Care Home: Cheviot Nursing Home

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What the care home does well The premises are secure, clean, well maintained, well decorated and comfortable furnished with appropriate aids to enable residents full access. The gardens are attractive, well kept and accessible to residents and wheelchairs users. Care planning is individualised to meet residents` changing needs and is regularly reviewed. Excellent standards of personal and nursing care are provided and there is good access to specialist health care services. The home works closely with the local hospice and specialist team to provide high standards of palliative /end of life care. Support is given to relatives who are able to stay overnight should they wish. There is good staff communication with regular handover between shifts and frequent discussions to discuss and find solutions with regard to residents` changing needs. Social and therapeutic activities are provided by staff to meet the individual needs of residents. This includes meaningful activities for individual residents and themed days to provide stimulation and enjoyment for all residents and staff. Staff are robustly recruited, well supported and well trained and there is good teamwork. There are no agency staff employed. Staffing levels are appropriate for residents` needs and enable staff to spend time interacting with them. Staffing levels are increased to meet the dependency needs of residents receiving end of life care and intermediate care. The home has a quality assurance programme in place that includes residents, their representatives and other stakeholder consultation, with regular audits and an annual plan for the home. There are good standards of health and safety with regular maintenance and refurbishment. The home is well managed and the manager is well supported by senior management. What has improved since the last inspection? Administration of medicines had improved. The premises have had fire closures fitted to residents` rooms. Fire plans are now on display in reception and the main corridor of the home. Corridors have been repainted and a new washing machine has been purchased. The kitchen has been refurbished and new equipment and safer storage provided. Alcohol gel has been introduced for visitors to reduce the risk of i infection and a rota wash ands steam cleaner has been purchased to assist with minimising the risk of infection. The facilities for relatives has improved and a new sofa bed purchased for overnight stays. New flooring has been laid in the staff cloakroom and rest room. The manager now has her own office to enable her to meet with residents and their relatives in private. Additional profiling beds and hoist slings have been purchased. Wheelchair scales have also been purchased to enable wheelchair users to be weighed and therefore monitor their nutritional intake more accurately. A hot water dispenser has been provided in the kitchen in the small lounge and a digital lock fitted for safety. A booklet of photographs has been complied and is used to reassure prospective residents by showing them images of the home, the staff, the home`s pet rabbit and the visiting PAT dog. The syringe driver policy has been reviewed. Updated medication training has been provided for all nurses in addition to the annual syringe driver training. A dignity programme had been established to promote residents` dignity and encourage staff to maintain high standards in upholding the privacy and dignity of residents. Time has been allocated for key carers to spend with residents. Night bites have been introduced to tempt residents` appetites. A water dispenser has been purchased and small drinks of water are provided in cones throughout day to prevent dehydration. Toiletries are new provided for intermediate care guests and small china bells have been made available on tables in the dining areas, to facilitate requests for assistance more quickly. Fire drills are more structured and fire training has been adapted to the environment. The safeguarding policy has been reviewed. A Mental Capacity Act Policy and Procedures has been written and approved by the Adult Safeguarding Team. Mental Capacity Act training has been introduced which has raised awareness and brought about some positive change. The Deputy Manager has attended Train the Trainer on the Mental Capacity Act and continues to provide training throughout the Trust. The Manager and one trained nurse have attended Deprivation of Liberty training. The manager is attending a leadership development programme. Health and safety checks had been introduced to check foam mattresses for evidence of deterioration and prompt replacement. What the care home could do better: The room temperature of medication storage should be monitored to ensure it remains within safe recommended levels(25 degrees centigrade). Key inspection report Care homes for older people Name: Address: Cheviot Nursing Home 11 Park Road Colchester Essex CO3 3UL     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Diana Green     Date: 0 8 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Cheviot Nursing Home 11 Park Road Colchester Essex CO3 3UL 01206763648 01206763987 cheviot@balkernegardens.fednet.org.uk www.balkernetrust.org.uk Balkerne Gardens Trust Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Tania Claire O`Keefe Type of registration: Number of places registered: care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: 1. The registered person may provide the following category/ies of service only: Care home with Nursing Code N 2. The maximum number of service users who can be accommodated is: 33 to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Physical Disability Code PD Old age, not falling within any other category Code OP Date of last inspection Brief description of the care home Cheviot Care Home provides nursing and personal care with accommodation for up to 33 older people. The home provides intermediate care, a short term rehabilitative Care Homes for Older People Page 4 of 29 Over 65 33 0 0 33 Brief description of the care home service and is also registered to care for service users with a terminal illness. Cheviot is owned by a charitable organisation, named Balkerne Gardens Trust Limited. The home is located in a quiet cul-de-sac within walking distance from Colchester town centre. The home was opened in 1989 and consists of a two-storey building with a newer purpose built wing also two-storey. There are 29 single en-suite bedrooms and 2 double en-suite bedrooms. There is a passenger lift. The home has enclosed gardens to the rear of the property that are attractive and accessible to wheelchair users. Cheviot is accessible by road and rail and the nearest station is in Colchester. Parking is available in the small car park and adjacent road. The fees for the home are £810.11. Additional charges are made for newpapers, toiletries, chiropody and hairdressing. This information was provided on 8th April 2010. 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: 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 3 star. This means that people who use this service experience excellent quality outcomes. This unannounced inspection took place on 8th April 2010. All of the Key National Minimum Standards (NMS) for Older People, and the intended outcomes, were assessed in relation to this service during the inspection.The report has been written using accumulated evidence gathered prior to and during the site visit, including the agencys Annual Quality Assurance Assessment (AQAA). The Annual Quality Assurance Assessment (AQAA), which is required by law to be completed by the service, is a self assessment that focuses on how well outcomes are being met for people using the service. This was completed by the registered provider and returned to us prior to the visit to the home. Information received in the AQAA provided us with some detail to assist us in understanding how the registered persons Care Homes for Older People Page 6 of 29 understand the services strengths and weaknesses and how they will address them. The inspection process included reviewing documents required under the Care Home Regulations. A number of records were looked at in relation to residents, staff recruitment and training, staff rotas and policies and procedures. Time was spent talking to residents, their relatives, staff, the manager and Deputy Director who was in attendance on the day of the inspection. The Deputy Director, manager and staff were welcoming and helpful throughout the inspection. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? Administration of medicines had improved. The premises have had fire closures fitted to residents rooms. Fire plans are now on display in reception and the main corridor of the home. Corridors have been repainted and a new washing machine has been purchased. The kitchen has been refurbished and new equipment and safer storage provided. Alcohol gel has been introduced for visitors to reduce the risk of i infection and a rota wash ands steam cleaner has been purchased to assist with minimising the risk of infection. The facilities for relatives has improved and a new sofa bed purchased for overnight stays. New flooring has been laid in the staff cloakroom and rest room. The manager now has her own office to enable her to meet with residents and their relatives in private. Additional profiling beds and hoist slings have been purchased. Wheelchair scales have also been purchased to enable wheelchair users to be weighed and therefore monitor their nutritional intake more accurately. A hot water dispenser has been provided in the kitchen in the small lounge and a digital lock fitted for safety. A booklet of photographs has been complied and is used to reassure prospective residents by showing them images of the home, the staff, the homes pet rabbit and the visiting PAT dog. The syringe driver policy has been reviewed. Updated medication training has been provided for all nurses in addition to the annual syringe driver training. A dignity programme had been established to promote residents dignity and encourage staff to maintain high standards in upholding the privacy and dignity of residents. Time has been allocated for key carers to spend with residents. Night bites Care Homes for Older People Page 8 of 29 have been introduced to tempt residents appetites. A water dispenser has been purchased and small drinks of water are provided in cones throughout day to prevent dehydration. Toiletries are new provided for intermediate care guests and small china bells have been made available on tables in the dining areas, to facilitate requests for assistance more quickly. Fire drills are more structured and fire training has been adapted to the environment. The safeguarding policy has been reviewed. A Mental Capacity Act Policy and Procedures has been written and approved by the Adult Safeguarding Team. Mental Capacity Act training has been introduced which has raised awareness and brought about some positive change. The Deputy Manager has attended Train the Trainer on the Mental Capacity Act and continues to provide training throughout the Trust. The Manager and one trained nurse have attended Deprivation of Liberty training. The manager is attending a leadership development programme. Health and safety checks had been introduced to check foam mattresses for evidence of deterioration and prompt replacement. 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 9 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 10 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People planning to live at Cheviot can be assured they will have full information to enable them to make a decision and they will received a full assessment of their need prior to admission to ensure they can be met. Evidence: The home had a statement of purpose and service user guide that included the aims of the service and the philosophy of care and met regulatory requirements. Information leaflets were seen on display for residents and visitors information, ensuring they had access to a range of information including for example, on the Mental Capacity Act and Deprivation of Liberty Standards. Completed surveys received from residents and their representatives confirmed they had received sufficient information to make a decision before moving into the home. The admission procedures were discussed with the manager of the home. Referrals were accepted by telephone and information on care needs obtained including a copy Care Homes for Older People Page 11 of 29 Evidence: of the community care assessment provided by the social worker. Prospective residents and /or their relatives were encouraged to visit the home and view the accommodation. A telephone call was received from a relative during the visit to the service and they were encouraged to view the home and to receive further information. We were informed that assessments were undertaken either in the persons own home, care home or hospital. A pre-admission assessment was undertaken using a pre-assessment form as a prompt to discuss care needs. Key workers were introduced as soon as possible with some attending the assessment prior to the residents admission. Information was used following admission to complete a full assessment and care plan. Three residents care plans were viewed during the visit to the service. All included a very detailed pre-admission assessment form that provided key information on the residents care needs from which a care plan could be developed. Care records viewed included very detailed care plans for care needs (maintaining a safe environment, mobilising, communicating, eating, drinking, eliminating, breathing etc.) The home provided an intermediate care service which included some residents being admitted to prevent hospital admission. Residents were cared for in a separate wing of the home with access to rehabilitation facilities. The service included support by occupational therapists and physiotherapists, in addition to the personal and nursing care provided at the home. Positive feedback was received from health and social care professionals about the standard of the service provided. Care Homes for Older People Page 12 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that their individual health and personal care needs will be met and their privacy and dignity will be upheld. Evidence: Three residents care records were viewed during the site visit. All three contained a pre-admission assessment detailing the residents care needs. Care plans were seen for maintaining a safe environment, mobilising, communicating, eating and drinking, eliminating, personal care, breathing, resting and sleeping, controlling body temperatures, expressing sexuality, spiritual needs and dying. All care plans were detailed with the individual needs and preferences of the resident showing that these had been discussed and recorded to ensure staff had guidance when providing their care. Evidence of the residents or representatives agreement was seen in each of the care plans viewed. Nutritional risk assessments were undertaken on admission and reviewed with weight monitoring also undertaken monthly. Risk assessments were seen for risks associated with manual handling, use of bed rails, tissue viability and Care Homes for Older People Page 13 of 29 Evidence: self medication. All had been regularly reviewed ensuring that residents changing needs were assessed and that staff had information to be able to meet them. Daily records provided good detail of how the resident spent their day and recorded any changes in their condition or mood and the action that had been taken as a result. The records showed that residents received regular health screening (pulse, temperature, blood pressure, urine testing) as relevant and were regularly seen by a GP and nurse practitioner. The residents care records viewed also confirmed they had received visits from their GP, intermediate care nurse, chiropodist, occupational therapist, physiotherapist and Macmillan nurse. The medication systems were discussed with the manager and a registered nurse. Medication was administered by registered nurses and a list of staff signatures and initials was maintained to enable appropriate follow up in the event of an adverse incident. The home had a medication policy and procedures that had recently been reviewed and provided comprehensive guidance for staff. Very detailed procedures were available for staff guidance including for example for people receiving intermediate care. Medication was supplied from the local supplying pharmacist in monitored dosage systems and individual containers. Medication was stored in a clinical room and stored in a locked trolley that was secured to the wall. A drug refrigerator was also available and temperatures were monitored and recorded. However there was no record of room temperatures being monitored to ensure medicines were stored within safe recommended levels (maximum 25 degrees centigrade). The medication storage and medicines administration records for three residents were examined. All medication was available as prescribed and records were recored accurately. There was a cupboard for CD storage that met requirements and a CD register that was recorded accurately and in full with entries of the name and address made on receipt of CD drugs on discharge/disposal. There had been one medication error recently involving medication given via a syringe driver that was discussed with the manager. This had been reviewed with the hospice and procedures also reviewed. The member of staff responsible for the error had received supervision. All nurses had received training in use of syringe drivers and a medication refresher training given to most staff. In addition medication competencies had been adapted from the PCT training and were to be introduced for staff assessment. It was therefore evident that lessons had been learnt and robust action taken to minimise the risk of this happening again. Staff were observed to be friendly but respectful to residents during the visit to the home and to be courteous in their conversations with them. Residents spoken with confirmed that personal care was provided in private and from observation it was Care Homes for Older People Page 14 of 29 Evidence: evident that efforts were made to maintain privacy. Rooms included personal items of furniture and lockable facilities for storage of valuable and medication in the event that a resident chose to self medicate. Staff training has recently been provided in upholding dignity which followed the Royal College of Nursing (RCN) guidance. Reminder notices were seen in the home that gave residents an indication of how they could expect to be treated which confirmed the effort that staff were making in respect of upholding their dignity. A relative also told us all residents are treated with the utmost respect and consideration. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Cheviot provides social activities that meet residents cultural expectations and enhance their lives. Visitors were warmly welcomed into the home. The home provided residents with a well-balanced and nutritious diet with choices accommodated. Evidence: There was no designated activities coordinator employed at the home. The AQAA informed us that A full range of activities is provided but the focus is more on meeting individual needs through one-to-one interaction and engaging residents in more meaningful activity and on a daily basis, carers provide activities for residents and are encouraged to spend time with them either in groups or individually. For example one resident had recently been taken to Castle Park to view a tree that held significant memories for them. Other residents enjoyed being taken out regularly into the garden, for walks and on shopping trips. A health professional also told us Staff try hard to reduce the isolation whilst stimulating residents with a range of activities. The home held regular themed events and photographs of these were seen on display in the home. The AQAA informed us that during 2009 an Australian themed week was held and a highly commended NAPA certificate was presented for this ad the kitchen refurbishment. More recently a Chinese Day had been arranged where staff dressed in Care Homes for Older People Page 16 of 29 Evidence: authentic costumes and a Chinese meal was served. Another event had comprised a trip to Hawaii where staff dressed as air hostesses and a mock plane journey arranged. During the visit to the home several residents were enjoying their lunch in the gazebo and near to the pond in the garden. One resident and their relative told us that staff took them on shopping trips in Colchester and they were always able to spend time in the garden enjoying watching the fish in the pond. Another told us that a variety of activities are arranged to enable residents to lead an interesting and stimulating life. The AQAA informed us that the home is constantly re-evaluating ways to promote the importance of activities and the introduction of an activity box using information from assessments has proved helpful. Developments have included the recent acquisition of a pet rabbit that has brought much enjoyment to residents and staff and in particular during a recent competition to name him. The homes statement of purpose detailed the visiting arrangements for the home. The visitors book also provided evidence that numerous people visited the home. Relatives spoken with during the visit to the home confirmed they could visit during the day, evenings and at weekends. One relative told us the staff create a warm and welcoming atmosphere at all times for residents and their visitors. During the visit to the home residents were observed to have a choice of where they ate their meals and how they spent their day. Residents were seen spending time in their own room, in the garden or in one of the communal rooms of the home. Residents rooms were seen to be personalised with their own belongings (photos, pictures, ornaments etc.) Information on advocacy services was seen on display in the home and the statement of purpose contained details of advocacy services that could be arranged on behalf of residents. The homes kitchen had been refurbished since the previous key inspection and was well fitted, clean and well organised. The menus were discussed with the cook in charge and were seen to be rotated on a four weekly basis and were varied and nutritious. All food was cooked on site with home made cakes and pastries also provided. The dining room was adjacent to the kitchen enabling food to be served without delay. Tables were nicely laid with table cloths, cutlery, condiments etc. A small, well fitted kitchen that staff and relatives were able to access was also provided off one of the lounges. During the visit to the home staff were observed serving hot and cold drinks throughout the day. The home had a water dispenser and a tray was also set up with conic cones to provide small frequent drinks to residents throughout the day, encouraging residents to maintain their fluid intake and thereby minimising the risk of dehydration and urinary tract infections. The lunchtime meal comprised sausages with apple sauce with a vegetarian option, parsley potatoes, carrots, Care Homes for Older People Page 17 of 29 Evidence: courgettes, followed by autumn pudding. Specialist diets were catered for and supplements were also provided as needed. We were informed that night bites were provided in the evenings comprising small sandwiches and a range of canapes. This was good to see as it enabled residents, particularly those with small appetites or nutritionally at risk to be tempted to eat. Residents records viewed confirmed that a nutritional risk assessment was undertaken on admission to the home and weights monitored with nutritional supplements provided as needed ensuring that residents did not lose weight unduly. Care Homes for Older People Page 18 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured their concerns and complaints will be listened to and acted upon and they will be protected by the homes safeguarding and recruitment procedures. Evidence: The home had a complaints procedure that is available in large print or audio version and was included in the statement of purpose and service user guide. A copy was also seen on display in the home. The AQAA informed us that the ethos of the Trust is to welcome comments and complaints and the Manager of the Home actively promotes this. All staff are encouraged to promote this and to not be defensive when residents or their relatives complain. The record of complaints was viewed during the visit to the home. Three complaints had been received in the previous twelve months. The records confirmed that these had been appropriately investigated in line with the homes procedures and action taken to address any issues. The manager said that she operated an open door policy and was freely available for residents and their relatives should they have any concerns. The AQAA informed us that Copies of correspondence from residents or their relatives are available and Trustees always inspect the complaints record when they visit to do their monthly inspection. The home had safeguarding procedures in place and the records confirmed that all staff received training in safeguarding adults during the first weeks of employment and regular updated training by the in-house trainer. The Essex safeguarding Care Homes for Older People Page 19 of 29 Evidence: procedures were available for staff guidance in the event of needing to refer an allegation. A whistle blowing policy was also available to support staff should they witness an allegation of abuse. There had been one safeguarding alert raised by the home to protect a resident and from discussion with the manager it was evident that procedures had been appropriately followed. The homes recruitment procedures were inspected and were confirmed to protect residents by ensuring all relevant checks were undertaken prior to appointment. Care Homes for Older People Page 20 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. Cheviot is clean and hygienic and provides a safe, well-maintained homely environment. Evidence: A tour of the premises was made during the visit to the home. The home was secure with a door entry system in place. The reception hall is welcoming with a visitors book and full information about the home on display together with comprehensive information about related services.The home has two floors that can be accessed by stairs and a lift. All rooms were single with en-suite facilities. Variable height beds were provided and we were informed that a number of profiling beds had been purchased since the previous key inspection. Several residents rooms, communal rooms, bathrooms, a shower room, the kitchen and laundry were viewed. All accommodation was very pleasantly decorated and furnished to a high standard. The home was clean and well maintained with no odorous smells. The home had a programme of maintenance in place with full-time maintenance staff employed. The attractive gardens were laid to lawn with shrubs, flower beds, a fish pond and gazebo that were accessible to residents and wheelchairs users. Records viewed during the visit to the home confirmed that systems were in place to ensure the building complied with the requirements of the local fire and environmental health department. The home had stairs and a passenger lifts to enable access throughout the premises. Care Homes for Older People Page 21 of 29 Evidence: There were grab rails in corridors and aids in bathrooms and toilets to meet the mobility needs of residents. Call systems were provided throughout communal and individual rooms to enable residents and staff to call for assistance and records confirmed these were well maintained. A range of specialist pressure relief equipment and mobility aids were available to meet the needs of individual residents. This included for example, a range of slings for hoists to be used to meet individual residents needs, walking aids and perching stools. The home was clean with no malodorous smells evident. Systems were in place to ensure staff had personal protective clothing (liquid soap and paper towels) for use when providing personal care in residents en-suites and bathrooms. The laundry room was large with separate rooms for clean and dirty laundry and was well equipped. There were three washing machines and two driers that were in working use, a rotary iron, standard iron and ironing table. Washing machines had sluice facilities (able to wash at 65 degrees centigrade for a minimum of 10 minutes) to minimise the risk of infection. Designated staff were employed for laundry duties. Systems were in place to minimise risk of infection via the use of red bags for any laundry soiled by body fluids, placed directly in the washing machines; washing machines had the capacity to carry out sluice wash cycles. Laundry and personal clothing viewed was observed to be well laundered. Sluice rooms were provided on each floor of the home. These were observed to be well organised with appropriate hand washing facilities and fitted with mechanical sluices that were well maintained. Care Homes for Older People Page 22 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that they will be cared for by skilled and well trained staff who have been robustly recruited and who are employed in sufficient numbers to meet their needs. Evidence: In addition to the manager and deputy manager there were two registered nurses and ten care assistants (including one nursing assistant) on duty. Staffing levels were appropriate to meet the needs of residents, some of whom were very dependent and to enable them to spend time in conversation with them. The duty rota was seen and confirmed the staffing levels were as discussed. Feedback was received from a relative who told us there is a very good ratio of staff to patient so it is nearly always possible to get help without waiting too long and they always seem very caring and look after x ....to the highest degree and there were always enough staff on duty. One health professional told us they treat each resident individually ensuring all their needs are met to a very high standard. Another also told us care from the nursing staff is excellent. The home had eighteen care staff from a total of twenty-five with NVQ level 2 or above and a further seven care staff who were undertaking training. The percentage of staff with NVQ level 2 training therefore exceeded the recommended standard for 50 of care staff to be trained to NVQ level 2. Care Homes for Older People Page 23 of 29 Evidence: The recruitment files of three recently employed staff were inspected. All had evidence that the required checks had been obtained (two satisfactory references, CRB/POVA checks) and copies of birth certificates, passports, and photographs obtained before the individuals commenced employment at the home. All had received a statement of terms and conditions of employment. The home had a very comprehensive training programme for essential skills that included health and safety, manual handling, fire safety, food safety, basic first aid, COSHH, safeguarding adults, infection control and bereavement. An extensive range of training to meet residents and staffs individual needs was also provided for example in dignity, medication, Mental Capacity Act, spiritual care, Deprivation of Liberty, dementia care, Liverpool Care pathway, Parkinsons Disease, diabetes,end of life etc. The training matrix was viewed and confirmed the training provided was as discussed and that a range of leadership training was also provided for senior 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that the home is a well managed care home that has good standards of health and safety that protects them and staff. Evidence: Discussions were held with the registered manager for the home who is a registered nurse and holds the following qualifications: BSc. Hons. Palliative Care; ENB 931 Care of the Dying; ENB 941 Care of Older People; RSA Assessors Award and has managed the home for several years as well as having a number of years experience as a senior nurse at Cheviot. During that period she has undertaken regular updated training and attended a number of courses relevant to her clinical and managerial position. The manager is supported by a deputy manager. The records viewed also provided evidence of updated training having been undertaken since the previous key inspection. From observation and an inspection of records, the home appeared to be well managed. The AQAA informed us that the Trust has a Business Plan, which is updated by the Trustees on a regular basis, and each Home has an individual Annual Development Plan. A copy of the home annual quality assessment objectives was Care Homes for Older People Page 25 of 29 Evidence: provided during the visit to the home. This included a number of areas for improvement, for example in developing a booklet of photographs to show prospective residents, developing the key worker role, building on the dignity project to have dignity champions, improving documentation to involve residents more in decision making etc. Residents are consulted as part of the annual review and the AQAA informed us that a respite care quality questionnaire is in place in addition to an intermediate care questionnaire showing that the home aimed to listen to the views of all people receiving care at Cheviot to ensure their needs were being met. We were informed that the Trust had an external Health & Safety Audit in October 2008 and a review of the actions and recommendations in 2009 showed that these have all been met. The arrangements for handling residents monies were discussed with the manager. A policy and procedures were in place for staff guidance. Neither the manager nor representative were appointee for any resident. All residents had a relative or representative to manage their finances on their behalf. Personal allowances were held in secure facilities on their behalf. The personal allowances and records were inspected for three residents. The amounts of money were present and correct for all three with records of transactions made and receipts held as evidence. The home had a health and safety policy and procedures in place for staff guidance. The records confirmed that staff had attended health and safety training following appointment. Evidence of a sample of records viewed showed that there were systems in place to ensure the servicing of equipment and utilities and there was evidence of appropriate weekly and monthly internal checks being carried out (e.g.checks on fire equipment, fire alarms and emergency lighting etc.). Care Homes for Older People Page 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 9 The temperature of medication storage rooms should be monitored to ensure these remain within safe recommended levels (25 degrees centigrade). 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!