Care Home: Chilton Care Centre

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What the care home does well The home is a positive place to live; the atmosphere is positive but also secure and comfortable. The manager and staff are dedicated, talented and clearly enjoy working with the people who live there. People who live at the home like it. They have an individual service and are able to be in control of their lives whilst being respected and supported by staff in the best interests. This promotes their wellbeing and quality of life. There is a talented and enthusiastic manager at this home who has been in charge of this home for 12 months and can demonstrate considerable improvements that have been made and can show firm plans about how the home will be continue to be developed. She has the confidence of her employers and people using the service find her approachable and fair. The manager has strong principles about how the organisation should support people who are older or have dementia type illnesses. She supports peoples` rights and helps to empower them as valued citizens. She is enthusiastic about their work and can demonstrate how she intends to give good quality, person centered care and support for the benefit of the people who live at this home. People who move to the home have their needs assessed in detail by social or healthcare workers and the manager so that everyone is sure that this is the right place for them to live. This is very important where people have complicated care needs that require well-managed and agreed ways of supporting them. People who have dementia type illnesses are well supported at the home. They have staff who are skilled and knowledgeable of their preferences, personal histories and backgrounds so that they live in a reassuring environment where they are supported as individuals. The home is welcoming attractive and has been adapted so that it helps people with dementia feel comfortable and interested in their surroundings. Staff talk to people they understand their personal timescales and can help to relate to these using their local knowledge. The staff and manager help people to make choices about their lives and support them to have interests. The staff work well as a team. Staff are trained so that they have the skills they need to support the care and lifestyle needs of people living at the home and there are sufficient staff available so that these needs can be met. Care is provided to people with a different needs, varied ages, expectations and backgrounds. Both care practice and staff recruitment practices are governed by equal opportunity principles. Peoples` bedrooms are private and they can make them their own with furniture and possessions if they want to. The owners and manager are good at recognising and researching where improvements need to be made. They ask people for their views and have already drawn up plans about how they wish the home to improve and develop the quality of service they provide for people living at the home. The changes had already been put in place by the time of this inspection. What has improved since the last inspection? The home has been significantly improved since the last inspection. All the legal requirements made at the last inspection have been met. Improvements have taken place in all areas, for example, There is now a skilled manager who has been assessed by the Care Quality Commission as having the skills qualities and experience to properly run the home. There are sufficient well trained and experienced staff who understand peoples needs and have good care practices. People are asked for their views and action is taken when this is needed. Following storm damage the ground floor has been rebuilt, and the rest of the home substantially redecorated and refurbished including all corridors, communal areas and bedrooms. Adaptations have been made to help people who have dementia type illness, to get around the home and to find rooms stimulating. Care planning has improved so that the needs of the people living at the home can be seen and understood by staff and changes can be made when this is required. People who live at the home are happy, their health needs are supported, visitors notice that they are smiling, feel at ease and are content. What the care home could do better: There are now no areas where the home has not been assessed as meeting the National Minimum Standard or the Care Homes Regulations. However the manager has shown that she plans to continue to improve the quality of service and enhance the lifestyle of the people who live at the home. Key inspection report Care homes for older people Name: Address: Chilton Care Centre Hunter Terrace Chilton Co. Durham DL17 0EX     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: Steve Tuck     Date: 0 9 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Chilton Care Centre Hunter Terrace Chilton Co. Durham DL17 0EX 01388724011 01388724012 chiltoncarecentre@yahoo.co.uk www.guardiancarehomes.co.uk Guardian Care Homes (UK) Limited care home 40 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 40 The registered person may provide the following category of service only: Care Home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Old Age, not falling within any other category, Code OP - maximum number of places 22 Dementia Code DE, maximum number of places 18 Date of last inspection Brief description of the care home Chilton Care Centre provides a home to older people who need help with their personal care needs and older people who have dementia type illness. The home can not provide nursing care but is visited by community nursing services. The home was first registered in 2006 and provides accommodation over two floors. Set in the village location of Chilton the home is near local shops and is on a bus route. Care Homes for Older People Page 4 of 28 Over 65 0 22 18 0 Brief description of the care home There is a choice of lounge and dining areas on each floor and there is a pleasant central garden patio area. The home has car parking including those designated for people with mobility problems and there is a lift to help residents and visitors reach the first floor. There are forty single bedrooms. All have their own toilet facilities with a shower. There are also communal bathrooms where people can be assisted to have a bath if needed. At the time of this inspection fees charged ranged from £394 to £526 per week. The costs of newspapers, hairdressing, and toiletries are not included in the fees. Fees vary depending on peoples circumstances, further details can be found in the homes Service User Guide. Fees for private chiropody and hairdressing are in addition the these charges please contact the home for further details about fee levels. Care Homes for Older People Page 5 of 28 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: Before the visit we looked at: Information we have received since the last Key Inspection. How the service dealt with any complaints and concerns since then. Any changes to how the home is run. The providers view of how well they care for people. We asked them to examine their own service and write to us with the results. We sent surveys to people who use the home, people who arrange for residents to live there, those who visit the home to support people like doctors and therapists and the staff who work in the home, to ask what they think about services there. The Visit An unannounced visit were made on 9th December 2009. Care Homes for Older People Page 6 of 28 During the visit we: Talked with the people who use the service the staff, the manager and visitors to the home. Observed life in the home. Looked at information about the people who use the service and how well their needs are met. Looked at other records which must be kept. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around parts of the building to make sure it was clean safe and comfortable. We told the manager what we had found. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 28 What the care home does well: The home is a positive place to live; the atmosphere is positive but also secure and comfortable. The manager and staff are dedicated, talented and clearly enjoy working with the people who live there. People who live at the home like it. They have an individual service and are able to be in control of their lives whilst being respected and supported by staff in the best interests. This promotes their wellbeing and quality of life. There is a talented and enthusiastic manager at this home who has been in charge of this home for 12 months and can demonstrate considerable improvements that have been made and can show firm plans about how the home will be continue to be developed. She has the confidence of her employers and people using the service find her approachable and fair. The manager has strong principles about how the organisation should support people who are older or have dementia type illnesses. She supports peoples rights and helps to empower them as valued citizens. She is enthusiastic about their work and can demonstrate how she intends to give good quality, person centered care and support for the benefit of the people who live at this home. People who move to the home have their needs assessed in detail by social or healthcare workers and the manager so that everyone is sure that this is the right place for them to live. This is very important where people have complicated care needs that require well-managed and agreed ways of supporting them. People who have dementia type illnesses are well supported at the home. They have staff who are skilled and knowledgeable of their preferences, personal histories and backgrounds so that they live in a reassuring environment where they are supported as individuals. The home is welcoming attractive and has been adapted so that it helps people with dementia feel comfortable and interested in their surroundings. Staff talk to people they understand their personal timescales and can help to relate to these using their local knowledge. The staff and manager help people to make choices about their lives and support them to have interests. The staff work well as a team. Staff are trained so that they have the skills they need to support the care and lifestyle needs of people living at the home and there are sufficient staff available so that these needs can be met. Care is provided to people with a different needs, varied ages, expectations and backgrounds. Both care practice and staff recruitment practices are governed by equal opportunity principles. Peoples bedrooms are private and they can make them their own with furniture and possessions if they want to. The owners and manager are good at recognising and researching where improvements need to be made. They ask people for their views and have already drawn up plans about how they wish the home to improve and develop the quality of service they provide for people living at the home. The changes had already been put in place by the time of this inspection. Care Homes for Older People Page 8 of 28 What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 28 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 28 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. Trained staff from the home find out and understand the needs of people who wish to live there before they move in. This information helps to make sure that peoples needs can be met at the home and agree the ways in which staff are to support them. Evidence: By looking at records kept at the home we could see that each persons needs are assessed before they move there, either by health services staff local authority social workers and the manager. This is so that the manager has a good understanding of peoples health and social care needs and can be sure that the home is going to be suitable for people who are going to live there. Where possible the person themselves or their representative is involved in the assessment process. The manager said that she liked people to visit the home first before they decided to move there so that they had an understanding of what it was like, but accepted that this is not always possible because people may need to move there quickly if they are experiencing problems or are waiting to leave hospital. The manager does visit people while they are receiving Care Homes for Older People Page 11 of 28 Evidence: treatment in hospital. The manager also finds out what cultural and lifestyle needs people have to make sure that these can be met. The manager has also had training which has given her the skills to find out what peoples needs are. The manager says that she has the skills and flexibility to decide if peoples needs can be met at the home and where this is not the case, she can help people to find an alternative. As a result of these measures, all of the people living at the home at present have been properly placed and the home is able to meet their needs. One relative said, Its a community home, everyone knows it. Another said, They find out what people need before they move in. There is good information about the home in the Statement of Purpose and a Service User Guide is available for people and their relatives who live or are interested in moving there. The Service User Guide has information in it about what it is like to live at the home, how people can be supported, what the accommodation is like, how to make a complaint and a copy of the recent inspection report. This is available in the home and relatives said that they were given information which told them all about the home before their relative moved in. The Guide also includes information about how residents rights will be respected regardless of age, gender, sexual orientation, race and religion. The information can be produced in large print, in different languages and in easy read style to make it easier for people to understand. There is information about the terms and conditions and range of fees charged. Care Homes for Older People Page 12 of 28 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. Peoples care and health needs are well supported at this home and the way that staff give out medication makes sure that they get the treatment that has been prescribed. And every person has a plan of their care which shows how their care needs will be met and gives guidance that staff need. Evidence: Every person has an individual plan which records what the home will do to support them. New planning arrangements have been put in place since the last inspection and although some have more information in them than others, these give a good description of the support that people need. Staff at the home know lots about the needs of people who use the service and how they prefer to be supported. This is particularly important where people have dementia type illness and need to have consistent care which is based on their known preferences, lifestyles and background. Staff were asked in detail about the ways that they support people and could describe their needs in a lot of detail. Almost all areas of their care were described in their care plans, the manager and senior staff from the organisation have carried out a lot of work with staff to show how care plans are to be used so that they co-ordionate the Care Homes for Older People Page 13 of 28 Evidence: care that people receive. Staff demonstrate that this training has been successful. One staff said,I didnt realise just how much we knew about most peoples lives - it gives you something to chat about and helps people to feel happy and included. The manager and staff have started to use specific techniques to support people who have dementia type illness. Staff have taken part in training courses and are applying their knowledge whilst they work with people in the home. Staff support people as individuals, their care is centered around each persons specific needs and personal time frame. Staff immediately know if someone has become unwell or anxious and take steps to support them, for example by talking about a common topic or past experience. As a result of this the overall atmosphere in the home was happy, inclusive and welcoming. There were several examples of good practice taking place at the home. For example, staff had found that singing along with one person who has dementia type illness improved communication and the person became much more reassured and confident. The manager has shown that she has been careful to make sure that people living at the home are able to be successfully supported there and that their healthcare needs can be effectively met. She shows a full understanding of the needs of the people who live at the home and works in partnership with other healthcare professionals to make sure that they are supported. Staff now work with other community-based health and social support staff to make sure that peoples wider needs are supported by fully coordinated care. For example there are regular visits from GPs and other health professionals including, dentists, opticians and chiropody services. Care plans are regularly reviewed and updated according to changes in social, personal and health care needs. For example those people who have reduced appetite or low weights are regularly weighed and treatment advice sought from dietitians. Their recommendations are acted upon and care plans are updated. There are records which show the measures in place which help prevent pressure damage, moving and assisting, continence promotion, nutrition and mental health condition which are completed, reviewed and updated monthly. No one at the home was suffering from pressure damage. Due to their levels of need, most people living at the home need support to administer their own medicines, and designated staff therefore help in this area. Medicine is securely stored in a locked purpose made cupboard and records are in place for all Care Homes for Older People Page 14 of 28 Evidence: medicines received, administered and disposed of. A thorough check of medicines kept at the home showed no discrepancies. There is a register of staff who are authorised to administer medication. Staff at the home are good at watching out for people who may be experiencing pain by monitoring the expressions and responses and making sure that they get medication to help relieve their symptoms. People living at the home are treated with respect by staff who know them well. Examples include locking their bedroom doors, receiving their mail, being addressed by their preferred name and being able to go wherever they wish inside and where possible, outside of the home. Relationships between people and with staff are relaxed, friendly and informal which helps them to feel comfortable. People appeared to be relaxed and happy with the support they get from staff. Staff meet at the start of each shift where they talk to each other about peoples needs so that they remain up to date, work well as a team and remain consistent. One person who lives at the home said, You can rely on the staff to keep you entertained when you need them. Care Homes for Older People Page 15 of 28 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 who live at the home are encouraged and supported by the staff to lead fulfilling lives with their rights as individuals being respected and to eat healthily which supports their physical and emotional wellbeing. Contact with family members and friends are supported where possible so that people keep up links with those outside the home. Evidence: The home has two staff who are responsible for organising activities at the home. The staff also help people who live at the home with social and recreational activities. Activities are displayed in a written and picture style in the hallways of the home. The activity person keeps records of all events that residents have taken part in. Care plans contain information about people so that staff can make sure their likes and dislikes are known. On the day of the inspection people were meeting together to plan for Christmas and were putting together lists of people who they wanted to send cards or gifts. Some people were listening to music whilst others were entertaining visitors. Care Homes for Older People Page 16 of 28 Evidence: Some people, through their own choice have taken on tasks at the home as a way of helping out and keeping busy. For example dusting or clearing the tables. Some people at the home have dementia type illness and need to support to take part in activities. The first floor area has been redecorated in line with current best practice so that people with dementia care needs will find it interesting and easier to get around. Specific areas have also been developed, for example there is an indoor garden with seating and plants, some of the walls are decorated with 1960s album covers and there are historical photographs of the local area. The manager confirmed that training is to take place for activities staff in the next few weeks which will help to further develop the way they support people with dementia care needs. People living at the home and their relatives said that there was always something going on to keep them entertained. There are lots of photographs on display, which show events that have taken place throughout the year. People living at the home are encouraged to be in control of their lives as far as possible. They are able to maintain links with their friends, relatives and the local community and groups from the nearby school visit the home which helps people to remain included. Several people had visitors throughout the inspection. Staff spent time with them and shared information about their relative if necessary or acceptable. Information about advocacy is available for anyone who needs impartial support and people at the home and their relatives again said that they were confident that the manager would sort problems out if they had any. All of the people living at the home are encouraged to bring items and keepsakes with them to making their own bedrooms homely and personalised. There are dining rooms on both floors, both are pleasantly decorated and furnished. People living at the home are encouraged to make choices about their diet. Everyone said that they like the meals at the home and that they are asked what they would like to eat. Staff were seen asking people about their choice of meal, size of portion to make sure that they always had their choice of meal. Comments from some of the people living at the home were, I like the food, I changed my mind today because the chicken looked nicer but that was OK. Staff are available during meals to offer support and assistance where needed and this makes meal times a relaxed, social and unhurried experience for everyone. The cook has extensive knowledge of the meals which people living at the home prefer and make sure that the only good quality ingredients are used to prepare meals. Menus Care Homes for Older People Page 17 of 28 Evidence: were available which confirmed that a range of meals are provided which give people a balanced diet and refreshments are available throughout the day and night. People living at the home and their families are involved in choosing the meals that are included in the menu. Where people need it food supplements are available to help people to maintain their health for example if they have diabetes or have difficulty maintaining their weight. In previous inspections there it has been noted that the food produced is a strength of the home and very popular with the people who live there. The cook has demonstrated an ability to produce wholesome meals in a home cooking style without the need to use pre- packaged ready made items for convenience which can be of less nutritional value for the population at this home. The cook makes an extensive range of traditional and contemporary meals as well as pastries and other confectionery. At this inspection there was evidence that home based cooking was taking place but there was noticeably less food stocks available even after a delivery from suppliers. Care Homes for Older People Page 18 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home and their families can make a complaint if they are unhappy, have a grievance or dispute which helps them to have control over their lives and there are measures in place which protect people who live at the home from being harmed which helps to promote their safety and security Evidence: There is a complaints procedure which tells people what to do if they are not happy. This informs people about who they should make a complaint to and how much time that a complaint will take to look at. There is a record kept at the home of any complaints, which includes details of any investigation and the outcome. This has improved since that last inspection. No one has approached the Care Quality Commission (CQC) because they have been unhappy with the way that the home has managed their complaint. A relative said, I dont think I would have a problem If I had to make a complaint. Whilst there have been no instances where abuse has taken place or been suspected, the home has an adult protection procedure which can be used where necessary to protect people living at the home. Staff have guidance and training about what to do if they see or suspect abuse is taking place and all staff spoken to showed that they knew what to do and what they expected to happen so that people remain protected. Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely environment, which promotes their privacy, independence and comfort during their stay at the home. The home is clean, pleasant, hygienic and well maintained which supports the health and lifestyles of people living there. Evidence: All communal areas and some of the bedrooms were viewed during the inspection. There has been a major programme of refurbishment at the home since the last inspection following a storm where the home was flooded. The first floor has also been extensively improved to provide a better more appropriate place for people to live who have dementia type illness. This has improved the comfort of the people who live there and has given them a more attractive and hygienic place to live. The home has been adapted so that all the people who live there can have safe access to the areas where they live. Everyone is able to lock their bedroom doors so that they can have privacy and there are areas where people can meet and talk in private. There is an enclosed garden and a patio area which are used for functions and celebrations or for people to sit outside if the weather is good. The bedrooms are pleasant areas, which have a useful range of comfortable furniture and fittings. Most people have furnished their rooms with their items, photographs and keepsakes. Everyones bedroom has been kept in a good state of repair and Care Homes for Older People Page 20 of 28 Evidence: redecorated and refurbished where this has been required. The bathrooms have all been designed to help people who have mobility needs to use them. And there are enough toilet and bathrooms available so that people can easily access them. The home is kept clean by staff who take steps make sure that there are no unpleasant odours. There is sufficient staff time, equipment and materials in place to make sure that cleaning is successful and the home remains hygienic and attractive. The home has two floors and the manager has spent the past 12 months working through a planned programme of improvements which have now been completed. The home now looks attractive, well kept and welcoming. Visitors and people who live there said that they were happy with the way the home was decorated and furnished. The manager has drawn up a programme of future maintenance and repairs so that the home remains fit for its purpose in meeting peoples needs. There are laundry facilities are in place to make sure that that peoples clothing and linen is hygienically cleaned and the risks of passing on any infections is reduced. Arrangements are in place to make sure that clean clothing is always returned to their owner and mistakes are avoided. There were no health and safety or maintenance issues that were noted at this inspection. The home is inspected by the Fire Prevention Authority and the local council to make sure that the building and safety systems are suitable for the protection of those who live and work there. Care Homes for Older People Page 21 of 28 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. There are sufficient staff working at the home to meet the needs of the number of people who presently live there. The ways that staff are employed makes sure that people are protected and most staff have been trained to make sure that their care practice is good. Evidence: The manager has organised the home so that overall there are sufficient staff available to meet the needs of the people who currently live there. Staff support each other and their manager both in their practice and also in their willingness to remain flexible about their working hours so that people who live at the home will benefit. Staff know a great deal about the needs of the people who live at the home and can describe these in detail; they get on well together and with people who live at the home and promote an inclusive and supportive structure at the home. Staff work in teams and they have structured ways of working so that people get consistent support. One person living at the home said,I couldnt do without them, theyre like family. Staff spend time with people who live at the home, listening to their opinions and experiences and taking part in discussions and laughing together which creates a Care Homes for Older People Page 22 of 28 Evidence: happy atmosphere at the home. Staff turnover at the home is low which gives people who live there and staff the opportunity to get to know each other. Over three quarters of the staff team have now attained National Vocational Qualification awards in care at level 2. Staff are either working towards either Level 2 or higher levels. There is a plan in place which describes the training which staff are to undertake based on the needs of the home and their personal training requirements. The manager makes deliberate attempts to recruit staff from similar cultural backgrounds as the people living at the home. In some cases they share the same community and social links, which helps to make sure that people are confident with the way in which they are supported. Examination of files for staff newly appointed in the home confirm that robust checks are carried out before they are employed to work in there. This includes receiving appropriate references and completing the necessary criminal record check to make sure that staff are suitable to work with people who are vulnerable. Staff files contain employment history, records of training and any training certificates. Care Homes for Older People Page 23 of 28 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. The home is well managed, organised and efficient; and people are asked for their views about the quality of the care they receive. All of which gives people who use this agency the confidence that they will continue to have their needs met by staff who support their best interests. Evidence: There has been a new manager appointed at the home since the last inspection. The owners have also appointed a new senior management team to support the manager and help her to improve the quality of service at the home. The manager has worked at this home for over three years as the deputy manager and has also worked in other homes in a management position. The manager has undertaken some nurse training and has also managed in legal services. She currently undertaking the Registered Managers Award (RMA) and has an National Vocational Qualification at Level 3. The manager has been assessed by the Care Quality Commission to see if she has the skills, qualities, experience and knowledge and has now been successfully Registered Care Homes for Older People Page 24 of 28 Evidence: to manage the home. The manager demonstrates that she has experience and skills in supporting the needs of older people at this home which she has used to promote their independence wellbeing and lifestyles over the past year. She has shown her capacity, skills and insight to organise and improve the home. She is highly motivated well organised and has an excellent understanding of how the home operates so that the organisations ways of working can be used to improve and promote the lifestyles of people living there. She has an open positive and inclusive ethos, has the support of her managers and the respect of her staff, which reassures people living at the home and their relatives that the service can continue to be provided in their best interests. One person who lives at the home said, Shes been good at organising things here. One staff said, She has introduced ways of working which makes the service much better - Im proud to work here now and so are my colleagues. Another said, The manager has helped me understand the work we do and how people with dementia are to be supported. I think I work better now that I understand this. People living at the home are empowered to give their views about all aspects of the support they get from staff. There are a number of meetings held at the home and also other informal occasions where the manager is able to check that people are satisfied with the service. There are regular surveys sent to people who live at the home and their relatives. And the senior manager also visits the home each month and collects the views of peoples families and friends, social work and healthcare staff who visit the home so that they can check to see if the service is meeting the needs of all parties. This helps the manager to monitor progress and develop the service. The manager organises this information in a way which shows how improvements have been made at the home and what future plans are being made. Staff at the home help people who live there to manage their money. Detailed records are kept of peoples day to day finances and where staff have supported them to make purchases. Checks showed that these are accurate and there are safeguards in place to help prevent theft or fraud. There were no noticeable hazards at the home throughout the inspection and arrangements are in place to minimise risks for people living there and the staff who support them. The home has been subject to inspections by the Fire Prevention Authority and local authority environmental health officers to make sure that the home is safe. Care Homes for Older People Page 25 of 28 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 26 of 28 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 15 The manager should make sure that there is sufficient stock of kitchen ingredients so that the range of home cooked products, which are enjoyed by the residents, can continue to be successfully made. Care Homes for Older People Page 27 of 28 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). 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