Care Home: Elm View Nursing Home

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What the care home does well Elm view provides a homely and comfortable environment for residents. It is decorated and furnished to a good standard and there are many homely touches. There is a relaxed atmosphere where residents support one another. The outcome for the residents is good. For example nine residents spoken with said "the home is lovely, the staff are kind and caring and do what they can to help me". The routines in the home are flexible to suit the needs and wishes of people who use the service. The staff work hard to ensure the well-being and comfort of the residents and treat them with respect and kindness. Staff were described as "kind and helpful"; "very caring and keep the place clean". Residents feel that if they had something to complain about they would speak to a member of staff. Eight residents spoken with said they had nothing to complain about. Three relatives told us "the staff are always friendly and approachable". Staff feel well supported and are encouraged to undertake training to ensure they have the skills and knowledge to meet the residents needs. What has improved since the last inspection? Residents now benefit from clearer and more comprehensive information and documentation of assessed needs, to ensure that care provision can be tailored to their needs and preferences. Residents benefit from improved systems to measure quality of service, and allow for their input in the running of the home. What the care home could do better: Residents liberty would be better protected through clear understanding and use of the guidance of the Mental Capacity Act 2005 in relation to consent, for the use of bed rails and other forms of potential restraint, to maintain their safety. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Elm View Nursing Home Moor Lane Clevedon North Somerset BS21 6EU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Patricia Hellier     Date: 2 9 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Elm View Nursing Home Moor Lane Clevedon North Somerset BS21 6EU 01275872088 01275872088 greadys@bupa.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Belmont Care Limited care home 46 Number of places (if applicable): Under 65 Over 65 46 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is 46. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Elm View is a purpose built home providing 45 beds for residents requiring nursing care. It is situated in an urban area and surrounded by well-maintained gardens. The building and decor is of a high standard providing a comfortable and homely environment. Accommodation is provided over two floors with a passenger lift giving easy access to all floors. There are 41 single rooms, and 2 double rooms, all with ensuite facilities. All rooms have a call bell system. There is a large open dining area and two comfortable lounges. Part of one lounge is designated as a quiet area and can be used for receiving visitors or for family celebrations. Care Homes for Older People Page 4 of 29 Brief description of the care home Provision is made within the home for a variety of activities and outings, which also enable close links with the local community to be maintained. A minibus is available to take residents to the local shops, or for trips to Weston-Super-Mare or the surrounding countryside. The provider makes information available through a company leaflet and service specific booklet about the home. CSCI reports are displayed in the entrance to the home and available for all to read. The fess range from 685 pounds to 850 pounds per week with additional charges being made for hairdressing, chiropody, newspapers, escorts, toiletries and social therapy entrance fees. This information was provided in April 2009. Care Homes for Older People Page 5 of 29 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: two star good 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: This inspection took place over two days and a total of nine hours were spent in the home. To gather enough evidence to support our judgments for this inspection we (The Commission) asked the service to complete an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met the people using the service. It also gave us some numerical information about the service. We also reviewed all correspondence and regulatory activity since the last key inspection. We sent surveys to people living in the home, staff who work there and healthcare Care Homes for Older People Page 6 of 29 professionals. We received nine surveys from people in the home and the replies indicated that responsive staff meet their care needs and they are provided with all that they need. Comments from the residents were the home and care is excellent. It is a happy community to which it is a privilege to belong. While comments were received regarding the poor quality of food 90 of respondents told us they liked their meals at the home. Two people commented it occasionally take some time to answer the call bells. This was discussed with the manager who was concerned and said she would look into it. Feedback from surveys sent to staff told us this is a very happy home; enjoy the job and proud of the service we provide; the well-being and happiness of residents is paramount. The staff told us that they thought the service could be improved through better communication between staff and departments and better understanding and provision for people with high dependency needs. The healthcare professionals who returned surveys told us the home provides a high standard of nursing care with helpful staff, and a pleasant living environment. They also told us the home treats people as individuals provides flexible care provision tailored to individuals needs. Areas for improvement they suggested were more individual time on a social basis, and more trips out. They also told us some people feel hurried when being hoisted due to staff shortages and can wait for some time for the bells to be answered. Overall they told us they are satisfied with the care provision of the home. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 29 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 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive the information they need to make a well informed choice about living at the home. The homes assessment process is thorough and ensures that it is able to meet residents needs. Prospective residents and relatives benefit from being encouraged to visit the home to assess its suitability. Residents are not provided with intermediate care at the home. Evidence: Prospective residents are provided with a comprehensive brochure and Service User Guide containing the Statement of Purpose and all necessary information to ensure they, or their relatives, know about life in the home at all times. Each resident has their own copy. it is also readily available in the reception area of the home. The Statement of Purpose was well written and informs people about what the care home can and cannot provide. It also states the fees - what is included, with a list of extra charges clearly mentioned. The document also makes a statement about meeting Care Homes for Older People Page 10 of 29 Evidence: peoples needs whilst respecting their religion and culture race sexuality and sexual orientation. Contracts were seen for both publicly funded residents and also for a privately funded resident. Both contained clear and informative information, however the breakdown of costs of care was not clearly stated. This is recommended to meet current good practice guidelines. We read four residents assessment records to see how well needs are being assessed. The assessment records we saw contained a good level of information and showed that residents needs had been assessed. One resident was asked about the admission process and said that the manager had visited them in hospital to make an assessment. She told us she was settling into the home well and that the staff are looking after me well. In discussion with the manager she told us she visits the person either at their home or in hospital and talks to them, a relative or advocate and staff at the hospital, as well as the social work involved to help her to get a clear picture of the individuals needs and how they could be met. The actions taken to support the individual had also been recorded in the assessment records. The assessment records we read were being regularly reviewed and updated to ensure they have accurate information to provide appropriate care and support to meet the residents needs. We talked to the manager about how residents needs are reassessed or reviewed, and she explained that the home has a key worker system and a registered nurse is allocated to take responsibility for residents nursing assessment and care plans. Information from hospitals following transfer to the home is used in care planning and is held on the file. Assessment is made of skin integrity on admission from hospital, or home, and well recorded to provide a clear picture in relation to any skin damage or pressure sores. This is good practice. Prospective residents are encouraged to visit the home and assess the quality and facilities of the home for themselves. One resident told us that she and her relatives had been given opportunity to see the home, meet the staff, and discuss any queries with the staff and management prior to her moving in. Care Homes for Older People Page 11 of 29 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 benefit from care plans that give clear information regarding personal and specialist health care and support to enable staff to meet their health and social care needs in a person centered manner. Risks to residents are fully assessed and actions to minimise these planned for the safeguarding of residents. Residents benefit and are protected by the homes management of medicines. Respect and dignity are well maintained by kind and caring staff. Evidence: Individual records are kept for each of the residents and include details of personal preferences and interests, reflecting a person centered approach. We read in depth four care plans to see how residents are supported with their needs. We found the care plans to be informative and clearly showed actions to meet the individuals needs in a person centered way. Two of the care plans inspected clearly showed information regarding the end of life care needs of the resident, and how staff could support them at this time. Care Homes for Older People Page 12 of 29 Evidence: In the four care plans we saw clear and informative information about choices and preferences to daily life, food and the individuals preferred form of address. The care plans contained good information about the individuals life history, family and contacts. Information also described a persons hobbies, sociability and preferred activities to enable staff to provide person centered care. All care plans contained manual handling, nutrition, falls and pressure sore risk assessments, with the outcome being used to inform the provision of care. While the risk assessment clearly stated regular change of position for those at risk of developing pressure damage to the skin, no recorded evidence was seen regarding this to show how staff ensure clear rotation of pressure points, to minimise risk. Other personal and environmental risk assessments were present to ensure the safety of the resident while promoting independence as far as the individual is able. Pressure relieving equipment was seen in use in a number of areas in the home, and staff were able to describe the principles of pressure relief management for the benefit of residents. All other identified risks had been translated into the care plans to meet their needs and reduce the risks. Daily records were up-to-date and written in a respectful manner that tended to focus on physical needs. In one record we looked at, psychosocial issues were identified and suggested actions as to how to assist the individual to find their equilibrium and a positive quality of life. No reference in the daily records was made to this individuals psychosocial needs, only their physical needs. Residents and relatives quality of relationships and life would be enhanced if staff focused on these are areas to fully embrace holistic care. People living at home have access to healthcare specialists and care plans showed that specialist health care professionals are consulted when the home feels expert advice is necessary. Records indicated good interprofessional working relationships for the benefit of individual residents. Records and residents spoken with confirmed they are also helped to attend outpatients appointments, the dentist, optician and chiropodist. Staff spoken with said they knew each of the individuals preferred way of being looked after, and residents spoke to said they thought the staff understood what they wanted. Surveys received told us that residents feel the home and care is excellent; it is a happy community to which it is a privilege to belong. Three residents spoken with told us the staff are very kind and caring. They are always ready to help. Several other residents told us the staff are always friendly and polite. Care practices observed should caring interactions and good communication skills from Care Homes for Older People Page 13 of 29 Evidence: staff. However we did note two residents in reclining chairs where support for their feet had not been provided. This unsatisfactory practice was discussed with the deputy manager and rectified during the inspection. While talking with residents in the lounge area we noted that no member of staff came in to check if immobile residents needed anything, as none had access to a call bell. We did notice staff bringing residents into the lounge and then walking out again without appearing to make any connection with residents. Residents benefit from the homes clear policies and procedures for the management of medication. We looked at records kept by the home for medication and the way the medication is stored. We saw all procedures were being carried out correctly, and risk assessments for people who wish to continue to manage their own medication had been undertaken to ensure their ability to do this. Since the last inspection regular medication audits are undertaken by the management of the home to ensure the safe management of medication. We looked at the audit trail of medicines for three people and in one case the tablets and records seen did not tally. The deputy manager is aware of this and outlined clear actions that would be taken to ensure continued safe management of all medicines. All residents spoken with felt that kind and caring staff respect their dignity and privacy. In the AQAA, and in discussion with the manager we were told of plans to increase staff awareness of dignity issues which will include a dignity week to focus on the training and resources available to inform staff. This is in response to the recent national drive to increase staff awareness in this area. The home has an equality and diversity policy that recognises the cultural and social needs and differences that are present in society. The staff team is international and has experience of equality and diversity issues. Both management and staff demonstrated clear knowledge and desire to meet cultural and diversity needs of residents as and when they should arise. Care plans inspected demonstrated good implementation in regard to individuals needs in this area. Care Homes for Older People Page 14 of 29 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. Residents in the home benefit from the development of meaningful activities which recognise their diverse needs, enabling them to maintain some control over their lifestyle. Continued contact with family, friends and the local community is encouraged to provide a quality of life. Menus are flexible and seek to provide a balanced nutritional diet. Evidence: An excellent range of activities is provided with posters displaying information of forthcoming events throughout the home. Residents spoken with said there is a wide variety of choice and activity. On a noticeboard in the main entrance of the home a programme of activities was displayed, showing the variety of activities. Evidence was seen that many local residents, schoolchildren and family members are encouraged to attend events provided. There is also a minibus to take residents out on daytrips. Residents spoken with told us they enjoyed the day trips and would like more, but opportunities are limited due to the size of the minibus. We were told of the recent introduction of an exercise class for residents while sitting in their chairs. Many residents said they enjoyed this however we observed that while Care Homes for Older People Page 15 of 29 Evidence: the provider of these classes has been trained, they do not have the specialist skills and knowledge to assist residents who have experienced a stroke to join in with these activities. It is recommended that specialist advice and support for this activity is sought. Since the last inspection a sensory garden has been made which is used by the residents. In discussion with residents we understood that when they are using it a member of staff is not always present, thus leaving them without any means of calling for help or assistance. It is recommended a member of staff should always be present when the garden is in use, to ensure residents can obtain assistance with their needs in a timely manner. Records inspected showed good attendance at the many activities provided. The social therapist is employed three days a week and works hard to provide this programme of varied activities. On the day of inspection it was noted that a lot of the time was taken up in preparation for the afternoon activity, and a number of individual residents were left sitting in the lounge, or their rooms, with no activity provision. There is a library however we could see no sign of any large print or audio books. In discussion with both the activities organiser and the manager, we were told that any resident needing these is referred to the Royal National Institute for the Blind and a personal service set up to provide these things. Spiritual needs are catered for and local clergy, and other religious leaders as requested, visit when required. Several visitors was seen coming and going during the inspection. Relatives spoken with said they could come any time and felt their relatives were looked after by friendly and competent staff. Two relatives told us they could have a meal at the home if they chose. Residents we spoke to told us they are able to choose what time to get up and go to bed. They told us they are asked about their meal options, including their likes and dislikes. There was evidence of a good rapport between residents and staff, and care records contained clear information about residents preferred daily routines. We reviewed the residents menu to find out if residents are provided with a wellbalanced diet. The meal options seen were nutritionally well-balanced and varied, however residents told us the food quality can be very poor. We have very little in the way of fresh vegetables and fruit. Another resident told us the quality of meat has deteriorated in recent months. We have been told that this is because everything comes from the central supplier. A lot of the food comes as frozen or prepacked and is not therefore as nutritious as fresh supplies. Care Homes for Older People Page 16 of 29 Evidence: In discussion with the cook we were told that the company insists that all food is delivered from one supplier and the quality of food is not the same. The Cook confirmed that fresh fish is no longer an option for residents. Overall residents spoken with were satisfied in the main with the food provision, but reiterated the above comments. The Cook showed us a recent survey he had undertaken with a view to changing the menus for the summer season, and asking for other comments about the food. The overall response showed residents to be mostly satisfied with the food provision. We noted that special diets are well catered for and there are a variety of special meals provided for residents who need them. The cook and kitchen staff will well aware of individuals dietary needs. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are confident that they are listened to and requests acted upon. Knowledgeable and competent staff protect residents. Evidence: All residents are given their own copy of the homes comprehensive complaints procedure. Copies of this was seen in residents rooms and ensures they have the information they need to make a complaint. There have been five complaints since the last inspection, which have all been fully resolved. Records of these complaints and their investigation was seen and clearly recorded actions taken to resolve the issue, however the outcome for the complainant was not recorded. It is recommended that this is done to ensure a wholly satisfactory outcome for the complainant. All residents spoken with stated if they were not happy about anything they would speak to the manager. We saw a number of compliment cards that told us the staff are sensitive and wholehearted in the way they care for residents. Staff and residents told us the manager is very approachable and understanding. Residents are protected by a comprehensive policy and procedure that is available for responding to allegations of abuse, and staff demonstrated a working knowledge of this. Evidence was was seen that staff have received training in the recognition and Care Homes for Older People Page 18 of 29 Evidence: handling of abusive situations for the safeguarding of residents. This was verified through the inspection of training records and in discussion with staff. Care records seen showed that consent for the use of bed rails and other forms of restraint had not always been obtained from the resident or through a best interests meeting, under the guidance of the Mental Capacity Act 2005. Where people are assessed as lacking capacity to give consent; consent should be obtained either through the use of an IMCA or via a multidisciplinary approach (best practice meeting), and not just from a relative. All residents spoken with said the staff are kind and do their best. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with homely, safe and comfortable surroundings. The home has suitable equipment to maximise resident independence. Residents are protected through robust infection control practices. Evidence: The home is purpose-built, light, airy and furnished to a good-quality. It is arranged over two floors with a passenger lift to enable access. The property is well maintained with homely and comfortable communal spaces. The living accommodation is well decorated and homely, and residents rooms are personalised and comfortable. All rooms are provided with en suite facilities. The decor, fixtures and fittings are in excellent order. Since the last inspection a sensory garden has been developed which provides added interest and enjoyment for residents. As mentioned earlier in this report (see health and personal care section) when residents are using this a member of staff should be present to provide assistance when needed, or a method of calling for assistance implemented. The home employs a maintenance man who keeps clear and comprehensive records of maintenance and refurbishment plans to ensure the homes environment is maintained Care Homes for Older People Page 20 of 29 Evidence: at a high standard. The home has grab rails situated at relevant points and a shaft lift that is easily used to assist resident mobility, and aid independence within the home. All resident rooms are provided with a lockable space for securing personal possessions, if desired, and door locks that are accessible to staff in an emergency. On the day of inspection the home was clean and free from offensive odours throughout. The laundry facilities were well-organised, however it was noted that the concrete stand for the washing machines had flaking paint and was a potential source for cross infection. Staff interviewed and observed demonstrated good understanding of infection control procedures and practices and maintained a clean and hygienic environment. Staff told us they had recently had specific training and focus on this aspect of care provision which had been very helpful. The home has good facilities for ensuring that staff can maintain good hand washing practices, between caring for residents. Care Homes for Older People Page 21 of 29 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. The homes staffing levels are sufficient to manage the care needs of residents. Staff recruitment procedures are robust and provide the safeguards required for residents protection. Residents needs are met by well-trained staff. Evidence: The staffing rota seen showed that there are sufficient staff in the home with an appropriate skill mix to support the diverse needs of people living there. They showed that staffing is flexible and extra staff are brought in to cover busy times, sickness or holidays. Staff were seen to approach residents with directness, openness and consideration. Residents spoken with told us the staff are very good and kind. They come when they can though they are sometimes busy and I have to wait. Two residents who we spoke with, and a survey response, told us most of the staff of very good. In discussion with nine staff we were told sometimes we are very busy and there does not seem to be enough staff to meet the dependency needs of the residents. Six residents spoken with told us that there are busy times when they have to wait for staff, but they come when they can. We were also told that occasionally the delay can relate in embarrassing accidents for residents, and that staff are sometimes called Care Homes for Older People Page 22 of 29 Evidence: away part way through care provision. These issues were discussed with the manager during the inspection and she is planning to address the issues in the forthcoming staff meeting. Some of the staff team employed at the home are from overseas and they told us they felt welcomed and part of the team. Residents told us they fit in well and are good workers, but communication can sometimes be a difficulty. The personnel files for two people who had recently been employed showed that the home had followed their robust recruitment practices and all the relevant checks to safeguard residents has been completed before the person started work. The new staff confirmed they had a good induction and written records to support this were seen, thus ensuring staff have the appropriate skills and knowledge with which to meet residents needs. The home provides regular in-house mandatory training with clear records of attendance and renewal dates. We also saw evidence that staff have attended specialist training e.g. stroke awareness, Parkinsons disease, and dealing with challenging behaviour. The home views training as very important and staff told us they are encouraged to advance their skills and knowledge by undertaking National Vocational Qualifications (NVQ) and are well supported by management in doing this. Survey comments from staff told us the new induction methods are much improved. The home has a good reputation and the staff are very committed. We provide a good service and are very resident focused. Four staff when interviewed told us they enjoy the job and are proud of the service they offer; one another two told us the well-being and happiness of residents is paramount. When asked about ways the service could improve they suggested greater communication between staff and departments could be helpful. During the interviews with nine staff we verified that they felt they had been provided with a wide range of training and had good knowledge and skills with which to meet residents needs. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a well-run home with an appropriately qualified manager and supervised staff. Residents can be confident the management processes ensure consultation with them, their families and visiting professionals to ensure they have a say in the running of the home. Residents can be confident that monies handled for them, by the home, are well managed. Health and safety issues are monitored in the home to ensure that issues identified and addressed when they arise Evidence: Since the last inspection the deputy manager has become the manager, and is currently in the process of registering with the Commission. Staff feel she has good communication skills, good knowledge and provides clear leadership, guidance and direction to staff, to enable them to provide a good service to residents. Residents told us she is approachable, available and seeks to ensure all their needs are met. Two residents told us they would like to see more of her, as she is often in the Care Homes for Older People Page 24 of 29 Evidence: office. One resident told us the manager is very good and responded well to my concerns. Staff interviewed stated they felt well supported by an approachable manager. They told us the managers have an open door policy and are always available to provide support and assistance. Policies, and practice guidance, are provided in the home. These ensure staff are provided with current good practice advice for the benefit of residents. Staff are aware of the policy folder and can access it as needed. Records inspected were well maintained in the main, but attention to detail in dating and signing records is recommended as good practice. Systems are in place for people using the service, visitors and relatives to comment on the running of the home. Residents and relatives meetings are held regularly to provide a forum for exchange of ideas for the development of the service provision, and to share information from the company, that affects the running of the home. Residents and relatives told us that they are always encouraged to express their view and to air their grumbles. Regular audits of various aspects of the home and carried out each month to ensure systems and practices for the protection of residents are maintained. The results of these audits are in the process of being collated in preparation for reporting back to residents and staff to demonstrate the good practice of the home. The management of resident monies by the home were inspected. No cash is held by the home as all residents have an account for extras for which they are billed monthly. These records appeared well maintained. Supervision for staff takes place on an informal basis during the year culminating in an appraisal. Staff interviewed said supervision takes place regularly and when we needed. Records inspected showed that issues relating to resident care, personal and professional development had been discussed and actions planned to address issues raised. Supervision is cascaded down through the organisational structure, which provides clear channels of communication to and from the manager to ensure best practice provision from all staff for the benefit of residents. A maintenance man is employed and he ensures that all aspects of the home are safe and well maintained for the protection of residents. Records inspected indicated regular safety and fire checks are carried out. Staff spoken with confirmed that regular far instruction and drills had taken place. Records indicating regular maintenance to gas and water systems were seen, together with servicing records of all equipment. Care Homes for Older People Page 25 of 29 Evidence: A number of staff have received first aid training. All accidents and incidents are well recorded and audited by the manager monthly, for any trends to ensure residents are provided with good care. Care Homes for Older People Page 26 of 29 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 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 17 13 The registered person must ensure that residents legal rights are protected through appropriate application of the Mental Capacity Act 2005 in relation to issues of consent. To ensure the protection of residents 10/07/2009 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 7 The registered person to assist staff to be more aware of the psychosocial needs of residents and how to meet them as part of holistic care. The registered person to ensure that a clear audit trail of all medicines entering and leaving the home is maintained for the safety of residents The registered person should review the washing machine stand to ensure potential for cross infection through flaking paint is minimised. 2 9 3 26 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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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