Care Home: Cunningham House

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What the care home does well Residents are happy living at Cunningham House. They feel safe and well cared for and they speak highly of the staff team. Comments included `the staff should be complimented as to how well they do`, `The staff are kind and friendly`, `I really enjoy living here` and `I could not wish for better, I have everything that I need`. People are properly assessed before they come into the home and their care needs are met in an individual/ person centred way. Staff are good at risk assessing and management, and are prompt when dealing with any health care matters. Residents have choice about how they spend their day and they can be reassured that the manager has an objective approach to any concerns raised and is thorough when dealing with complaints. Residents benefit from a well trained and stable staff team and a management team that is keen to ensure that an excellent service is provided. There is regular consultation with residents and the management team manage and support the care staff team well. What has improved since the last inspection? This is the first inspection for this home since it was re- registered in June 2009. What the care home could do better: The team at the home need to assess residents social care needs to ensure that any therapeutic activities that could be develop are considered in order to promote independence, self worth and the retention of skills. The social programme for residential residents could also be developed. Key inspection report Care homes for older people Name: Address: Cunningham House Cunningham House Pike Way North Weald Epping Essex CM16 6BL     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Diane Roberts     Date: 1 1 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Cunningham House Cunningham House Pike Way North Weald Epping Essex CM16 6BL 01992524160 01992524778 r.moor@abbeyfield.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Abbeyfield Society Name of registered manager (if applicable) Mrs Rosemary Moor Type of registration: Number of places registered: care home 54 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 54 The registered person may provide the following categories of service, 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, Dementia, Code DE Date of last inspection Brief description of the care home Cunningham House is a purpose built two-storey home located just outside the village of North Weald. The home is registered as a care home to accommodate up to 54 older people (over 65) up to 25 of whom may be living with dementia. The new unit offers Care Homes for Older People Page 4 of 27 Over 65 0 54 54 0 Brief description of the care home care to people who have dementia. Over all, the home offers single room accommodation situated on both floors and provides communal lounges and dining rooms, a hairdressing room and an activity lounge. All communal areas are accessible to the residents. The home is well designed to meet the needs of the current residents and provides aids, adaptations and equipment to assist those with limited mobility. The home provides 24-hour personal care and support residents with varying levels of need. The grounds of the home are both large and well maintained. The gardens and patio area are easily accessible to both residents and visitors. There is ample car parking for visitors at the front of the property. Both a Statement of Purpose and Service User Guide are available to prospective residents/purchasers. The homes fees range from £564.90 to £579.60 for a general residential bed and for a dementia registered bed, where all the rooms are ensuite, the fee is £729.75.00 Additional costs are charged for hairdressing, chiropody and newspapers etc. Care Homes for Older People Page 5 of 27 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: We visited the home for a whole day and met with the manager and her team. Prior to this we reviewed all the information that we already had on the home and this included the managers Annual Quality Assurance Assessment. The manager was asked to complete this and this tells us how well they think are doing, what they think they do well and what they would like to improve upon. We refer to this throughout the report as the AQAA. On the day of the inspection we spoke to residents and staff at the home and prior to that we sent out surveys to residents, asking for feedback on the home. The response was quite good and these comments are referred to in the report. Whilst at the home we also reviewed records and undertook a tour of the home. Care Homes for Older People Page 6 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 27 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 8 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to be properly assessed before coming to Cunningham House and that they will have all the information they may need. Evidence: The manager has a statement of purpose in place for each unit. There is a service user guide available in each bedroom on the residential unit and in reception on the unit for people with dementia. The service user guide contains a good level of information, such as residents comments about the home, the complaints procedure and advice on resources. The guide was up to date and included many pictures of the home. The format was discussed with the manager with regard to the font size and the wordy nature of the guide. A review, with residents input, may be of value to make it more user friendly, especially for those with dementia. Brochures are sent out to prospective new residents and the most recent inspection report is freely available. We looked at two recently completed pre admission assessments. The manager tends Care Homes for Older People Page 9 of 27 Evidence: to undertake all the assessments along with the appropriate deputy manager from either the residential or the unit for people with dementia. These were seen to be comprehensive and contained detailed information on the prospective residents physical, sensory and emotional needs. There was sufficient detail on those people with dementia to assess the level of dementia and how it was affecting the individual. Very good social histories were also taken which contained a good level of person centred information, which would help staff to get to know the person and aid a smoother admission and settling in time to the home. On reviewing the care plans, information from the assessments had been used to develop the care plan. It was also noted that after admission a six weekly review is carried out and that, as far as possible, residents and relatives attend. Overall the assessments contained sufficient detail on which the team could decide whether they could meet a persons needs. Residents had letters on file from the manager confirming that following assessment the team at the home could meet their assessed needs. The manager in her AQAA said that I have developed a thorough pre-admission document that covers physical health, mental health and social needs as well as ascertaining their abilities, personal choices and preferences. We would concur with this statement. New residents that we spoke to said I think I have settled in well and having my own things with me has helped, we have a brochure and my relative came to look around the home for me and I am very happy with my choice. Care Homes for Older People Page 10 of 27 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. Residents can expect to have their personal and health care needs met in a person centred way. Evidence: The manager has a comprehensive care planning system in place. We looked at two care plans in detail and used three further care plans for cross referencing. Overall the care planning and management in the home is very good. The required care plans and risk assessments were in place and these were all up to date, with evidence of regular reviews. The manager has a system in place to monitor that care plans have been reassessed and updated where necessary. On discussion with care staff, they knew the residents and their care needs well and could relate to them as individuals. Where possible residents had signed some of their care plans and some of their own risk assessments. The care plans are written in the first person which promotes a person centred approach by the care staff team. The care plans were seen to be quite person centred and identified areas of ability and strengths rather than just being needs led. Some included a paragraph for residents Care Homes for Older People Page 11 of 27 Evidence: on what was important to them. Throughout the care plans there was evidence of residents wishes and preferences, such as choices around clothing, preferences with regard to toiletries etc., helping staff to be able to care for residents as individuals. Care plans showed a good level of understanding by the staff team as to how one issue may affect another. For example, pain management was discussed in mobility care plans, highlighting to staff how pain may affect mobility. Staff do need to ensure that issues noted at the time of review are fully considered and added to the care plan. For example, one resident was suffering with an infection to the skins of their legs and whilst this was noted there was no guidance for staff on how to care for them. The manager in her AQAA said all residents have an individual plan of care that is initially drawn up from the pre-admission assessment and then reviewed on a regular basis and at least monthly to ensure their health, social and personal care needs are fully met. We would concur with this statement. Staff complete dependency rating scores on a monthly basis and it was positive to see that in some cases, following a period of time at the home, some residents dependency was reducing, which is good. Staff also complete a wellbeing assessment, which is reviewed monthly and is particularly relevant for those residents with dementia and/or who have limited communication. Residents were seen to be well presented with staff having taken care to ensure that their hair, nails and clothes etc. were cared for. The interaction seen between staff and residents was positive and friendly. Daily notes are completed and overall these were quite good, often giving an account of the care provided and of the resident themselves, reflecting their wellbeing, for example, she feels well. Residents who commented on the care provided said the staff are good with your dignity, they have a very caring approach, the staff are lovely, the young staff try hard but they often do things for you that you can really do for yourself and you really need to do them, they help you with your nails and they have good attention to detail, if you are unwell at all, you can stay in bed if you want and if you need to see the doctor, you see one and there is always someone there if I need help. Residents had a comprehensive risk assessment in place which included risks, such as going out, skin condition, pain and manual handling. These were seen to be up to date and linked to care plans were required and if needed a more detailed risk assessment, including any management had been completed, for example, on nutrition. Records Care Homes for Older People Page 12 of 27 Evidence: showed that residents are weighed monthly and all residents have a nutritional risk assessment in place. It was positive to see that where required, residents were steadily putting on weight and that a healthy diet was still encouraged. Where residents need to put on weight appropriate snacks had been identified to have between meals. Records overall showed that residents weight and nutrition is closely monitored. Records show a proactive approach to health care with doctors being contacted in a timely manner and residents having access to a range of other professionals such as chiropodists etc. No residents have developed pressure sores whilst living in the home in the last year and risk assessments in relation to skin care are good and many residents have equipment in place to reduce risk. Each resident has a hospital passport in place that were seen to be up to date and would go with the resident should they have a hospital admission, giving the ward a very good outline of the resident, their needs/choices and medication etc. These were very good and would be valuable to any hospital team. Some residents, but not all, had preferred priorities for care completed, linked to end of life care and these showed good input from the resident and/or their relatives. The staff team said they are completing these where they can and are trying to get them done for all the residents. We checked the medication system on the unit for people with dementia. Medications are supplied by a local chemist and records show that they are checked in by a senior member of the care team. Each residents has a photo on their profile and staff have easy access to information about the medications that each resident is on. Signing for the administration of medications was seen to be accurate and homely remedies, such as cough medicine are dealt with appropriately. A coding system is used for any medications omitted or not given and these were seen to be appropriate. For those residents on antibiotics there is a separate record to detail why the person is taking the antibiotic, to make staff more aware of any acute illness. Care plans show evidence of planned medication reviews. Staff use a dosset box system and also have spare boxes should residents go out for the day. These were seen to be fully labelled as required. No controlled medications were being held although the correct storage and records were available should they be required. Care Homes for Older People Page 13 of 27 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. Resident have choice in their daily lives and can generally expect their social care needs to be met. Evidence: From the records and from talking to residents and staff, the routines of the day are primarily resident led. Residents we spoke to said that they had choice about how they spent their time and when they got up and went to bed etc. Comments included I like to get up when everyone else does and I go to bed whatever time I want to, They would bring my breakfast later to me if I chose to and I can go at my own pace in the morning. Staff spoken to said we ask residents if they would like a bath, if they want a bath they can have their breakfast later if they want and the residents choose to get up at different times, most have their breakfast in their rooms. Residents had social care plans in place that detailed residents preferences in relation to social activities and their choices with regard to the routine of their day, which is good. The team do however need to assess the residents individual social care needs to see if there is any specific input/activity that would help, for example, with the retention of skills, independence and the promotion of self worth. This gives a slightly more therapeutic approach to social activities as well as providing entertainment. Care Homes for Older People Page 14 of 27 Evidence: Occasionally, staff have not completed some records, such as favourite activities and hobbies and suggestions for activities, the key workers need to ensure that this is completed. Staff had completed a what you would like to do form with residents along with a life story and on the whole these were completed well, giving a good picture of the individual resident. We spoke to the activities officer who had only been in post a short time and who works on the unit for people with dementia. She was still finding her feet and getting to know the residents but showed a very person centred approach to her role and an appreciation of residents rights and dignity, aiming to provide age appropriate activities. She was able to show us that she had been assessing residents social needs in relation to abilities to recall so that she could provide the appropriate support. She has also been observing residents and ensuring that they are able to participate, for example, providing large print items. At the moment she said that the type of activities offered are crafts, tea and chats, folding laundry, reminiscence videos, hand massages and puzzles. There is a vacancy on the residential unit for the activities officer and this has been for quite some time, with the care staff taking the lead on this in the meantime. We discussed the current provision with the senior staff on this unit who told us that all the team chip in to provide activities and they work out what they are going to do and who will do it with the residents. They said that there was a lack of interest on the residents behalf and this was compounded by the fact that there was no one person to concentrate on this for them. The deputy said that they are making efforts to address this for residents individually and for group activities. They also said that the home has a minibus but people rarely go out. The activities programme on the residential side needs a full review and further focused consultation with the residents. Records shows that some residents take part in a basic activities programme whilst some do not at all. Activities include, board games, crafts, beauty, watching videos and quizzes. Staff were seen to be providing activities to residents such as skittles, board games, manicures etc. Residents on both units were seen to be in good spirits, chatty and interacting with the staff members in a friendly way. At Christmas the residents key worker is given an allowance to go out and purchase presents for the residents that they know they would like. Residents who commented on the activities said I read a lot and am not missing out on anything here, I had never played bingo before in my life but now I do and I won!,we have a quiz once a week and memory testing games but lots of the residents dont come, I like the chair exercises, more people come to that, we go out on local walks in the better weather and they do have activities on but they are not very well attended. The tables were seen to be nicely laid for lunch and had vases of fresh flowers on them. Staff working on the unit for people with dementia need to be more aware of Care Homes for Older People Page 15 of 27 Evidence: promoting residents independence by providing them with condiments, gravy etc. so their independence is promoted. The staffing levels to give this level of support are good, so this could be improved. Staff on this unit also require more guidance in relation to feeding residents a soft or pureed diets as they kitchen had prepared these well and individually and staff were then seen to be mixing the different foods all together. Menus are displayed on the tables and staff around the home were heard to be offering residents choice. The food we saw looked good and residents were seen to be enjoying their meal. Residents were seen to have access to drinks during the day, other than at drinks rounds, either in their rooms or in communal areas. Fruit was also seen to be available around the home for residents to have if they wish. Residents who commented on the food said the food is brilliant, too much so and there is too much to eat, you definitely get a choice and you are always offered something hot and they will make you an alternative, the food is mostly very good, you get a nice choice, they have homemade cakes in the afternoon, they do ask us what we would like to eat and what we think about the food. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that their concerns would be listened to and that, as far as possible, they would be protected from abuse. Evidence: The complaints procedure is available around the home but often obscured on notice boards by other papers. The content is sound but the print is small and this could be reviewed. The manager has a logging system in place for any complaints and the records were good, showing the action taken and the level of any investigations. The manager had dealt with six, mostly minor, complaints since June 2009 and these related to bed fees, TV reception, food and medication. There was evidence that these matters had been satisfactorily resolved. In the care plans, there was evidence that the complaints procedure had been discussed at the time of placement reviews and this helps to ensure that both residents and relatives are aware of how to make a complaint. Residents who commented said I have seen the complaints procedure but I dont really understand it, I am sure that anything I raised would be dealt with properly, we see the manager a lot and they have residents meetings every month where we can raise anything we want, I feel confident that anything I raised would be taken seriously and they always try to resolve any issues. The manager in her AQAA said we have a robust adult safeguarding policy and all staff have to attend training in this area that highlights their responsibility. Staff spoken to showed a good understanding of adult protection matters and training Care Homes for Older People Page 17 of 27 Evidence: records show that nearly all staff had attended training on this subject. Residents who commented said they make me feel safe here and the staff are kind and helpful. Care Homes for Older People Page 18 of 27 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. Residents live in a clean, safe and well maintained home. Evidence: We toured the home with the deputy manager. The home was seen to be very clean and well maintained. No odours were noted. The home has a relaxed and generally homely atmosphere. There are good pictures up around the home that promote reminiscence, however this could be developed further on the unit for people with dementia, giving them more items to interact with. Staff do have photo books etc. that could be used and when these were put out later in the day, residents took great interest in them. Consideration could be given to adding more homely touches to the DE unit, especially in the dining room. Signage is generally good around the home, especially on the unit for people with dementia, where the bedrooms doors have signs individual to each resident, promoting their independence. Signage on the general residential unit needs a review as they do have residents with differing levels of confusion and improved signage for toilets, bathrooms and perhaps some individual bedrooms may be of value. Residents bedrooms were very nice and many of them had bought their own personal items with then, such as small pieces of furniture etc. Refurbishment work has been completed on the bathrooms in the residential unit and these have now been all painted and have pictures up etc. One bathroom with a shower has been completely refurbished, tiled and contains a walk in shower. The Care Homes for Older People Page 19 of 27 Evidence: manager hopes to raise funds to extend the residential dining room by adding on a conservatory in the future, which will add room and enable residents to further enjoy the forest that the home backs onto. A sensory garden has been completed that surrounds the unit for people who have dementia. This is an excellent resource and has two areas, one with a beach theme and one with a Hollywood theme. There are plenty of areas to sit, things to look at and the staff also have the facility to play music etc. outside. The unit for people with dementia also has a good activity room with plenty of facilities. The home also has a resident peacock and peahen that the staff team care for and residents find of great interest. Records in relation to fire safety were seen and found to be in good order with regular checks in place and a fire safety risk assessment completed. Consideration should be given to having more regular fire drills with staff as the last one recorded was carried out in April 2009. Care Homes for Older People Page 20 of 27 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. Residents benefit from a stable and generally very well trained staff team. Evidence: The current staffing levels at the home are for the unit for people with dementia are 1 senior and 4 care staff during the morning but there can be more than this and 1 senior and 2 care staff at night or more if required. On the residential unit the levels are 1 senior and 4 care staff in the morning, dropping to 1 and 3 in the afternoon and 1 senior and 2 care staff are night. The rotas show that these levels are maintained and no agency staff are used. Residents who commented on the staff team said nice staff team, day and night, they find time to stop and chat to you, the staff come quickly if you buzz for anything, the staff are to be complimented as to how good they are and the staff are always kind and help us a lot. Records shows that just over half of the staff team have achieved an NVQ qualification at either level 2 or 3 and NVQ training continues to be encouraged. The manager in her AQAA said The number of people with an NVQ has risen and a substantial number are working towards this award. We agree that there has been a significant improvement in this area. Care Homes for Older People Page 21 of 27 Evidence: We looked at three staff files to check the robustness of the recruitment procedures in the home. These were seen to be very good with all the required checks and documentation being in place at the right time, for example, before the new member of staff commences work. A checklist system is used and staff are also given the General Social Care Councils, Code of Conduct booklet. Training records show that there is a good training programme at the home which encompasses, statutory training such as manual handling and fire and also a wide range of other subjects that relate directly to the needs of the residents. For example, staff working on the unit for people with dementia have been attending courses relating to dementia. Staff across the home have been trained in care planning, infection control, oral care, equality and diversity, care of the aging skin, understanding Parkinsons disease etc. Overall compliance levels are good. Some staff have also attended courses on mental capacity, challenging behaviour and nutritional assessment. It would be beneficial if more staff attended these courses. There was evidence of induction training for new staff to the home and where required they are completing the common induction standards with Skills for Care. Staff who commented on the training provided said there is a lot of training and generally its very good. The manager in her AQAA said We are increasing the number of course that we are offering staff in addition to the mandatory subjects to make them more competent and satisfied in their role. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home that is well run and were their views and opinions are valued. Evidence: The manager has been registered at the home for over six years and has extensive experience in the management of care homes. She is a qualified nurse, with a post graduate award in Dementia and has an NVQ level four in management. The manager keeps herself up to date and often takes part in local initiatives to, for example, My Home Life with Help the Aged, to improve the quality of life for people living and working in care homes. The manager also takes an active part in the organisation of adult safeguarding in Essex. The manager is also trained to provide manual handling and adult safeguarding training directly to the staff team in the home. The manager holds regular meetings with the different staff teams in the home and minutes are available. These show that the manager is aware of issues in the home and that she keeps a close eye on standards. The minutes also show that the staff have the opportunity to raise any issues and/or items that they feel need attention. Care Homes for Older People Page 23 of 27 Evidence: The manager has a quality assurance system in place that focuses upon feedback from residents. Both residents and relatives/visitors are asked to complete a yearly survey and in addition to this residents have a monthly meeting where they are consulted and can feedback on anything of concern. Minutes are kept of the meetings. Results of the last survey in 2009 were, overall, very positive with only some variable comments about the food and the laundry service. Relatives also were surveyed and the results showed that overall people were happy with the home and the services that their relatives received. In addition to this a representative from the provider visits monthly and completes a report and during that time, residents are also asked for their opinions. Residents are given feedback from the surveys when the results are out and the manager discussed any action points at the residents meetings. The manager does set dates for relatives meetings and posters are displayed but no-one chooses to attend. Residents who commented said I could not wish for a better home, I have everything I need and I really enjoy living here and am looking forward to spending Christmas here with my friends. In addition to feedback surveys other audit tools are used. For example, a monthly visual risk assessment is completed for each of the residents bedrooms and medication administration is also audited. Staff supervision files show that the manager and senior staff in the home undertake supervision with care staff. As well as meeting with the staff member, records show that unplanned and observational supervisions also take place. The deputies and the manager meet each week and staff supervisions are reviewed. Records also show that the manager of the home has dealt appropriately with any matters of concern or performance. Staff spoken to confirmed the arrangements for supervision and said that often, senior staff worked with them which helped promote good practice. We looked at the accident records for the home and these were completed well, with no causes for concern. There was also recorded evidence that staff followed up any major matters, such as falls, with the appropriate health care professional where required. It was possible to speak to a falls prevention officer who was visiting the home on the day we visited. She commented positively on the home with regard to them referring appropriately to them and said that the staff team were able to provide her with all the information that she needed. Residents records showed that residents who had come to live at the home, with a previous history of falls, were no longer experiencing this issue. No health and safety issues were noted in the home and staff training compliance levels for health and safety and COSHH are good. Care Homes for Older People Page 24 of 27 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 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 12 16 Ensure that residents have 01/04/2010 their social care assessed and that the social care programme meets the needs of the residents as far as possible. So that residents social needs are met and that they are optomised as far as possible. 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 2 1 16 Continue to develop the format of the service user guides. Consider reviewing the format of the complaints procedure and its display around the home. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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