Care Home: Country View Nursing Home

What the care home does well Country View Nursing Home is an established care home with nursing. It is a large country house situated in pleasant surrounding overlooking the countryside. The home is clean, tidy and has a welcoming atmosphere, whereby staff greet visitors to make their experience of the home pleasant. People using the service are encouraged to be involved in all aspects of their care planning to ensure their needs, requirements and wishes are known and can be me by the home. People are encouraged to maintain as much independence as practicable, whereby they continue to make decisions and choices for themselves. People`s routines are promoted and supported by the home, which includes social interests and observance of their faith or religious beliefs. People are encouraged to receive visitors at any time and can use the smaller lounges for privacy. Staff are caring and patient. Staff interact with people well, showing respect and awareness of people`s needs and abilities. The comments received in the surveys from people using the service, relatives, General Practitioner and staff, and on the day with regards to what the service does well, included: "Looking after people and making effort to given them some quality of life" "Understanding the needs of the individual - all residents are treated with respect" "The management are very good at appointing staff with the right attitude - they all work well together as a happy team and it shows in their work and has created a good atmosphere at the home" "On the whole, a very good place, staff are friendly 99% and caring" "I have been more than satisfied with the care and attention given to my .... All the staff have been very kind and professional in their dealing with her. I have no complaints whatsoever" "It offers good health care by all concerned and we do our best to meet the needs of residents and relatives" "I feel, as a GP, residents health needs are well met" "Good atmosphere between staff and staff; staff to residents and relatives" "I feel the staff at the home are extremely loyal and hardworking, a real asset to the home. They generate a community feeling within the home and deliver comfort and great care to all that live there" What has improved since the last inspection? Since the last inspection of Country View Nursing Home has addressed the requirements set at the last inspection. The management systems, recording and disposal of medicines is now in place and robust. There has been improvements to the home environment, which includes new carpets and curtains in the lounge, dining room and six bedrooms have been decorated and furnished. Country View Nursing Home has appointed new care staff. The Responsible Individual has confirmed a trained nurse has been identified for the position of the Acting Manager for the service. Staff have received information and training in Mental Capacity Act and the Deprivation of Liberties Act. Staff have access to E-learning. This is training on-line providing staff with a range of learning tools. The comments received in the surveys and directly from people using the service with regards to the improvements made to the service included: "Much better now, introduced systems and having staff responsible for specific duties e.g. laundry, cleaning, so care staff are on the floor" "Introduced a flow-chart for medication received in and disposal, records and signatures now required" "The food, meals have improved since ... has been in" What the care home could do better: This was a positive inspection of Country View Nursing Home. The information received from the people using the service and our findings during the site visit demonstrated that County View Nursing Home continues to improve the quality of care and services provided. There were no significant areas of risk identified during the inspection of the service. The Responsible Individual confirmed a trained nurse has been identified to be the Acting Manager and will in due course submit an application to be the Registered Manager for the home. We have also made a good practice recommendation that should be considered. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Country View Nursing Home Country View Nursing Home Warkton Kettering Northants NN16 9XQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rajshree Mistry     Date: 0 3 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. 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. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 37 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: Country View Nursing Home Country View Nursing Home Warkton Kettering Northants NN16 9XQ (01536)484692 01536518376 countryviewnh@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Country View (Warkton) Limited care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: No one falling within category PD may be admitted into the home where there are 4 persons of category PD already accommodated within the home No one falling within the category of OP may be admitted to the home where there are 29 persons of category OP already accommodated within the home. The total number of service users accommodated in the home must not exceed 29. Date of last inspection Brief description of the care home Country View Nursing Home is privately owned and set in a rural part of Northamptonshire. It is a large converted country house, with a ground floor extension. There is ample car parking to the front and the rear of the home. Care Homes for Older People Page 4 of 37 Over 65 29 0 0 4 1 4 1 1 2 0 0 8 Brief description of the care home Country View Nursing Home is registered to provide both nursing and residential care. Accommodation is both single and double bedrooms and there is a range of communal areas. The garden patio and terrace overlook the lawn and landscaped garden to the rear. The Responsible Individual provided us with the range of fees, which are £510.00 to £550.00 per week. There is additional personal expenditure for private chiropody, hairdressing, papers/magazines, toiletries and taxis . People considering using Country View Nursing Home should contact the home directly to discuss individual needs and requirements. Full details for Country View Nursing Home and any specific requirements can be obtained in the form of the Statement of Purpose and the Service User Guide. The latest Inspection Report from the Care Quality Commission is avialable at the home or accessible via our website: www.cqc.org.uk Care Homes for Older People Page 5 of 37 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: The quality rating for Country View Nursing Home is 2 star. This means the people who use this service experience good quality outcomes. We as it appears throughout this Inspection Report refers to the Care Quality Commission (CQC). Any reference to the Commission for Social Care Inspection (CSCI) should be taken as CQC, who hold the legal responsibilities previously held by CSCI, as of 1st April 2009. This key inspection started with review of the last key inspection dated 5th June 2007 and the subsequent four random visits to the home to check compliance. We looked at the information we had about the management of Country View Nursing Home and the events that affects the well-being of the people using the service, which includes any concerns or complaints we may have received. Care Homes for Older People Page 6 of 37 We received from the Responsible Individual the completed Annual Quality Assurance Assessment (AQAA) document, which is the homes self-assessment of the standards within the home. We sent out 23 surveys to the people using the service and surveys for their relatives. We received 10 surveys from the people using the service and 10 from relatives. The responses and comments received indicated that people were generally satisfied with the quality of care, services and facilities provided. The responses indicated people had the opportunity to live the lifestyle of their choice, participate in social events arranged by the home and observe their religious beliefs and practice. The responses also indicated people were confident to complain and supported by staff that cared. The comments received are reflected in this inspection report to support our findings. We sent out 32 surveys to the staff of which only 4 were returned. The majority of the responses received indicated that staff were recruited fairly and received training to meet the needs of the people using the service. We received comments with regards to what the service does well and what could be improved. These comments are included throughout this Inspection Report with our own findings. We sent 1 survey to the General Practitioner (GP) practice, which was completed. The response and comments indicated the staff met the needs of the people living at Country View Nursing Home. We visited Country View Nursing Home on 3rd June 2009, starting at 9.30am and finishing at 5.30pm. The nurse on duty and the Responsible Individual assisted us during the site visit to the home. The main method of inspecting we used was case tracking. This means looking at the range of nursing and personal care people receive that is met by staff. We look at how peoples rights, choice, dignity and independence is promoted by the home. We selected four people to case track, all of who had differing needs, abilities and included a person that was new to the home. We spoke with those people and other people using the service. We read the care files containing information about the persons health and personal care needs, lifestyle and how these are met. We made observations of people, how they are treated by the staff with regards to meeting their needs and promoting their well-being. We spoke with visiting relatives to gather their views about the quality of care provided by the staff at the home, their observations and experiences. We looked at the accommodation offered to people using the service. This included communal areas, bathrooms and individual bedrooms, with permission. We spoke with the staff at all levels on the day to ascertain the recruitment process, training, staff skills and the management of the home. We looked at the staff files that demonstrated the staff recruitment, training and skill-mix. We read the information people received about Country View Nursing Home. We looked at how the policies and procedures are followed by the staff to ensure peoples health and safety. We looked at specific records to demonstrate the day-to-day management of the service. The Care Quality Commission has a focus on Equality and Diversity and issues relating to these are included throughout the main body of this Inspection Report. Care Homes for Older People Page 8 of 37 What the care home does well: What has improved since the last inspection? Since the last inspection of Country View Nursing Home has addressed the Care Homes for Older People Page 9 of 37 requirements set at the last inspection. The management systems, recording and disposal of medicines is now in place and robust. There has been improvements to the home environment, which includes new carpets and curtains in the lounge, dining room and six bedrooms have been decorated and furnished. Country View Nursing Home has appointed new care staff. The Responsible Individual has confirmed a trained nurse has been identified for the position of the Acting Manager for the service. Staff have received information and training in Mental Capacity Act and the Deprivation of Liberties Act. Staff have access to E-learning. This is training on-line providing staff with a range of learning tools. The comments received in the surveys and directly from people using the service with regards to the improvements made to the service included: Much better now, introduced systems and having staff responsible for specific duties e.g. laundry, cleaning, so care staff are on the floor Introduced a flow-chart for medication received in and disposal, records and signatures now required The food, meals have improved since ... has been in What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.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 10 of 37 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 11 of 37 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 received good information about the service, are involved in the assessment process to make sure their needs can be met by the home. Evidence: We wanted to find out what information people receive about Country View Nursing Home. The information we gathered from the self-assessment tool completed by the Responsible Individual (owner) stated people are encouraged to visit the home and receive a brochure and service user guide. We read the Service User Guide, which was comprehensive and outlines the types of services people can expect to receive, the process of moving in, the accommodation and facilities available to them should they choose to move to the home. The aims and objectives of the home are set out in the form of the Statement of Purpose. This includes the key policies and procedures, the admission process, the complaints procedure and the skills and qualifications of the staff and the management team. Care Homes for Older People Page 12 of 37 Evidence: The survey responses received from the people using the service and their relatives confirmed that they and their relatives received information about the home. People using the service and their relatives that we spoke with said they had the opportunity to visit the home before choosing to move in. We wanted to find out whether people considering using Country View Nursing Home were involved in the process to say what help they need on a daily basis. This process is known as the assessment of needs,which looks at whether the home is able to meet the persons health and personal care needs. We spoke with people that we chose to case track, other people using the service and some visiting relatives. They confirmed the nurse from the home carried out an assessment of needs. For people who are financially supported by the local authority or the Primary Care Trust through continuing health care, the social worker or the trained assessor completed an assessment of needs. The comments received from the people using the service and visiting relatives supported our findings and included the following comments: We came and had a look round and liked the family atmosphere here - its very relaxed Yes, I chose to come here My daughter came to see the home before I moved in I didnt want to come to a care home but had to due to my failing health She moved here by choice, assessed by the nurse and all things considered she is much better having all her needs met here We read the care files for the people we case tracked. All had a copy of the homes assessment of needs. The assessments were comprehensive and showed a range of information gathered about the person, which included their personal details and key people such as family and General Practitioner; health, nursing and personal care needs, medical history, illness such as stroke and Parkinsons, physical and mental well-being, dietary needs, medication, cultural and diversity needs. The assessment reflected the persons views and wishes indicating they and their relatives were involved to personalise their care. This showed that the assessment process was robust to ensure peoples needs would be met by the staff at the home. We spoke with the trained nurse on duty with regards to assessing people. They Care Homes for Older People Page 13 of 37 Evidence: described the assessment process, having done the assessment for the newest person that moved to the home and the communication with the social worker. The records supported the information given by the trained nurse demonstrating a robust admission process. We wanted to find out what information staff receive about a new person that moves to the home. Staff we spoke with confirmed they receive information from the nurse in charge and have the initial plan of care in the care file by the time the person moves in. This supported the responses received in the staff surveys. The majority of surveys responses received from the people using the service indicated they had a contract in place for their stay at the home. Two people using the service and a visiting relative confirmed they have a contract. The Responsible Individual provided us with a sample copy of the contract, which sets out the terms and conditions of the stay. Some care files we read also had the individual placement agreements, where the person is financially supported by the Local Authority or by Continuing Health Care, which forms part of the contractual agreement. This showed people using the service have a clear signed agreement for their stay at Country View Nursing Home. Country View Nursing Home does not provide intermediate care services. Care Homes for Older People Page 14 of 37 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. Peoples health and care needs are met through improved care planning and staff that understand and promotes their health and well-being. Evidence: We wanted to find out how peoples health and personal care needs are met. The information we gathered from the self-assessment tool completed by the Responsible Individual provided a summary of the systems and practice within the home. It states they involve the person, their relatives and professionals in the care planning; staff are informed of peoples needs, good access to professionals such a medical, advocacy and legal and the staff ensure peoples privacy and dignity is promoted. The selfassessment stated the staff at the home use the Liverpool Care Pathway, which ensures that end of life care is provided with dignity and comfort. All the survey responses received from the people using the service and their relatives indicated people receive the care and support they need. This supported the comments received from the people that we spoke with during the site visit, where some people required nursing care and had limited physical mobility and others who Care Homes for Older People Page 15 of 37 Evidence: required minimal assistance. People indicated that they had been involved in developing their plan of care and where unable to do so relatives have been consulted to ensure needs are met with consideration to their preferences and wishes. Several people using the service, including the newest person and visiting relatives, all spoke positively about the nurses and the care staff that assisted them with their health and personal care needs. They were able to describe the help they needed and how staff assisted them on a daily basis. One lady being cared for in bed said, staff do pop-in and check on her. They told us that the staff know her new routine from being mobile to now being nursed in bed following a stroke. They pointed out the air mattress and setting, which was correct and demonstrated they were provided with appropriate equipment to prevent pressure sores developing. This showed care plans are updated to reflect new and changing needs of people using the service. Some of the comments received from visiting relatives and the people using the service with regards to care planning and having their individual needs met included: I am the first residents they have had suffering from .... and the staff have made an effort to find out about it so they know how it affects me Understanding the needs of individual - all residents are treated with respect I have been more than satisfied with the care and attention given to my ... The home looks after me really well, I am happy with the service I get Looking after people and making effort to give them some quality of life Staff we spoke with confirmed that they have a key-worker system in place, whereby they have specific role towards a person using the service. This may include ensuring the person has sufficient supply of personal toiletries. Staff spoken with demonstrated a good understanding of peoples health and personal care needs and risks. Staff showed a good awareness of how dementia and Parkinsons affects people and gave examples of how they approach and encourage independence and decision making . Staff were observed using safe techniques when using the hoist to transfer a person into the chair. This supported the responses we received in the staff surveys. The trained nurse on duty confirmed that there are regular reviews of care plans, especially when changes to peoples health occurs. We saw the trained nurse meeting with a social worker and the newest person to discuss their continuing care needs. Care Homes for Older People Page 16 of 37 Evidence: This showed the staff at the home work with health and social care professionals to ensure the care provided is in consultation with the person to ensure the home is the right place for them. The care files read showed reviews do take place regular, which supported the comments received from visiting relatives have attended the review meetings. People using the service gave examples of how staff ensure their privacy and dignity is maintained. This was consistent with staff describing to us how they ensure peoples privacy and dignity it maintained, making reference to the use of privacy screens in the shared bedrooms. This supported our own observations, as we saw a number of people throughout the day being hoisted in and out of chairs safely and in a dignified manner. Some of the comments received to demonstrate how peoples well-being was promoted included: My clothes are matched together better so the colours go together well I do like to wear matching jewellery You probably notice it more with the ladies, in fact they all look well dressed matching colour of clothing, their nails looking clean and cut We read the care files for the people we case tracked. The care plans have improved and contains information to reflect the changing needs and support required with consideration as to how the persons illness or disability affects them. There are care plans for the day and night, which showed consideration had been made to peoples needs and lifestyle. The nursing plans reflected the monitoring in place to prevent sores, which included turning charts and monitoring the fluid and nutrition intake, for some people. We saw good evidence of improved practice with regards to monitoring blood sugar levels and what action should be taken if there are concerns, which may require the General Practitioner (GP) or the dietician. The care files contained appropriate risk assessments and the safety measures were detailed in the care plans to promote peoples health, safety and well-being. These included falls management, epileptic seizures, nutrition, moving and handling and for people who required bed-rails to ensure they were appropriate for their care and safety. The daily records completed by the staff demonstrated health and care needs were met as per the care plan. In addition, any concerns regarding the persons health and well-being was recorded and reported to the nurse in charge, for example contacting the GP. This was supported by comments received from visiting relatives, who said the home keep them informed on important matters. Care Homes for Older People Page 17 of 37 Evidence: People using the service and visiting relatives told us they have good support from GP and specialist nurses. This supported the responses received in the surveys from people using the service and relatives. Care files we read detailed visits from the GP and the Chiropodist. People using the service now benefit from having a single GP practice to promote consistency and continuity of care. The trained nurse informed us that the GP visits every Tuesday, so people are able to see the GP, if they need to. The information we gathered from the self-assessment tool completed by the Responsible Individual also stated the senior staff also receive regular updates from the Macmillan nurses and the hospital with regards to providing palliative care. The survey response received from the GP indicated people are supported to live their choice of lifestyle; privacy and dignity is respected and the staff have the skills and experience to care for the people using the service. The comments included in the surveys were: I feel as a GP, residents health needs are well met I enjoy working with the staff and residents there We wanted to find out the management systems for medicines. Since the last inspection of the home, we carried out a number of random visit to ensure the management systems for medication was safe. People we spoke with during the site visit all confirmed they receive their medicines on time from the trained nurse on duty. We observed the trained nurse giving the medicines at breakfast when we arrived and at lunch time. We observed people having their medicines given to them at lunch time by the trained nurse, checking the records against the medication. The recording was completed individually after the medicine was taken and consistent with best practice. We spoke with the trained nurse regarding the improvements made to the management of medicines. They confirmed that trained nurses are responsible for administering medication, which is kept in a locked trolley in the treatment room. There was secure storage of medication ordered for the following month and clearly labeled with name of the person it is prescribed for. We concluded after speaking with the trained nurse on duty that there is a clear auditable system and recording of medication ordered, received and stored. There is now a robust system, records and contract in place for the disposal of old or unused medication. We checked the management, storage and recording systems for controlled medicines (strong medication). This was robust and managed in line with current best practice. Care Homes for Older People Page 18 of 37 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. Peoples lifestyle and interests are promoted by maintaining social contact and offered good choice of meals that promotes their well-being. Evidence: We wanted to find out how people spend their day and what opportunities people have to maintain contact and engage in social events. The information gathered from the self-assessment tool completed by the Responsible Individual stated, provides a wide range of activities to suit the needs of people such as quizzes, crafts, painting, bingo, reminiscing therapy and music to movement. It also gave examples of social outings that take place such as trips, to the shops and rides around the local countryside. The information we read about the home in the service user guide and the statement of purpose also detailed a range of social and leisure opportunities available to people including to practice religious or spiritual beliefs. We received a mixed response from the surveys from people using the service and their relatives with regards to activities arranged by the home. The comments received were reflective of individual opinions and preferences, which included; Extra activities enjoyed Care Homes for Older People Page 19 of 37 Evidence: I am bored alot of the time - better activities please Be nice to go out, all we do is watch TV Visitors always welcome and are able to talk to the staff - all staff are very approachable During our visit to the home, we saw some people were sitting having their breakfast, some people were watching television in the lounge, one person was seen going out with their relatives and others were in their bedrooms. We noted that the lounge is set up with clusters of seating and a television in each corner of the room. People were sat in watching television or talking to each other or their visiting relatives. The same television programme was on, to avoid conflicting noise, which was preferred by the people using the lounge. The seating arrangement in the lounge provided people with an opportunity to engage and converse with each other, which promoted stimulation. Throughout the day we saw people receiving visitors. Several relatives told us they visit regularly and can use the transport provided by the home to go out. This showed the home recognised the need for transportation to encourage people to maintain contact with the family and the community. We saw a clergy from the local church visit a gentleman at the home who continues to practice his faith. This showed peoples preferences and diversity needs and choices were supported. In the lounge we saw notices displayed of the activities and social events that take place at the home, including the Residents & Relatives Meeting. These included Church services, quiz nights, PAT-a-dog, hairdressing, singing, films and music to movement. This was consistent with the information gathered from the selfassessment tool and the information in the service user guide provided to people. People we spoke with using the service told us their visitors are welcome at any time and encouraged to be involved with the home. One lady we spoke with, who stay in bed, pointed out the bird box on the window where birds often come to feed, which they enjoyed watching. The newest person told us they have certain things they like to do, which has been supported by the staff at the home. We observed some staff in one part of the lounge doing an word game, which made people think and stimulated their minds. Some of the comments received indicated that most people were happy with their lifestyle and opportunities to engage and be stimulated in the home that included: Care Homes for Older People Page 20 of 37 Evidence: My ... plays bingo and shes always winning I actually enjoy watching TV, especially some mornings, Im quite busy as I have several programmes I need to watch I like to watch the birds, they come, eat and fly away. I cant go outside by I feel as if I am outside We wanted to know what information staff receive about peoples interests and choice of lifestyle. Staff told us the care plans provide information as to peoples interests and gave examples how to support people to engage in activities and make choices for themselves. The care plans showed how the information gathered from the assessment of needs was used to ensure the persons lifestyle needs and requirements were taken into account. The nurse on duty told us that the home has transport available for relatives to use to take people out. People told us that they were valued and treated well. One relative commented up on how well people look and said, Its the attention to detail, whereby today she has a grey cardigan on, which is worn with a blouse with white and grey trimmings Clothes are matched together better so the colours go together well In fact, they all look well dressed, matching colours of clothing, their nails look clean and cut The care plans we read for the people we case tracked, detailed peoples interests, religious observance, hobbies and family and friends that are important to them. The daily records we reflected the activities people joined in such as bingo, going out with family or receiving holy communion. The newest person had a weekly activity plan, having moved to the home for a short stay. They told us that they enjoy going out shopping or just out with a member of staff everyday. This showed that the person was support to continue their weekly activities programme. We wanted to find out what the meals were like. The majority of responses in the surveys received from the people using the service and their relatives were complimentary about the choice of meals. People using the service also complimented the choice of meals offered. The comments received included: I enjoy my meals Care Homes for Older People Page 21 of 37 Evidence: Food is generally ok, ... usually comes round with the menu and you choose Food is probably a difficult area but more imagination could make more flavoursome meals with greater variety of ingredient The food - meals have improved since ... has been in He eats well since coming here Ive put on weight since coming here They bring my meals to me on a tray The care files read contained peoples dietary needs, requirements and preferences, ranging from sugar free meals, soft diets to vegetarian meals. People appeared to enjoy their meals at the dining table, whilst others had their meals in the lounge or their bedrooms. The meals were served in a large plate with raised sides to promote independence and dignity without having to use plate-guards. The meals were well presented, appetising and nutritious. We saw some staff assisting people individually with their meals in a discreet and sensitive manner. Throughout the day we observed people being offered drinks and snacks, whether they were in the lounge or in their bedrooms. This also showed peoples dignity was respected and their health and wellbeing promoted. Care Homes for Older People Page 22 of 37 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident to complain and protected by staff recruitment processes and training to ensure people are safe from harm and abuse. Evidence: We wanted to find out whether people were aware of the homes complaint procedure, confident to make a complaint and felt safe and protected at Country View Nursing Home. The information gathered from the self-assessment tool completed by the Responsible Individual stated there is a very transparent and open management, complaints are dealt with by the manager/matron and no complaints received in the past 12 months. The complaints procedure was displayed in the reception area, along with the contact details of Advocacy services and included in the service user guide. The complaints procedure clearly set out the process, timescale and what to do if people remained dissatisfied. The surveys responses received from people using the service and their relatives all indicated that they were aware of how to complaint and who to speak with if they are unhappy about the care or the provisions at the home. People we spoke with during our visit said they were confident to speak with the staff, nurse or the matron if they had a complaint. The GP survey response also indicated they had no complaints about the service. Some of the comments received included: I am happy with the home and can think of nothing that affects me to do anything Care Homes for Older People Page 23 of 37 Evidence: better Matron most approachable and caring I have been more than satisfied with the care and attention given to my .... I have no complaints No concerns, Ive complained before and have acted on issues quickly Not had any complaints but I would speak with ... (nurse) or other nurses here Complaints, what can you complain about here The staff we spoke with and the staff surveys responses indicated that staff were confident to receive concerns or complaints, which would be passed to the nurse in charge. This supported the information in the self-assessment tool stating that have advised staff with regards to the complaints procedure. The self-assessment tool completed by the Responsible Individual stated the home received no complaints about the service and no complaints were recorded in the complaints log. The Responsible Individual and the nurse in charge both indicated that where possible minor issues are addressed quickly before they escalate. This showed that the service is pro-active in responding to concerns quickly and thus had not received any complaints. The CQC did receive a concern with regards to the roles of the Responsible Individual and the Managing Director. We raised this with them and we were provided with their individual and specific roles and responsibilities within the home. Our findings during the site visit confirmed this. We wanted to find out if the staff knew what safeguarding issues meant and how to deal with any allegations or suspicions with regards to abuse. Safeguarding issues means promoting the well-being of people using the service from harm, risk and abuse. Staff we spoke with including the new carer demonstrated a good understanding of the types of abuse that could occur and were aware of their responsibility with regards to following procedures by reporting it to the nurse on duty. The newest member of staff said they had received induction training that included training in safeguarding adults and the multi-agency procedure. All the staff we spoke with said they had attended the Dementia Awareness and Care Homes for Older People Page 24 of 37 Evidence: Mental Capacity training recently and showed some awareness of the rights of people and the knowledge gained. Staff were confident to raise concerns with regards to poor practice using the homes whistle-blowing procedures. This further supported the responsibility of the staff in promoting the well-being of people from harm and abuse. This was consistent with the staff training records viewed showing appropriate training is in place. The staff surveys and discussion with the newest member of staff employed confirmed they started work after pre-employment checks were carried out. These include the receipt of satisfactory references and criminal records bureau (CRB) check. This is a check to assess the suitability of the applicant to work with vulnerable people. With regards to the registered nurses, they are employed following confirmation of their registration with the Nursing and Midwifery Council (NMC). This demonstrated that staff recruitment procedures are followed to ensure peoples health and safety is protected and promoted. Care Homes for Older People Page 25 of 37 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 living in a comfortable, clean and tidy home that promotes their health and well-being. Evidence: We wanted to find out what type of accommodation and facilities are offered to the people using the service. The information gathered from the self-assessment tool completed by the Responsible Individual stated there is a welcoming and happy atmosphere at Country View and people are allowed to personalised their room. There was also information with regards to how the home maintains compliance with regulations such as health, safety and fire including the emergency evacuation plan. The service user guide provided information about the facilities such as the lounges, dining area and the garden, which people can you. The survey responses received from people using the service and their relatives all said it was a clean and tidy home. This was consistent with the comments received from the people we spoke with on the day including some visiting relatives. We did receive some individual comments relating the improvements to the decor and lighting which we shared with the Responsible Individual. The comments received were; Extremely good with hygiene, the patients are kept clean and the home, therefore has no unpleasant smells Care Homes for Older People Page 26 of 37 Evidence: The home is kept tidy and does not smell Improve decor and lighting to make main room more attractive and less oppressive The home is very friendly and caring. It is situated in beautiful surroundings - more like a 5-star hotel than a residential home We spent time talking with some people in the lounge with visiting relatives, the dining room and also spoke to a few people being nursed in bed. Although there is a large lounge, it was well furnished and the seating has been arranged into small clusters to encourage people to converse. Visitors were made welcome and could spend with the relative in the lounge, which many did. The ambiance in the home was pleasant and relaxing. There was natural and good lighting in the lounge on the day of our visit. There are smaller lounges that people can also use, along with the garden terrace that overlooks the lawn and the establish flower beds. The majority of the bedrooms are shared and provided with a privacy screen. The bedrooms we looked at were clean, well decorated and furnished. People had personalised the bedroom with pictures and photographs, which made them look homely and comfortable. There is a nurse call bell system throughout the home. There was equipment such as hoists, available for staff to use to assist people with moving and handling. People being nursed in bed were using profile beds and air-flow mattresses to promote their well-being. There were lavatories, baths and assisted bathing facilities close to the bedrooms. This supported the information received from the people using the home and the surveys. The home employs domestic staff who are responsible for the cleanliness of the home, bedrooms and the laundry room. People we spoke with were satisfied with the cleanliness of the home and the laundry arrangements. The self-assessment tool completed by the Responsible individual stated improvements have been made with new carpeted and curtains in the lounge and dinging room, new flooring in the kitchen and six bedrooms have been decorated and furnished. It also identified areas planned for improvements that included to refurbish the garden, lounge and a further four bedrooms. We saw staff wearing protective clothing when preparing to assist people with any nursing or personal care tasks and when assisting at meal times. Staff spoken with demonstrated a good understanding of infection control practices and the measures Care Homes for Older People Page 27 of 37 Evidence: taken to prevent cross infection. The training records viewed showed staff receive regular training and updates. This confirmed staff are trained and aware of the current best practices that promotes peoples safety and well-being. We concluded from the information we received, comments and observations made that the home environment promotes peoples health and well-being. Care Homes for Older People Page 28 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are protected and supported by good staff recruitment and training that promotes their health, safety and well-being. Evidence: We wanted to find out if the staff recruitment process, the skill-mix and staffing levels met the needs of the people living at Country View Nursing Home. The information we gathered from the self-assessment tool completed by the Responsible Individual indicated the staff recruitment, the staff compliment and training ensures peoples needs are met safely. The service user guide read detailed the experience of both owners, of which one is the Responsible Individual. The survey responses received from the people using the service and their relatives were generally positive with regards to the staff. The comments received were shared with the Responsible Individual and included: The staff are always willing to help and are cheerful in their jobs The management are very good at appointing staff with the right attitude - they all work together as a happy team and it shows in their work and has created a good atmosphere at the home All the staff have been very kind and professional in their dealings with her Care Homes for Older People Page 29 of 37 Evidence: Staff are friendly and show they really care about the residents, the staff work very hard The majority of staff survey responses were positive about the staffing levels and training received. The nurse on duty was in charge of the home and showed us the staff rota. There is a trained nurse on duty at all times and a complement of care staff appropriate to meet the needs of the people living at the home. The trained nurse told us that agency staff are used in exceptional circumstances. The staffing levels reflected the staff on duty and additionally the Managing Director and the Responsible Individual. We observed staff interacting with the people using the service in a polite and courteous manner, which showed staff treated people with respect. We concluded from our observations and discussions with the people using the service, the staff and the nurse in charge that staffing levels and consistency of staff was good. We spoke with the staff including the newest member of staff who described the recruitment process they completed. We checked the five staff files, which included the newest member of staff and the nurse on duty. All the files contained evidence of pre-employment checks such as satisfactory references and a criminal records bureau (CRB) check. This is a check to assess the suitability of the applicant to work with vulnerable people. We saw the registration for nurses with the Nursing and Midwifery Council (NMC). This supported the responses we received in the staff surveys with regards to the recruitment process. We concluded that the staff recruitment procedure was good and protects the people using the service. Staff spoken with including the newest member of staff confirmed they completed the induction training, known as the Foundation Training, using the Skills for Care workbook. The staff files contained evidence of training completed by the staff, which included first aid, moving and handing, fire, mental capacity awareness, safeguarding adults, infection control and health and safety. A number of staff confirmed they had attained or were doing the National Vocational Qualification (NVQ) level 2 in care. The information gathered from the self-assessment tool completed by the Responsible individual stated that 92 of care staff had attained NVQ level 2 and above with one member of staff currently studying NVQ level 4. The trained nurse said they maintain their skills and knowledge by attending regular updates and training, including the Mental Capacity Act and the Deprivation of Liberties. They confirmed they are due to attend training on venepuncture and male catherterisation. The Responsible Individual confirmed the staff now have access to E-learning, which is on-line learning. This Care Homes for Older People Page 30 of 37 Evidence: shows staff have a variety of learning tools available to them. We concluded that the staff knowledge, skill-mix and expertise is good to safely meet the needs of the people using the service. Care Homes for Older People Page 31 of 37 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are benefiting from the management of the home, are consulted about the quality of service they receive that promotes their health, safety and well-being Evidence: We wanted to find out whether the management of Country View Nursing Home protects and promotes the well-being of the people using the service and the staff. The information gathered from the self assessment tool completed by the Responsible Individual summarised the management systems in the home and liaison with health and social care professionals, people using the service and their relatives. Since the last key inspection of the service, the Registered Manager who is a Managing Director voluntarily withdrew from the post. The Responsible Individual advised us that a trained nurse has been identified to be the Acting Manager and will in due course submit an application to CQC to be the Registered Manager for the home. Care Homes for Older People Page 32 of 37 Evidence: The comments received in the surveys from the people using the service, relatives, GP and the staff were generally positive about management of the home. Our observations and discussion the people using the service and the visiting relatives also indicated that they were satisfied with the management of the home. The nurse on duty confirmed they have the responsibility for the staff rota, allocation of duty and the supervision of staff to ensure peoples needs are met. Staff spoken with all confirmed they have clarity in their roles and responsibilities, take instructions from the nurse in charge and work as a team. Staff confirmed they have regular staff meetings, training and supervision to ensure they receive the right information about meeting peoples needs and changes in best practice. The nurse is responsible for the supervision of the care staff, who confirmed they receive timely supervisions to discuss work issues and training needs. We read the minutes of the last staff meeting dated 5th May 2009, covering issues relating to the people living at the home and training. Staff spoke positively about the nurse in charge. However, we did received mix comments in the staff surveys, which we shared with the Responsible individual but our findings did not consistently support that negative comments. Much better now, introduced systems and having staff responsible for specific duties e.g. laundry, cleaning so care staff are on the floor Regular staff meetings would improve staff morale and incentives or appraisals would improve staffs general mood Communication between management and staff, about job roles within management structure that changes could be better Better management of medication system now We concluded the management of the home benefits the people using the service and can improve leadership with the appointment of the Acting Manager. We saw notices displayed with regards to the Residents and Relatives Meetings. People using the service and some visiting relative said they were aware of these meetings and have attended on occasions. We read the minutes of the last meeting held on 1st May 2009 and the topics discussed were the Summer Fete, donated money, PAT-a-Dog and included the date for the next meeting. We concluded that people had the opportunity to be involved and consulted about important issues in the Care Homes for Older People Page 33 of 37 Evidence: home. The Responsible Individual confirmed there is a quality assurance system in place whereby views are gathered through surveys given to people using the service, relatives and health and social care professionals involved with the home. We read the summary of the stakeholders surveys carried out in 2008, which was shared with the people using the service at the Residents and Relatives Meeting at the time. We discussed with the Responsible Individual that some consideration should be made to measuring the results from the quality assurance against the aims and objectives written in the statement of purpose. This would show if peoples experiences and expectations of the service is consistent and would help develop new aims and objectives as the service develops. We wanted to find out how people are supported to manage their money. Whilst some people preferred to manage their own money, other people preferred to have some money held in safe-keeping by the home. The home has a system in place to manage peoples money safely and records are in place to confirm this. The information we gathered from the self-assessment tool completed by the Responsible Individual stated all the policies and procedures are reviewed and kept up to date. Staff we spoke with confirmed they have access to the policies and procedures and received regular updates, in line with changes in practice and new legislation. On the day of our visit we saw an engineer servicing the hoists in the home. The selfassessment tool completed by the Responsible Individual detailed the programme of maintenance, servicing and testing of equipment and checks in place, which includes fire. We found risk assessments in place for people to ensure their safety such as moving and handling. The Responsible Individual confirmed risk assessment were completed regarding the fire doors from the dining room into the lounge, which have now been re-hung following advice from the Fire Officer. Our observations, findings and information read during our visit to the home confirmed the practice in the home was good. We concluded that the home environment is safe and well maintained for the people living and the staff working at Country View Nursing Home. Care Homes for Older People Page 34 of 37 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 35 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 33 The home should consider measuring the results from the quality assurance against the aims and objectives in the statement of purpose to show if the expectations of the service are met, help identify areas of improvement and ensure the statement of purpose evolves as the service develops. Care Homes for Older People Page 36 of 37 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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