Care Home: Chevington Lodge Residential Home

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What the care home does well Interaction between the staff and people that lived at the home was observed to be professional and caring. Staff were attentive to the needs of people that lived at the home. Staff were knowledgeable about people`s individual needs and they were provided with changes in people`s needs and well being in regular care plan reviews and daily hand over meetings. Staff were provided with a good training programme that provided them with the information that they needed to meet the needs of people that lived at the home. The home was regularly monitored and people were asked about their views of the service in the regular quality assurance exercises, which included satisfaction questionnaires and regular audits. What has improved since the last inspection? People`s individual care plans provided detailed information of how people`s assessed needs were to be met. Staff recruitment records included evidence that the required checks were undertaken on staff that worked at the home, such as CRB (Criminal Records Bureau) checks to ensure that people were safeguarded by the home`s recruitment procedures. What the care home could do better: The home should provide adequate hand drying towels in all communal toilets to ensure that cross infection is minimised. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Chevington Lodge Residential Home 8 Flixton Road Bungay Suffolk NR35 1HQ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Julie Small     Date: 2 4 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. 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 Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Chevington Lodge Residential Home 8 Flixton Road Bungay Suffolk NR35 1HQ 01986892710 01986896490 info@chevington.f9.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Jean Margaret Clegg Type of registration: Number of places registered: Mr Malcolm Blackham,Mr Robert Blackham,Mrs Sally Crawford care home 42 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Chevington Lodge provides personal care to up to 42 older people with dementia in a large converted house in a residential area of Bungay. It is within a short distance of the town centre and is on a bus route. The home overlooks the river Waveney to the rear and is set in a sizeable garden, which is accessible to service users. A sensory garden to the front of the house has been completed and provides a safe and pleasant space for residents to use in good weather. The garden has been specifically designed for people with dementia and is a very positive and impressive addition to the environment of the home. Accommodation in the home is on three floors and consists of 36 single bedrooms and three double bedrooms. Of these 28 have en suite facilities. There are a number of communal areas including the main lounge, a garden room, a Care Homes for Older People Page 4 of 32 Over 65 42 12 0 0 Brief description of the care home television lounge, a quiet lounge, two dining rooms and space for service users to entertain guests in private. Care Homes for Older People Page 5 of 32 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 quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The unannounced inspection took place on Wednesday 24th September 2008 from 10.45 to 19.25. The inspection was a key inspection, which focused on the core standards relating to older people and was undertaken by regulatory inspector Julie Small. The report has been written using accumulated evidence gained prior to and during the inspection. The registered manager and the providers were present during the inspection and they provided the requested information promptly and in an open manner. Care Homes for Older People Page 6 of 32 During the inspection four staff recruitment records, staff training records, the care plans of four people who lived at the home and fire safety records were viewed. Further records viewed are detailed in the main body of this report. Four staff members, a relative of a person that lived at the home and three people who lived at the home were spoken with. Prior to the inspection an Annual Quality Assurance Assessment (AQAA) and surveys were sent to the home to provide people with an opportunity to share their views about the service. The AQAA, one relative/visitor survey and three staff surveys were returned to us. The fees at the home range from 495 - 565. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 32 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 32 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 can expect to be provided with the information that they need to make an informed choice about where to live and to be provided with a needs assessment before they move into the home to ensure that their assessed needs are identified and met. The home does not provide an intermediate care service. Evidence: The Statement of Purpose was viewed and included the information about the home which people needed that enabled them to make decisions about where to live and about the services that were provided at the home. The Statement of Purpose included the aims, objectives of the home, peoples rights, dignity and choices, fire safety, details of the managers and staff training and qualifications, the procedure for making complaints including the contact details of CSCI (Commission for Social Care Inspection), quality assurance activities which included the results from the last satisfaction questionnaires, the services that were provided by the home and details Care Homes for Older People Page 10 of 32 Evidence: about the environment. The home also provided a relative and resident information pack, which included a summary of the information that was provided in the Statement of Purpose, the terms of residence, which detailed what service people could expect to be provided with and a list of items that was suggested for people to bring to the home with them when they moved in, such as toiletries and items of clothing. The AQAA stated relative/resident information pack is very informative, showing photographs of the home and includes terms of residency. A relative survey stated if they usually received enough information about the home to help them to make decisions. A person that lived at the home was spoken with and they said that a relative had lived at the home and that they had told them about the home. The person said that they had also visited the home prior to deciding if they wanted to move in. The records of four people who lived at the home were viewed and they included the local authority needs assessments for those who were local authority customers, a record of the persons details that were provided at the point of referral to the home and a needs assessment that was completed by the management of the home. The needs assessments identified the support that each person needed and preferred on a daily basis. The assessments included details of their support and daily care needs, continence, dietary needs, communication, medical history and medication. The records also contained stars assessments, which were tick box documents that identified peoples abilities in areas such as nutrition, comprehension, expression, memory, aggression, eating and dressing. The AQAA stated that they collect evidence from the social worker and other health professionals, including talking to prospective residents/relatives for their individual requirements. The peoples records that were viewed included care plans, which identified how their assessed needs were met and they were regularly updated with the peoples changing needs and preferences. Care Homes for Older People Page 11 of 32 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. People can expect to have their needs and preferences set out in an individual care plan, to have their health care needs met, to be protected by the home’s medication procedures and to be treated with respect. Evidence: The support that people needed and preferred to meet their assessed needs were recorded in an individual care plan. The care plans of four people who lived at the home were viewed and they included details of the persons personal care requirements and preferences in areas such as their communication, mobility and dietary needs. The care plans included details of the peoples preferences regarding when they usually got up in the morning and the time that they preferred to go to bed. The care plans were reviewed on a monthly basis to reflect the persons changing needs and preferences and the review documents included the persons progress and if there were any changes in their condition. The peoples records that were viewed clearly identified how their needs had changed for example with difficulties with Care Homes for Older People Page 12 of 32 Evidence: swallowing solid food and stiffness in a persons body and how their changing needs should be met. The daily records that were viewed identified how staff had observed their condition and actions that they had taken to meet their needs. The care plans included life stories that were provided by family members and the person that provided a history of their lives, which helped to meet their assessed needs. The providers were spoken with and explained that the life story work assisted them in developing individual care plans and enabled the staff to know the individual better, such as their preferred routines. The care plans viewed included risk assessments, which identified the possible risks in peoples daily living and methods of minimising the risks. The risk assessments included manual handling, falls, walking and pressure areas. The home also maintained environmental risk assessments, which identified the risks and methods of minimising the risks of each area of the environment, including peoples bedrooms and communal areas. People that lived at the home and a relative of a person that lived at the home who were spoken with confirmed that their needs were met and that they were happy with the service that they were provided with. A relative survey stated that they usually felt that their relatives needs were met at the home and that their relative was usually provided with the support that they expected or agreed. Three staff surveys stated that they were always given up to date information about the needs of the people that they supported and one survey commented any changes that occur i.e. conditions etc, the care plan is updated and all the carers are made aware of any changes with residents. Two staff surveys stated that the ways that they passed information on about people always worked well and one stated that it usually did. One survey commented we have a full hand over for each shift. The manager will report to all carers on each shift any changes. Whatever happens all residents have a care sheet which is filled in by the carer night and day these are read out in handover. Staff spoken with had a clear understanding of peoples individual needs and how their needs were met. They confirmed that the care plans were informative and explained how they should meet peoples individual needs and that the hand over meetings were informative about what has happened with each person. The AQAA stated comprehensive care plan drawn up with relative and reviewed on a monthly basis. Review chart set up to enable clear management of care plan reviews. Care Homes for Older People Page 13 of 32 Evidence: People living at the home were provided with support that ensured that their health care needs were met. Four peoples records that were viewed included details about how their individual health care needs were met, which included details of the health care treatment that they had received, such as from the GP, dentist, chiropodist and optician. Daily records were maintained which identified peoples well being and daily activities. Records were maintained which identified where staff had observed changes in peoples health conditions, such as where they had noted areas of the body that were sore and how staff should be observant of their condition and how the areas should be kept clean. There were records of where people had fallen and actions which had been taken in the prevention of falls. A person that was spoken with reported that the staff called a doctor promptly if they had concerns about their well being. A relative of a person that lived at the home confirmed that their relatives health needs were met. The AQAA stated excellent relationship with the home doctor and district nurses. Consultant psychiatrist making regular reviews with residents requiring his services giving comprehensive feedback and good management of skin care. It was noted during the inspection that people’s privacy was respected. Staff were observed knocking on bedroom and toilet doors and waiting to be invited in, before entering them. a staff member was observed to ensure that the bathroom door was closed when they were supporting a person with their personal care. A staff member was observed to ask a person to leave the communal area into a private room during the administration of cream to their leg and a person had stated that they did not want to leave the chair that they were sitting in, the staff member covered them with a screen which ensured that their privacy was maintained while they had cream administered to their knee. There were two shared rooms and both had curtains to ensure that their individual privacy was maintained. Staff were observed to be attentive to peoples needs and they were observed asking them if they would like drinks and if they were comfortable. The interaction between staff and people that lived at the home was observed to be caring and professional. It was noted that staff answered call bells promptly and people looked clean and tidy. A person that lived at the home and a relative that were spoken with confirmed that their privacy was respected and that the staff were caring and treated them with respect. The AQAA stated privacy and dignity covered in induction training. Monitored in audits, social contacts with relatives and friends encouraged. Key points covered in Care Homes for Older People Page 14 of 32 Evidence: Statement of Purpose. Medication was stored, handled and administered in a safe way, ensuring that people who lived at the home were safeguarded. The majority of people’s medication was stored in MDS (monitored dosage system) blister packs, which were administered from a secure medication trolley which was stored in a secure medication room when not in use. The medication record keeping safeguarded people with regards to the administration of medication. MAR (medication administration record) charts were viewed and were completed appropriately to show when people had taken their medication and when they had refused it and the reasons for refusing the medication, for example if they were not in pain and did not wish to take PRN (as required) pain relief medication. Peoples care plans that were viewed included a list of their prescribed medication. The controlled medication book was viewed and completed appropriately, which included the signatures of two staff to show that people had taken their medication and a running total of the administered and stored medication. The actual stored controlled medicines were checked against the medication records and it was found that it matched with the running total. The lunchtime administration of medication was observed and a staff member clearly explained the procedures for the safe handling of medicines. One person at a time was assisted with their medication, the staff member checked the records to ensure that they were administering the correct medication and dosage to the correct person, by checking the MAR charts for the persons name, photograph and the dosage of the prescribed medication. When people refused their medication the staff member was observed to remind the people what their medication was for. Following this two people decided that they did want to take their medication after all, which showed that staff were aware of the support that people required with memory loss. Training records were viewed and evidenced that staff who were responsible for administering medication were provided with medication training. The home had a medication procedure which clearly explained the safe handling, storage and handling procedures of medication. The AQAA stated that medication was audited monthly, ongoing accredited training. Good MAR sheet management Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to be provided with a choice of activities which they could choose to participate in, to be supported to maintain contacts, to be supported to make choices in their lives and to be provided with a balanced diet. Evidence: People were provided with a good activities programme which included visiting entertainers, boat trips, trips to the zoo using the community bus, singing, making picture frames, knitting, making cake mixtures, playing a game with balls which included discussing their weight and texture then throwing them, making dream catchers, discussing their previous employment, planting flowers in the garden, talking about the news on the radio and one to one activities including reading letters and reading the news paper. A staff member had bought in their pet rabbit, which people petted and stroked if they chose to. The activities book showed which people had participated in activities and if they had enjoyed them. Activities were provided at the home seven days a week and there were photographs in the home of activities that people had participated in. The AQAA stated employ activities co ordinator. Organise outside trips. Organise Care Homes for Older People Page 16 of 32 Evidence: internal events i.e. fete, raffles (Christmas and Easter). Introduction of chore based activities centred around the new kitchen facilities. Beauty therapist. During the inspection people were observed to be chatting to staff, reading books, watching television and listening to the radio. A staff member was observed supporting a small group of people with art work. A person that was spoken with reported that there were plenty that they could do to keep them busy and a relative stated that there were trips, visiting singers and various activities that their relative could choose to participate in. Care plans that were viewed included information about the contacts that people maintained with their family members and friends. People that lived at the home and a relative that were spoken with said that their family and friends were welcomed into the home. A relative stated that they could help themselves to a cup of tea when they visited, from the new kitchen area, this was confirmed by the manager and the providers who reported that the kitchen area allowed visitors and people that lived at the home to prepare drinks for themselves. During the inspection people were observed to receive visitors from family members and friends. The interaction between staff and visitors was observed to be friendly and professional. People spoken with said that the staff at the home listened to them. One person spoken with said that the staff had put their name on their walking frame, which ensured that they did not lose it. They said that they had been concerned that someone would take it away, the staff had listened to the persons concerns and took actions to ensure that the person was happy. The care plans that were viewed detailed the preferences that people had, which included the times that they preferred to go to bed, how they wished to be addressed by staff, their likes and dislikes with food and drinks and how staff should provide them with daily choices, such as what clothes they wished to wear. A relative survey stated that people were usually supported to live the lives that they chose. The AQAA stated the use of life story and care plans enables us to be aware of residents choices. Strong promotion to personalise their own rooms. During the inspection it was noted that people were provided with choices such as their meal and drink choices and what they wanted to do during the day. People spoken with said that the quality and the quantity of food was very good and a staff member reported that people were provided with choices of alternatives if they Care Homes for Older People Page 17 of 32 Evidence: did not wish to have the meals that were on the menu. People who lived at the home were provided with a diet which was appealing and nutritious. The menu was viewed and it was noted that the planned meals were balanced and nutritious. On the day of the inspection the main meal gammon, potatoes, fresh vegetables and chocolate sponge with sauce. Softened meals were softened separately which provided people with the opportunity to enjoy the different colours and tastes of their meal. People were observed to be provided with drinks regularly throughout the day. The dining rooms were provided with sufficient tables for people to enjoy their meals at. People that required assistance to eat their meals were supported by staff who sat next to them during their meal and remained with them until they had finished their meal. Staff were observed to speak the people that they were supporting about what they wanted on their fork next, if they were enjoying their meal and if they wanted to continue to eat. It was noted that the staff made efforts to ensure that their meal time was enjoyable, for example a staff member said ooh look (the persons name) chocolate pudding do you want some? and that people maintained as much independence as possible, for example a staff member supported the person to hold their fork and they said you hold it and I will help you. Peoples care plans that were viewed clearly identified peoples specific dietary requirements, food allergies and the support that people required with eating. One care plan that was viewed identified that the person had been unable to swallow their food, they were observed by staff and then a softened diet was provided which assisted them in swallowing their meal. The AQAA stated creation of a pleasant and unhurried atmosphere. Small group dining enabling a more positive experience. New facilities enable some residents to independently make cups of tea. Care Homes for Older People Page 18 of 32 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 can expect to be protected from abuse and to have their complaints and concerns listened to and acted upon. Evidence: People were provided with the information that they needed to enable them to make complaints about the service that they were provided with. The home had a complaints procedure and a summary of the procedure was included in the Statement of Purpose and relative and resident information pack. The AQAA stated that they had received one complaint in the last twelve months which had been resolved within twenty eight days and that they act on any issues at Chevington Lodge. The complaints procedure is in resident/relative information pack. We notify CSCI of any issues. We try to nip any problem in the bud before they have chance to escalate. The complaints and compliments book was viewed and concerns and complaints were dealt with in a timely manner and there were several letters and cards from relatives thanking the staff at the home for the support that they had provided to their relative. One staff members records included a letter from a relative thanking them for the support that they had provided to their relative when they moved into the home, lived at the home and when they had died. A range of cards and letters of thanks were Care Homes for Older People Page 19 of 32 Evidence: viewed, which were from family members of former residents thanking the staff for the care and support that they had provided their relative with. Three staff surveys said that they knew what to do if a resident, relative, advocate or friend had concerns about the home. One relative survey stated that they knew how to make a complaint and that the home had usually responded appropriately if they had raised concerns. A staff member who was spoken with explained that they observe people for signs of distress, when they were unable to communicate issues verbally and that they acted upon areas that people were not happy with. Staff were informed of their responsibilities in safeguarding adults who lived at the home by the homes safeguarding policy and procedure and by attending adult safeguarding training, which was evidenced in the training records that were viewed. Staff spoken with were aware of their responsibilities in the protection of people who lived at the home. The AQAA stated that there had been no safeguarding referrals in the last twelve months and abuse training, management protection on vulnerable adults, solid recruitment practice i.e. POVA (protection of vulnerable adults) and CRB (Criminal Records Bureau), regular audits on residents finances. Care Homes for Older People Page 20 of 32 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 can expect to live in an environment which is clean, safe and well maintained. They cannot be assured to be provided with adequate hand drying facilities to minimise cross infection. Evidence: People were provided with a clean, safe and well maintained environment to live in. At the time of the inspection it was noted that the home was clean, attractively furnished and well maintained and there were no unpleasant odours. A tour of the building was undertaken and it was noted that the communal areas were clean, comfortable, well maintained and tidy. People spoken with were complimentary about the environment that they lived in and they reported that the home was always clean and and a pleasant place to live in. The communal lounges and dining areas were light and airy, with sufficient comfortable seating for people to use. The manager and providers explained how the home decor and furnishings of the home were maintained to a good standard and recent audits that were sent to us identified that parts of the communal areas had been redecorated. One dining area had been refurbished and provided a kitchen area where visitors and people that lived at the home could make themselves drinks. The Care Homes for Older People Page 21 of 32 Evidence: AQAA stated maintenance programme includes house checks and audits. Managed area for people of a similar disposition. Secure sensory garden. Small dining area. Individual lounges including quiet room, therefore offering plenty of choice. Developing of kitchen area for people with dementia. Providing a light airy fresh environment with views over the countryside. Extensive grounds for accompanied walking. People’s bedrooms that were viewed were clean, well maintained and held their personal memorabilia which reflected their individuality and choice. It was noted that the bedrooms provided attractive views of the grounds. The provider explained that people were provided with a wander mat in their bedroom as well as the call bell, to ensure that people were provided with the appropriate support if they were confused about the ways that they could call for staff. Each persons bedroom door provided a name plate, which also included a picture of something that they recognised as personal to them, such as a photograph of their younger days or pictures of something that they enjoyed, such as pictures that linked to photography. The manager and the providers explained that the pictures were to enable people with dementia to recognise the whereabouts of their bedroom doors. There were also pictures on the bathroom and toilet doors to ensure that people could identify the appropriate rooms that they needed to use. The gardens of the home were secured, attractive and well maintained. There was seating provided for people to use if they chose to. The providers explained that they had developed a sensory garden which people with dementia could enjoy. The activities book that was viewed showed that people were supported in planting flowers, which provided them with the opportunity of contributing to the attractive garden. The laundry area was clean and contained washing and drying machines and hand washing facilities, including liquid soap and disposable paper towels. Communal toilets and bathrooms provided hand wash liquid, however not all communal toilets provided disposable paper towels to minimise the risks of cross infection. The provider explained that the they used fabric towels because they were familiar to people with dementia and that they were more likely to use them, however, they understood the issues of cross infection with using fabric towels and would provide disposable towels. Sluice rooms provided appropriate hand washing and drying facilities which minimised cross infection. Staff were observed using good infection control procedures during the inspection, which included washing their hands and wearing protective clothing when working with food and issues of personal care, which protected people from cross infection. Staff spoken with had a knowledge of good infection control procedures. Staff training records were viewed and staff were provided with infection control training. It was Care Homes for Older People Page 22 of 32 Evidence: noted during a tour of the building that one toilet floor was wet and soiled, this was dealt with immediately once the provider had seen it. The AQAA stated good cleaning programme, remote laundry area, bed sheets cleaned by outside contractors. Management team focused on infection control. Care Homes for Older People Page 23 of 32 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 can expect to be supported by staff that are trained and competent to do their jobs and to be protected by the homes recruitment procedures. Evidence: During the inspection staff were observed to meet the needs of people, they responded to call bells promptly and they were attentive to peoples needs. Staff were observed chatting to people, they were caring and patient when people were confused about their environment and the people around them. During the lunch it was observed that there were sufficient staff numbers to enable them to assist individual people with their meals. The staff rota was viewed and it was noted that the home was staffed throughout the twenty four hour period. A staff survey stated that there were always enough staff to meet the individual needs of the people who lived at the home and two stated that there were usually enough staff and one commented we have eight staff on am and pm so that we can cater for the needs of residents. Staff spoken with reported that they felt that there were sufficient staff on duty at all times to meet the needs of people. People that lived at the home that were spoken with reported that staff were available when they were needed them and that they were very nice. A relative of a person that lived at the home that was spoken with stated that the staff were attentive Care Homes for Older People Page 24 of 32 Evidence: to their relatives needs and that they thought that there were adequate numbers of staff to support the people that lived at the home. The AQAA stated good range of age and ability. Good rota system. Positive atmosphere within the home. Positive feedback from relatives regarding staff. Four staff recruitment records were viewed and they held all the required documentation which ensured that people were safeguarded by the homes recruitment procedures. The recruitment records included CRB (criminal records bureau) checks, their work history and two written references. Three staff surveys stated that their employer had carried out checks, such as their CRB and references, before they started work and one commented my CRB clearance was passed before I started work. The providers explained methods that they used to ensure that overseas workers met with their requirements, which included visits, telephone conversations and probationary periods. Staff training records viewed evidenced that newly appointed staff were provided with an in house induction, which included instruction on the expectations of them in the home in areas such as health and safety and reporting and recording. They were provided with an induction based on the Skills for care Common Induction Standards. During the inspection a newly appointed staff member was observed working on their induction with the training manager. The staff member reported that they were enjoying the induction and that it was informative. Three staff surveys stated that their induction covered everything that they needed to know to do the job when they started and one commented we were given all training and do not work alone until our trainer and manager were satisfied that we were competent and confident with residents. Staff spoken with confirmed that they were provided with an induction when they started working at the home and several training courses, which provided them with the information that they needed to meet the needs of people. Newly appointed staff were also provided with the support from a named experienced staff member that acted as a mentor during their induction period. The training manager was spoken with and explained how they managed the staff training at the home and ensured that the required updates, such as with manual handling, were provided in a timely manner. The training certificates and a training matrix were viewed and showed that staff were provided with training courses such as manual handling, first aid, adult safeguarding, fire safety, health and safety training, managing challenging behaviour, person centred planning people with dementia, food hygiene, dementia awareness and MUST training. The training manager also explained an Alzheimers awareness eight week training programme yesterday, today and Care Homes for Older People Page 25 of 32 Evidence: tomorrow, which informed staff about the specialist support that people that lived at the home required. Staff spoken with stated that they received appropriate training to support them in meeting people’s needs. Three staff surveys said that they were provided with training which was relevant to their role, helped them to understand and meet the individual needs of people and kept them up to date with new ways of working and that they felt that they had the right support, experience and knowledge to meet the different needs of people. The home had met the target of 50 staff to have achieved a minimum of NVQ (National Vocational Qualification) level 2 by 2005, which was identified in the National Minimum Standards relating to older people, which showed that staff had been assessed as competent in their job in meeting people needs. The AQAA stated positive culture with NVQ. More staff undertaking NVQ 3 and senior care achieved NVQ 3 and NVQ 4. Care Homes for Older People Page 26 of 32 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. People can expect to live in a home which is managed by a person that is fit to be in charge, that staff are appropriately supervised, that is run in their best interests, that their financial interests are safeguarded and that their health and safety is promoted and protected. Evidence: The home was managed by a person that was fit to be in charge, who had been assessed as fit by the CSCI registered manager application process and who had achieved an NVQ level 4. The deputy manager had also achieved an NVQ level 4 and deputised for the manager in their absence. The manager and the deputy manager were spoken with and had a clear understanding of their roles and responsibilities. The manager regularly updated their knowledge by attending training courses, such as fire training, medication, manual handling and nutrition. The manager was supported in their role by the providers of the home and during the Care Homes for Older People Page 27 of 32 Evidence: inspection they were provided with a supervision meeting. Supervision records were viewed and showed that staff were provided with regular supervision meetings where they could discuss issues with their work role and people that lived at the home. The AQAA stated that they had a good management of staff supervision. There were regular monthly, quarterly and annual audit visit reports available in the home, which had been undertaken by the providers to show that the running of the home was monitored on a regular basis. The reports were routinely forwarded to CSCI for our information, the audits included discussions that the providers had undertaken with people that lived at the home to monitor their satisfaction with the service that they were provided with. The AQAA stated that they provided effective quality assurance system on a daily, monthly, quarterly and yearly basis. Annual satisfaction questionnaires were undertaken, which identified if the people that lived at the home were satisfied with the service that they were provided with. The results of the most recent questionnaires were summarised in the Statement of Purpose and relative and resident information pack for the attention of those with an interest in the home. The homes procedures for safeguarding peoples finances were viewed and it was noted that they were detailed and provided sufficient information to staff who supported people with their spending monies. The AQAA stated that they provided minimal responsibility for residents finances. What money is in safekeeping and is reconciled in audit. The records for people’s finances that were kept in the home for safekeeping were viewed. The records included a running total of peoples money, their spending and the receipts for the spending. The balance of two people’s money was checked and it was noted that the records and the balance matched. Peoples health and safety was promoted and protected in the home. Health and safety records were viewed and it was noted that regular safety checks and services were routinely made, such as water temperature, fridge and freezer temperatures, lifts, hoists, assisted baths and electrical appliance safety. Fire safety records were viewed and monthly checks were undertaken of fire safety equipment by the maintenance worker, quarterly checks were undertaken by a fire safety company. The provider explained that the fire alarm system identified when faults were present. The provider was spoken with about the frequency of the fire checks and they reported that the day after the inspection they had contacted a fire officer. They stated that the fire officer had stated that it was recommended to make weekly fire safety checks but that the home had took compensatory action by ensuring that the quarterly checks by the fire safety organisation were undertaken more Care Homes for Older People Page 28 of 32 Evidence: regularly than the required time scales of annual checks. However, the provider stated that following the discussion with the fire authority they would undertake weekly fire checks. The home had a fire risk assessment, for which one of the providers had attended training in. It was noted during the inspection that fire doors were closed in line with fire safety. The providers explained further efforts they had made to ensure that people that lived at the home were safeguarded, which included the provision of a document to contractors that enter the home, for which they were asked to sign to agree that they would, for example, ensure that they would ensure that their tools were secured at all times and not available for the people that lived at the home. Staff training records viewed and discussions with staff evidenced that they were provided with health and safety related training such as food hygiene, manual handling, fire safety and infection control to ensure that staff had been notified of safe working practices. The homes policies and procedures were viewed and included food hygiene, manual handling, fire safety, health and safety and the COSHH (control of substances hazardous to health) which were available for staff reference to ensure that people were supported in a safe manner. Care Homes for Older People Page 29 of 32 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 30 of 32 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 26 It is recommended that suitable arrangements are made for hand drying in all communal toilets to prevent cross infection It is recommended that the fire safety checks are made which meets with the fire authority recommendations 2 38 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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. 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