Care Home: Conifers

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What the care home does well The residents are cared for in a very dedicated and respectful manner in wellmaintained and comfortable surroundings. Residents appeared relaxed and all spoken with stated that they are treated with care and respect. Activities provided in the home are varied and suit the individual needs of the residents. The residents/relatives stated that they enjoy these activities and have choice on whether to join in. Staff said they are well supported and that the training provides a good knowledge base to meet residents needs appropriately. The quality of the documentation in the home is in excellent order, up to date and readily available. The home is clean, hygienic and fresh smelling throughout. All comment cards received from residents stated that they enjoy the meals, there is a choice and the food offered is of a good standard. What has improved since the last inspection? Since the last inspection, several aspects of the home have been significantly improved upon. These are detailed in the body of the report but are outlined as follows; Care plan documents contain more comprehensive information about the residents needs and preferences. These are supported by detailed action plans for staff. Individual and environmental risks have been reduced or eliminated through assessment and regular monitoring. Social care assessments have been improved and activities relevant to individual needs and preferences have been implemented. Staff are supported through regular supervision, training and team meetings. Relatives and residents are provided with the opportunity to be involved in decision making and care planning. Efficient administrative systems are now in place to support and monitor care practice. Conifers has undergone a range of environmental improvements to provide a more comfortable and safer environment for the people who live and work there. What the care home could do better: The home needs to continue to develop on identified areas of improvement, outlined in their AQAA. The remaining refurbishment plans to continue improvements of the environment need to be completed. The manager must submit her application for registration with CQC as soon as references are returned to her. CQC must be notified in writing when this is done. Key inspection report Care homes for older people Name: Address: Conifers Seal Square Selsey Chichester West Sussex PO20 0HP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Beth Tye     Date: 0 8 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 31 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 31 Information about the care home Name of care home: Address: Conifers Seal Square Selsey Chichester West Sussex PO20 0HP 01243602436 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Family Care Private Company Limited care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 20 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Dementia (DE) Date of last inspection Brief description of the care home Conifers is a care home providing personal care and accommodation for up to twenty service users in the category of dementia, over sixty-five years. It is owned by Family Care Private Company Limited. The home is located in Selsey and is close to shops and other amenities in this seaside town. It is a detached property with accommodation on three floors with eighteen single rooms and one double room. Several rooms have sea views. There are sitting areas and a dining room. The responsible person on behalf of the company is Mr Samarasekara. The managers post is currently vacant. The homes weekly fees range from 400 to 500 pounds depending on the level of needs of the resident. This information was obtained at the time of the inspection visit. Members of Care Homes for Older People Page 4 of 31 Over 65 0 20 0 9 0 1 2 0 0 9 Brief description of the care home the public may wish to obtain more up-to-date information from the care home. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This service has been rated as two stars, which is a Good quality rating. The site visit was undertaken by Ms Beth Tye, as part of the inspection process. It took place on 8th December 2009 between 10.30 and 4pm. The acting manager and senior carer facilitated the visit. An Annual Audit Questionnaire Assessment had been completed by the acting manager and forwarded to the Commission prior to the visit. All documents required on the day were made available. Nine comment cards were received from residents, all filled out with the aid of relatives who added their own comments and four were recieved by staff working at the home. These comments were all positive. Comments from residents, families and professionals elicited by the homes own quality assurance systems were seen in the Care Homes for Older People Page 6 of 31 home and these were also very positive. We looked at four residents pre-admission assessments, care plans, daily recording, social care and health records. Other records sampled included recruitment and training records for four members of staff, the record of complaints, quality assurance records and records relating to health and safety issues in the home. The premises were viewed including communal areas, kitchens, bathrooms and bedrooms. A number of interactions between people living in the home and staff, arrangements for lunch and medication dispensing and storage were observed. We spoke with a relative and some residents, all spoke very highly of the home and the care offered, which they said was delivered in a respectful manner. They also stated that the activities were appropriate and they were given choices. The atmosphere in the home was very relaxed and sociable. Many of the residents were sitting in the lounge socialising. Others were seen in their rooms listening to music, reading, watching television or with visitors. This report is compiled using information as described above and also information held on file at the Commission. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The home needs to continue to develop on identified areas of improvement, outlined in Care Homes for Older People Page 8 of 31 their AQAA. The remaining refurbishment plans to continue improvements of the environment need to be completed. The manager must submit her application for registration with CQC as soon as references are returned to her. CQC must be notified in writing when this is done. 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 31 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 31 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. To ensure residents needs can be met appropriately by the home, the manager undertakes a full assessment prior to admission. Each resident is provided with a written contract of terms and conditions, which is signed by all involved parties, so residents are clear about their rights within the home. Evidence: The manager assesses individuals prior to admission. During the visit, pre-admission assessments were examined for four residents. These identified relevant areas of need including, nursing, mobility, communication, health and social needs. Files seen contained correspondence from external health professionals such as social services and health. Records demonstrated the information collated prior to admission is then translated into care plans and reviewed on a regular basis by the acting manager. All records are kept in a locked office only accessible by care staff to ensure confidentiality. Care Homes for Older People Page 11 of 31 Evidence: Residents spoken to confirmed they are given up to date information about the home prior to admission, including a Service Users guide and complaints procedure. Copies of these were seen in some residents bedrooms during the visit. Pre admission visits and printed literature helps residents (and their families) to make an informed decision about moving to the home and what to expect. All residents have received a copy of their Terms and Conditions for the home, which they or their families had signed following admission. This informs residents of their rights and what to expect of the home. Care Homes for Older People Page 12 of 31 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. Staff have appropriate training and information to ensure they are able to meet residents health needs. Risk assessments and daily recording specific to individual need promote the welfare and well being of residents. Information is reviewed and updated daily due to effective monitoring systems. Medication is dispensed in line with the homes policies and procedures. Current care practices ensure residents feel they are treated with respect and their right to privacy has been upheld. Evidence: During the visit we looked at four care plans. Each care plan contains relevant and detailed information relating to health, personal and social care and gave clear instruction to staff in order to meet the needs appropriately. Information seen on care files was up to date and easily accessible. There was evidence to demonstrate that the manager undertakes regular care reviews for residents, and up date the care plans as changes occur. Care Homes for Older People Page 13 of 31 Evidence: Health and social care records also demonstrated that the care provided was relevant to individuals assessed needs and links are established with community health professionals to provide this. These include regular visits to the home by a GP, the chiropodist (six weekly) dentist (six monthly) and optician (annually). The home has good links with social workers, PCT, continence advisor and the local mental health team who offer advice and resources as required. Records of visits and correspondence from community agencies were seen on each of the residents files. Daily records and observation sheets are kept for each resident and intervention is recorded at the end of each day and night shift. Daily records are divided into sections which match every aspect the care plans. Staff are required to record all significant information at the end of each shift (this is then transferred to the main care records). The manager/senior staff will then use the information to monitor care, trends, behaviours and risk elements and then alter care records and action plans accordingly. This innovative way of working ensures residents care needs are assessed daily and changes to their care are implemented as soon as required. All care records seen were up to date and in excellent order. Risk assessments are in place for all residents and contain details about specific risk areas for individuals or appropriate action to be taken by staff. Detailed risk assessments and appropriate action plans for staff promote a better understanding of need and responses in addition to supporting residents to maintain independence safely where possible. A previous requirement made in respect of this has now been met in full. Records demonstrated that staff complete a full mandatory training programme. This provides staff with the skills and knowledge base to respond appropriately to residents health care needs. Particular attention is given to ensuring privacy and dignity when delivering care. Staff make every effort to ensure residents have choices and that their preferences are respected. An example of this was seen on the care plans as aspects of it were written in the first person. My name is X and I like and dislike By recording information from the residents perspective, staff are encouraged to relate to individuals and consider their views and preferences. Feedback and discussion with the residents and their relatives confirmed that good practice is maintained in the home and residents are treated with dignity and respect. Capacity and consent of residents is assessed prior to admission and is an on-going process as part of the reviewing system in the home. Conifers has good links with Care Homes for Older People Page 14 of 31 Evidence: specialists in this area, such as the mental health team, community psychiatric nurses and the local GPs. Assessment in this area provides the home with an understanding of the residents capacity to make decisions and can then promote individuals preferences in their daily lives whilst ensuring their safety. This information was reflected in feedback and the information seen on care files during the visit. We observed staff directly and indirectly during the visit and noted that they were friendly, caring and professional with the residents and the residents were at ease with the staff. The home records information relating to family visits and their contribution to care planning. There are also sections on care files which either the residents and/or their family sign action plans to demonstrate their involvement. Relatives comments on feedback forms included The home does really well looking after its residents and the staff are always pleasant and co-operative Staff were observed communicating with residents in a caring and respectful manner. All residents spoken to said they were very well looked after. The medication administration procedures were discussed and policies and procedures are in place to ensure safe medication administration. Photographs of residents are displayed on records as an extra safeguard towards safe administration. All staff who dispense medication have undertaken a 12 week course at Chichester college which results in a home learning exam. This ensures staff have the necessary knowledge to dispense medicines safely within the home. Care Homes for Older People Page 15 of 31 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 living at Conifers are able to make the day-to-day decisions about how they want to live their life. There is a range of activities for those who wish to participate, and residents are encouraged to maintain contact with all their old friends and family wherever possible. The food is of a high standard, and offers a choice of menu, with people able to eat either with other residents or in their own room should they prefer Evidence: The routines in the home are flexible and in the main are planned around the residents needs and preferences. We looked at four social care assessments during the visit. The assessment of social care needs for each resident is detailed and provides a clear picture of residents individual wishes, life history, their likes and dislikes. Each care file contains an about me life story which enables staff to have a clear picture of the resident, prior to their admission. Preferences for activities are detailed on each care plan and daily records. The activity log was seen and demonstrates that where possible, the home provides activities that individuals enjoy and would prefer. These include walking, reading, beauty therapies, Care Homes for Older People Page 16 of 31 Evidence: card games, crafts, visits to the local village and library, music, reminiscence sessions, specialist films and one to one time with carers. In addition to this the home has a rolling activities programme which involves professionals visiting the home on a regular basis. These include a theatre group, beautician, vocal therapist and musician. Residents can participate as they wish. On the day of the visit, a theatre group visited the home and all residents chose to join in. There were also a large number of family members present. We observed the residents singing, dancing and all the residents appeared to be enjoying and participating in the entertainment. In addition to the activity plans the staff complete a cognitive function and behaviour screening chart, which records the residents capacity, changes in behaviour and identifies possible risks. The action plans for staff which results from this information, ensures the residents are supported to maintain independence (where possible) whilst being kept safe. There was evidence on files to show all information relating to social care is monitored daily by the senior staff and reviewed when required. An activities plan is on display in the home to enable residents to plan their time, although routines are flexible to meet residents needs. Feedback from families confirmed that residents can choose what they want to do as far as social events, routines and also what times they go to bed and get up in the morning. Flexibility enables individuals to have choice and express a preference in their daily lives. There is now a designated room upstairs for hair and beauty treatments and one to one activities with residents who would prefer some privacy. Residents and relatives also confirmed that the visiting arrangements for the home are open and visitors can come and go as they please and are made welcome by the staff. Feedback forms confirmed relatives felt welcomed and involved by the home. The manager has an open door policy for residents families, staff or other involved parties to discuss any issues or aspect of the home. Care plans contain a section to record when families are consulted or notified about the care of their relatives. Where possible care plans are signed to demonstrate their involvement. Staff spoken to during the visit confirmed that the manager is always available to support us and give advice. This practice, alongside regular meetings, demonstrates that staff, residents and their families are encouraged to participate in decision-making about the care the home provides. Care Homes for Older People Page 17 of 31 Evidence: During the visit staff were observed interacting with the residents. Staff were seen throughout the day being respectful, kind and sensitive to residents needs. One staff member was observed working with the residents, she used gentle prompts and encouragement to engage residents and maintain their focus on the activity they were undertaking. The menu offered at the home takes in to account the preferences of residents and specialist dietary requirements, which are recorded on care plans. All residents have nutritional assessments and attached risk assessments to ensure specialist dietary needs are adhered to and monitored. Preferences and dislikes are recorded and taken into account by the homes cook. An alternative meal is on offer at lunchtime and teatimes. This promotes choice for the residents and provides an opportunity for them to eat what they prefer, whilst meeting their dietary requirements. Residents spoken with said they really enjoyed the food and it was always very good We spoke with the cook who has control of the food budget and we saw that the fridge and larder were well stocked with good quality food. The cook has enhanced her knowledge through a nutrition and health training course. We saw records are kept of individuals daily dietary intake, which also indicate if someone chooses an alternative to the main meal and what mid-morning snacks and fluids people have on a daily basis. This ensures dietary requirements and preferences are monitored and reviewed on a regular basis in line with residents assessed needs. Care Homes for Older People Page 18 of 31 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. Residents who use this service or their representatives are able to express concerns, and have an access to an effective complaints procedure. Residents are protected from abuse and have their rights protected. This judgement has been made using available evidence including a visit to this service. Evidence: The home has a complaint procedure, which is outlined in the statement of purpose and displayed in the home. Complaints are recorded and investigated with feedback to complainant within 28 days with the actions taken. All residents and visitors spoken with said they knew who to complain to and that they would do so if they thought it appropriate. Staff induction and training records indicated that all staff receive training in safeguarding vulnerable adults. Staff spoken to, did know what to do if they suspected abuse. Staff personnel files seen during the visit, were in very good order and held all appropriate checks and references. This ensures residents are safeguarded from risk Care Homes for Older People Page 19 of 31 Evidence: of harm. Regular staff meetings within the home encourage feedback about how the home is run and identifies which areas could be improved upon. Information on advocacy services is available if needed. Care Homes for Older People Page 20 of 31 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. The home has undergone significant changes and improvements since the last inspection. Conifers provides a homely environment to the people who live there. All areas are clean, tidy, well maintained. The bathing facilities are able to meet the needs of all residents. Equipment and safety checks necessary to ensure the welfare of the residents are in place. Evidence: Since the last inspection the home has made significant improvements to the homes environment. Previously there had been requirements made in respect of infection control, alarm systems and unsafe toilet cisterns. Following the visit we found that these requirements had been met in full. The kitchen has been refurbished and decorated. Fire protection glass and fire proof curtains have been installed. The washing is no longer taken through the kitchen but through a side entrance in order to comply with infection control procedures. The heating system in the home has been upgraded. Solar panels have been fitted to the north facing roof, this provides a more efficient energy system. Strip lighting has been installed in the downstairs rooms, with plans to continue this through the rest of the house. The new lighting makes the communal areas brighter Care Homes for Older People Page 21 of 31 Evidence: and gives a sense of more natural light in the alcove areas of the dining and living spaces. The home has been redecorated throughout. The communal areas are warm, homely and comfortably furnished. A new large plasma screen television has been positioned in the lounge, so residents can sit at some distance and still see the screen. The old carpets have been replaced with vinyl flooring in the downstairs are and some bedrooms. A cupboard has been built for wheelchair storage to reduce the risk of trip/fire hazards. A Cosh cupboard has been built (and is lockable) to comply with health and safety procedures of the home. A stair lift has been fitted at the rear of the building to provide residents with access to all floors. Anti bacterial soap and hand towel dispensers are positioned at all sinks in the home. Hand sanitizers have also been positioned in communal areas and hallways, with glove and bag dispensers to promote infection control in line with the homes polices. Records seen during the visit demonstrated that all of the staff have attended relevant training for infection control and health and safety procedures. This promotes good practice in the area of safety and welfare for the residents and reduces the risk of infection spreading within the home. There are hoists, bath aids and specialist equipment to promote the independence of those who require assistance with personal care needs. Two new toilets have been installed and a walk in shower room is in the process of being built upstairs to replace one of the old bathrooms. This will provide less mobile residents with the opportunity to shower as well as bathe in the future. All toilets and bathrooms are signposted to prompt residents as to their whereabouts. Two bedrooms have been fitted with en-suite toilets with plans to complete an additional four in the early part of 2010. Carpets upstairs have been replaced throughout the top floor landings, which improves the look of the home. Health and safety hazards have been reduced as all fire doors have been fitted with new safety strips, window restrictors have been installed on upstairs windows, heating pipes in bedrooms have been insulated with safety foam and radiators have been covered. There are floor pressure alarm mats in each bedroom. This notifies night staff if residents have got up in the night and reduces the risk of falls or injury. A call bell Care Homes for Older People Page 22 of 31 Evidence: system is installed in every room so staff can attend an emergency situation swiftly, should it arise. During the visit we looked at the homes safety records in respect of the environment. These included fire training, water temperature checks, risk assessments and equipment checks. All records seen demonstrated the home undertakes regular monitoring and recording to ensure the residents health, safety and welfare is promoted at all times. Care Homes for Older People Page 23 of 31 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. The home employs staff in sufficient numbers and provides them with training to meet the needs of people who use the service. People who live in the home are protected by the homes staff recruitment procedures. Evidence: Staff rotas reflected that there are enough skilled staff on duty at all times in the home. There are no staff vacancies at present. The majority of staff are long standing team members who have been at the home a number of years. Both staff and residents fed back how this enabled consistency for residents and allowed more time for one to one care. The homes annual quality assurance assessment (AQAA) stated that all staff had satisfactory pre-employment checks. Further evidence of this was seen at the time of our visit through inspecting a sample of four staff members recruitment records. These files contained the required information, such as dates of employment and completed job application forms, two written references and evidence of satisfactory Protection of Vulnerable Adults (POVA) and Criminal Records Bureau (CRB) checks. Following examination of staff records it was concluded that, recruitment procedures in the home are good and in line with the homes recruitment policies. All staff files seen were found to contain the necessary documentation required by Schedule 2 of the Care Regulations. Training records of four staff files were looked at during the visit. They showed that Care Homes for Older People Page 24 of 31 Evidence: staff undertake a six week (in house) induction programme which includes all aspects of care in the home, health and safety and best practice guidance. The staff induction workbook includes reference to appropriate policies and procedures and a checklist covering all aspects of the home which is overseen by the acting manager. As part of their induction, all new employees are required to undertake shadow shifts with senior staff (the number is dependent of their level of experience). This practice promotes a consistent approach to care practice in the home. The mandatory training for staff covers fire safety, first aid, manual handling, health and safety, adult protection and infection control. In addition the home has provided some specialist training to meet assessed needs of the residents. This includes; Dementia (including The Mental Capacity Act), Nutrition and Palliative Care. The acting manager has a detailed training programme in place which identifies training needs and timetables refresher updates. There are plans for the home to provide more specialist training to staff such as Deprivation of Liberty training in early 2010. Examination of training records, observation and feedback from surveys and during the visit highlighted that staff are skilled and competent in their roles. Staff spoke with during the visit were clear about their roles and responsibilities and how to respond appropriately to residents needs. Comments made about the staff by the residents and their families included staff treat the residents as individuals, compassionate, pleasant and co-operative and the staff are very good at offering choices. This was supported by observation of care practice and examination of care records during the visit. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and staff benefit from the leadership and management approach within the home. Overall the residents welfare is a priority within the home, and this is supported by administration systems, policies and procedures. Evidence: Since March 2009 the acting Manager has been in post at Conifers. Following completion of her six month probation period she is now in the process of applying to the Commission to Register as the homes manager. On the day of the visit she was able to demonstrate that she had completed the application but was waiting for return of her CRB checks and medical references before sending off her application. It was agreed that she would notify the Commission in writing once she had undertaken this. The acting manager has had several years experience in health and social care management. She has completed the National Vocational Qualifications Level 3 and 4 and is due to complete the Registered Managers Award in January 2010. It was evident from evidence collated at the visit, survey forms and feed back from staff, Care Homes for Older People Page 26 of 31 Evidence: residents and relatives that the new manager has made significant improvements to all areas of the home, since coming in to post. All previous requirements have now been met in full and some areas of improvement have exceeded the standards. Staff feedback reflected that the management provides good leadership and direction. Staff spoken to stated if there are problems the manager is always around to deal with it. And that the manager is supportive. One staff member stated we all know what we are doing in our jobs and are supported to do it well and moral is excellent here because of support by the manager. This approach enables staff to seek guidance when needed to ensure residents needs are met appropriately. The administrative systems which support the care practice in the home have been overhauled and improved since the acting manager has come into post. The home now has very clear and up to date recording procedures in respect of care practice, health and safety and promoting the welfare of the residents. All care records and documentation seen was in excellent order and information was easily accessible. Health and safety is maintained through record keeping, training and servicing of necessary equipment. All equipment checks and servicing is carried out within the safe guidelines. Policies and procedures are in place and reviewed on a regular basis by established monitoring systems. Residents are encouraged to manage their own finances or if this is not viable and a representative of the resident take on the responsibilities for this. No residents financial accounts are dealt with by the home Staff in the home receive regular supervision and have undergone annual appraisals with the acting manager. They also undertake a comprehensive induction, training relevant to their role and attend regular staff meetings. This promotes good practice in the home, helps identify learning needs and gives them the opportunity to contribute to the way the home is run. Conifers has a annual quality assurance assessment in place which is used to inform the annual business plan. Questionnaires are sent out annually and the results once published, are available to any involved parties. In order to monitor the impact of the changes since taking up her post the acting manager has sent out six monthly questionnaires to involved parties. (The second batch are due to go out in January 2010). This will provide an opportunity for the manager to monitor responses from people living, working and involved in the home. She informed us that from this information, an action plan will then be put into place for on going improvements. Care Homes for Older People Page 27 of 31 Evidence: Care Homes for Older People Page 28 of 31 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 29 of 31 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 Care Homes for Older People Page 30 of 31 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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