Care Home: Dormy House

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What the care home does well The manager and her staff team continue to work hard to minimise the disruption to the residents caused by the ongoing building and refurbishment work. The staff work hard to ensure that residents` needs are appropriately assessed and that their care is planned to ensure that these needs are met, whilst encouraging and enabling residents to maintain their independence where possible. Each resident is treated as an individual and the home is responsive to their diverse needs. The home supports residents to follow personal interests and activities. All residents spoken with said that they felt safe at the home with one resident adding `always` and another commenting `the girls always make sure I am.` Relatives were complimentary about the home and staff, with comments received on survey forms including: `the staff are caring and Dormy House is very comfortable. Overall it is a very pleasant place to be, in quiet and relaxing surroundings`` `I can`t fault the care my relative receives`, `We find the home atmosphere caring and compassionate. Each resident is treated as an individual and their privacy is respected` and `We, as a family, thank you for all the excellent care so far and we look forward to the move to the new building.` All interactions observed between the management, staff and residents evidenced that the home has a close and caring staff team. When asked what the home does well, comments from staff included: `Dormy House is a nice place. The residents, relatives, staff and employers have harmonious relationships. Team work for the good of the residents. Good in all aspects: service, care, clean and tidy` and `It`s nice to work here and the management is good.` What has improved since the last inspection? Two recommendations made at the last inspection have been met, all residents` files now contain individual bathing risk assessments and bath hot water temperatures are checked and recorded prior to a resident getting into a bath. Since the last inspection the home have been carrying out extensive building and refurbishment, increasing the number of beds the home is registered for by twenty five. In their AQAA, the manager described the improvements: `Phase 1 of the new building project is completed. The 16 new bedrooms and en-suite bathrooms are beautifully furnished. They are clean, bright and comfortable. The residents have enhanced the character of this area with their own personal effects, giving the rooms an individual homely feel. The communal bathrooms have new assisted baths and are very spacious. There is a new small sitting room with a kitchenette for the residents. The conservatory and foyer have now been completed. The gardens at the front of Dormy as well as the atrium have been landscaped. We have incorporated a physiotherapy room into the new residential wing. The new environment has been designed based on the latest trends from Bradford and Sterling Universities. We have re designed and developed the laundry. We have purchased new equipment to enable us to improve the laundry service. Further training has been implemented and an experienced Laundress has been added to our team.` Phase 2 of the home`s five year plan was to build a new dementia wing and demolish the old. This phase was completed to a high standard a few weeks prior to our visit. What the care home could do better: A requirement has been made regarding improving future staff recruitment procedures so that residents and their relatives or representatives can be confident that all required checks have been done on the staff to make sure that they are suitable to work with them. Key inspection report Care homes for older people Name: Address: Dormy House Ridgemount Road Sunningdale Berkshire SL5 9RL     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: Denise Debieux     Date: 2 8 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 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Dormy House Ridgemount Road Sunningdale Berkshire SL5 9RL 01344872211 01344875111 dormy@caringhomes.org www.caringhomes.org Dormy House (Sunningdale) Limited care home 88 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) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 88 The registered person may provide the following category of service: Car home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Dementia (DE) old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Dormy House provides care and accommodation for up to eighty eight older people and is also registered to provide care to people with dementia. The home is a large mansion that has been extended on three sides, providing single and double rooms sited over two floors. Lifts provide access to the upper floors for those with mobility problems. There is ample car parking available to the front of the home, which is situated in a Care Homes for Older People Page 4 of 31 Over 65 0 88 88 0 Brief description of the care home quiet residential street, within walking distance of the local Sunningdale shops, train station and local bus routes. Fees range from £387 to £1200 per week. This information was provided on 28th January 2010. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This unannounced visit formed part of a key inspection and was carried out on 28 January 2010 starting at 10am. The registered manager was present as the representative for the establishment. It was a thorough look at how well the service is doing. It took into account detailed information provided by the manager and any information that CQC/CSCI has received about the service since the last inspection on 02 July 2008. The people who live at this home prefer to be referred to as residents. For clarity and consistency this term will be used throughout this report. On the day of this visit twenty of the fifty two current residents were involved in the inspection and information was gained from nine on duty staff. Prior to the inspection, survey forms were sent to fifteen residents, ten social and health care professionals Care Homes for Older People Page 6 of 31 and to fifteen members of staff employed at the home. Survey forms were returned by five residents, two social and health care professionals and seven members of staff. These survey forms were correlated and the results were shared with the manager during the inspection. Comments made on the survey forms, both positive and negative, were included in the correlation. Care was taken to exclude any comments that could identify the writer. The manager demonstrated a pro active attitude to the results of our survey and plans to explore any concerns raised further as part of the homes quality assurance process. Some of the comments made to us on the day of this visit and made on the survey forms are quoted in this report. The home sent us their annual quality assurance assessment (AQAA) when we asked for it. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. The AQAA was clear and gave us all the information we asked for. Residents care plans, staff recruitment and training records, menus, health and safety check lists, activity records, policies, procedures, medication records and storage were all sampled on the day of this visit. We looked at how well the service was meeting the standards set by the government and have in this report made judgements about the standard of the service. We would like to thank the residents and staff for their time, assistance and hospitality during this visit and the residents, relatives, social and health care professionals and staff who provided additional information and participated in the surveys. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? Two recommendations made at the last inspection have been met, all residents files now contain individual bathing risk assessments and bath hot water temperatures are checked and recorded prior to a resident getting into a bath. Since the last inspection the home have been carrying out extensive building and refurbishment, increasing the number of beds the home is registered for by twenty five. In their AQAA, the manager described the improvements: Phase 1 of the new building project is completed. The 16 new bedrooms and en-suite bathrooms are beautifully furnished. They are clean, bright and comfortable. The residents have enhanced the character of this area with their own personal effects, giving the rooms an individual homely feel. The communal bathrooms have new assisted baths and are very spacious. There is a new small sitting room with a kitchenette for the residents. The conservatory and foyer have now been completed. The gardens at the front of Dormy as well as the atrium have been landscaped. We have incorporated a physiotherapy room into the new residential wing. The new environment has been designed based on the latest trends from Bradford and Sterling Universities. We have re designed and developed the laundry. We have purchased new equipment to enable us to improve the laundry service. Further training has been implemented and an experienced Laundress has been added to our team. Care Homes for Older People Page 8 of 31 Phase 2 of the homes five year plan was to build a new dementia wing and demolish the old. This phase was completed to a high standard a few weeks prior to our visit. 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 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be 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. This home does not offer intermediate care. Evidence: We were advised that, on the first enquiry from a prospective resident or their representative, the resident and/or their representative will be invited to visit the home. During the initial visit the prospective resident or their representative is given a copy of the homes brochure and an opportunity to discuss all aspects of living at the home. Following the initial visit to the home, and if the resident wishes to continue, the manager, her deputy or one of the senior nurses will visit the resident and carry out a pre admission assessment to ensure that the home can meet the residents needs and wishes. The manager explained that on the day of admission the resident is Care Homes for Older People Page 11 of 31 Evidence: given a chance to settle in to their room and new surroundings and then on the second day they are given a more in depth introduction to other residents and staff. The preadmission assessments for the three most recent admissions were sampled. In each case comprehensive pre admission assessments had been carried out to ensure that the home could meet the residents identified needs. In the AQAA, to demonstrate what the home does well, the manager stated: Preadmission assessments and visits. This enables the resident to meet at least one key member of the team prior to admission, to enable them to get a true picture of their new home and to discuss any issues they may have. They are given the opportunity to visit for lunch or tea with their families prior to admission. The input from both the resident and their family is invaluable and gives us a good base to start building their care plans. This statement was supported by the findings of this inspection. All five residents who returned survey forms said they had received enough information to help them decide if the home was the right place for them prior to moving to the home. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health and personal care needs are met. The home has a plan of care that the resident, 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. Residents rights to privacy are respected and the support they get from staff is given in a way that maintains their dignity. Evidence: Five care plans were sampled during this visit. They were all based on information obtained during preadmission assessments and had been drawn up shortly after each residents admission to the home. These care plans set out the actions which need to be taken by care staff to meet the health and personal care needs of the residents and included their abilities and preferences in how they wish their care to be delivered. Care plans are reviewed on a monthly basis and daily notes are kept that reflect the care given. These daily notes demonstrated that any changes or new concerns are promptly acted upon. It was seen that care plans are updated when a persons needs or situation changes and that appropriate health professionals are consulted if and Care Homes for Older People Page 13 of 31 Evidence: when needed. The care plans sampled included a comprehensive range of risk assessments which were well documented and reviewed on a regular basis. Where a risk had been identified the care plan included actions needed to remove or minimise the risk. All residents files had risk assessments covering: moving and handling; bathing; nutrition; mobility and risk of skin breakdown. Where indicated, additional risk assessments were in place, e.g. for residents able or wishing to manage their own medication; risks associated with memory loss or confusion; risks associated with the use of bedrails. At the last inspection it was recommended that individual bathing risk assessments be put in place, these were seen in the care plans sampled, meeting the recommendation. In the AQAA, to demonstrate what the home does well, the manager stated that they have: developed new documentation which we have implemented with each new resident. The manager also explained that they are in the process of transferring all existing care plans over to the new system. The staff have recently had training in person centred care planning and are using this training as they review and update the care plans to the new documentation. Of the five residents who returned survey forms, two said that they always receive the care and support they need and three answered usually. Comments received from relatives on the survey forms included: I cant fault the care my relative receives and We find the home atmosphere caring and compassionate. Each resident is treated as an individual and their privacy is respected. Excellent support for the relatives, communicating all changes in the residents care, considering our opinions and willing to meet individual changes in circumstances. The two social and health care professionals who returned survey forms both said that the home always seeks advice and acts on it to meet peoples social and health care needs and improve their wellbeing. Part of the lunchtime medication round was observed and the medication administration records, medication storage, policies and procedures were all sampled and found to be in order. Data provided in the homes AQAA does not identify any residents with specific religious, racial or cultural needs at this time. However, from the evidence seen and comments received, we consider that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. On the day of this visit staff were observed to always knock before entering the Care Homes for Older People Page 14 of 31 Evidence: residents bedrooms, all personal care took place behind closed doors and all interactions observed between staff and residents were seen to be caring and respectful. All residents spoken with felt that the staff always respected their privacy and dignity. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each resident is treated as an individual and the care home is responsive to their diverse needs. The home supports residents to follow personal interests and activities and they 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. Residents have nutritious and attractive meals and snacks, at a time and place to suit them. Evidence: The routines of daily living are arranged to suit individual residents preferences and choices. This was confirmed by residents spoken with during this visit. The home employs three activity organisers, one works forty hours a week, another works twenty hours a week and the third works twelve hours a week. We were advised that, in the first week after a resident moves to the home, they are visited by one of the activity organisers to discuss their interests, hobbies and previous occupation. This information is used to explore individual activity plans with the resident and, where possible, for arrangements to be made for past interests to continue. For example, one resident had been a gardener and identified his interests as gardening. The home have arranged that this resident accompanies the Care Homes for Older People Page 16 of 31 Evidence: maintenance person sometimes and arrangements are in place for him to work alongside the gardening team, especially in the warmer weather. When asked on the survey forms if they felt the home arranged activities they could take part in, three residents answered always and two answered usually. One relative commented that they felt more effort should be made with activities. The home has been carrying out substantial new building works and refurbishments since the last inspection. The residential wing has been redeveloped and a new dementia wing has very recently been completed, increasing their bed capacity by twenty five. In their AQAA the manager described the impact this has had on activity provision while the work is being carried out: The redevelopment of the residential wing and car park reduced the number of functions and activities. Activities continued throughout, we increased the number of entertainers as functions had to be suspended. We are now able to plan future events. Dementia therapies: it has been difficult to create the changes whilst the new (dementia) unit is being built. The manager told us that, now the major building work has been completed, they are looking forward to focusing on the activity provision and also to developing an activity programme specifically designed for those residents with dementia or other cognitive impairments. In the AQAA, to demonstrate what they have changed as a result of listening to residents, and the improvements made in the last twelve months, the manager stated: We have increased the activity hours, varied the activities to suit individuals. We have now finished the new conservatory, giving the residents a choice of three day rooms. There are now four kitchenettes where the residents can offer refreshments to their families and friends. The conservatory and foyer have now been completed. This has enhanced the day areas and provided an area for activities (arts and crafts) to develop. Exercise and movement to music classes have been very popular. We have a state of the art hairdressing salon which is in itself an activity for all our residents to enjoy. In the AQAA the manager described their plans for improvement over the next twelve months: To complete the new unit and develop the activities through the new environment. The kitchen for example will have see through units to enable the residents to recognise daily objects and enable them to carry out normal activities under supervision when necessary. The decoration, pictures and memory boxes will enhance the daily activities. The new environment has been designed based on the latest trends from Bradford and Sterling Universities. The gardens will have a purpose to include activities along the pathways. This statement is supported by the findings Care Homes for Older People Page 17 of 31 Evidence: on the day of our visit. By the day of this inspection, the dementia unit had been completed and some residents had already moved in. It was seen that the home have already made a good start on developing the activities on that unit so that residents are able to participate in activities that are meaningful to them. Residents are able to choose which activities they attend or participate in and their individual rooms were all seen to contain many personal possessions which were arranged to suit their individual wishes. There are no restrictions to visiting times and staff support and encourage residents to maintain family links and friendships inside and outside the home. Menus sampled showed that the home offers a varied and well balanced menu, with residents able to choose alternatives if they do not want the dish that is on the menu on the day. The home have also developed a picture menu for residents with dementia. The lunchtime meal was taking place during this visit, the food was well presented, the atmosphere in each dining room was pleasant and relaxed and there were ample staff available to offer help and assistance as needed. All residents spoken with at lunchtime said they were enjoying their meal and that they liked the food and choices available. Meals were also commented on positively by relatives on the survey forms, comments included: The food is good and the food (quality and presentation) is of a high standard. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If residents 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 home safeguards residents from abuse and neglect and takes action to follow up any allegations. Evidence: The home has a complaints procedure in place that is available to all residents and their relatives and is also included in the residents guide. All residents surveyed said that they knew who to talk to if they were not happy and residents spoken with during the visit were aware of how to make a complaint. In the AQAA, to demonstrate what the home does well, the manager stated that: Residents forget they have a complaints procedure in their rooms. This became obvious following our resident survey. I now regularly remind residents, at meetings, where to access the complaints procedure and encourage them to give me the opportunity to address any issues they may have. This statement is supported by the findings of this inspection. There is a whistle blowing policy in place and the home have a copy of the latest Berkshire Safeguarding Adults Policy and Procedure. Training in safeguarding adults is included in the homes staff induction and all staff receive regular updates on any changes to the local safeguarding procedures. All staff surveyed stated that they knew Care Homes for Older People Page 19 of 31 Evidence: what to do if anyone raised concerns about the home. We were advised that the manager and registered nurses have attended training on the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards, with the manager demonstrating a good understanding of the required processes. There was one entry seen in a care plan sampled that indicated that not all staff have fully understood the five key principles of the MCA, the manager plans to review these with all staff. All residents spoken with said that they felt safe at the home with one resident adding always and another commenting the girls always make sure I am. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The location and layout of the home and gardens are suitable for their stated purpose. The ongoing, extensive, refurbishment, maintenance and redecoration programme is providing the residents with clean, pleasant and homely surroundings in which to live. Some bedrooms are in need of redecoration but the standard of personal and communal accommodation in the newly built and refurbished areas is high. Evidence: Residents spoken with expressed their satisfaction with the accommodation provided at the home, especially those that have moved to new or newly refurbished rooms. Residents surveyed said that the home was always/usually fresh and clean. As described earlier in this report, there has been major building and refurbishment work since the last inspection. In the AQAA, the manager described the improvements: Phase 1 of the new building project is completed. The 16 new bedrooms and en-suite bathrooms are beautifully furnished. They are clean, bright and comfortable. The residents have enhanced the character of this area with their own personal effects giving the rooms an individual homely feel. The communal bathrooms have new assisted baths and are very spacious. There is a new small sitting room with a kitchenette for the residents. The conservatory and foyer have now been completed. The gardens at the front of Dormy as well as the atrium have been landscaped. We have incorporated a physiotherapy room into the new residential Care Homes for Older People Page 21 of 31 Evidence: wing. The new environment has been designed based on the latest trends from Bradford and Sterling Universities. We have re designed and developed the laundry. We have purchased new equipment to enable us to improve the laundry service. Further training has been implemented and an experienced Laundress has been added to our team. Phase 2 of the homes five year plan was to build a new dementia wing and demolish the old. As stated earlier, this phase was completed a few weeks prior to our visit. On the day of this visit we were shown around all areas of the home and grounds. The new wings and refurbished rooms offer an excellent standard of accommodation and environment for the residents and there are many innovative fixtures and fittings designed, and installed, specifically for the resident groups the home caters for, for example, movement sensors by the bed that turn on the light in the en-suite toilet when movement is detected, helping people to find their way and reducing the risk of falls during the night. The new furniture and furnishings were all seen to be of a high quality. The manager explained their five year plan, which includes the refurbishment of remaining bedrooms in the main house. Now that the two new wings have been built, work has been started on this next phase. As stated above, the standard of accommodation in the newly built and refurbished areas is very high. A number of bedrooms, which are awaiting refurbishment, were also seen during our visit. Although in need of refurbishment, these rooms were seen to be clean and homely. The manager assured us that essential maintenance work is continuing on these rooms, to make sure that residents are safe, but that no redecoration is planned for rooms that are included in the refurbishment plan. We were advised that the home have not increased fee rates this year for residents who are due to have their rooms refurbished. All personal bedrooms were seen to be personalised to the individual residents wishes and the manager advised that they are holding regular meetings with the residents and their relatives to draw on their ideas for the ongoing development. Laundry facilities are sited on the ground floor with washing machines suitable for the needs of the residents at the home. On the day of this visit the home was found to be warm and bright with a homely atmosphere and a high standard of housekeeping apparent. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have safe and appropriate support as there are enough competent staff on duty at all times. The home has a staff recruitment procedure in place but the registered manager needs to ensure that all required checks have been carried out before allowing new staff to begin working at the home. Residents needs are met and they are cared for by staff who get the relevant training and support from their managers. Evidence: The staff rota evidenced that staff are provided in sufficient numbers to meet the needs of the residents at the home. At the time of this inspection there were eighteen residents living in the dementia unit. The morning (8am to 2pm) and afternoon shifts (2pm to 8pm) are covered by two registered nurses and four carers with one registered nurse and three carers working the night shift. There are currently thirty four residents living in the residential/nursing units. Staffing for that side of the home is three registered nurses and nine carers in the morning, two registered nurses and eight carers in the afternoon/early evening and one registered nurse and five carers overnight. The manager advised us that staffing levels are calculated on the individual needs of the residents living at the home at any one time. Any additional hours identified in care plans following assessment are also taken into account. Of the five residents who returned survey forms, all said that staff are usually Care Homes for Older People Page 23 of 31 Evidence: available when they need them. One relative commented that the staff are pleasant and helpful. The staff team comprises the manager, her deputy manager, ten registered nurses, two registered mental nurses, four senior carers and forty four carers. Of the forty eight non registered care staff, twenty seven hold a National Vocational Qualification (NVQ) level 2 or above in care. During this visit the files of three recently recruited members of staff were sampled. All files were seen to contain proof of identity, two references, a completed application form and enhanced Criminal Record Bureau (CRB) and Protection of Vulnerable Adult (POVA) or Independent Safeguarding Authority (ISA) list checks had been obtained. However, the home were unaware of new regulations that came into force in July 2004 and were not aware they should be verifying applicants reasons for leaving previous employment with vulnerable adults; that references should be verified or that full employment histories were required. In one file sampled, an employment gap of thirty seven years had not been explained or explored; in another the CRB certificate was potentially invalid as the persons name did not match with the name on their proof of identity and in a third file there was reference from a previous employer who did not appear in their employment history. The amended recruitment requirements and Schedule 2 of The Care Homes Regulations 2001 were reviewed with the manager and a copy of the CQC guidance, explaining the changes, was left with the home for their reference. A requirement has been made. It is positive to note that, following this inspection, we were advised by the manager that a full audit of all staff files had been carried out, any missing information had been identified and action had been taken to obtain missing information and verify documentation. Staff induction is in line with the new, mandatory Skills for Care common induction standards and we were advised that staff are supervised until they have completed their induction. Mandatory health and safety training is included in the staff induction and the staff training log demonstrated that staff are booked on additional training and updates when needed or indicated by the needs of the residents they support. The head office monitors the monthly record of staff training and notify the manager when updates are due. Monitoring of staff training is also included in the regional managers monthly quality assurance visits. Care Homes for Older People Page 24 of 31 Evidence: In the AQAA, to demonstrate improvements in the past twelve months, the manager stated: More in house training from support team. More e learning opportunities. Following our relative survey we have restructured the staffing level for the new dementia wing. Plans for improvement in the next twelve months include: Plan new staffing levels in line with the expansion. Training and development in all areas especially dementia care. Of the seven staff members who returned survey forms, six said that they are given training which is relevant to their role, that helps them to understand and meet the individual needs of residents and that keeps them up to date with new ways of working, one person left this answer blank. When asked what the home does well, comments from staff included: Giving training e.g. e-learning, NVQ. Good quality of care. Team work and Its nice to work here and the management is good. Give training to everybody. Of the five residents who returned survey forms, two said that the staff always listened and acted on what they said and three answered usually. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can have confidence in the home because it is led and managed appropriately and is run in their best interests. Residents, or someone close to them, control their own money and choose how they spend it. The environment is safe for residents and staff because appropriate health and safety practices are carried out. Evidence: The manager is a registered nurse and holds her Registered Managers Award qualification. Her management style is inclusive and the residents benefit from the ethos, leadership and clear management approach of the home. All staff who returned survey forms felt that they receive enough support from the manager and that she meets with them regularly to discuss how they are working. Staff spoken with were complimentary about the management of the home, with one carer saying that they wouldnt want to work anywhere else, and another that: we all Care Homes for Older People Page 26 of 31 Evidence: work as a team, the manager and deputy are very good and always makes time for us if we have any questions or concerns. The home has an effective quality assurance and monitoring system in place that is based on seeking the views of the residents and their relatives. We were advised that the home carry out yearly resident and relative surveys, correlate the responses and then formulate an action plan to address any issues that are raised. The regional manager carries out monthly quality assurance visits and speaks with residents to gain their opinions and to see if they have any concerns. In their AQAA, the manager told us that they have developed a more detailed newsletter and that the residents have: formed their own committee who meet with us regularly in order to improve the services we provide to suit their individual needs. Policies and procedures are in place to protect residents financial interests. The manager told us that the home does not handle the financial affairs for residents. Each resident, who wishes to, has a personal allowance account, which is audited and monitored by the regional administrator, all transactions on these accounts are signed and witnessed by two members of staff. Health and safety monitoring check sheets were sampled and found to be well maintained and up to date. At the last inspection a recommendation was made regarding routine measurement of bath hot water temperatures. This recommendation has been met, all bath water temperatures are checked weekly by maintenance staff and care staff also measure bath water temperatures each time the bath is used and before the resident gets in the bath. All staff have received required safe working practice training and updates and staff were observed to be following appropriate health and safety practices as they went about their work. All interactions observed between the management, staff and residents were inclusive, caring and respectful. Relatives were complimentary about the home and staff, with comments received on survey forms including: The food is good, the staff caring and Dormy House is very comfortable. Overall it is a very pleasant place to be, in quiet and relaxing surroundings and We, as a family, thank you for all the excellent care so far and we look forward to the move to the new building. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 19 The registered person must ensure that no person is employed to work at the home without first making sure that all the required checks and documentation have been obtained and must ensure that all staff involved in recruitment are fully aware of, and adhere to, the requirements of the Care Homes Regulations 2001 and related amendments. So that residents and their relatives or representatives can be confident that all required checks have been done on the staff to make sure that they are suitable to work with them. 28/02/2010 Care Homes for Older People Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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