Care Home: Chilton Court Residential Home

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What the care home does well Prospective residents have their needs assessed and are provided with the information they need to make an informed choice about whether the home is suitable before they move in. Residents have individual, personalised care plans in place and this enables staff to provide the care and support required to meet their personal and health care needs met. People are encouraged to maintain their Independence, they are treated with respect and their dignity is maintained. The home has a planned activities programme, visitors are made welcome and residents are satisfied with their life styles and daily routines. Residents tell us that they know how to make complaints and they feel confident that complaints are listened to, taken seriously and acted upon. The environment is homely, clean and comfortable, and well maintained. People have confidence in the staff and management and they tell us that they are well cared for. The comments we received from residents and their relatives were highly positive and included; `Staff are exceptionally alert, kind and attentive and no request is ignored`, `Excellent staff`, `We are made to feel cared for and safe as we get older`, `They look after me very well in all ways`, `Very kind and caring staff`, `We are satisfied with the service and the care` and `..an excellent first class establishment with wonderful friendly staff. Equal to a first class hotel`. What has improved since the last inspection? Since our last key inspection in August 2007 the home has had a refrigerator installed in the medication room so that medicines requiring refrigeration can be stored safely and at the correct temperature. The temperature of the fridge is monitored to ensure the correct temperature is maintained. Food that is prepared and stored in refrigerators and freezers is now appropriately labelled to ensure that it is used within a safe timescale or disposed of. The laundry door has been replaced to meet fire regulations and the WC in bathroom 2 has had a raised toilet seat fitted and is now in use. Documentary evidence of identification checks, which is required to ensure robust recruitment processes are in place, was held on the staff files we examined. The minutes of the meetings held with Courtyard residents had been maintained and were available for inspection. What the care home could do better: People are offered a healthy balanced diet but the menu should be developed in consultation with residents to ensure that their choices and preferences are reflected. The menu should also be displayed for everyone to see so that they know the menu options in advance. A recent safeguarding matter was not handled in accordance with local authority protocols. Although we were advised that lessons have been learnt it was evident that care staff did not undertake safeguarding training and this must be addressed to ensure that they recognise the signs and symptoms of abuse and know the correct procedures for reporting concerns. The three staff files we looked at did not include photographs and one member of staff had been appointed without references. We were advised that this was an oversight that would be immediately addressed. The providers must ensure that all required documentation for staff is in place and they must not start work before they have received satisfactory references. Staff induction needs to be completed in a more timely manner and the training and development programme for care staff must be reviewed and developed to ensure that they have the right skills and competencies to do the job. The matter of ensuring that there is a robust and efficient quality assurance system in place should be addressed so that the service can effectively monitor their own performance and address any shortfalls. Key inspection report Care homes for older people Name: Address: Chilton Court Residential Home Gainsborough Road Stowmarket Suffolk IP14 1LL     The quality rating for this care home is:   one star adequate 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: Tina Burns     Date: 1 2 0 3 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 30 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 30 Information about the care home Name of care home: Address: Chilton Court Residential Home Gainsborough Road Stowmarket Suffolk IP14 1LL 01449675320 01449675320 hilary@stowcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Stowcare Limited Name of registered manager (if applicable) Mrs Jean Mary Hayward Type of registration: Number of places registered: care home 47 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Chilton Court is a private residential home for older people. The home was first registered in 1986 to accommodate 19 residents. In April 1998, the original building was converted to accommodate a further four residents. A further extension was added in 2000 taking the number of residents to 33. The owners of Chilton Court have since extended the service provision by the creation of The Courtyard, a care housing complex on the same site as Chilton Court, which was completed in May 2000 and officially opened in September of the same year. The Courtyard enables people to receive support and assistance with personal care in the comfort of their own homes and can accommodate up to 14 residents. This increased the home s registration to 47 residents. Chilton Court and The Courtyard are situated on the Gainsborough Estate, Care Homes for Older People Page 4 of 30 0 Over 65 47 Brief description of the care home approximately one mile from Stowmarket town centre. The building is in pleasant surroundings with well-maintained gardens and a pond that is home to a large number of ducks. The fees for the residential home start at £540.00 per week. All fees depend on the accommodation occupied and the dependency of the resident. The fees do not cover the cost of hairdressing, chiropody, newspapers or toiletries. Care Homes for Older People Page 5 of 30 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: one star adequate 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: This was an unannounced key inspection which focused on the core standards relating to older people and was undertaken by regulatory inspector Tina Burns. The report has been written using accumulated evidence gained prior to and during the inspection. The homes manager was not present at the time of inspection but the deputy manager was on duty and assisted us throughout the process. The inspection included a tour of the building and observations made throughout the day. The inspector also spoke with several residents and members of staff and and the operational manager who is also a director of the company. Records examined included three residents care plans, three staff files, and a range of health and safety and maintenance records. Information was also provided in the homes Annual Quality Assurance Assessment that was completed by the registered manager and submitted to us in July 2009. The Care Homes for Older People Page 6 of 30 service was given the opportunity to update the information provided in the AQAA at the time of the inspection. We also used the information we received from surveys completed by five residents, eight members of staff and two health care professionals and five relatives. People living at the home were referred to as residents and this term will be used throughout this report. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: People are offered a healthy balanced diet but the menu should be developed in consultation with residents to ensure that their choices and preferences are reflected. The menu should also be displayed for everyone to see so that they know the menu options in advance. Care Homes for Older People Page 8 of 30 A recent safeguarding matter was not handled in accordance with local authority protocols. Although we were advised that lessons have been learnt it was evident that care staff did not undertake safeguarding training and this must be addressed to ensure that they recognise the signs and symptoms of abuse and know the correct procedures for reporting concerns. The three staff files we looked at did not include photographs and one member of staff had been appointed without references. We were advised that this was an oversight that would be immediately addressed. The providers must ensure that all required documentation for staff is in place and they must not start work before they have received satisfactory references. Staff induction needs to be completed in a more timely manner and the training and development programme for care staff must be reviewed and developed to ensure that they have the right skills and competencies to do the job. The matter of ensuring that there is a robust and efficient quality assurance system in place should be addressed so that the service can effectively monitor their own performance and address any shortfalls. 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 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to be provided with the information they need to make an informed choice about whether the home is suitable and will meet their needs. Evidence: The homes certificate of registration was on display in the entrance to the home and the Commissions last key inspection report and annual service review were also on display in the main corridor. A copy of the homes Statement of Purpose and Service User Guide was provided on request and brochures about the home were available for people to look at or take away. Five out of five residents that completed a surveys told us that they had received enough information about the home before they moved in so that they could decide if it was the right place for them. They also told us that they had received a contract covering the terms and conditions of residency. Care Homes for Older People Page 11 of 30 Evidence: The residents records we looked at during the inspection included signed copies of their terms and conditions of residency. They also included copies of their pre admission assessments and where applicable copies of assessments from the local authority or hospital ward. Before a new resident is admitted to the home a pre admission assessment is undertaken by the manager or deputy manager. The assessments we looked at covered areas such as sight, hearing, mobility and dexterity, personal care, continence, dietary needs, disabilities, allergies, history of falls, foot care, teeth and dentures, medical history, weight, medication and mental capacity. The homes category of registration is old age, not falling within any other category. However two of the residents we tracked had dementia. We were advised that one of them had been resident for several years before being diagnosed with dementia but the other was diagnosed with the condition prior to admission. Information provided to us and discussion with the resident concerned confirmed that they currently have low level dementia care needs which do not need a specialist response and are appropriately met by the home. Following the inspection the general manager contacted us to confirm that it was the providers intention to develop the service in the future so that they can provide specialist dementia care. They told us that they intended to submit this in their application to register with us under the new regulations later this year. The Statement of Purpose tells us that following admission there is a months trial period so that the resident can check that they are happy with the care provided and the service can cope with their requirements. The home does not provide intermediate care. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can expect to have their personal and health care needs met. Further more, they can expect to be treated with respect and have their dignity maintained. Evidence: The AQAA tells us that residents have individual care plans in place that are reviewed on a monthly basis and this was confirmed when we looked at records of three people during our inspection. The care plans we looked at reflected individuals needs and preferences and specified the assistance they required. They covered areas such as; communication, continence, daily life, death and dying, emotional support, finance, medical needs and medication, mobility, nutrition, personal care and sleeping. Information provided in the AQAA, feedback we received and observations made on the day of our inspection confirmed that the service appropriately supports people with their health needs. There was good evidence of close working relationships with local GPs and district nurses and comments from relatives that completed surveys included; interacts well with the General Practice and other NHS services, Attends to Care Homes for Older People Page 13 of 30 Evidence: residents every needs and is alert to the slightest drop in health. Of the two health care professionals that completed surveys one said that peoples social and health care needs are always properly monitored, reviewed and met by the service and the other said usually. Both confirmed that the service always seeks advice and acts on it to meet peoples social and health care needs. Their comments included Communicates well with the multi disciplinary team to ensure appropriate and timely interventions for care needs and provides excellent care all round. Out of five residents that completed surveys three told us that they always receive the care and support they need and two said they usually receive the care and support they need. Five out of five told us that the home always makes sure that they get the medical support they need. Comments we received were complimentary of the service and included; They look after me very well in all ways, Staff look after me and make sure I am alright and I am very happy, I have no complaints. We looked at the procedures for storing and administering medication. A Monitored Dosage System was used and Medication Administration Records (MAR charts) were clear and included photographs of the resident concerned. The MAR charts we looked at had been appropriately completed, signed and dated. The deputy manager advised us that senior staff continue to take responsibility for the handling of medication and they have all undertaken training provided by the prescribing pharmacy. Since our last key inspection a suitable refrigerator had been installed in the medication room so that medicines requiring refrigeration are secure and stored at suitable temperatures. Three out of five residents that completed surveys told us that staff always listened to them and acted on what they had to say and two said that staff usually listen to them and act on what they say. One resident told us; We are made to feel safe and cared for as we get older, but at the same time we retain dignity and Independence and another said staff are exceptionally alert, kind and attentive and no request is ignored. Observations on the day of our visit were that all personal care was given in private and residents dignity was maintained. Care Homes for Older People Page 14 of 30 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 use this service can expect to have a lifestyle that matches their expectations. Further more they can expect a well-balanced, nutritious diet. Evidence: Information provided in the AQAA, observations made during the inspection and feedback we received confirmed that there is open visiting arrangements and visitors are always given a warm welcome by the home. Residents can meet with their visitors in the privacy of their own rooms or in one of the communal areas. There are several communal areas throughout the main building and courtyard area. They include; three lounge areas, three dining areas, small seating areas and a conservatory. This gives people plenty of options about where to spend their time and who to spend it with. Since our last key inspection an activities coordinator has been appointed. There was a planned programme of activities displayed in the entrance to the home for the week of our visit. It told us that the activity for Monday was skittles & target practice, Tuesdays activity was crosswords, Wednesdays activity was 1-1 activities with individual residents, Thursdays activity was Craft and Fridays activity was Giant Scrabble. On the day of our visit we observed the activity Giant Scrabble taking place. Several residents participated and appeared to enjoy the session which was well Care Homes for Older People Page 15 of 30 Evidence: planned and organised by the activities co-ordinator. Three of the five residents that completed surveys told us that there were always activities arranged for them to take part in and two said there were usually activities arranged. The records we looked at that were maintained by the activities co-ordinator confirmed that there were usually planned activities five days a week. The records that we looked at for January told us that the following activities had taken place; art and craft, skittles, ball games and exercises, 1-1 activities with individual residents, Nintendo WII games, mime games, general knowledge quiz, uno card game, word games, reminiscence, crosswords, manicures, brain games, making trifles, pet therapy and discussing local news. Residents we spoke with had personalised their bedrooms with their own possessions and personal effects that they had brought with them when they moved in and there was good evidence that care staff promote the principals of choice and Independence whilst offering a helping hand where support is required. The home had a large dining room that consisted of three adjacent areas and residents could eat in one of them or in the privacy of their own rooms. On the day of our inspection most people were having their main meal in the dining room. The dining room was comfortable and pleasant, tables were attractively set and the lunch provided looked wholesome and appetising. The main option on the day of our visit was breaded fish and this was served with chipped or mashed potatoes, tomatoes and peas. The dessert of the day was lemon meringue pie. Of the five residents that completed surveys one said that they always like the meals provided, two said that they usually like the meals provided, one said sometimes and one told us that they provided their own meals. One person commented that the meat was often tough and another said that the menu could be improved so that it was more varied and there could be a more interesting choice of vegetables. On the day of our visit the menu was not on display so we asked to look at a copy. It was a rolling four week menu and the deputy manager told us that they changed it every summer and winter. The main meal for each day had two options with the exception of Sunday which was always a roast dinner. The tea time meal was assorted sandwiches and cakes although the deputy manager said that in fact hot food was often an option at tea time. We were advised that residents were asked to chose their main meal a day in advance. On the day of our visit the residents we spoke with did not know what they were having for dessert but they did know that they were having Care Homes for Older People Page 16 of 30 Evidence: fish for their main course. We spoke with the deputy manager about the possibility of displaying the menus so that people knew in advance what options were available. They told us that they would arrange for it to be displayed in the hallway or dining room. We also recommend that the service actively seeks residents views about meals so that the menu can be developing according to their preferences. Following our last key inspection we made a requirement that food prepared and stored in the refrigerator and freezer is clearly labelled with the date for food safety reasons. At this visit we found that prepared food stored in this way was correctly labelled. A food premises inspection had been undertaken by the borough council in March 2009 and the report told us that good standards were in place. Care Homes for Older People Page 17 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident that their complaints will be listened to, taken seriously and acted upon but they cannot be fully assured that they will be appropriately safeguarded from abuse. Evidence: The AQAA tells us that all new residents and their families are given a copy of the complaints procedure and a copy is displayed on the noticeboard in the entrance to the home. It tells us that complaints are taken seriously and investigated, as they are reported, by management. Five out of five residents that completed surveys told us that they know how to make a formal complaint. They also confirmed that they could speak to someone informally if they were not happy. One person told us We are able, via residents meetings, to voice any concerns we might have and another said Staff are exceptionally kind, alert and attentive. Records we looked at told us that the home had received two formal complaints during the past twelve months. Although the subsequent investigations and outcomes were not well recorded the deputy manager was able to give us clear information about the action taken to address the complaints and the subsequent outcomes. We discussed the need to have clear records and the deputy manager said that they would ensure that action and outcomes are clearly recorded in the future. The commission has not Care Homes for Older People Page 18 of 30 Evidence: been contacted by anybody directly about complaints relating to the home. The AQAA tells us that the manager and operations manager have attended a protection of vulnerable adults course and there are written policies in place about verbal and physical aggression that all staff are asked to read. The AQAA also tells us that all staff are given a POVA (Protection of Vulnerable Adults) booklet and the manager and deputy manager go through the procedures for reporting concerns and allegations in staff supervision. The AQAA also tells us that more senior staff need to be encouraged to attend a protection of vulnerable adults course. It does not confirm that anyone outside of the management team have undertaken safeguarding adults training. We spoke with staff on duty and they confirmed that the operations manager had spoken with them about procedures for reporting abuse as part of their induction and they all told us that they felt confident that they could report any concerns or allegations to a manager. However, when we looked at the records of three carers none of them had completed safeguarding training and this was confirmed to be the case by the deputy manager. The service has made one safeguarding referral in the past twelve months. It was made a month after the event and local authority procedures were not followed. The operations manager confirmed that they were regretful that the matter was not dealt with in accordance with safeguarding protocols and told us that the experience had been a learning curve. They assured us that they had familiarised themselves with the local authority safeguarding procedures and any future incidents or allegations would be handled appropriately. At the time of the inspection the safeguarding matter was still being investigated by the appropriate authority. We examined the recruitment records in three staff files and discussed the procedures in place for checking volunteers and work experience students. We found that appropriate CRB (Criminal Record Bureau) checks had been carried out but there were no references in place for one member of staff that had been employed several months previous. This is addressed under the Staffing section of this report. Care Homes for Older People Page 19 of 30 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 who use this service can expect to live in a comfortable, clean and wellmaintained environment. Evidence: At the time of inspection the home was safe, clean and tidy with no unpleasant odours. Four out of five people completing surveys told us that the home was always fresh and clean and one said it was usually fresh and clean. Information provided in the AQAA and observations made during our visit confirmed that the premises is well maintained. The furniture, decor and facilities are comfortable, pleasant and of a good standard and create a homely and relaxing environment. There had been several improvements made to the building since our last inspection. In addition to redecoration to parts of the building three bathrooms in the main house had been refurbished and were fitted with assisted baths, there was also a large shower room. The laundry room was appropriately equipped with two commercial washing machines and a tumble dryer and procedures were in place to ensure that soiled linen was handled safely. There was a stock of disposable aprons and gloves for staff use and suitable hand washing facilities were available throughout the home. Care Homes for Older People Page 20 of 30 Evidence: The requirements relating to the environment that were made following our previous key inspection had been met. The laundry door had been replaced to meet fire safety requirements and the WC in bathroom 2 had been fitted with a toilet seat. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to be supported by a team of dedicated and caring staff but they cannot be certain that they will be appropriately trained to meet their needs. Further more, they cannot be assured that they will be fully protected by the recruitment procedures in place. Evidence: Four out of five residents that completed surveys told us that staff were always available when they needed them and one said that they were usually available. Three said that they always received the care and support they need and two said usually. Out of eight care staff that completed surveys two said there were always enough staff to meet the individual needs of residents, five said there was usually enough staff and one said that there was sometimes enough staff. The staffing levels at the time of our inspection were one senior carer and three carers during waking hours and one senior carer and one carer at night. The manager and deputy manager were full time and supernumerary. There were also a team of anciliary staff consisting of cooks and kitchen assistants, domestics and a laundry assistant. The home also shared a full time activities co-ordinator and a maintenance worker with another home owned by Stowcare Ltd. At our last key inspection in August 2007 there were higher levels of care staff on duty Care Homes for Older People Page 22 of 30 Evidence: in the morning and afternoon. Never the less on the day of our visit people we spoke with said that they felt staffing levels at the home were adequate and our observations were that people were provided with the assistance they required in an appropriate and timely manner. One person we spoke with told us When people buzz (their call bells) carers are quick to respond. The AQAA tells us All new staff have a CRB check and three written references are obtained. The eight members of staff that completed surveys also told us that appropriate checks such as CRBs and references had been carried out before they started work. Three staff recruitment records were examined and included copies of their application forms, employment histories, declarations of health, evidence of ID checks and Criminal Record Bureau checks (CRBs). Two out of the three had written references on file. The member of staff without references had been employed for more than four months and we were advised that references had been formally requested but had not been provided. The deputy manager told us that this had been an oversight and agreed to address the matter by requesting further references. None of the staff files that we looked at included a photograph but we were advised that this would be addressed as a matter of urgency. The AQAA tells us that All new staff undertake an induction programme at Chilton Court. People we spoke with on the day of our inspection and discussion with the deputy manager confirmed that new staff have an induction with the operations manager that includes moving and handling training, food hygiene and infection control. The homes policies and procedures are also discussed and new carers are expected to complete the Passport to Care Homes induction workbook that covers the skills for care induction standards. We looked at the workbooks for three carers and none of them had been completed. One of the carers had been employed for approximately five months, another for ten months and another for fifteen months. We asked why the workbooks had not been completed within the specified six months and we were advised that staff were not allowed to take them home to complete and they did not have time within their working day. Of the eight members of staff that completed surveys four said that their induction covered everything they needed to know to do the job very well, three said it mostly covered everything they needed to know and one said partly. The AQAA tells us All care staff are offered various training courses, these include dementia, drug courses, hygiene, etc. It also says Staff are Chilton Court are given regular first aid training and manual handling updates and we need to encourage more staff to take the opportunity to do more training courses. Care Homes for Older People Page 23 of 30 Evidence: Eight out of eight carers that completed surveys told us that they were given training that is relevant to their work, keeps them upto date, helps them to understand the needs of residents and gives them enough knowledge about healthcare and medication. One carer we spoke with on the day of our visit told us we have done occasional training and with the exception of an in-house induction there was no evidence of training in the three staff files we looked at. We asked if there was a central training record we could look at, such as a training matrix, so that we could get an overview of the training provided but this was not available. The homes Annual Quality Assurance Assessment tells us that out of the twenty two carers employed five had completed an NVQ level 2 in care or above. The AQAA tells us more staff need to be encouraged to enrol for an NVQ qualification. One carer we spoke with told us that they hoped to start an NVQ when they had finished their induction workbook. Despite the lack of evidence relating to staff training the comments we received from residents and their relatives about the quality of care provided were highly positive. Comments included; Staff are exceptionally alert, kind and attentive and no request is ignored, Excellent staff, We are made to feel cared for and safe as we get older, They look after me very well in all ways, Very kind and caring staff, We are satisfied with the service and the care and ..an excellent first class establishment with wonderful friendly staff. Equal to a first class hotel. Care Homes for Older People Page 24 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live and work at the home tell us it is well run and have confidence in the management. However, the absence of effective quality assurance systems does not provide assurance that the home is run in the best interests of service users. Evidence: Mrs Jean Hayward is the registered manager and has worked at the care home for many years. The Statement of Purpose tells us that she has an NVQ level 4 in Care Management and the Registered Managers Award. It also tells us that she has undertaken training in dementia and protection of vulnerable adults. Mrs Hayward was not on duty on the day of inspection. However the deputy manager was on duty and assisted us throughout the day. The Statement of Purpose tells us that the deputy manager has worked at the home for many years and holds an NVQ level 4 in Health and Social Care. The AQAA tells us that the manager and deputy manager have attended the following courses in the twelve months prior to completing the AQAA; Deprivation of Liberty Care Homes for Older People Page 25 of 30 Evidence: Safeguards, First Aid, Manual Handling and The Essentials of Safe Clean Care. The deputy manager was fully receptive to the inspection process and welcomed discussions about how the home might improve. Feedback from staff, residents and relatives confirmed that the managers were approachable and well respected. Records we examined during our visit evidenced that appropriate health and safety checks are carried out. There were appropriate fire precautions in place and hot water temperatures were regularly monitored and maintained at safe levels. On the day of inspection there were no obvious risks or hazards noted and we observed that there was suitable Moving and Handling equipment provided and infection control measures in place. The AQAA was submitted to us when we asked for it. It had been completed by the manager and was adequately detailed. The AQAA tells us We do regular quality assurance surveys and hold meetings with our Courtyard residents every three months. When we visited the minutes for the residents meetings were provided and we asked why similar meetings for the residents accommodated in the main building did not take place. The deputy manager was not sure and said that she would discuss the matter with the manager. We asked if there had been any quality assurance surveys carried out and we were told there had not. Further more there was no evidence that there were any formal quality assurance processes in place and this was discussed with the deputy manager who agreed to raise the matter with the manager as an area for development. Records of Regulation 26 visit reports were provided up to December 2009. We were advised that since then visits had continued but hadnt been typed. This confirmed that the operational manager visits at least on a monthly basis to discuss matters of the home with the manager, the staff and the residents. It is helpful that their office is on the same site. The deputy manager confirmed that they did not act as agent or appointee for any of the residents bank accounts or benefits. Residents manage their own finances with assistance from their relatives or representatives as appropriate. Lockable facilities are provided in residents rooms for small amounts of cash and valuables. Feedback from staff confirmed that they receive planned one to one supervisions and appraisals. Four out of eight staff that completed surveys told us that they meet with their manager regularly to discuss how they are working, three said that they meet with their manager often and one said sometimes. Care Homes for Older People Page 26 of 30 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 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 18 13 Safeguarding concerns or allegations must be addressed in accordance with local authority protocols. This is to ensure that residents are fully safeguarded from abuse. 19/03/2010 2 18 13 Staff must be provided with safeguarding adults training so that they recognise signs and symptoms of abuse and know how to report it.. This is to ensure that residents are fully safeguarded from abuse. 21/05/2010 3 29 19 Care workers must not be appointed until satisfactory references are obtained. This is to ensure that the recruitment process is robust and safegauards residents. 26/03/2010 Care Homes for Older People Page 28 of 30 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 4 30 18 The satff training and development programme must be reviewed and developed and evidence of staff training must be maintained. To ensure that staff are trained and competent to do their job. 30/04/2010 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 home should more actively seek residents views and opinions about meals and menus so that people can be fully assured that the meals they are offered reflect their likes and preferences. Care Homes for Older People Page 29 of 30 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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