Care Home: Cheswardine Hall Nursing and Residential Home

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What the care home does well The feedback from the people living at the home and visitors to the home was encouraging. Peoples` health needs are monitored and we saw evidence of the home engaging the support of health care professionals where necessary. Cheswardine Hall provides people with a clean and comfortable place to live with the opportunity to personalise their own bedrooms. There is a relaxed and homely atmosphere. People are supported to maintain their friendships and links with people that are important to them. What has improved since the last inspection? The care of two people who were resident at the home has been under investigation by the multi-agency adult protection process since our last key inspection. This focused on whether appropriate care had been provided to two residents with pressure ulcers, and whether relevant outside professional guidnace had been brought in to advise and treat them. Since that time the care planning format has changed, recording is more detailed and we found evidence that professionals such as Community Nurses have been involved where necessary. Refurbishment and decoration is ongoing. What the care home could do better: Pre admission assessments should be carried out by the home and records of the homes assessment should be retained. Where appropriate individual care plans must include the guidelines for staff to follow in the care of medical conditions, and the action taken. For example when a person is a diabetic, how their diabetes is managed should be recorded. The induction process should be linked to the Skills for Care Council. Evidence that staff have completed all the mandatory and specialist training to equip them to do their job should be held on staff training files. Key inspection report Care homes for older people Name: Address: Cheswardine Hall Nursing and Residential Home Cheswardine Hall Nursing And Residential Home Cheswardine Market Drayton Shropshire TF9 2RJ     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: Karen Powell     Date: 1 2 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Cheswardine Hall Nursing and Residential Home Cheswardine Hall Nursing And Residential Home Cheswardine Market Drayton Shropshire TF9 2RJ 01630661316 01630661316 stephen@cheswardinehall.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Anne Poole RN,Mr Stephen George Poole care home 48 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: 48 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 48, Physical disability (PD) 48 Date of last inspection Brief description of the care home Cheswardine Hall was built about 1880 in the style of a large country house, set in beautiful private grounds with a small lake. The home provides residential and nursing care for a maximum of 48 older people. It is owned and managed by Stephen and Anne Poole, both of whom take an active part in the daily operation of the Home. The homes furniture, decor, fixtures and fittings reflect the character and opulence of the house. Information on the service is available in the form of a statement of purpose Care Homes for Older People Page 4 of 29 Over 65 48 0 0 48 2 0 0 1 2 0 0 9 Brief description of the care home and a residents guide. Both documents are kept up to date with the latest information, are easy to read and can be available in other formats if required. The provider has a website. The weekly fee range is £375.00 to £875.00. Readers wishing to know more about this information should contact the service directly. Care Quality Commission Inspection reports for this service are available from the provider or can be obtained from www.cqc.org.uk Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection of the service was unannounced and was carried out by two inspectors over two days for approximately eight hours in total. A range of evidence was used to make judgements about this service to include discussions with people using the service, the manager and senior management team members, visitors, a visiting professional and staff. We also examined a number of records to include care records of people living at the home, staff training, staff recruitment and health and safety records. We also gained feedback from people who live at the care home, relatives, staff and visiting professionals from completed questionnaires. Some feedback is contained in the report. We looked at what the home has told us about what has happened since our last visit. These are called notifications and are a legal requirement. Four people who live in the home were case tracked this involves establishing Care Homes for Older People Page 6 of 29 individuals experience of living in the care home by meeting them, discussing their care with staff, looking at care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. An Annual Quality Assurance Assessment (AQAA) document was posted to Cheswardine Hall for completion. The AQAA is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for them to share with us areas that they believe they are doing well. By law they must complete this and return it to us within a given timescale. The proprietors completed this, and some of the information is included in the report. The purpose of the inspection was to assess all 22 Key National Minimum Standards for Care Homes for older people and any further standards necessary. Information to produce this report was gathered from the findings on the day and also by review of information received by CQC prior to the inspection date. A quality rating is provided throughout the report based on each outcome area for the people who use the service. These ratings are described as excellent/good/adequate or poor based on findings of the inspection. The weekly fee range is £375.00 to £875.00. Readers wishing to know more about this information should contact the service directly. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with information about the home so that they can make an informed choice that the home is suitable for them. Assessment of needs are not always undertaken prior to admission to determine if the home is able to meet their individual needs. Evidence: The home has designed an information pack which is made available to people thinking about moving in. This provides people with information about what they can expect from the service. There is also a website and e mail address available. We looked at the care records of two people who had moved into the home since our last inspection. Although the home told us in their completed AQAA and at our visit that pre assessment visits are an integral part of our homes pre-admission procedure we did not see any evidence on either of the files we looked at. Where someone had transferred from another care home a transfer letter was seen, and Care Homes for Older People Page 10 of 29 Evidence: where a social worker had been involved with another individual a care needs assessment from the social worker was seen. One person told us that their relative had visited the home before they moved in to look round. Most of the people who move into the home do so with the intention of making it their longer term home. However, there is provision for people to stay for shorter periods if they choose. We had feedback from someone who has used the service for a respite stay for their relative and told us my wife was looked after by the management and staff throughout her two week stay, excellent respite and nursing home, good personal service. We have no hesitation in choosing Cheswardine Hall should future developments arise. The home does not provide intermediate care. Care Homes for Older People Page 11 of 29 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. Assessments and care plans require further development to ensure peoples needs are fully met promoting their health and well being. Evidence: The care of two people who were resident at the home has been under investiagtion by the multi-agency adult protection process since our last key inspection. This focused on whether appropriate care had been provided to two people living at the home with pressure ulcers, and whether relevant outside professional agencies had been brought in to advise and treat them. Since that time we have found evidence that professionals such as the Community Nurses have been involved where necessary. The adult protection process has not yet reached a conclusion. We examined four care plans. Relevant risk assessments were in place in almost all of the records examined, including falls, pressure care, nutrition and continence. However we found areas where there were gaps which could lead to people not receiving the health care they need. Examples of these were, whilst staff were Care Homes for Older People Page 12 of 29 Evidence: correctly monitoring blood sugar levels, there was no information about what would be the normal range for the person and what action should be taken if the level was too high or too low. Care plans included wound management details but could be further developed by introducing a section for highlighting monitoring of skin integrity, given that this is a relevant topic for the type of issues developed by the age group of people who access the service. The wound care for someone admitted earlier this year resulted in a sacral wound healing within a month of admission. Photography as a means of recording progress is now being used with the consent of the individual concerned. Care plans should emerge from information known from information provided by pre admission assessments, which would further enhance the current information made available to staff. The file for a person admitted a week prior to this inspection contained only an admission sheet with basic details and hospital discharge information, a needs assessment had not been recorded and a plan of care was not in place. The nurse in charge on the day of the inspection told us that some training had been provided in wound management and the use of compression bandaging. However, the lack of records made it impossible for us to establish how many nursing staff had undertaken training to update their knowledge of wound care or any aspect of their ongoing professional development. The completed AQAA told us each resident is given the opportunity to select their own GP and given access to all NHS facilities in the community. We saw that people are supported to access the healthcare they need and there is evidence that advice is sought from the appropriate healthcare professionals and appointments are recorded in peoples notes. Input from the speech and language therapist, physiotherapist, district nurse and GP was recorded to have taken place. We spoke to a visiting district nurse who gave positive comments about the home referring those people who live in the residential care to the community nursing services when required. We received comments from another health and social care professional who completed and returned the questionnaire to us. They told us they felt peoples social and health care needs are properly monitored, reviewed and met by the care service. They also told us they felt the care service seek advice and act on it to meet peoples social and health care needs. When asked the question what does the service do well? they told us very efficient nursing care with appropriate review requests from healthcare professionals. Care Homes for Older People Page 13 of 29 Evidence: Care plans contained a record of input from other health care professionals involved in individuals care. For example the involvement of a district nurse. Care plans we sampled had been reviewed on a monthly basis. It was stated by a senior manager that they have reviewed all of the people who live at Cheswardine Hall to ensure that people are not deprived of their liberties. The home has made one application to the local authority but it was declined as the matter was considered by the deprivation of liberty safeguarding team not to constitute a deprivation. Both the registered manager and a senior manager have attended the deprivation of liberty safeguarding awareness training. The home has policies and procedures in place for the safe handling of medication. We looked at the medication administration records (MAR) and storage of medication. MARs had been signed when medication had been given indicating that medication had been given as prescribed. Medication receipt was satisfactory and in line with good practice. One person told us they receive their medicine regularly by the staff as their preference. We observed people to be treated with respect during the visit with their dignity and privacy being maintained. People confirmed that their individual privacy was respected. Staff were observed to talk with residents in a friendly and respectful way. One staff member who completed and returned a survey to us told us when asked what the home does well? it always ensures privacy and dignity are paramount. It has a very safe environment. People are encouraged to keep in touch with members of their families, people told us that their friends and families can visit when they wish and they can see their visitors in private if they wish. Eleven relative/carer/advocates completed and returned a survey about Cheswardine Hall six told us they always feel the care service meets the needs of their relative/friend, while five answered the service usually meets their needs. Comments from these people included excellent care, very caring staff. I am happy with the care given to my mother. Home seems to be run very well. A family run business that really cares about their residents, from managers, chef, laundry lady and carers who really do care. Cheswardine Hall looks after X very well. The day to day personal care is very good. My father is always clean and well turned out. The Poole family always take time to discuss my fathers needs with myself and my sister to keep us informed. One person told us they thought the home did well in Day to day care Care Homes for Older People Page 14 of 29 Evidence: in terms of cleanlines (both environmental and personal) medical attention and provision of health food. Care Homes for Older People Page 15 of 29 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. There are opportunities for the people living at the home to engage in recreational and social activities but these are not suited to all people and as a consequence those who are unable to participate in the arranged activities are likely to become uninterested. People are provided with healthy, well presented meals according to their dietary requirements and choice. Evidence: The home tries to obtain information about individuals likes and dislikes and we saw some information recorded in care plans. However, options seem to have reduced since our last key inspection particularly for those people who wont or cant engage in larger group activities. We saw the weekly activity plan on display in the home. This included a visit from the hairdresser three times a week, chair aerobics one afternoon, and games with staff on another afternoon. There is a film night held on Thursday with approximately 10 people who use this facility. A church service is held on Fridays and the mobile library visits every two weeks. A get together for those people who wish to join in happens on a fortnightly basis with tea and cakes in the music room. Care Homes for Older People Page 16 of 29 Evidence: Although activities are provided the needs and interests of some people living in the home are not fully met, because although the arranged activities may be suited to some, they are not suited to all. For example, the ball throwing game or chair aerobics. Some people we met have complex care needs and are unable to take part in group activities and would benefit from one to one activities. We discussed this with the senior managers of the home. We asked in a questionnaire what could the service do better? These were the comments we recieved from relative/carers who completed and returned the questionnaire about Cheswardine Hall more activities for the residents, encourage them to leave their rooms, when they self isolate themselves. We feel X needs more one to one attention, X has dementia and we feel they need more stimulation. Provision of more stimulating environment and activities for residents and I would like some focused one to one activities for my father. There is little focus in care plans on the preferences of individuals and how staff could promote their interests and daily quaility of life through social activities, and records seen show that some individuals had done very little. Some personal profiles in care plans were seen to be blank. Generally people we spoke to and those people who returned completed questionnaires to us said they were happy with the food although some comments were made about what changes they would like to see, we fed these back to the management team at the end of our visit. Other comments we received included food excellent like the variety of food available friendly staff love the chefs try to cut out on pastry desserts, like them every now and then. Menus looked balanced and offer a healthy eating option. We spent some time observing the lunchtime meal. There are two sittings held at lunch and those people who require assistance attend the first sitting. Lunchtime was relaxed, staff did not rush people through their meals and second helpings were offered. The menu reflected what was being served on the day of our visit. One relative told us the meals are tempting to older palates, and discussed in minute detail. My mother eats better and more than she has for years, and looks well on it. Care Homes for Older People Page 17 of 29 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 living at Cheswardine Hall have access to a complaints procedure, which is accessible and ensures the views of people are listened to. Some staff training has taken place, however because of a lack of evidence it is difficult to establish whether all staff have received the training and induction considered necessary to equip them with the skills to carry out their responsibilities. Evidence: People we spoke with told us they knew what to do if they were unhappy with the service they receive and reported that they have no concerns of complaints about the home. The complaints policy is made available to people in the homes information pack and in their contract. It was stated on the AQAA and confirmed by senior managers that there have been no complaints received since the last inspection. There have been no complaints to the Care Quality Commission. The completed AQAA told us it is true to say that most residents do not make any serious complaints, but sometimes raise little niggles about aspects of the service. These are also taken seriously and dealt with accordingly to this end we ensure that as many people as possible know that we have an established system, and know how to access it. Eleven relative/carer/advocates completed and returned a survey about Cheswardine Hall ten told us they knew how to make a Care Homes for Older People Page 18 of 29 Evidence: complaint and one stated they did not know how to make a complaint. It was confirmed by staff and on the completed AQAA that all staff are given training on how to report bad practice (whistleblowing) and the managers ensure that every effort is made to protect the residents by maintaining confidentiality and access to records. It was established through discussion with staff and examination of individual staff training files that not all staff have completed adult protection training as required in the national minimum standards for care homes for older people. This must be completed as a priority to ensure that people are protected from abuse at all times. As mentioned earlier in the report there is an ongoing adult protection investigation which has yet to be concluded. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Cheswardine Hall are provided with a clean and homely place to live, which is equipped to meet their individual needs and makes them feel safe and secure. Evidence: We took a partial tour of the home and found it to be clean and tidy. One respondent who completed and returned the questionnaire to us and told us the public and private rooms are very well maintained. The daily cleaning is impressive. Another told us environment is always calm and peaceful accommodation is very clean and comfortable. Ongoing renewal and maintenance of the home ensures that the service provides an environment that is well maintained for people who live there. People who use the service are encouraged to personalise their rooms according to their choice, and this was evident when we viewed the home. We were told that the home has had an infection control audit in March 2009, the outcome of which was positive. People told us that the standard of the laundry is good and they always wear their Care Homes for Older People Page 20 of 29 Evidence: own clothes because their clothes are labeled and dont get mixed up. Clothing looked well cared for on the day of our visit. Some staff have not completed infection control training whch should be provided to them. This will ensure they have the knowledge and skills to undertake their role in this area. The home is set in pleasant grounds and in nice weather can be accessed by people if they wish to sit and walk around the garden. We were told by one respondent who completed and returned the questionnaire to us when the weather is good residents are taken out into the fresh air in the landscaped grounds. Care Homes for Older People Page 21 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some staff training has taken place, however because of a lack of information it is difficult to establish whether all staff have received the training and induction considered necessary to equip them with the skills to carry out their responsibilities. Evidence: We looked at the files of five staff employed since our last inspection to make sure that pre employment checks are undertaken so that staff are checked as being suitable to work with vulnerable adults. Generally the files contained all of the information required to demonstrate a robust recruitment process is followed. All people consulted as part of the inspection told us that the staff treat them well and that they are happy with the care and support they receive. We observed staff supporting people throughout the day, they did this with respect and were professional at all times. Staff told us that they are given regular updates about people living at the home during handover on each shift, and supported through updated care plans. Staff we spoke to demonstrated a clear understanding of the peoples needs. All staff are formerly supervised and appraised, we saw records to support this. Staff spoken to told us they felt well supported by the manager of the home. Care Homes for Older People Page 22 of 29 Evidence: The homes induction process although stated on the completed AQAA is a comprehensive introduction, is not consistent with Skills for Care expectations and the home should address this so that staff are equipped with the knowledge and skills to support the people in their care. We were shown induction checklists which, were incomplete and in one case a completed induction record could not be provided. We asked the question to staff did your induction cover everything you needed to know to do the job when you started. Three staff completed and returned a questionnaire to us. One answered very well and the two answered mostly The completed AQAA told us staff training records confirm that the home has provided staff with internal and external training on the healthcare needs of residents including those who may be immobile for long periods of time. We were provided with evidence of completed staff training after the inspection by the provider, which confirmed staff are supported to attend training and further develop their knowledge and skills. It was acknowledged some staff require refresher training in safe working practices for example fire safety and protection of vulnerable adults. Information in the homes completed AQAA told us that plans for improvements over the next 12 months include to continue to support our staff in their NVQ accreditation studies and also to offer further opportunities for external training to complement our current mandatory training opportunities and to roll out our revised and updated internal training programme, which will support our existing core training with additional topical, care focus training modules designed to complement NVQ studies and further upskill our care team. The service told us in the what we could do better section of the management and administration outcome group of the AQAA that we recognise where improvements can be made with regards widening the training opportunities for our staff although mandatory courses are fully supported, our desire to provide further training to develop the knowledge, understanding and skill sets of our staff. Clearly this will benefit our staff and also importantly benefit the residents for whom they provide care. The managers also recognise the need to reflect more accurately the progress individuals are making with regards to their training achievements, this matter will be tackled as a priority to reflect the same level of professionalism and data standards as present in the recently revised and updated care planning files. The completed AQAA told us 80 of care staff are qualified to NVQ level 2, 40 are qualified to NVQ level 3 and 20 of care staff are working towards or due to start NVQ 2 in care, although confirmation of this could not be provided at our inspection visit. It was stated on the completed AQAA and also discussed at the key inspection the Care Homes for Older People Page 23 of 29 Evidence: homes intention to introduce the gold standards framework and preferred priorities in care initiatives for people in the end stages of their life. We spoke to staff who told us they had completed compression bandaging, wound management, verification of death and public access defibrillation update. One staff member told us teaching is very good for trained staff. Care Homes for Older People Page 24 of 29 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. Overall Cheswardine Hall is managed in the best interests of people living and working there. The management team have an understanding of the areas in which the service needs to improve in the best interests of people living at the home. Evidence: The home is managed by the registered manager who is assisted by her husband and joint manager and business partner. As of 2008 two of the providers sons who are both currently undertaking their NVQ 4 in management joined the management team. Currently the qualified nurses employed at the home lead on all clinical matters with the ongoing support of the multi disciplinary community team of GPs, district nurse, physiotherapists and other health care professionals who visit the home as and when required. We discussed the homes quality assurance process and were told that the annual surveys are due to be sent to people living at the home and relatives at the beginning of December. We saw feedback forms in the reception area inviting people to share their views. We were told by the home that there have been no completed forms returned at the time of our inspection. However, people we spoke with Care Homes for Older People Page 25 of 29 Evidence: expressed their satisfaction with the service they receive but commented that they did not have any formal means of making their views known, through residents meetings or a committee, and seemed to think their views were not always welcomed. Staff feedback about the registered manager was good and they told us they felt although they do not hold regular staff meetings the communication between management and staff is good. We looked at random routine maintenance checks required by regulation and found these to be in place. As reported earlier some staff need updating in fire safety training. The management of peoples finances was not looked at during this visit. However the completed AQAA told us service users are safeguarded by the accounting and financial procedures at the home. Our home has robust policies and procedures in place to ensure the management of individuals money. Care Homes for Older People Page 26 of 29 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 27 of 29 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 3 Provide evidence to show that the home has carried out its own needs assessment of people who have choosen to move into Cheswardine Hall. This is to ensure the home is able to meet the needs of the individual before they move in. Care plans could be further developed to provide more information to staff about the needs of the people they care for. This will ensure all health and social care needs are met. One to one activities are developed for those individuals who are unable to access group activities. This will ensure opportunities are provided for those who do not wish to or are unable to participate in group activities. All staff undertake infection control training. This will ensure staff have the knowledge and skills to undertake their role. New staff should receive induction training that is linked to the skills for care training. 2 7 3 12 4 26 5 30 Care Homes for Older People Page 28 of 29 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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