their plan of care. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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