Care Home: Emmaus House

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• Chirnside House
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• Parkside
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What the care home does well This home makes sure they give new people plenty of information and encourages them to visit before they make up their minds. They are careful to only admit people once they know they can give them good standards of care. People who live in this service told us that they receive excellent care and services. On the day of our visit we noted that people looked well nourished, were extremely well groomed and alert and interested in everything going on around them. These are some of the things people told us in surveys: "I`m quite happy living at Emmaus House, the care I received is very good." "I get the best of care. It is the best home to be in in the district." "They look after us very well." "We are well cared for with everything provided. Pleasant, friendly staff, very clean and good activities." We had plenty of evidence on the day to show that people receive good standards of health care provision. We met a visiting health care professional who was entirely satisfied with the way the staff team worked with her. People told us that they had good levels of health care from the local doctors and nurses and also from people like opticians and chiropodists on a regular basis. The medication kept on behalf of residents was well managed. A number of people are supported to take their own medicines and they explained to us how this was done. Medicines are stored and administered correctly. In surveys and through observation and discussion we could see that the staff team here treat people with respect, dignity and empathy. The Trust runs this home on Christian principles and management encourage staff to treat people appropriately. A number of residents told us that the staff team were very caring and one person said that over the years she had come to see the staff team as friends. One survey said: "The treatment and care of the residents is first class. Carers and kitchen staff and cleaners do an excellent job." On the day of our visit around half of the residents went out on a shopping trip to Workington. These trips and other outings to places of interest are a regular event and people were enthusiastic about going out and about. The home is very good at providing varied activities but there continues to be a strong spiritual element in the activities programme. The home provides people with nutritious and well prepared meals and snacks. Residents were extremely satisfied with food provided and many people had put on weight since admission. Nutritional planning is done if someone is underweight. The home has never had a formal complaint, nor made an adult safeguarding referral in 18 years since it has been opened. Residents told us that they knew how to complain. "For me the home does very well. If I had a complaint I would tell them and I am sure they would listen and do something about it. I have no complaints about anything." Staff have regular training on safeguarding vulnerable people and could discuss their responsibilities at length. The manager had helped people get their voting rights for the forthcoming general election. Emmaus House is a purpose-built building that has recently been extended. All areas were clean, orderly and odour free. New carpets were being laid on the day of our visit and many areas had been redecorated. Maintenance and repair is done on a regular basis. Residents were happy with their home and pleased with the way the housekeeping staff looked after the environment, their clothing and household linens. We looked at recruitment, deployment, training and development of the staff team. People are suitably recruited and inducted into their jobs and there is an ongoing compulsory training plan. People are given the right kind of core training to do their jobs safely and correctly. Staff are supervised on a routine basis and individual members of the team told us that they were very happy in the work that they did. "We work well together as a team. I enjoy coming to work and feel that this job is somehow just like an extension of my own family. I am happy to give up some of my own time to do things with residents." The manager of this service is experienced in the care of older people, is trained as a nurse and has a qualification in managing care homes. We saw her training profile that shows she keeps her training up to date. Staff and residents told us that they respected and trusted her and would not hesitate to go to her with any concerns. The Trust and the manager send regular updates to the Care Quality Commission. There is a very comprehensive quality monitoring system in this home and we have plenty of evidence from this and from the visit to show that time and resources are invested every day into making this home as comfortable and pleasant as possible for people. We checked on a number of the management systems in the home. This included the management of small amounts of money for residents, food and fire safety, maintenance and repair and general health and safety matters. All of these things were up-to-date as were the regular training updates for staff in things like infection control, food safety and manual handling. Fire risk assessment and management plans were up-to-date. What has improved since the last inspection? We could see that the written plans of care had improved since our last visit and we had a discussion with the manager about ways to continue this improvement. Since our last visit the home has created an extension that provides them with one more bedroom and more storage space. These extra rooms have allowed the home to become even more comfortable than before. The monthly reports that are sent to us from the Trust show ongoing improvement and development in this service. These range from buying new pieces of equipment to changes in the way staff are trained. Month on month there are subtle developments which have been brought about because the manager and the staff team consult with residents about what they want. We judged that this is a service that is committed to improvement. One member of staff said in a survey: "The home always puts the needs of the residents first. I am not sure what could be done better as they are always looking at ways of improving the home." A resident told us on the day: "We are asked all the time about what we need, what we want and what they could do more for us. Any suggestions we make are considered and put into place. We couldn`t ask for more than that." What the care home could do better: There was nothing we noted on the day that we wanted the home to do better. Key inspection report Care homes for older people Name: Address: Emmaus House Walkmill Close Moresby Parks Whitehaven Cumbria CA28 8XR     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: Nancy Saich     Date: 2 0 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Emmaus House Walkmill Close Moresby Parks Whitehaven Cumbria CA28 8XR 01946591362 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): office@emmaustrust.co.uk Cumbria Emmaus Trust Name of registered manager (if applicable) Mrs Patricia Margaret Davies Type of registration: Number of places registered: care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is: 25 Date of last inspection Brief description of the care home Emmaus House is a purpose built home that caters for up to twenty-five older people, some of whom may have dementia. The home is owned and operated by the Emmaus Trust, a charitable organisation set up by the Christian Brethren Church. Some, but not all residents are members of this church. Mrs Patricia Davies manages the home. Care Homes for Older People Page 4 of 30 Over 65 0 25 25 0 Brief description of the care home The home is in a residential area of Moresby, a village approximately three miles from Whitehaven, and is within walking distance of village amenities. The home has its own grounds and car parking. The weekly charge ranges from £398 to £426 per week depending on care needs. More information about the home and the cost of staying there is available from the manager or the chairperson of the trust. Care Homes for Older People Page 5 of 30 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: This was the main or key inspection for this year. The home was last inspected on 2/05/07 and has had annual service reviews since then. There had been nothing of concern in the home to warrant any random visits to the service. We asked the manager to fill out a form called the Annual Quality Assurance Audit (the AQAA) some weeks prior to our inspection. This document asks for information about the progress of the home, some statistics for staff and residents, information about how the home is operating and for future plans for the service. This was received with in the timescales and with plenty of details. We also checked on any information received by or about the service. The Trust and the manager regularly update us by sending copies of their monthly reports, copies of their internal quality audits and a yearly business and financial plan. We also looked at information the law requires them to send us. We had received good levels of Care Homes for Older People Page 6 of 30 information in the last three years showing that the home continues to be well managed. We had received nothing that concerned us about this service. We then sent out postal questionnaires to residents and staff. We received 100 returns of these and the contents were extremely positive. We quote from these in this summary. The lead inspector, Nancy Saich, then made an unannounced visit to the home on the above date. We met residents individually and in groups, shared a meal with them and observed staff interacting with them. We sat in the main lounge and observed the way things were conducted in the service. We met with families and friends of relatives, spoke to a district nurse and to the manager and to all the staff on duty and to a number of staff who came into the home to escort people who were going out for the afternoon. We read a range of documents about care and services that backed up what was said and what was seen. Care Homes for Older People Page 7 of 30 What the care home does well: This home makes sure they give new people plenty of information and encourages them to visit before they make up their minds. They are careful to only admit people once they know they can give them good standards of care. People who live in this service told us that they receive excellent care and services. On the day of our visit we noted that people looked well nourished, were extremely well groomed and alert and interested in everything going on around them. These are some of the things people told us in surveys: Im quite happy living at Emmaus House, the care I received is very good. I get the best of care. It is the best home to be in in the district. They look after us very well. We are well cared for with everything provided. Pleasant, friendly staff, very clean and good activities. We had plenty of evidence on the day to show that people receive good standards of health care provision. We met a visiting health care professional who was entirely satisfied with the way the staff team worked with her. People told us that they had good levels of health care from the local doctors and nurses and also from people like opticians and chiropodists on a regular basis. The medication kept on behalf of residents was well managed. A number of people are supported to take their own medicines and they explained to us how this was done. Medicines are stored and administered correctly. In surveys and through observation and discussion we could see that the staff team here treat people with respect, dignity and empathy. The Trust runs this home on Christian principles and management encourage staff to treat people appropriately. A number of residents told us that the staff team were very caring and one person said that over the years she had come to see the staff team as friends. One survey said: The treatment and care of the residents is first class. Carers and kitchen staff and cleaners do an excellent job. On the day of our visit around half of the residents went out on a shopping trip to Workington. These trips and other outings to places of interest are a regular event and people were enthusiastic about going out and about. The home is very good at providing varied activities but there continues to be a strong spiritual element in the activities programme. The home provides people with nutritious and well prepared meals and snacks. Residents were extremely satisfied with food provided and many people had put on weight since admission. Nutritional planning is done if someone is underweight. The home has never had a formal complaint, nor made an adult safeguarding referral Care Homes for Older People Page 8 of 30 in 18 years since it has been opened. Residents told us that they knew how to complain. For me the home does very well. If I had a complaint I would tell them and I am sure they would listen and do something about it. I have no complaints about anything. Staff have regular training on safeguarding vulnerable people and could discuss their responsibilities at length. The manager had helped people get their voting rights for the forthcoming general election. Emmaus House is a purpose-built building that has recently been extended. All areas were clean, orderly and odour free. New carpets were being laid on the day of our visit and many areas had been redecorated. Maintenance and repair is done on a regular basis. Residents were happy with their home and pleased with the way the housekeeping staff looked after the environment, their clothing and household linens. We looked at recruitment, deployment, training and development of the staff team. People are suitably recruited and inducted into their jobs and there is an ongoing compulsory training plan. People are given the right kind of core training to do their jobs safely and correctly. Staff are supervised on a routine basis and individual members of the team told us that they were very happy in the work that they did. We work well together as a team. I enjoy coming to work and feel that this job is somehow just like an extension of my own family. I am happy to give up some of my own time to do things with residents. The manager of this service is experienced in the care of older people, is trained as a nurse and has a qualification in managing care homes. We saw her training profile that shows she keeps her training up to date. Staff and residents told us that they respected and trusted her and would not hesitate to go to her with any concerns. The Trust and the manager send regular updates to the Care Quality Commission. There is a very comprehensive quality monitoring system in this home and we have plenty of evidence from this and from the visit to show that time and resources are invested every day into making this home as comfortable and pleasant as possible for people. We checked on a number of the management systems in the home. This included the management of small amounts of money for residents, food and fire safety, maintenance and repair and general health and safety matters. All of these things were up-to-date as were the regular training updates for staff in things like infection control, food safety and manual handling. Fire risk assessment and management plans were up-to-date. What has improved since the last inspection? We could see that the written plans of care had improved since our last visit and we had a discussion with the manager about ways to continue this improvement. Since our last visit the home has created an extension that provides them with one Care Homes for Older People Page 9 of 30 more bedroom and more storage space. These extra rooms have allowed the home to become even more comfortable than before. The monthly reports that are sent to us from the Trust show ongoing improvement and development in this service. These range from buying new pieces of equipment to changes in the way staff are trained. Month on month there are subtle developments which have been brought about because the manager and the staff team consult with residents about what they want. We judged that this is a service that is committed to improvement. One member of staff said in a survey: The home always puts the needs of the residents first. I am not sure what could be done better as they are always looking at ways of improving the home. A resident told us on the day: We are asked all the time about what we need, what we want and what they could do more for us. Any suggestions we make are considered and put into place. We couldnt ask for more than that. 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 10 of 30 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 11 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in this service are given suitable information and in turn the manager gathers information about them so that any new admission is done correctly. Evidence: The service had an up-to-date Statement of Purpose, Service User Guide and small brochure. These things are put together in an information pack that is given to relatives and the person themselves. The service also has a website www.emmaustrust.co.uk with links to our website and other information. People in the service and their relatives said they were given plenty of information about the home. We met a number of people who had not been in the home long and they told us that they had been given the opportunity to spend time in the home and had been given all the information they needed. They also told us that the manager had asked them about their needs and wishes prior to admission. We looked at the files for people who had been admitted recently and at some files for Care Homes for Older People Page 12 of 30 Evidence: prospective new residents. The manager uses a comprehensive assessment form and gathers information from the person themselves, their families and professionals who are involved with their care. Most files had social work assessment and many had hospital discharge information. We have evidence to show that the manager is very careful about admissions and would only admit people who she is certain they can deliver the right levels of care to. She balances the rights of existing residents with the needs of any new person. We judged that the admission process is very thorough in this service. Care Homes for Older People Page 13 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in the home received very high standards of personal and health care delivered in a respectful and dignified way. Evidence: We read a number of the written plans of care and we found that several improvements had been made since our last visit. Residents files now include social histories, and something that is entitled one-page profile -- a person centred description. We judged that this shows the promise of making care planning in this form much more individualised. The files we read contained enough information for people to receive very good levels of care. We discussed with staff and the manager ways to improve strategic planning when people have a specific problem. At present this is done by word-of-mouth and through daily notes. The manager acknowledged that this form of care planning needed to be more robust and had already started to look at ways forward for this. We judged that work on this is ongoing and look forward to hearing about further progress on this. Care Homes for Older People Page 14 of 30 Evidence: People told us that personal care was delivered very well and that the staff team understood their needs. The daily notes were written in some depth and these showed some very detailed recording of how peoples health and personal care were managed. We saw examples of change and improvement after admission and a number of people told us that they had put on weight or had healthcare issues managed properly and that this had improved their general health and well-being. This home is a Christian home and a number of people wanted to talk about their spiritual well-being. They felt that admission to the home had improved this along with their physical health. We noted that every person in the home was extremely well groomed and dressed in their own individual style. Staff appear to take pride in helping people to make the most of themselves and the residents of this home are smartly dressed and if they choose to wear make up they are assisted in this. A number of people went out in the afternoon on a shopping trip and everyone was assisted and encouraged to get dressed up and go out. People were extremely eager to go out and took a lot of pride in their appearance. A number of staff did this on a voluntary basis because they want residents to have the same opportunities as everyone else in the community. Residents files showed visits from healthcare practitioners from local surgeries. We met a district nurse on the day who was very happy with the way health care was managed in the service. We also noted on the records that specialists like psychiatrists, psychologists, speech therapists, specialist nurses, dentists, chiropodists and opticians came to the home when necessary. We checked on medication retained on behalf of residents and found that this was ordered, stored and administered appropriately. There is a quality monitoring process and medication is checked regularly. The local pharmacist visits the home and all staff have been trained on the medication administration system. Controlled drugs are dealt with appropriately and the use of sedative medicines is carefully monitored. A number of people told us that they managed some, or all, of their own medicines and they confirmed with us that weekly checks are made to make sure that they continue to do this properly. We also noted that people were given medication in a timely fashion and spoke to one person who could confirm that they had one particular drug early in the morning because this suited her needs. We met a number of people who live in the home both individually and in groups. We found them to be assertive and confident. People told us they were treated with dignity and respect and given very good levels of care. Visiting professionals and Care Homes for Older People Page 15 of 30 Evidence: relatives confirmed this. Our survey results were also extremely positive about the way staff approached people and how care was delivered. Care Homes for Older People Page 16 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in this service have that kind of lifestyle they want and need and were enthusiastic and engaged with life. Evidence: People in this service told us that they got up and went to bed as they chose. Some people prefer their own company and spend a lot of time in their own bedrooms following their own hobbies and interests. The majority of the residents come down for lunch and seem to enjoy each others company. People we spoke to said that they could follow their own chosen lifestyle and the staff respect their wishes. We noted in our discussions that people were kept very much in touch with the local community. A number of people go out regularly to church on a Sunday and to meetings during the week. Members of the Trust and the church visit and spend time with residents. People are taken out and about and community groups are invited into the house. Residents were able to talk about local news items and were also able to discuss national and global events. We judged that people were given an interesting life and were in turn still interested in what was going on in the wider world. Their values and opinions were of interest to the staff team and their rights and needs were respected accordingly. Care Homes for Older People Page 17 of 30 Evidence: A number of people we spoke to said that they joined in with the wide range of activities on offer. A good proportion of the residents went out to Workington for a shopping afternoon on the day of the inspection and they told staff which shops they wanted to go to and were deciding amongst themselves where they were going for afternoon tea. There is plenty of opportunity in this home to attend religious services. A number of residents are members of the Christian Betheren church but others come from different denominations. Different members of the clergy are also encouraged to come to the home to deliver spiritual care. The activities organiser is supported by volunteers and by members of the staff team. Every week there are reminiscence sessions, craft and creative activities, discussion groups, quizzes and other in-house entertainment. There were a number of notices advertising a fashion show, a Cumbrian quiz night and planned outings. The manager writes to us every month about the operation of the home and we noted over the months that there have been a wide range of in-house activities,entertainments and outings enjoyed by the residents. We judged that the range of activities has continued to improve since our last visit whilst the spiritual care of the residents has continued to be uppermost in the planning for daily life. We met a number of visitors on the day and received surveys from relatives and friends. They told us that they were made very welcome in the home and that they felt relaxed about visiting and appreciated being involved in their relatives care and having the opportunity to participate in the life of the home. Visitors can share a meal with residents and are always invited to join in with parties and entertainments.There is a guest room available if relatives need to stay. We shared a very pleasant lunchtime with residents. Not only was the food well presented and well-prepared but the whole atmosphere in the dining area was relaxed and sociable. Tables were properly set with good-quality crockery and linens. People were encouraged to help themselves at the table and could specify quantity and type of food they wanted. We visited a very well organised and clean kitchen where a range of foodstuff was available. People told us that they could ask for snacks and drinks at any time both day and night and that quality and standard of catering was always very high. We saw a well-planned menu and spoke to the cook and the kitchen domestic. Both of these team members had suitable training and also knew the needs and preferences of each individual. The Cook explained how they prepared meals to give good levels of protein, calcium and vitamins. Now one had any complex dietary Care Homes for Older People Page 18 of 30 Evidence: needs on the day but she was able to describe how they had helped people to maintain a good intake of nourishing food when this had been an issue. People ate well and enjoyed the whole dining experience. Care Homes for Older People Page 19 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in this home are listen to, protected from harm and given their rights by the robust approach to these matters. Evidence: This service has never received a formal complaint. The trust has a suitable complaints policy and procedure and a number of people we spoke to on the day were fully aware of their right to complain and understood how they would go about it in a formal way. People did, however, tell us that they felt confident enough to address complaints directly to the person concerned and would then talk to someone from management. They told us that members of the Trusts committee visited regularly and they would have no hesitation to complain to them if things still did not change. No one had any complaints on the day and several people told us that issues were not allowed to build up and become complaints. We also asked people about safeguarding and we were told that they judged that nothing abusive was going on in the service. Again we were told that they were confident about speaking up if something was wrong. Several people told us that they felt confident enough in the management and in the Trust and they would not hesitate to speak out if anything concerned them. Staff also told us that they were able to speak up if something concerned them and were encouraged in individual supervision to explore anything of this nature that Care Homes for Older People Page 20 of 30 Evidence: might worry them. Again individual staff on the day and in surveys told us there was nothing of concern in the service. There had been no safeguarding referrals made in this service. The manager has suitable training, experience and understanding of safeguarding procedures and had information about local safeguarding arrangements. The staff team have annual training provided by a local further education college. We ask care staff and housekeeping staff about safeguarding and everyone we spoke to could answer very clearly about their responsibilities. Staff told us that if they believed management or the Trust were not dealing with safeguarding they would not hesitate to report the matter to external agencies. People in this home were able to discuss the forthcoming general election and we noticed that people had received their polling cards on the day of the visit. Some people said they had postal votes and others said that arrangements were being put in place to take them out on election day to vote. People in the home told us they felt they were supported in all aspects of legal and civic processes. Care Homes for Older People Page 21 of 30 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. This home provides people with a clean, comfortable environment and also allows people to have their own individual space where they can feel private and secure. Evidence: Emmaus House was purpose built some 18 years ago. It is a two story building situated in a residential part of Moresby village. It is near to the village amenities, is set in its own very pleasant grounds and has suitable parking facilities. There is local public transport. The home does not have its own transport but hires a minibus where necessary. One or two people said they thought the home would benefit from having their own specialist tail lift vehicle. Since our last inspection the home has been extended to allow for one more bedroom and to give more storage space. The office has been relocated and several other areas reconfigured to make the building more convenient for residents and staff. We toured all parts of the home and we could see that bedrooms were personalised, nicely decorated and furnished to meet the needs of the individual. All bedrooms in this home are single occupancy with ensuite facilities. There is a quiet lounge on the first floor and a large shared sitting and dining area on the ground floor. This large groundfloor room is set out in small areas so that people Care Homes for Older People Page 22 of 30 Evidence: have an intimate experience whilst being in a larger environment. A number of people said they enjoyed sitting outside on the patio or would spend time in the conservatory so that they could look out onto the views of distant fells. All areas of the home were extremely clean and well maintained. We could see that new carpets have been laid in communal areas and on the day of her visit a number of bedrooms were being re-carpeted. The home has purchased new curtains and bedlinens and a number of new beds. We receive regular reports about this home and we have noted that every month there is maintenance work and new purchases and repairs. The regular monitoring of quality can be seen in the environment and we judged that this home is of an extremely high standard. We noted that staff enjoy helping people to make their individual space as pleasant as possible and also noted that the manager and the rest of the team are keen to make sure that the home doesnt start to look dated. We checked on the laundry and the kitchen and we found that good hygiene levels were in place here and that both areas were scrupulously clean. Suitable infection control measures are in place and staff have been trained to deal with this. The manager says that they always buy good quality cleaning materials and have regular deep cleans on carpeted areas that have heavy traffic. The home was fresh, odour free and orderly. We could see where staff had introduced small homely touches in shared areas and in corridors. People told us that staff cared for their clothing properly and that their bedding was always clean and fresh. Care Homes for Older People Page 23 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home has a dedicated, well trained and experienced staff team who put the care of residents at the heart of their work. Evidence: We were given four weeks of rosters for the service. We could see that, by both day and night ,shifts were covered by staff in suitable numbers. We looked at the mix of skills and experience on each shift and this too was satisfactory. Staff surveys told us that staffing levels were always good and extra staff were put on if people were unwell or if there was an outing or entertainment where more staff were necessary. This service has a high number of staff with NVQ level II and III. New staff without this qualification are registered as soon as they have finished their basic training. We checked on how people were recruited into the service. We saw application forms, record of interview and background checks for three new starters. The manager had been very careful to follow the process expected by the Trust and she was able to show that no one started to work with vulnerable people unless she was entirely satisfied with all these background checks. We were given a copy of the training plan for the coming year and we also noted that records of training were kept individually for staff. Staff at all levels confirmed that Care Homes for Older People Page 24 of 30 Evidence: they had received training in what the Trust considered to be the core skills necessary. Housekeeping staff, care staff and senior carers could be seen working appropriately with people and using the right kind of skills and techniques. For example every person we asked could discuss appropriate manual handling techniques, understood infection-control, food and fire safety and were fully aware of how to safeguard vulnerable people. We also noted on the records of training given and in the planned training that people were given specialist training appropriate to their job role or to the needs of individual residents. For example people who give out medication were fully trained in this and the entire staff team were invited to a training session about Parkinsons disease. We looked at individual training records. One record for a person employed as a domestic included all of the core training and had specific training on infection-control and using hazardous chemicals. This person had also attended a course on challenging behaviour and had attended more than one session on safeguarding people. The trust has compulsory training that people must attend and these relate to the role they play. Supervision notes showed us that staff could also ask for supplementary training in areas that interest them. One person told us about going on a training course for activities and spoke at length about how she had put this into practice. A senior carer explained to us how training needs are assessed. Her record showed that she had attended 15 training sessions in the last year. These were core and specialist courses and she too could talk about how she applied training to practice. The staff we met on the day acted in a caring and responsive way and were keen to keep their practice up to date. A number of staff regularly give up their time to take people out. The trip out on the day of inspection was done by staff in their own time. We judged the team to be caring and enthusiastic about the work they do. Care Homes for Older People Page 25 of 30 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. Management systems in this home run very smoothly and give people a lifestyle that is free from anxiety because they know that things work well in their home. Evidence: This home is owned by a charitable trust. There is a management committee who are closely involved with the running of the home and the manager reports to them in the first instance. The manager has been in post for around six years and is experienced in caring for older people and in managing staff. She has a range of qualifications and we had evidence on the day to show that she continues to update her practice. Our surveys and discussions on the day give us evidence to show that people who live in the home, relatives, visiting professionals and the staff team respect her management skills and trust her to run the home appropriately. The Trust has developed their own individual Quality Monitoring System and this has provided the home with an organised approach to record keeping, policies and procedures and operational standards. The Trust ensures that there is ongoing Care Homes for Older People Page 26 of 30 Evidence: monitoring of all the systems in the home and that they regularly consult with the people who live in the home. They communicate with us on a monthly basis, telling us of ongoing improvements and developments. We also receive an audit of their annual quality monitoring, and annual business and financial plan and from time to time communications about any other planned developments. This charitable trust is very keen to achieve high standards in all areas and are happy to invest time and money to make sure that the home is not only compliant with the law but also gives people a comfortable home and meaningful lifestyle. We looked at the quality monitoring systems throughout the day and found them to working smoothly as part of the daily routines of the home.We judged that the systems are working extremely well. We checked on money that is kept on behalf of residents. The sums involved were small, accounts were detailed and up-to-date with receipts for transactions. Most people deal with their own money and some people have solicitors involved. Neither the manager nor the trust act as agents for any person in the home and are not involved with large financial transactions. We checked on formal supervision for staff and found that this was up-to-date and recorded appropriately. The manager discussed some ideas for future plans and improvements so that supervision would continue to help with the general development of the team. The quality monitoring systems in this home are a very well written in regard to monitoring safe working practices. We saw that manual handling training and risk assessment is up-to-date, fire safety matters are dealt with routinely and all staff appropriately trained, senior staff have first aid training and everyone has food hygiene and infection control training. We also had evidence during the day to show that this training in health and safety is put into practice. Kitchen and laundry areas were clean, staff had good knowledge of their responsibilities, infection control was well maintained and the home was secure and free from any visible hazards. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 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 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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