Care Home: Dove Court Nursing Home

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What the care home does well People were given clear information about services offered at the home to help them to decide whether it was a suitable place for them and whether their needs would be met; new residents were admitted only when it was clear their needs could be met by the staff and facilities at Dove Court. Residents said they were given choices, could do what they wanted and made their own decisions; comments included `I can get up at any time` and `I can suit myself`. One visitor said `they support people to live the life they choose`. There was an advertised daily programme of interesting activities and entertainments which residents said they could choose to participate in. The menu offered a choice of healthy and nutritious meals and records showed that alternatives to the menu had been made available which would ensure that residents dietary needs and preferences would be met. Residents made positive comments about the meals including `I cant grumble about the food, there is a choice`, `if you want anymore you can go and get some`, `the food is lovely`, `the food is pretty good`, `the food is not my type, not what I`m used to` and `I look forward to my meals`. The service welcomed any concerns, complaints, suggestions or compliments and used them to improve the service. Residents said they were treated well and had `no complaints` about the service; comments included `I feel safe here` and another said `there are no dangers here`; one visitor said `I have no complaints`. There were clear procedures to help staff to recognise and respond appropriately to protect residents from any abuse or neglect. Residents said they were happy with their bedrooms and most had brought in personal items to make them feel more comfortable and homely. Residents made positive comments about staff including `very nice staff they do very well`, `if I waken in the night they look after me`, `staff are very nice indeed` and `staff are excellent with me`; they also said `the staff are alright but sometimes its a job to find someone`. Records showed that staff had received appropriate training, support and supervision to help them to understand the needs of residents in their care. The majority of staff had a recognised qualification in care which gave them the skills and competence to look after people properly. People made positive comments about the home. One visitor said `the service does everything well`, staff said `management communicates well with residents and staff and tries to build positive relationships` and residents said `I find it very good here` and `this is a nice place, a good place`. There were a number of systems in place to monitor whether the service was meeting people`s needs and expectations and to determine whether the service could be improved; this showed that peoples views and opinions were considered and they were involved in decisions about the day to day running of the home. What has improved since the last inspection? Staff had received training to help them to recognise and respond appropriately to any signs of abuse or neglect. Redecoration and refurbishment of the units was ongoing; this ensured that the environment was safe, pleasant and comfortable. Improvements had been made to the gardens which were safe, accessible and well maintained; residents and their relatives were observed enjoying the gardens. Rotas showed that there were sufficient staff to meet residents needs and this was kept under weekly review. What the care home could do better: There were concerns that some of the records, particularly diet, fluid and positional change charts, did not reflect the care that was being given; this could result in residents not receiving the care they needed. One of the units needed some attention to make sure it was a clean and pleasant place for residents to live in. Key inspection report Care homes for older people Name: Address: Dove Court Nursing Home Shuttleworth Street Burnley Lancashire BB10 1EN     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: Marie Matthews     Date: 2 7 0 5 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 33 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 33 Information about the care home Name of care home: Address: Dove Court Nursing Home Shuttleworth Street Burnley Lancashire BB10 1EN 01282830088 01282839898 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.bupa.com BUPA Care Homes (CFHCare) Ltd Name of registered manager (if applicable) Ellen Roberta Pepper Type of registration: Number of places registered: care home 120 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N. 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, Mental disorder, excluding learning disability or dementia - Code MD, Physical disability - Code PD. The maximum number of service users who can be accommodated is: 120. Date of last inspection 120 120 0 120 Over 65 0 0 120 0 Care Homes for Older People Page 4 of 33 Brief description of the care home Dove Court Nursing and Residential Home is a 120 bedded home situated on the outskirts of Burnley. The home comprises of four units of thirty beds. Robin is an elderly frail nursing unit, Kingfisher and Swallow are dementia units with nursing and Nightingale a residential unit. The communal areas on each unit comprise a lounge, dining area, conservatory and smoke room. Garden and patio areas surround each unit. There are sensory gardens that provide pleasant, stimulating areas for residents and their visitors. A central administrative block contains the main office, kitchen and laundry areas and a hairdressing salon. Ample parking areas are provided for visitors and staff. Dove Court is located on a main bus route and is close to local amenities, including a Post Office, a Church, Public House, bowling green and local shops. A health centre and public library are also within the locality. Dove Court provides care for up to 120 people, male or female, generally over the age of 65 years. Care can be provided for young adults, who are under pensionable age, who have physical disabilities. The registered provider is Care First Health Care Ltd. A company owned by BUPA. Information about the services offered at Dove Court is provided in the form of a service user guide and is available, with a summary of the most recent inspection report, to existing and prospective residents and their relatives. On the day of the inspection the weekly fees ranged from £331.50 to £701.50. Items not included in the fee include newspapers, toiletries, hairdressing and private chiropody. Care Homes for Older People Page 5 of 33 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 key unannounced inspection, including a visit to the home, took place on 26th and 27th May 2010. The last inspection visit to this service was completed on 10th July 2007 followed by annual reviews. The inspection process included looking at records, a tour of the home, discussions with the regional manager, registered manager, clinical care manager, three members of staff, four visitors and nine residents. The home sent us their annual quality assurance assessment (AQAA) before the inspection visit; this gave us a good picture of what had improved over the last twelve months and where further improvements were needed. Information was also included from surveys completed by three residents, one visitor and eight staff. There had been a number of recent safeguarding alerts which were currently being investigated; the homes senior management team were working with the local authority to provide further clarification and an action plan. Some aspects of the Care Homes for Older People Page 6 of 33 concerns were looked at during the inspection visit and referred to within this report. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? Staff had received training to help them to recognise and respond appropriately to any signs of abuse or neglect. Redecoration and refurbishment of the units was ongoing; this ensured that the environment was safe, pleasant and comfortable. Improvements had been made to the gardens which were safe, accessible and well maintained; residents and their relatives were observed enjoying the gardens. Rotas showed that there were sufficient staff to meet residents needs and this was Care Homes for Older People Page 8 of 33 kept under weekly review. 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 33 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 33 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were given clear information about services offered at the home to help them to decide whether it was a suitable place for them and whether their needs would be met. Residents were admitted only when it was clear their needs could be met by the staff and facilities at Dove Court. Evidence: The information about the services offered at Dove Court was up to date and clear and was available in a number of alternative formats; this would provide people with information that would help them to decide whether it was a suitable place for them and whether their needs would be met. Surveys indicated that people received enough information to help them with their decisions. Residents were only admitted once a detailed assessment of their needs had been completed; this information was used to develop a plan of care. Senior staff gathered useful information about peoples needs from a range of sources including the Care Homes for Older People Page 11 of 33 Evidence: resident, their carers and other relevant professionals; this would ensure that all aspects of their needs would be considered. People were encouraged to spend time in the home to meet and chat with staff and other residents and to view the facilities. Senior staff had received training to help them to deal with any enquiries and new admissions; this would help to make sure that prospective residents and their families would be given the information and support that they needed. Staff knowledge and approach to prospective customers was monitored and feedback was given to help them to improve the way they dealt with people. Terms and conditions of residency, or contracts, had been given out to everyone so that they were aware of their rights and responsibilities whilst they stayed at the home. People were assured, in writing, that their needs could be met. Records showed that staff had received appropriate training to meet the needs of the current residents. Survey information indicated staff had the right skills and experience. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health and personal care needs were met although some aspects of the record keeping could be improved. Evidence: The records of five residents were looked at in detail. The care plans were organised and detailed and gave a good indication of what care and support was needed to meet all aspects of residents needs. The care plans contained useful information about residents personal routines and preferences; this would help staff to provide the support that residents wanted. The content of the care plans had been reviewed and up dated at least every month and (there were gaps in the reviews on one of the units but the manager was already aware of this and appropriate action had been taken); this ensured that the records reflected the current needs of each resident. There was evidence that residents or their relatives had been involved in the Care Homes for Older People Page 13 of 33 Evidence: development and review of the care which would help to ensure they received the care and support they both needed and wanted. One visitor said they were kept up to date and that the resident received the agreed care and support. Letters had been sent to relatives inviting them to be more involved in the care and to remind them that the manager was available to discuss any issues. Records showed that residents health was monitored and that appropriate advice had been sought if there had been any concerns. There were registered nurses on duty at all times and most care staff had received training in health care which would help them to recognise and respond appropriately to any changes in residents health. Residents said they received the medical support they needed and that the GP had visited when they needed. Residents had been transferred to hospital only if there had been any immediate concerns about their health and well being and also following advice from the GP. Daily records showed that residents were supported with all aspects of care as detailed in the care plan; staff had been given new prompt cards to help them to improve the content of the records. There were ongoing assessments to determine whether residents were at risk of developing pressure sores; appropriate interventions had been taken to reduce or remove any risks and appropriate advice had been sought from specialist nurses. However there were concerns that the records did not reflect the care that was being given; an example of this was that although the care plans included instructions regarding the frequency of positional changes and staff were observed to follow the instructions there were no records to support this had been done. This issue was discussed with the registered persons at the time of the visit and appropriate action taken. The incidence of any pressure sores was closely monitored and appropriate action had been taken to ensure residents were receiving the correct care and attention. Continence assessments were in place and appropriate care and attention, with reference to maintaining residents privacy and dignity, was reflected in the records. Falls risk assessments were in place and appropriate action had been taken to reduce or remove the risks. The use of bed rails was properly assessed, discussed with the resident or their relatives and kept under review; this would help to determine whether this form of restraint was appropriate. There were a large number of residents that needed support to maintain a good Care Homes for Older People Page 14 of 33 Evidence: dietary and fluid intake. Nutritional screening was undertaken on admission and at regular intervals which would help to identify whether residents were at risk of malnutrition and dehydration; weights were checked at least each month and appropriate advice had been sought to respond to any fluctuations. There had been a period when the weighing scales were broken (on one unit) and replacement scales had been ordered; however alternative measures had been used to monitor any changes in weight. Records of weights were also monitored each month by the clinical care manager; this ensured that prompt and appropriate action was taken to respond to any fluctuations in residents nutritional status. There were concerns that residents, who were deemed to be at risk, did not have clear records to support that their daily dietary and fluid intake was being monitored. This was discussed with the manager at the time of the visit and appropriate action taken. There was evidence that the content of the care plans was regularly monitored and appropriate action taken to ensure staff were adhering to policies and procedures and meeting residents needs and expectations. People said they were happy with the care and support they received. Residents said staff listened to and acted on what they said, which would ensure they received the care they needed and wanted. Residents said I am content with the care provided and Im satisfied; one visitor said Im quite happy with the care. It was clear from observation of care practices that staff were able to provide the care and support that each resident needed. Staff had received training to help them to respond to people properly and to help them to maintain residents privacy and dignity. Staff were observed responding to residents and visitors to the home in a positive, respectful, helpful and friendly manner. Medication policies and procedures provided staff with safe guidance. Records were examined and showed that medicines were managed safely and stored appropriately. Staff had received medication training to ensure they were safe to practice. The home had a good relationship with the community pharmacist which ensured residents medicines were delivered on time; there were procedures to support staff with the collection of any out of hours prescriptions. There were good systems in place to monitor whether medicines were managed properly and records showed that any shortfalls in practice had been identified and Care Homes for Older People Page 15 of 33 Evidence: appropriate action taken. There were procedures to support staff with death and dying. Records showed that residents preferences had been discussed which ensured that their wishes would be adhered to at the time of and following their death. There was a flat available for relatives if they wished to stay with residents who were very ill; this would help to provide people with the support they needed. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents individual and diverse needs, expectations and preferences were met. Residents were offered a varied and appealing diet that met their dietary needs and preferences. Evidence: Within the care plans there was a very good record of the choices residents were offered; this included preferences for dressing, times for getting up and going to bed and what they liked to eat. Residents said they were given choices, could do what they wanted and made their own decisions; comments included I can get up at any time and I can suit myself. One visitor said they support people to live the life they choose. The care plans contained useful information about residents likes, dislikes, routines and preferences which would help staff to make the right choices for some residents who were unable to make decisions for themselves; the information would also help to plan suitable activities. Some residents had advocates who were able to advise and act in their best interests; the contact details of the advocates was recorded on the care records. Care Homes for Older People Page 17 of 33 Evidence: Activities staff were employed to provide a range of suitable activities and entertainments that met residents diverse needs, preferences and expectations; activities were held either in groups or on a one to one basis and activity staff had been given training and support to help them to improve this service. There was an activities committee which was run by volunteer residents, relatives and staff; this had helped to improve the range of activities and entertainments made available to residents and to plan fund raising events. There was an advertised daily programme of interesting activities and entertainments which residents said they could choose to participate in; some of the activities took place on other units and residents were escorted by staff if they wished to participate. Records showed what activities residents had been involved in and whether they had enjoyed it although these were not always completed in sufficient detail to reflect what had taken place. Comments from residents included nothing goes on here, I can have a chat anytime, I play dominoes, there is a church service and someone comes and takes me and there is enough going on, I have been to a pantomime; one member of staff said the home has a good activities programme. Group and one to one activities had taken place on all of the units on the day of the inspection visit. The garden areas had been improved and provided a pleasant, interesting and safe place for residents to wander. Contact with the local community was maintained in various ways including a recent spring Fayre and sessions to get everyone involved in growing their own vegetables and plants. Some residents had attended entertainment in the local community and a minibus had been hired; one resident said she had enjoyed going out. Visitors were made to feel welcome and able to visit at any reasonable time. One resident said all my family come to see me and they can come anytime. The menu offered a choice of healthy and nutritious meals and records showed that alternatives to the menu had been made available which would ensure that residents dietary needs and preferences would be met. There was a nite bite menu that offered snack foods throughout the night and a recently introduced wander box that offered finger foods for residents who were reluctant or unable (due to their medical condition) to remain seated at the dining table. Menus were available in suitable formats for all residents to understand what was available. Care Homes for Older People Page 18 of 33 Evidence: Food was served by unit staff from a hot trolley and some staff had been provided with training to help them with food presentation which would help to make the food more appealing and attractive to residents. The lunchtime meal looked hot, nutritious and healthy and residents said they had enjoyed it. Residents made positive comments about the meals; comments included I cant grumble about the food, there is a choice, if you want anymore you can go and get some, the food is lovely, the food is pretty good, the food is not my type, not what Im used to, Im enjoying the food, I look forward to my meals and the food is very good, there is plenty for me and you get asked if you want more. Staff, residents and their visitors had been consulted about the meals and their views had been used to improve the menus; this helped to ensure residents were offered food that they enjoyed and involved more people in the day to day decisions and running of the home. Special days such as birthdays and anniversaries were celebrated and an alternative menu was made available. Dining areas were bright and clean and residents were given the support and assistance they needed from patient and helpful staff. Care Homes for Older People Page 19 of 33 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were protected by clear procedures and staff awareness. Evidence: The service welcomed any concerns, complaints, suggestions or compliments; the information was monitored and used to improve the service. Each unit had a suggestions box to allow people to have their say. The complaints procedure was clear and gave people an understanding of how their complaints and concerns would be dealt with. The information could be made available in other formats and the contact information for other useful local agencies was included with the information. People could raise their concerns by speaking to managers or staff, completing a form which would be handed into the office or they could meet with the registered manager; people were also invited to meet with the registered manager at weekly afternoon tea sessions. In the last twelve months there had been eight complaints, six of which were upheld; records showed that any concerns and complaints had been responded to appropriately. There had also been a number of compliments that gave positive views of the service provided at Dove Court. Surveys indicated that residents were treated well and residents said they had no complaints about the service they received and would speak to either key staff or Care Homes for Older People Page 20 of 33 Evidence: their relatives if they were unhappy. One resident said I feel safe here and another said there are no dangers here; one visitor said I have no complaints. Surveys indicated that people knew who to speak to if they were unhappy with the service and one visitor said they had raised a concern in the past and it had been responded to properly. Some staff had received training to help them with customer care and surveys indicated that they knew how to respond if people had any concerns or wished to make a complaint; this would help to ensure that peoples views were taken seriously and dealt with according to procedures. There were clear safeguarding policies and procedures and staff had attended training in this area; this would help them to recognise and respond to any signs of abuse or neglect. The Lancashire County Council safeguarding procedures were also available to help staff to follow good practice. In the last twelve months there had been six safeguarding adults referrals made with two investigations; this showed that the home understood the procedures and had responded appropriately to protect people. There was a whistle blowing policy to support staff with understanding their obligations to report any poor practice. There had been a number of recent safeguarding alerts which were under investigation at the time of the inspection visit; the local authority contracts monitoring team had conducted an initial investigation and the management team at the home was working with them to provide further clarification and to develop an action plan. There were clear procedures and some staff had undertaken training to be able to handle any difficult or challenging behaviour safely. The use of bed rails was assessed, discussed with residents and their relatives and kept under review; this ensured people were involved in discussions regarding any limitations to their choice and would help to ensure that this form of restraint was appropriate. Some staff had received training in the Mental Capacity Act and the Deprivation Of Liberty Safeguards which would help them to understand and appropriately support residents with their right to make their own decisions and choices. One residents care Care Homes for Older People Page 21 of 33 Evidence: records were looked at and showed that restrictions to their choices had been appropriately assessed and kept under review. Care Homes for Older People Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was clean, safe and well maintained. Evidence: A tour of all areas was undertaken and it was clear that redecoration and refurbishment of the units was ongoing; this ensured that the environment was safe, pleasant and comfortable. However some areas needed attention on one of the units including damage to walls and woodwork, splashes and stains to walls and ceiling in the dining area, stained equipment and damaged furniture. The manager advised she would look into this. The maintenance records on each unit showed that requests for repairs were noted in the book and were attended to although it was recommended that on completion of the work the book should be dated; this would help to monitor whether work was completed in a timely fashion. The home had responded to any recommendations made by the fire safety officer and environmental health officer to ensure all areas were safe. Improvements had been made to the gardens which were safe, accessible and well maintained; residents and their relatives were observed enjoying the gardens. Secure gardens were provided for residents on the dementia and seating, bird tables and bird Care Homes for Older People Page 23 of 33 Evidence: feeders were placed in the gardens and outside bedrooms for residents to enjoy. Communal areas were bright and comfortable and smoking areas were provided. There were various seating areas on each unit for those residents who preferred to spend some time quietly. Memory boxes were provided outside some residents rooms on the dementia units; these contained personal items and photographs of the resident, family, friends and pets to help them to recognise their room. All bedrooms were provided with lockable storage and locks to doors; this would help to maintain residents rights to privacy. Call bells were supplied in all areas to enable residents to summon assistance from staff and assessments were in place to support non-provision. One resident said when I press the button they come and help me. Residents said they were happy with their bedrooms and most had brought in personal items to make them feel more comfortable and homely although this varied from room to room. Comments included I like my room, I have my own TV, bed and bedding and I have everything in my room that I need; another resident said my room is plain it isnt like home. Bedrooms did not have en-suite facilities although bathrooms and toilets were accessible, suitably equipped and clearly signed. Aids and adaptations were provided to maintain residents safety and comfort and to promote their independence where possible. The units were warm, bright and airy. The temperature of the heating was controlled and there was plenty of hot water available. There were policies and procedures for the control of infection for staff to follow good practice and staff had undertaken training to help prevent cross infection. There were no unpleasant odours and surveys indicated that the home was fresh and clean; one resident said everything is clean. The laundry was suitably equipped and well organised. Residents were appropriately dressed; comments from residents included its a very good laundry, my clothes are looked after,my family take my clothes and wash them and the laundry loses my clothes all the time. Care Homes for Older People Page 24 of 33 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff were suitable, competent and provided in sufficient numbers to meet residents needs. Evidence: Rotas showed that there were sufficient staff to meet residents needs. Residents and staff said there were sometimes and usually enough staff and one resident said staff seemed stressed and overworked at times. The nurse call system was answered promptly which was a good indicator that there were sufficient staff. The roles and responsibilities of staff were clearly defined and understood and one member of staff said they worked as a team. One staff commented we communicate well with each other and have a good knowledge of the residents enabling good care to be given. The staff group was balanced in terms of ages, gender and cultures; this allowed residents to have some choice regarding whom they wished to be cared by. There had been concerns that staff were moved around the units to cover any shortfalls in the numbers of staff which meant that staff didnt understand the needs of the residents and that some units were left understaffed; we spoke to three staff who said units were always sufficiently staffed and one unit had introduced communication Care Homes for Older People Page 25 of 33 Evidence: books to improve staff awareness. Staff attendance, staff deployment, ocuppancy numbers and needs of residents were regularly monitored and appropriate action taken to ensure the home was suitably staffed. The manager advised that staffing had recently been increased to ensure appropriate cover and to ensure that residents were looked after by staff who were familiar with their needs. Residents made positive comments about staff including very nice staff they do very well, the night carers are good, if I waken in the night they look after me, staff are very nice indeed and staff are excellent with me; they also said the staff are alright but sometimes its a job to find someone. Four staff employment files were looked at in detail and showed that a safe and fair recruitment procedure had been followed; this would reduce the risk of residents being cared for by unsuitable people. Staff confirmed that all recruitment checks were completed prior to employment. Records showed that staff had received appropriate training, support and supervision to help them to understand the needs of residents in their care. The majority of staff had a recognised qualification in care which gave them the skills and competence to look after people properly and showed that the organisation was committed to improving standards of care. Staff said they received relevant training to help them to understand and meet residents needs. A programme of weekly training sessions, both fomal and experiential, had been introduced to help improve and maintain staff skills, knowledge and competencies. The home had a dedicated training room on site. New staff received a period of supervised induction which would ensure they were aware of residents routines, the homes policies and procedures and were safe to practice. Staff met regularly as a group when they were kept up to date and were able to air their views and opinions. The home had a system called Personal Best which encouraged staff to provide an individualised service to residents and their visitors; it recognised and rewarded staff who had contributed over and above the standard practice. Staff, residents and visitors contributed to the Personal Best scheme by nominating staff for the award. Staff made comments about the standards of care; comments included staff care Care Homes for Older People Page 26 of 33 Evidence: about the residents, the home provides good care in a variety of settings, care staff are very caring and the residents are well looked after and the home cares and supports the staff and residents quite well. Care Homes for Older People Page 27 of 33 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. The home was safe and run in the best interest of the people living there. Evidence: The registered manager is Ellen Pepper; she has the required qualifications and experience and is competent to manage this home. Mrs Pepper is involved in the business and financial planning and is able to ensure that people receive value for money. She is supported by a clinical service manager and unit and departmental managers who share responsibility for monitoring and improving the standards of care in the home. Mrs Pepper is able to meet with and share experiences with other managers within the group and is supported by a senior person within the organisation. She is also able to access a range of regional and national experts, within the organisation, with various skills and expertise. People made positive comments regarding how the home was managed. One visitor Care Homes for Older People Page 28 of 33 Evidence: said the service does everything well, staff said management communicates well with residents and staff and tries to build positive relationships and residents said I find it very good here and this is a nice place, a good place. The home sent us their annual quality assurance assessment (AQAA) when we asked for it; this gave us a good picture of what improvements had been made and where further changes were needed. The day to day management of the home was regularly monitored by a senior person within the organisation and changes were made to respond to any shortfalls and to improve the service. There were a number of systems in place to monitor whether the service was meeting peoples needs and expectations and to determine whether the service could be improved. The home had again achieved the Investors In People award which was an independent accrediting body that monitored the day to day management of the home and the training and development of staff; the results of the report were used to improve the service. Annual surveys were sent out to residents and their relatives and the results of these were analysed, made available and used to improve the service; this showed that peoples views and opinions were considered and they were involved in the day to day running of the home. There were internal audits to monitor whether staff were following policies and procedures; any shortfalls would generate an action plan to improve practices. Regular meetings were held with residents and their relatives and people said they were able to voice their opinions about the service. Regular newsletters were produced to keep people up to date with any changes or improvements to the service. It was clear that peoples views and opinions had been considered and action had been taken to improve the service. An mystery shopper regularly contacted the home to check the quality of the service and the response and knowledge of staff; the outcome of this contact was used to identify any shortfalls. Staff had access to a range of up to date policies and procedures which provided them Care Homes for Older People Page 29 of 33 Evidence: with safe guidance. Key policies were provided to all staff and a Policy of the Month was displayed for all staff to read; this would help to keep staff up to date with safe guidance. Clear accounting and financial records were maintained; the company audited these records to ensure residents best interests were protected. Records were accurate and stored securely; any shortfalls in record keeping were referred to under the appropriate outcome area in the report. Information supplied by the registered manager prior to the inspection showed that health and safety records had been properly maintained and systems protected residents, staff and visitors to the home. The home had a designated person who was responsible for health and safety which would help to keep people safe. Regular meetings were held to enable staff to raise any issues and to improve peoples safety. All staff had received regular training to keep themselves and others safe. Care Homes for Older People Page 30 of 33 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 31 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 8 Records to support regular positional changes should be in place for any residents who are identified to be at risk from developing pressure sores. Records to monitor dietary and fluid intake should be in place for any residents who have been identified to be nutritionally at risk. The maintenance book should indicate the date that work is completed; this will help to determine whether work is completed in a timely fashion. Prompt action should be taken to respond to the areas noted during the inspection tour. 2 8 3 19 4 19 Care Homes for Older People Page 32 of 33 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. 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