Care Home: Craghall Residential Home

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What the care home does well People who move into the home have a thorough assessment of their needs to make sure their care is properly planned. People have personalised care plans that show the care and support provided to meet their individual needs and respect privacy and dignity. Health care needs are well met and medication is administered safely by trained staff. There is a high level of satisfaction with the home`s services. People told us, "A very good standard of care in lovely surroundings", and, "Very friendly atmosphere. Nice to be able to have my family visit at any time, and nice to feel secure". A structured programme of daily activities, entertainment and regular outings is offered to give people opportunities to meet their social needs. Contact with family, friends and the local community is actively encouraged. Each person is treated as an individual and supported to stay independent and make decisions, so people have as much control as possible over their lives. People are consulted about the menu, and receive a varied and appealing diet with choice of meals that they enjoy. There is a clear system for making complaints that people are confident to use if they have any concerns about the service. Staff are guided by procedures and receive training on protecting vulnerable people from abuse to keep them safe from harm. The environment provides a high standard of comfortable and attractive accommodation that is equipped to meet people`s needs and disabilities. A robust recruitment procedure is followed to ensure suitable staff are employed. Good staffing levels are maintained and staff are well trained in many aspects of caring for older people. Staff take pride in their roles. They told us, "The home recognises individuals needs and has a flexible approach to all personal care", and, "I am very happy at this home. Good manager, staff and a good atmosphere". The home has an experienced manager who is committed to providing a quality service that is lead by the needs and wishes of the people living here. The health and safety of residents and staff is promoted through staff training and making sure there are safe systems of work. What has improved since the last inspection? Better planning has made sure that new people receive good information about the service, have their needs properly assessed and are more involved in the admissions process. People are also offered short stays at the home before choosing whether to move in permanently.Each person now has a staff member allocated as his or her key worker, with designated responsibilities and more involvement in helping to plan their care. More one to one social activities and outings are being provided to suit individual preferences. Staff have been given training specific to understanding people`s diverse needs, and how legislation affects their rights. More workers have also gained nationally recognised care qualifications. A plan to monitor and improve the quality of the service has been introduced that includes asking people their views so the home is run in their best interests. What the care home could do better: There are no requirements or recommendations as a result of this inspection. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Craghall Residential Home Matthew Bank Newcastle Upon Tyne Tyne & Wear NE2 3RD     The quality rating for this care home is:   three star excellent 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: Elaine Malloy     Date: 2 3 0 4 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 30 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 30 Information about the care home Name of care home: Address: Craghall Residential Home Matthew Bank Newcastle Upon Tyne Tyne & Wear NE2 3RD 01912846077 01912846082 noemail Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Wellburn Care Homes Limited care home 38 Number of places (if applicable): Under 65 Over 65 0 38 dementia old age, not falling within any other category Additional conditions: 6 0 The maximum number of service users who can be accommodated is: 38 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 38 Dementia - Code DE, maximum number of places: 6 Date of last inspection Brief description of the care home Craghall is a care home that provides personal care to 32 older people and 6 older people with dementia. The home is located in South Gosforth and has extensive wellkept grounds and car parking space. The property was converted to a care home. A major refurbishment and extension was completed in November 2004. This included installation of a passenger lift, stair lift and ramped areas to aid access. There are 34 single and 2 double bedrooms, and the majority have en-suite facilities. Four bathrooms and a shower room are provided. There is access by public transport. Local amenities and shops are available in Gosforth and Jesmond. Care Homes for Older People Page 4 of 30 Brief description of the care home A guide to the homes services and inspection reports are readily available at the home. The current weekly fees range from £399.00 to £505.00. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 star. This means that people who use this service experience excellent quality outcomes. The inspection was carried out by: Looking at information received since the last key inspection on 3rd May 2007. Getting the providers view of the service and how well they care for people. An inspector and manager visiting the home on 23rd April 2009. Care Homes for Older People Page 6 of 30 Talking to the home manager and other staff about the service. Looking at records about the people who live at the home and how well their needs are met. Looking at a range of other records that must be kept. Checking that staff have the knowledge, skills and training to meet the needs of the people they care for. Looking at the resources that the home has to operate the service. Getting the views of people living at the home and staff by talking to them, and from surveys they completed. Checking if improvements recommended at the last inspection have been made. The inspection was carried out over eight hours. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the service are not put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? Better planning has made sure that new people receive good information about the service, have their needs properly assessed and are more involved in the admissions process. People are also offered short stays at the home before choosing whether to move in permanently. Care Homes for Older People Page 8 of 30 Each person now has a staff member allocated as his or her key worker, with designated responsibilities and more involvement in helping to plan their care. More one to one social activities and outings are being provided to suit individual preferences. Staff have been given training specific to understanding peoples diverse needs, and how legislation affects their rights. More workers have also gained nationally recognised care qualifications. A plan to monitor and improve the quality of the service has been introduced that includes asking people their views so the home is run in their best interests. 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 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A clear admissions process provides people with good information to make informed choices and ensures individuals needs are thoroughly assessed so care can be properly planned. Evidence: People told us that they received enough information about the home before they moved in, so they could decide if it was the right place for them. A welcome pack is provided in each bedroom that includes a guide to the homes services for people to refer to. At the last inspection it was recommended that potential residents should have their care needs fully assessed before admission to the home is agreed. Care records showed that a pre-admission assessment is carried out and an assessment is obtained from the persons care manager. Care Homes for Older People Page 11 of 30 Evidence: Anyone considering moving to Cragall is invited to visit and spend time at the home, accompanied by their relatives if they wish. People can choose to have a phased introduction, and short stays can be arranged if there are vacancies. The last two people admitted to the home initially stayed for a period of respite before deciding to stay permanently. When admission has been decided, the person can select their bedroom if there are a number of vacant rooms available. They discuss and agree with the manager a suitable date and time for admission, and arrange for belongings to be brought in. An induction checklist is recorded to make sure new residents are given information about the service and orientated to the home. This includes introduction to other residents and staff, providing a welcome pack, and offering a key to their bedroom. Assessment information is used to record care plans that are put in place from the day the person is admitted. People admitted to the home in recent months indicated they have settled well. A relative told the inspector he is very happy with his mothers placement. He said his mother has made friends and has been on three outings since moving into the home two months ago. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal care needs are well met and they receive personalised support that ensures their privacy and dignity is properly respected. Evidence: Staff told us they are always given up to date information about the needs of the people they care for, and that the ways they share information about people always works well. A range of assessment tools are used to identify individuals needs. Care records showed that people have generally well recorded care plans that are set out into areas of strengths, needs, the goal to be achieved, interventions and evaluation. They address needs including personal care and hygiene, dressing and undressing, bathing, mobility, dementia, short term memory loss, disorientation, use of equipment and aids, assistance with meals, social activities, and religious beliefs. Care plans are nicely personalised and indicate the persons independent skills and Care Homes for Older People Page 13 of 30 Evidence: preferences. There was evidence of support being planned sensitively, such as guidance for staff to give reassurance, talk gently, and offer choices and discreet assistance. Staff evaluate care plans at least monthly to record whether the plan is working to meet the persons needs. Risks according to individuals vulnerability and providing care and support are assessed. The assessment includes risks associated with sensory impairment, medication, smoking, going out alone, mental health, finances, making hot drinks, bathing, transport, and night checks. A separate assessment of risk of falls is also completed. Plans are recorded that show how identified risks are minimised or managed to keep people safe from harm. People living at the home told us they always or usually receive the care and support they need. One person said, Im extremely happy here, they look after us all very well, and another said, Caring staff. People have a choice of doctor and 11 local GP practices are used. District nurses were currently visit on alternate days. A Psychogeriatrician assesses and reviews the needs of people with mental health frailty. The home has arrangements for regular visits from a chiropodist, dentist and optician. Information on each persons physical and psychological medical history are kept, and separate records are maintained of all contact with health professionals. People have their health care needs assessed and there was evidence of detailed care plans. These included plans for mental health and behaviour, continence, nutrition and weight monitoring, mobility, risk of falls, and pressure area care. People living at the home told us they always get the medical care they need. One lady praised staff for the support she has had after having a stroke, that left her with no speech, as she is now able to hold a conversation. Staff were observed to be very attentive and showed clear understanding of how best to support people. The manager said people are encouraged to retain independent skills, with the use of aids and equipment where needed. This was verified by a lady who has mobility needs. She described doing as much as possible for herself, and said she asks for minimal help from staff. She knows how to use her mobility equipment and whilst her room does not have an en-suite she said, I dont have to wait to go to the toilet as the staff come straight away. Her care plan included details of promoting independence, mobility and access, moving and handling transfers, health needs and medication. The home has a medication policy and procedures. People can continue to administer Care Homes for Older People Page 14 of 30 Evidence: their own prescribed medication, and if they choose to do so an assessment of the risks is carried out. The manager and senior staff only deal with medication and all have had relevant training. There is a large medication room that has appropriate storage and hand washing facilities. Medication records have photographs for identification purposes. Medication charts are provided by the supplying pharmacist. Pre-printed and handwritten directions for medication were clear. All charts examined were suitably recorded with staff signatures to verify medication given, and codes are used to state any reason why medication is not given. The register for controlled drugs was satisfactorily recorded. Medication records are audited each month. All bedrooms are currently used as single occupancy, and each person is offered a key to his or her room. Personal care and treatment is carried out in the privacy of the persons own room. People are asked about their preferences and these are recorded in their care record. This includes the name they wish to be addressed by, whether they want staff to check on them during the night, and preferences for receiving and dealing with correspondence. People can personalise and equip their rooms as they wish. Some people have chosen to have telephones installed in their rooms, and a pay telephone is also available. The home provides services to people of different ages, gender, disability, religion and beliefs. The manager said she is committed to making sure that each person is treated equally and as an individual. All established staff have had training on equality and diversity and the mental capacity act to give them an understanding of peoples diverse needs, beliefs and rights. Newer staff are booked to attend these courses. Staff told us they feel they have the right support, experience and knowledge to meet the different needs of the people who live at the home. The home has signed up to the dignity in care challenge, that is based on national expectations of what constitutes a service that respects peoples dignity. Staff have been provided with in house training on supporting people with dignity and respect. Privacy and dignity issues are built into peoples care plans and clearly state what must be done, for example covering a persons body with a towel during personal care. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are very well supported to live their preferred lifestyle, maintain contact with family, friends and the community and meet their social and dietary needs. Evidence: People have their social needs assessed and information is used to record care plans on how each person prefers to spend his or her time and individual interests. Records also showed that a life story is recorded so staff have an understanding of peoples background and history. One care worker has designated responsibilities for organising social activities, events and outings, and she has two hours each week off the rota to do this. A monthly activities programme is forward planned, with one or two activities each day. This is displayed on the notice board and each person receives a copy to refer to. Those people spoken with knew what activities were planned. A file is kept with details of activities that have taken place and photographs from events and outings. Photographs are also displayed in the home. Most people told us there are always activities arranged by the home that they can take part in. The Care Homes for Older People Page 16 of 30 Evidence: manager said more one to one activities are being provided and staff are accompanying individuals on shopping trips. The current programme demonstrated a varied range of activities including games, sing-a-long, film afternoons, reminiscence, manicures, seasonal events such as making Easter bonnets, and a visiting entertainer. The company also pays for people to come into the home to do exercise classes, arts and crafts, aromatherapy and audio visual shows with residents. Some people said they like to read and a there is a travelling library that provides supplies of books for people to borrow. Arrangements are also made for people to have newspapers and magazines delivered, and a lady who is partially sighted has audio story tapes to listen to. Staff were observed to be responsive and interact naturally with people, such as sitting chatting in the lounge area and helping a resident read the newspaper. Holy communion is held every two weeks in the home. Church of England clergy also visit residents and some people are supported to go out to places of worship on a regular basis. The home has an open visiting policy and visitors are welcome to take refreshments and meals. The manager said family and friends provide good support at social events. There are plenty of opportunities for outings, either on a small group or individual basis. The home has shared use of a minbus and regular trips are organised. This month there were outings to a museum, a shopping centre, and Alnwick Gardens. Each person now has a care plan that addresses their personal requirements for going out of the home. The plans show a good balance between promoting peoples rights not to be deprived of their liberty and making sure they are safe. Wherever possible people are free to come and go and many go out unaccompanied if they are able. This helps them to continue to attend community activities and keep contact with their family and friends. People living at the home confirmed they are offered choices and make decisions about their lifestyles. One person said, It is important I stay independent, the staff are there when I need them. Another said, They let me get on with how I want to live my life. Family and friends advocate on peoples behalf where the person has mental frailty. The home can also give people information on independent advocacy services. Resident meetings are held so people can give their views and suggestions to influence the service they receive. The minutes showed some good examples of people being Care Homes for Older People Page 17 of 30 Evidence: actively supported to be involved in the home. These included a lady who said she wanted to continue to do some housework, so staff arranged for her to help clear the dining tables and hang out washing. Another lady wanted to be involved in helping out at a barbeque held last year, so was given the job of taking admission fees. The extent of personal possessions to be brought into home is usually agreed before admission. People are encouraged to bring in items from their own homes and all bedrooms seen were well personalised with belongings. The manager said she aims for people to be involved throughout the ongoing process of assessing their needs and planning and reviewing their care. There is a policy on access to personal care records and people sign to verify they have read and agree to their care plans. Residents and relatives are invited to attend care review meetings. These are held four to six weeks after the person is first admitted and then at six monthly intervals, and give an opportunity to review and discuss the individuals current care needs. The manager does not act as an appointee for any residents finances. Family and solicitors assist people to manage personal finances, if this is needed. Each person now has an individual care plan for finances that states the level of support he or she requires. People have their nutritional needs assessed and care plans are put in place where needs such as poor appetite, weight loss and assistance with eating are identified. Special diets can be catered for, and two people are provided with a diabetic diet. The home employs a dining room assistant and one of her duties is to take trays of tea, coffee and juice to people in their rooms. Meal times are flexible and residents can choose to take meals in the main dining room or served on trays in their bedroom. People told us they always or usually like the meals at the home. The home is changing its menu cycle from three to four weeks. Menus show a very good variety and choice of meals. The daily menu is displayed and people are asked their choice of meal at the time of serving. The manager agreed to look towards having menus in a larger print, so they can be read by people with poorer eyesight. The inspectors dined with residents at lunch. The meal time was unhurried and staff were attentive to peoples needs. Tables were nicely set with cloths, serviettes, condiments and milk jugs and sugar basins. A range of hot and cold drinks were offered and some people had small teapots to serve themselves. There was a menu on each table and staff informed people of the choice of meals and responded to requests, for example to have a smaller size portion. The meal was well presented and tasty. Care Homes for Older People Page 18 of 30 Evidence: Residents said they enjoyed the food and confirmed they can have have alternatives to the menu. Comments included, We get good food, a balanced diet, and we never go hungry, and, I really enjoy the food here. Care Homes for Older People Page 19 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Effective systems for making complaints and safeguarding vulnerable adults properly protect people living at the home from harm. Evidence: Each person has a welcome pack in their bedroom that includes the homes complaints procedure. People living at the home told us they know how to make a complaint and staff said they know what to do if anyone has concerns about the service. Residents said, If I have any complaints I just tell the staff and they put it right, There is such natural kindness here, which Im so pleased to find, and, Ive been exceptionally lucky to find this place and have no complaints. Three complaints had been received in the past year, each of a minor nature. These were appropriately recorded and showed the actions taken as a result. The person who has made the complaint signs the entry to verify they are satisfied with the outcome. The home has policies and procedures on recognising and preventing abuse, safeguarding vulnerable adults and whistle blowing (informing on bad practice). No safeguarding alerts have been raised in the period since the last inspection. The manager is well aware of her responsibilities in the event of an allegation of abuse being made. All staff receive training during induction on how to protect vulnerable people and also complete further safeguarding training courses. Care Homes for Older People Page 20 of 30 Care Homes for Older People Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a clean, comfortable environment that is maintained to a high standard and properly equipped to meet peoples needs. Evidence: Craghall is an old building with extensive grounds and converted coach houses. Originally there were many areas that were not easily accessible by residents, and the provider company has made a number of changes to create better access into and around the home. The entrance area is level and has a keypad lock fitted, with a code for opening. There are fat pad light switches on walls to make it easy for people to switch lights on and off. These are at an accessible height for people who use wheelchairs. Corridors are wide in most parts of the building and there are ramped areas. All bedrooms are personalised and decorated to a high standard. As a room becomes empty it is redecorated and a new carpet is laid, so it is ready for a new resident. This was happening in one bedroom as the inspection was being carried out. People bring with them items of small furniture, photographs, religious and other artefacts, as they prefer. People make good use of their rooms and some have telephones installed and equipment such as televisions and music systems. Many rooms have one or two large windows which makes them light and airy. Bedrooms are individual in character and Care Homes for Older People Page 22 of 30 Evidence: shape and each resident spoken with said how much they like their room. While not all bedrooms have an en-suite facility, they are close to a toilet or bathroom with toilet. There is plenty of attractive and comfortable communal space where people can listen to music, read or watch television. Toilets are within close reach of lounges. In the past year new furnishings have been provided in the main lounge, new carpets fitted to hallways and stairs, and the kitchen floor replaced. The home has appropriate assisted bathing facilities and bathrooms are welcoming with tasteful tiles, ornamental candles, and pictures to bring some colour and warmth to the room. There is also a shower room on the first floor that is accessible for people using wheelchairs. Outside, the gardens are well tended and tables and chairs are available for people to sit out in the warm weather. There is ample car parking space within the grounds. Paintwork to some of the window frames was flaking and the manager confirmed that she would report this so they can be repainted. The home has infection control policies and procedures and staff receive relevant training. The manager is completing the Department of Health Essential Steps to Safe, Clean Care document to make sure all necessary infection control measures are in place. Suitable hand washing facilities are provided. There are arrangements for the disposal of clinical waste. People told us the home is always kept fresh and clean. The standard of cleanliness throughout was very high and the domestic staff should be commended for their hard work in keeping the building hygienic and free from odours. Care Homes for Older People Page 23 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are supported by good levels of staff who are well trained and skilled to meet their diverse needs. Evidence: At the time of the inspection there was 33 people living at the home. People are told that the home currently has an all female care staff team. Staffing levels of five care workers across the waking day and three carers at night are maintained. The manager has 24 hours supernumerary time each week. The home also employs two full time cooks, a kitchen assistant, two domestic staff, two laundry staff, full and part time dining room assistants, a part time handyperson and has a contract with a gardener. People living at the home told us staff are always or usually available when they need them, and that they listen and act on what they say. 12 staff have achieved National Vocational Qualifications (NVQ) in care at either Level 2 or higher and four staff are currently studying for this qualification. Staff told us employment checks were carried out before they started work. The files of two recently recently employed staff members were examined. These contained appropriate recruitment details including photograph, proof of identification, full Care Homes for Older People Page 24 of 30 Evidence: employment history in the application form, interview record and references from suitable sources including last employer. All staff are employed subject to Criminal Records Bureau Checks. Advice was given to the manager that the decision making process of employing a person with previous conviction(s) should be recorded. Staff said they received good induction training and are given training that is relevant to their role, helps them understand and meet individuals needs and keeps them up to date with new ways of working. Records of induction training were evident in staff files. Individual training records and certificates are kept, and an overview training matrix that shows all mandatory and specialist training undertaken and planned for the staff team. A greater variety of training has been provided in the past year, including courses on equality and diversity, the Mental Capacity Act, palliative care, epilepsy, diabetes, continence promotion and catheter care. The management also continue to provide regular in-house training, most of which is based on the homes policies and procedures. Recent topics have included nutritional screening, unexplained weight loss, coping after a death, falls prevention, behaviour, use of moving equipment, and the keyworker system. Care Homes for Older People Page 25 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well managed home that is run in their best interests and promotes their safety and welfare. Evidence: The homes Registered Manager is Christine Barbrook. She has 18 years care experience and has worked at Craghall since 2003. She has managed the home for the past five years and is currently studying for the Registered Manager Award qualification and National Vocational Qualification Level 4 in care. She is well supported by a deputy manager and team leaders who take charge of the home in her absence. An area manager from the provider company keeps in regular contact and visits the home at least monthly. Ms Barbrook also attends meetings with other managers within the company twice yearly. Wellburn Care Homes has an accredited quality assurance system. A range of methods are used to monitor and improve the quality of the service at the home. These include Care Homes for Older People Page 26 of 30 Evidence: audits, surveys, and resident and relative meetings. These methods have now been set out in an an annual quality plan with measurable outcomes. People living at the home told us what they think the home does well. Their comments included, It looks after all kinds of people, Gives me a good home, Everything, and, Good food, caring staff, clean environment and friendly atmosphere. Staff said, I am very happy at this home, good manager, happy staff and atmosphere. Residents always seem content, The home constantly offers new training to help my job role. It encourages staff to build better and new relationships with staff and residents, and always keeps staff up to date with residents needs and requirements, and, I enjoy my job and look forward to future training. Monthly visits and reports on the conduct of the home are carried out by an area manager. These are extensive and cover occupancy, employees, activities, environment, food and service, records of training, health and safety, and complaints, and discussion with residents, staff, and visitors. The manager receives copies of the reports and actions any recommendations made. As previously stated, each resident has a personal finance care plan. Cash can be held for safe keeping and records are kept of individuals accounts. Transactions were appropriately recorded and receipts are kept for purchases. There was plenty evidence of personal spending. Regular checks of cash and balances are conducted and recorded. The home has a health and safety policy and procedures. Staff are provided with health and safety training and regular updates of safe working practices training such as fire safety, moving and handling, first aid and food hygiene. One staff member has designated responsibilities for health and safety and has two hours supernumerary each week to carry out checks. Risk assessments are carried out to ensure safe systems of work and to minimise the risks in caring for individual residents. Fire safety records showed that checks and tests of emergency lighting, fire fighting equipment and fire alarms are done at the correct intervals or more often than required. Regular fire instructions are provided to staff and whilst a minority were slightly out of date, these were planned to take place in the near future. There is a system for reporting and recording accidents. The manager does an analysis of accidents to identify any follow up action needed and patterns. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 29 of 30 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). 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