Care Home: Elizabeth House

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What the care home does well People living in the home confirm that staff are kind and gentle when attending to their needs. A resident told us they `look after me very well`, another person said the `staff are very efficient and helpful`. A relative told us the `care workers are kind and look after my relative very well`. People are involved in an assessment of their needs before they come to stay, to make sure that staff are able to provide the support they need and any specialist arrangements and equipment can be put in place. The manager will also write to them and tell them who their key worker is so they have a named point of contact. People are able to tell staff how they wish to be supported and what their personal choices and preferences are so that a care plan centred on their individual needs can be put into place. A social worker involved in assessing people told us `Elizabeth House have provided a very good service to meet the needs of individual clients and work with them to tailor their care plan as appropriate`. People will be involved in regular reviews of their care as they move in and during their stay to make sure they are receiving the support they need. People can be confident in the safety of systems for giving them their prescribed medicines, because they are well managed and organised. However people will be supported if they are able to continue to manage their own medicines. People living in the home are offered a range of activities and events they can take part in which include opportunities for exercise and excursions outside the home. People are provided with a range of meals from a recently revised menu that they can choose from. We were impressed that the catering manager and her staff are so involved in monitoring people`s nutritional needs and providing alternative options where people need encouragement. People are living in a safe well maintained environment and tell us they value the high standards of cleanliness provided by the housekeeping staff. People are supported by staff who receive the training they need to support older people, including those with dementia. The level of training and personal development has been recognised in the Investors in People Award achieved this year by the managers and staff. What has improved since the last inspection? There has been a review of the policies and procedures related to preventing pressure sores and monitoring nutrition, falls and continence to make sure staff respond to people`s changing needs during their stay and seek timely advice from community specialists. Positive comments about communication between staff and the community nursing team were received from a visiting nurse. There has been a focus on continuing to develop a person centred approach to meeting people`s individual needs through training and supervision of staff. Elizabeth House is well maintained and the Welwyn Garden City Housing Association continue to invest in the home by upgrading facilities. Projects have included the refurbishment of the main kitchen, replacing the lifts making them more user friendly for residents and wheelchair users and reviewing the fire safety and emergency call systems. There are pleasant grounds for residents to use and people with dementia are able to walk in a private sensory garden designed to promote people`s well-being by providing points of interest and contrasts. What the care home could do better: This is the second inspection where we have not needed to make any formal requirements to improve the service for people living in the home. Constructive comments have been received positively and we have been told how the Chief Executive and Chair of the association intend to explore further ways to improve the experiences of people living at Elizabeth House and the quality of the service. The manager`s self assessment (AQAA) identifies areas that she needs to take forward including continuing to raise staff awareness of their responsibilities in relation to protecting people from harm and reporting any concerns. Key inspection report Care homes for older people Name: Address: Elizabeth House Elizabeth Close Moors Walk Panshanger Welwyn Garden City Hertfordshire AL7 2JB     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: Sheila Knopp     Date: 2 9 0 9 2 0 0 9 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 28 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 28 Information about the care home Name of care home: Address: Elizabeth House Elizabeth Close Moors Walk Panshanger Welwyn Garden City Hertfordshire AL7 2JB 01707338820 01707392404 eh@wgcha.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Welwyn Garden City Housing Association care home 51 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 51 The registered person may provide the following categories of service: Care Home only - Code PC to service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Older people , not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Elizabeth House provides accomodation and personal care for 51 older service users. It is owned and managed by Welwyn Garden City Housing Association (a charitable organisation) with offices in Welwyn Garden City. The two storey home was purpose built in 1983 and extensively refurbished in 2003. Three additional rooms were added in 2009. There are parking spaces in the front of the building. The home is in a Care Homes for Older People Page 4 of 28 Over 65 0 51 51 0 Brief description of the care home residential area with access to local shops and transport. Everyone is able to have their own ensuite room with wash hand basin and toilet. The rooms vary in size and the newer rooms also have an ensuite shower and kitchenette. There is a designated area on the ground floor, with 2 lounges a kitchen dining room and courtyard style sensory garden, that accommodates 13 people with dementia. A key pad system provides security for people living in this area. In the main area of the home there are a variety of communal areas, dining room, kitchen, laundry, hairdressing room and office accomodation. Specialist bathing and shower facilities are available for people who need support. Two lifts provide access to the first floor rooms. Residents have their own rooms with a wash hand basin and toilet. The new rooms also have en-suite showers and kitchen facilities. Fees for the service range from £487.78 - £571.71 per week (correct on 29/09/09) subject to an assessment of needs and size of room. Varying charges may be applied to local authorities purchasing accommodation. Full details are available on request from the manager together with information about the services provided and a copy of the latest inspection report. Information can be requested in different formats and is also available on the organisations web site www.wgcha.co.uk. Care Homes for Older People Page 5 of 28 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: Our last inspection to Elizabeth House took place on 26 July 2007. At that time the home was assessed as providing a good service, which meant that we carried out an annual service review on 25 July 2008. Annual service reviews do not involve a visit to the home but are an assessment of risk based on the information we have received since our last visit and seeking the views of people who live at Elizabeth House. For this inspection 2 inspectors visited the home between 10:10 am & 6 pm. We met with residents, visitors, staff and members of the management team. We reviewed relevant records that tell us about the care being provided, staff training and management of quality and safety systems. The registered manager was not on duty at the time of this unannounced visit but we found that the 3 assistant managers on duty during the day managed this inspection very well. To make sure we have reflected a wide range of views in this assessment we made Care Homes for Older People Page 6 of 28 survey forms available to residents, their relatives and health & social care professionals who have regular contact with the people living at Elizabeth House. We received completed surveys from 15 residents, 2 relatives and a doctor and social worker. The manager also sent us an annual quality assurance assessment (AQAA). The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information and provided details of the work carried out by the management team to maintain and develop standards within the service. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? There has been a review of the policies and procedures related to preventing pressure sores and monitoring nutrition, falls and continence to make sure staff respond to peoples changing needs during their stay and seek timely advice from community specialists. Positive comments about communication between staff and the community nursing team were received from a visiting nurse. There has been a focus on continuing to develop a person centred approach to meeting peoples individual needs through training and supervision of staff. Care Homes for Older People Page 8 of 28 Elizabeth House is well maintained and the Welwyn Garden City Housing Association continue to invest in the home by upgrading facilities. Projects have included the refurbishment of the main kitchen, replacing the lifts making them more user friendly for residents and wheelchair users and reviewing the fire safety and emergency call systems. There are pleasant grounds for residents to use and people with dementia are able to walk in a private sensory garden designed to promote peoples well-being by providing points of interest and contrasts. 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 28 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 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People looking to move into Elizabeth House can be confident that they will be involved in an assessment to make sure support can be provided to meet their individual needs and preferences. Evidence: To look at the arrangements made for people choosing to move into Elizabeth House we met with two residents who had recently come to stay and discussed their experiences. People are encouraged to visit Elizabeth House before making a decision to stay. One person told us about their relative visiting on several occasions to check things out before they came to stay. Elizabeth House is also able to offer people short breaks, which enables people to experience what it is like to live there. Before the manager agrees that the staff at Elizabeth House will be able to provide the Care Homes for Older People Page 11 of 28 Evidence: support each person needs senior staff will visit people where they are living or in hospital to asses their needs. Information will be collected from other health & social care professionals who know the person concerned. The assistant managers we spoke to during out visit were able to confirm that there is now a more robust approach to questioning hospital staff about peoples nursing needs and level of dependency before they are admitted to Elizabeth House for residential care. This is to make sure the service is right for them. Care Homes for Older People Page 12 of 28 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. People can be confident that they will be provided with the personal care and support they need because they are involved in planning their care and staff are well trained. People can be confident that there are safe systems in place to make sure they have their prescribed medicines and that they will be supported if they wish to continue to manage this for themselves. Evidence: To assess whether people are receiving the care and support they need, according to their individual wishes, we have considered the views of residents we spoke to during our visit and the residents and relatives who completed surveys for us. We reviewed relevant care and medication records and have taken account of the information we received from community health and social care professionals, who visit Elizabeth House and the managers self assessment (AQAA). Following their admission to Elizabeth House people are involved in a further assessment of their needs, which is then developed into a plan of care so that staff Care Homes for Older People Page 13 of 28 Evidence: know how they wish to be supported and what their preferences are. Regular reviews are carried out as people settle in so that any adjustments can be made. Ninety three (93 ) percent of residents who completed surveys said they usually (53 ) or always (40 ) received the care they needed. The care plans we reviewed were person centred, which is a particularly important approach for the care and support of people with dementia. They provide the information staff need to provide individual care and we saw that this approach was understood in practice. This means people receive care in a flexible and individual way that takes account of any diverse needs they have that require special equipment or arrangements to be made for them. We had contact with a general practitioner, mental health specialist and community nurse who made positive comments about the support being provided to residents at Elizabeth House. One person said Elizabeth House provides a very good service to meet the needs of individual clients and work with them to tailor their care plan and approach. Our review of care plans and discussion with residents confirmed that people have access to a full range of community health services such as dentists, opticians and chiropodists. Specialist equipment for the prevention of pressure sore is provided by the community nurses. Staff are monitoring peoples nutritional needs and risk of falls. The care plans and risk assessments have been reviewed to make them more responsive to changes in peoples health and staff are able to refer people to dietitians, falls services and specialist mental health services. People are supported to manage their own medicines if they are able to maintain their independence with this aspect of their life. Staff carry out regular risk assessments to make sure people are able to manage this safely. The systems within the home for making sure people receive the medicines they need were well organised and regularly reviewed. Staff receive training in the management of medicines to make sure safe practices are followed. The dispensing pharmacist who provides a service to the home also carries out audit. Information on the effects of each persons medication are available to assist staff. Care Homes for Older People Page 14 of 28 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. People can be confident they will be offered a range of opportunities to take part in activities and events, inside and outside the home, to maintain their interests and enable them to socialise. People are provided with a choice of meals and will have any dietary needs closely monitored as well as being provided with facilities to prepare their own drinks and snacks as they wish. Evidence: To look at how people are encouraged to maintain active social lives and enjoy their meals we have reviewed the information received from interviews with residents, completed surveys and information available in care plans and the managers self assessment (AQAA). We met with the catering manager and observed how people were offered drinks and served their lunch time meal. We also sampled the main meal on offer. People are asked about their interests when they come to stay at Elizabeth House and this is recorded and reviewed as part of their care plan so staff know how to support them. Seventy-nine (79 ) percent of people who completed our survey said there Care Homes for Older People Page 15 of 28 Evidence: were always (36 )or usually (43 ) activities they could take part in and this matches the managers own survey carried out in June where 79 of the people who completed surveys said the activities were good to excellent. An activity organiser is employed from 11 am - 4.30 pm during the week and we understand resources in this area are due to be increased to provide more time to develop this area of the service. The activity programme indicates a range of sessions take place and include opportunities to take part in exercise sessions. There is access to community transport and during the summer outings were arranged to cater for different tastes. These included trips to Capel Manor, Paradise Park and Hendon RAF Museum. People also go out to pubs, garden centres and local shops and supermarkets. Residents meet with the activity organiser to plan events and discuss ideas. The June meeting included details of the summer trip and barbecue and requests for particular films and CDs. Minutes of the meetings are kept and indicate 19 to 20 people are involved in giving their views on each occasion. A resident told us they particularly looked forward to quizzes. On the day of our visit people were bright and alert following their own routines. The staff supporting people who have dementia had created a calm atmosphere. This enabled them to respond to the needs of individual residents to promote their sense of well-being and comfort. We have been told about plans to review the communal areas within the dementia care unit to create further opportunities for activity and meaningful occupation, through the use of familiar objects and furnishings, to prompt peoples memories. Elizabeth House has a hairdressing salon that caters for men and women. Visitors are welcome in the home and there appears to be good communication with relatives. There are opportunities for people to take part in religious observances if they wish and the managers self assessment told us about the importance of links with the local community and visits from local schools. Seventy-nine (79 ) per cent of people who completed our survey said they usually like their meals. The homes own survey rated 75 of residents, who responded, as saying the meals were good to excellent. The manager has introduced new nutritional screening tools to monitor peoples needs more closely and the catering manager is actively involved in responding to changes in individual needs and monitoring their response to the meals they have. Where needed to improve peoples weight the catering staff make their own nutritional supplements and shakes. People are able to choose their meals from a daily menu. We made some suggestions about the serving of meals and drinks to increase the quality of peoples experiences and promote their independence. For example providing more opportunities for people to serve themselves at meal times and serving people sitting together at the same time. These Care Homes for Older People Page 16 of 28 Evidence: ideas have been picked up positively by the management team. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will be listened to if they have any concerns and their rights will be supported because staff receive training in promoting person centered care and protecting vulnerable people. Evidence: To look at how the views and rights of people living at Elizabeth House are protected we have looked at the information we have received about adult protection issues and complaints between our reviews of this service. We have also reviewed the information we have received from residents and relatives and what the manager has told us in her self assessment (AQAA). Eighty-six (86 ) percent of residents who completed our survey told us there was someone to speak to if they had a problem. A resident told us they listen to me. There are various opportunities for people to give their views on how the service is being run and the Chair of the association and Chief Executive are regular visitors to the home and meet with residents, visitors and staff. Monthly care plan reviews with residents and their relatives also provide an opportunity to discuss any issues as they arise. There are also monthly resident meetings. The managers self assessment tells us that staff are not to see a complaint as a criticism about the care we are offering, but away forward to improve and change the care. Care Homes for Older People Page 18 of 28 Evidence: Our last review of this service identified that there was an investigation in progress under the Hertfordshire Safeguarding Adult process (SOVA). This is a multi-agency process that brings professionals, who have a role in protecting vulnerable adults, together to investigate any concerns regarding their welfare and to make sure there is a protection plan in place. We are aware of 3 safeguarding investigations that have taken place and raised specific care issues that we have reviewed as part of this inspection. The managers self assessment told us that three serious concerns were acted on, service users listened to, and changes were implemented. She identifies the need for on-going training in safeguarding vulnerable adults and staff responsibilities to raise any concerns under the General Social Care Council Code of Conduct and whistle blowing procedures, to ensure they remain alert to any potential issues. This inspection has confirmed that staffing levels on the dementia care unit and revision of the homes procedures for assessing people before admission, making timely referrals to community specialists and reviewing pressure area care, nutrition and access to falls prevention services have taken place in response to problems identified. We have had discussions with the manager, based on the notifications we have received about incident in the home, that where individual residents get caught up in the more challenging behaviour of other residents, they also need to be referred under the SOVA procedure to make sure their rights are considered. There has been a reduction in reported incidents that indicate residents who have challenging behaviour are affecting other residents. As far as we are aware there are no outstanding issues. The managers are aware of the action they need to take under the Mental Capacity Act and involve Age Concern advocacy services where people need extra support to make decisions about their lives and to protect their interests. Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident Elizabeth House will provide them with a clean, comfortable, well-maintained home to live in that supports their individual needs and promotes good infection control standards. Evidence: Our assessment on the quality of environment provided for the people who live at Elizabeth house is based on our observations during the visit, interviews with residents, housekeeping staff, data from the managers self assessment (AQAA) and review of relevant maintenance and training records. On arrival at Elizabeth House you are aware of a warm home style atmosphere with comfortable furnishings and features that would be familiar to the people who live there. The home is divided into two separate living areas both with access to their own lounges, dining room, bathrooms and garden areas. Three new rooms with en suite showers have been added since our last visit. Elizabeth House supports people who have dementia and there has been a focus on creating an environment that reflects their needs. We have been told that further developments in this area are planned. Specialist advice is being sought to promote current thinking in planning suitable environments for people with dementia. The sensory garden provides a secluded peaceful place to walk in with raised beds, interesting planting and textures for people to touch and feel. We talked to one of the residents about the plants they were looking Care Homes for Older People Page 20 of 28 Evidence: at and how they felt and touched. People who live in the main area of the home are able to sit in a variety of communal areas and are able to make their own hot drinks or do their own washing in a pantry room on each floor if they wish. All residents are able to add personal possessions to their rooms to make them more familiar to them and staff are aware of how people like their belongings arranged. All residents have access to up to date assisted bathing and toiled facilities to support their needs. There is programme of continual refurbishment and renewal to maintain decorative standards and the safety of equipment and systems within the home. New lifts have been provided in the last year making them more accessible to residents and wheelchair users. The main kitchen has undergone a major refurbishment and the fire safety and alarm call systems have been reviewed. The people living at Elizabeth House express a high level of satisfaction with the cleanliness of the home and the work of the housekeeping team. People told us the home is always kept very clean and they value their clean home and room. Staff understand the need to maintain good infection control standards and are provided with the personal protective equipment they need to support this. A senior member of staff has attended training provided by the local Health Protection Unit (HPU) to act as a link for providing updated information on infection control standards. The staff at Elizabeth House are also taking part in a pilot infection control accreditation programme the HPU are running for care homes. This will involve further audits of infection control standards. The laundry service provides people with freshly laundered clothing and bed linen. There are appropriate systems in place to manage soiled linen and clinical waste. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident they will be provided with a consistent service that meets their needs because they are being supported by well trained staff who understand the need to provide person centred care. Evidence: Our assessment on the quality of staff provided at Elizabeth House and their ability to meet peoples individual needs is based on our discussions with residents and relatives, observation of the interaction between residents and staff on the day of our visit, discussions with staff on duty and a review of personnel and training records. Fifty-four (54 ) percent of people who completed our survey told us that staff were usually available when needed and 46 said this was sometimes the case. One person said the care workers are kind and look after my relative well. The residents we spoke with during our visit also confirmed that staff were kind and gentle. One person who completed a survey felt that on occasions less experienced staff could be impatient and difficult to understand. Another person said they needed to be treated as an adult. Our discussions with the management team confirmed that where people have reported a not so positive approach the organisation takes action to ensure staff are providing an individual service to each person. The managers self assessment (AQAA) said new staff are trained in the importance of treating service users as individuals. Care Homes for Older People Page 22 of 28 Evidence: On the day of our visit we saw positive and respectful interaction between staff and residents. The number of staff supporting people who have dementia has been increased since our last visit. The manager tells us in her self assessment (AQAA) that this has enabled staff to spend more individual time with each resident. A training manager is employed to oversee the training requirements of staff. This is a very good resource, which makes sure people are up to date with their training and staff development needs. Over 50 of the care staff have achieved National Vocational Qualifications (NVQ) in care which meets the bench mark standard set for care homes. Staff supporting people with dementia receive specialist training in this area. As the manager was not present on the day of our visit we were not able to review the recruitment records. Previous inspections have shown us that there are no problems in this area and the new staff we interviewed confirmed that references and criminal records checks had been taken up before they started work in the home. The manager confirmed in the self assessment (AQAA ) that all employment checks had been completed for all staff who started work in the last 12 months. Staff receive regular supervision so their practice is monitored and their training and personal development is kept under review. Meetings enable staff to give their views on the running of the home and keep up to date with what is expected of them. Care Homes for Older People Page 23 of 28 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. People can be confident in the service provided at Elizabeth House because the home is well managed, their views are fully considered and the associations systems for monitoring the quality and safety of the service are kept up to date in line with current practice and legal requirements. Evidence: The information in this report tells us that Elizabeth House continues to be well managed and the interests of the residents are at the fore front of the organisations approach to running the service. The Chief Executive, board members and senior managers of the housing association make regular visits to the home. They meet with residents, know their individual circumstances and provide the manager with a monthly report on the quality of the service. This tells us there is an open and transparent ethos because people are listening to residents and staff. The registered manager has many years experience and the qualifications required of a care home manager. Although the manager was not available for this inspection the Care Homes for Older People Page 24 of 28 Evidence: 3 assistant managers who were present demonstrated a sound grasp of the homes policies and procedures and were able to give us a good insight into the running of the home. This tells us there is sound management at all levels. In a recent survey conducted by the manager 100 of 23 people who responded rated the care provided at Elizabeth House as good to excellent and 96 said their overall impressions of the service were also good to excellent. The self assessment (AQAA) provided by the manager tells us she continues to review and evaluate the service to further enhance peoples experiences by providing strong leadership and promoting a person-centred ethos. It is an achievement to receive the Investors in People Award as this tells us about the organisations approach to monitoring quality and supporting staff to achieve good standards through training, supervision and appraisal. The manager is also continuing with her own personal development by undertaking further advanced dementia care training, which will benefit the development of this area within the home. There are quality assurance and auditing systems in place to monitor standards within the home. An annual report on the work of the association is also produces so people are kept up to date with developments. People are able to deposit money for their own personal day to day use if they wish. People depositing or withdrawing funds are given a receipt and the computerised systems enables statements to be produced. Regular internal and external audits are carried out to make sure all transactions can be accounted for. The association and management team are aware of their responsibilities to maintain a safe environment for people living and working in the home and this is supported by maintaining accurate training and maintenance records. A recent project has included a review of the fire safety systems and emergency procedures within the building. We have advised the management team to look at the procedures for storing plastic waste bags in each persons room as this may not be safe practice in all cases and needs to be kept under review as each person is admitted. Care Homes for Older People Page 25 of 28 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 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 27 of 28 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). 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