Care Home: Fairfax House

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What the care home does well People and their carers contribute to a detailed assessment of care and support needs before decisions are made as to whether the home is suitable for them. Information about the home is available in easy read format. Care plans show good detail of how people`s care and support needs are met and monitored. Details of people`s social history enhance the care plans. People are asked about who they want to provide their intimate personal care. Care plans are regularly reviewed and revised. People make decisions on how they spend their day. Staff make sure that people look their best. People have good access to healthcare professionals. Any concerns about people`s health are promptly referred to the relevant healthcare professional. People have their risk of developing any pressure damage assessed and regularly reviewed. Staff are trained so that they know about people`s potential risk of developing pressure damage. Systems are in place so that people receive their medication when they need it. People are asked about what they like to do and enjoy a range of activities both at the home and in the locality. People are regularly taken out with at least one trip out each week. People are regularly asked about what they like to eat and the menus adapted accordingly. The chef makes snacks throughout the day for people who still may be hungry or have forgotten that they have had a meal. Complaints are taken seriously and fully investigated with a response to the complainant detailing any findings or changes to practice. People are asked to comment on the service both during the quality audit and at different times throughout the year. Mr and Mrs Butchers keep the building in very good order. They look for different ways to improve the environment for people`s benefit. Staffing levels mean that people are well supported when they need it. Staff have developed good relationships with people who use the service. Staff are well trained and are offered a good programme of training. Mrs Butchers is qualified, competent and experienced in running the home. She continues to find ways to improve the home for people`s benefit and takes into consideration their comments when making decisions about how the home is run. What has improved since the last inspection? The controlled medication record is now kept securely. Full records are kept of controlled medication. Following discussion with people who use the service, more activities and trips takeplace in the locality. Ideas for activities are being considered for people who may have a dementia, following specialist training. The gardens have been landscaped so people have better access. What the care home could do better: The care planning files should be better organised so that only current information is available. Fluid charts should identify the amounts that people should be drinking each day. The totals should be entered each day so that staff can monitor whether people are drinking enough. The home should keep their own notes of treatments and not rely on those kept by the district nurses. When mistakes are made in recording controlled medication, the reasons why should also be recorded. Care plans should identify why people are taking medication that is prescribed to be taken only when they need it. Where medication has specific prescribing instructions, these should be included in the care plan. Preparations that have a limited shelf life should have the date they were opened on the container rather than the box. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Fairfax House 85 Castle Road Salisbury Wiltshire SP1 3RW     The quality rating for this care home is:   three star excellent 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: Sally Walker     Date: 2 8 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 30 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 30 Information about the care home Name of care home: Address: Fairfax House 85 Castle Road Salisbury Wiltshire SP1 3RW 01722332846 01722341716 Dianabutchers@btconnect.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) : Mr Alan Butchers,Mrs Diana Butchers care home 20 Number of places (if applicable): Under 65 Over 65 6 20 dementia old age, not falling within any other category Additional conditions: 0 0 No more than 6 service users with dementia, aged 65 years and over, may be accommodated at any one time The maximum number of service users who may be accommodated in the home at any one time is 20 Date of last inspection Brief description of the care home Fairfax House is a care home registered to care for 20 older people 6 of whom may have dementia. The registered providers are Mr and Mrs Butchers and Mrs Butchers is the registered manager. The home is on the outskirts of Salisbury on the main Salisbury to Amesbury road and is within walking distance of the city centre. The home is situated opposite Victoria park and all the first floor rooms at the front of the property look out across the park. The property is spacious and has been extended to give single room accommodation to all service users. There are 12 ensuite bedrooms, a bathroom, a hairdressing room and a passenger lift included in the extension. The home has a range of communal areas. the gardens have been landscaped to provide Care Homes for Older People Page 4 of 30 Brief description of the care home two large paved seating areas on different levels, a walkway and two ponds. The staffing rota provided for a minimum of 4 care staff during the morning with 3 care staff in the afternoons and evenings. There are two waking night staff. All rooms have a call bell system. This is one of 2 care homes registered to Mr and Mrs Butchers. 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 unannounced Key inspection took place on 28th April 2009 between 9.30am and 6.15pm. Mr and Mrs Butchers were present during the inspection. We looked at care plans, risk assessments, staff records, medication, menus, rotas, activities and made a tour of the building. We spoke with people who use the service, one relative and staff. As part of the inspection process we sent survey forms to the home for people who use the service, staff and healthcare professionals to tell us about the service. Comments are found in the relevant part of this report. Care Homes for Older People Page 6 of 30 We asked the home to fill out their AQAA (Annual Quality Assurance Assessment). It was filled out in full and returned on time. Some of the information we received can be found in the body of this report. The last Key inspection was on 12th April 2007. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the care home does well: What has improved since the last inspection? The controlled medication record is now kept securely. Full records are kept of controlled medication. Following discussion with people who use the service, more activities and trips take Care Homes for Older People Page 8 of 30 place in the locality. Ideas for activities are being considered for people who may have a dementia, following specialist training. The gardens have been landscaped so people have better access. 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 9 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 10 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care and support needs are fully assessed before they come to live at Fairfax House. The home makes sure that everyone involved with the persons care contributes to the assessment process. Evidence: People who are considering using the service have their medical and social needs assessed prior to coming to live at the home. Information is gained from the person, family and any healthcare professional involved in their care. The home gains very good information about peoples social and family history to aid the assessment and care planning process. Care management assessments are obtained from peoples social workers. People are given a Residents Information booklet as part of the admission process. This is in easily read format with picture and photographs. A copy of this document is Care Homes for Older People Page 11 of 30 Evidence: also available on the dining room notice board. The document was updated in January 2009. One of the people we spoke with told us they came and looked round before they moved in. A relative told us they had looked at different homes in the area before choosing Fairfax House. In a survey form one person told us I came in very quickly but I have since received information about the home. Care Homes for Older People Page 12 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care and support needs are generally well documented in their care plans. Care plans are in place on the day that they come to live at Fairfax House. People can decide who provides their intimate personal care. Peoples needs are regularly assessed and any risks associated with their continued well being are regularly monitored. People have good access to healthcare professionals. Systems for safe administration of medication are in place. Evidence: Each person had an individual care plan which was regularly reviewed and revised. Care plans are in place ready for when people come to live at the home. Generally peoples care and support needs were well documented. There were very good details of peoples social histories, how people preferred their personal care to be carried out and preferred routines throughout the day and night. People had been consulted about the gender of staff carrying out their intimate personal care. Care plans identified management of any risk to the person, for example, moving and handling and how to use any equipment. Mrs Butchers told us that the night care plans were in the process Care Homes for Older People Page 13 of 30 Evidence: of being further developed. We saw that one persons medical notes identified that they had a prolapse. Their care plan did not identify how they were supported with managing their condition. When we asked how this person was supported, it was clear that staff knew how to manage their condition. Another person whom we met with had dressings on their leg. The medical notes stated that the district nurse was dressing their wound. Their care plan did not show evidence of any healing. It was clear from talking with staff that they knew details of how the persons leg was healing. We advised that all conditions should be recorded in peoples care plans. We also advised that the home should not rely on the district nursing notes but must keep their own records of monitoring and healing of any wounds. The deputy manager said she would implement body maps for this purpose. We discussed the large amount of information that was held on file. We suggested that as there were a number of different places to record information, files should be rationalised to ensure that only current relevant information was available. Mrs Butchers and the deputy manager had recently undertaken training in tissue viability. People who were assessed as being at risk of developing pressure damage had pressure relieving equipment in place on their beds and in their chairs. Care plans also identified behaviour management, support with maintaining good nutrition with good detail of what the person should achieve each day. People are weighed on admission and weekly thereafter. The home have scales that people can sit on and any significant weight loss is alerted to their GP. Fluid charts are in place for those people who need support in maintain good fluid levels. We noted that staff were not totalling the daily amounts. We advised that putting the amount each individual should achieve on the form would enable better monitoring. People have their care plans reviewed monthly. Reviews are also carried out with the person, their representatives and care manager, every six months. The daily reports showed good evidence that care plans direct the care and support that they must have. We saw that staff had made efforts to ensure that people looked their best. Those people who we visited in their bedrooms had their call alarms within easy reach. They also had refreshments that they could reach. We saw that some people who wanted to stay in bed for the morning did so. They were supported to rise and get dressed before lunch. One person who wanted to go back to bed during the morning was supported to lay on their bed with a coverlet over them. People have good access to healthcare professionals. There was evidence in the daily Care Homes for Older People Page 14 of 30 Evidence: reports and the medical appointments record that any concerns are promptly referred to the relevant healthcare professional. One of the visiting relatives told us that they were kept up to date with their family members condition and well being. They said that whenever they visited the home did not smell and their relative was always kept clean and well dressed. They also told us that they were pleased that the home and GP had reduced the amount of medication that their family member was taking since their admission. They told us how this had improved their quality of life. In a survey form a care manager told us Recently accommodated a person with dementia. Needs were carefully assessed and information always relayed to me. Placement is now secure with thanks to staffs commitment. One of the GPs told us General all round cre. Senior staff are excellent. One of the people we spoke with told us about the arrangements for seeing their GP. They said staff would drive them to the surgery for appointments but preferred their GP to visit them at the home. They said they liked to have a member of staff with them when their GP came so they could remember all that was said. When we asked them about their medication they told us They are extremely careful with tablets. They told us they received their medication at the right time. We looked at the arrangements for administration of medication. Medication was kept securely. Staff were trained to administer the medication. The medication administration record showed that medication is checked as it is received into the home. Each person had a large photograph accompanying their medication administration record. Records were being properly kept of all administrations. The homes medication policy accompanied the medication administration record. Some action had been taken to address the requirement we made that controlled medication records show when this medication is received and the correct balance recorded. No controlled medication was currently prescribed. However the home was recording Temazepam as a controlled medication as a matter of good practice. We saw that some entries had been identified as incorrect and lines put through. We advised that rather than record mistakes made, the record should identify the date, an account of what happened with signatures of both the recorder and the witness. Action had been taken to address the requirement we made that the controlled medication record is kept securely. This is now kept in the drug trolley which is kept securely. Care Homes for Older People Page 15 of 30 Evidence: Action had been taken to address the requirement we made that records are kept of all administrations of controlled medication, including the name of the medication, who gave it and who witnessed the administration. We could not determine whether action had been taken to address the requirement we made that where two different painkillers are prescribed to be taken when required, that the care plan clearly identifies what triggers an administration. We saw that no one was currently taking two different painkillers. We advised that where medication was to be taken only when required, that the persons care plan should give guidance on what prompted an administration. We also advised that where some people were taking a medication with specific prescribing instructions, details should be included in their care plan. As a matter of good practice the home were recording when preparations with a limited shelf life were opened. We advised that the date should be written on the container rather than on the box which could be discarded. The local pharmacist from the Primary Care Trust had recently inspected the arrangements for medication. 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 are regularly asked what they like to do and about favourite pastimes. People enjoy a range of different activities at the home and in the locality. People follow their own preferred routines and are encouraged to make their own decisions. Visitors are welcomed. People are regularly asked about what they like to eat and enjoy a healthy diet. Evidence: There was a dated weekly plan for activities. A member of staff was planning events for May. These included more activities in the locality including: a Chinese buffet, a walk by the river with a picnic lunch and trips to a garden centre and the theatre. In the AQAA Mrs Butchers told us that more outings and less in house entertainment were planned following discussion with people who use the service. Activity sessions were planned for mornings and afternoons. There was an art session every Thursday. Other activities for that week included: reminiscence in housework and cooking, board and card games, bingo, skittles, ball games, music and sherry and trips out in the locality. A small group of people were going to a nearby supermarket for coffee. Many of the people we spoke with told us about their enjoyment of a visit to the local theatre. There is a separate file showing details of the different activities each person Care Homes for Older People Page 17 of 30 Evidence: has been involved with. Mrs Butchers told us that she reviews this folder to determine what people had benefited from and which other activities they might benefit from. Mrs Butchers told us that following recent dementia training and advice from a specialist dementia consultant, she was considering providing what she described as a Rummage Room. This would be a collection of various different items used to prompt discussion about different aspects of peoples lives, mainly for those people who may have a dementia. A student studying health and beauty at the local college had come in to manicure and paint some of the ladies nails. The ladies chose from a range of coloured nail polish. They enjoyed the chat whilst they were having their nails done. There is a hairdressing salon. The notice board in the dining room showed that the hairdresser come every Friday. The college had invited some of the ladies to have a make up sessions from students at the college. One person attends their local church. One person told us they went to the local library. Another person told us about going out for Sunday lunch and to the theatre. They also told us about what a good Christmas they had had. They said They made sure there was a good atmosphere. Assessments had been carried out with people who use the service with regards to their capacity in decision making. In the AQAA Mrs Butchers told us that staff had been trained in the Mental Capacity Act 2005. There was guidance to staff on determining how capacity may vary depending on individual circumstances. Independent Mental Capacity Assessors may be accessed when needed for peoples protection. There was good evidence in care plans and daily reports that people were regularly asked about their care and make decisions from day to day. In the AQAA Mrs Butchers told us that equality and diversity is considered in peoples assessment process. She also said that training was being sought in sexual diversity and orientation. We spoke to the chef and looked at the menus. The chef told us that the chef from the providers other home compiled the menus according to peoples preferences. She said she would change some dishes following further discussions with people. There was generally a choice of two or three dishes for lunch and supper. On the day of the inspection the lunch was roast chicken, which everyone liked, with three vegetables, potatoes and gravy and rhubarb crumble and custard for pudding. Alternatives were available if people did not like any dishes. The meals were prepared from local fresh ingredients. The chef told us that she could cater for any special diets. The chef told us that she had trained in food hygiene, moving and handling and fire Care Homes for Older People Page 18 of 30 Evidence: safety. They also told us that they had enjoyed a recent course in catering for people with dementia. They told us about people who use the service who would often come to the kitchen and say they had not had a meal or were hungry. The chef told us they would make them a sandwich or offer them some biscuits and a hot drink. The chef introduced us to one of the people who use the service who regularly helps out in the kitchen. We saw that any risks to this person whilst in the kitchen had been assessed. The person told us how they were benefiting from this activity. One of the people we spoke with told us about the different mealtimes throughout the day. They said they had chosen to have all their meals in their bedroom. They told us about all the different things they liked to eat and told us they enjoyed the quality of the meals provided. One of the visiting relatives told us that they were pleased with the amounts of fresh fruit that was provided. People were having their lunch either in the dining room, at individual tables where they were in the sitting room or in their bedrooms. The meal was well presented and looked appetising. Some people were supported to eat their meal with staff chatting to them and assisting them to eat at their own pace. People were encouraged to eat by staff talking to them about the meal. Mrs Butchers gave us examples of how some people who had had a very restricted diet at home, had been encouraged to try different foods and meals with good success and improved diet. In a survey form one person told us Apart from things I dont like, I am then given something I do like. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place for people who use the service or anyone else to complain about the service. Complaints are taken seriously and fully investigated with a response to the complainant. Some complaints may prompt a quality review questionnaire to people and their relatives. Staff know how to report any allegations of abuse to the local safeguarding process. Evidence: A complaints procedure was in place. Details of the complaints procedure were available in the residents handbook which was available in each persons room. The complaints log showed that all complaints are taken seriously with a full investigation carried out. Any complainants are informed of the outcome of the investigations and any action taken as a result of the investigations. Some complaints may initiate a quality review, where people who use the service or relatives are asked about issues relating to a complaint. We asked staff about how they would respond to allegations or observations of abuse. They were quick to tell us how they would activate the local safeguarding process. A copy of the local booklet entitled No Secrets in Swindon and Wiltshire was available to staff. Staff are regularly trained to recognise and report any abuse or concerns. We asked people who use the service what they would do if they were unhappy about Care Homes for Older People Page 20 of 30 Evidence: any aspects of the service. One person told us I would go straight to the boss. Another person told us they would tell the staff. They also told us Ive got no complaints, its a wonderful place. In a survey form one person told us I have not had to make any complaints. 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. Mrs Butchers continues to find ways to improve the quality of the environment for peoples benefit. People enjoy a warm, comfortable, well maintained and clean environment. Evidence: All of the bedrooms are single accommodation with twelve having their own ensuite toilets and wash hand basins. All of the bedrooms we visited were individually set out and furnished according to peoples own wishes. People told us that they liked their bedrooms. Mr and Mrs Butchers continue to improve the environment for peoples benefit. The garden has been remodelled to include two larger patio areas on different levels, two ponds and a walk way. People can walk round the garden in safety. The ponds are visible but inaccessible. Handrails have been installed on the walk way to the upper level. We saw people walking in the garden at different times of the day. The deputy manager told us that people often had meals in the garden in the better weather. A gardener is employed to maintain the grounds. In the AQAA Mrs Butchers told us that following discussion with people who use the service, a new walk in shower had been installed on the ground floor so that people Care Homes for Older People Page 22 of 30 Evidence: now have choice of a bath or a shower. She also told us that the sitting room has been rearranged following feedback. A new kitchen had been installed since we last inspected. Mrs Butchers told us about further plans to upgrade the building. New carpets were to be installed in all the corridors in the coming year. Toilets and bathrooms have large signs for easy identification. We looked at the laundry area. It was well organised and clean. Systems were in place to separate laundry according to washing instructions. There was also a system to deal with soiled or infected laundry. One of the people we spoke with told us staff collected their laundry from their personal bin and that if was returned that day or the next morning. Staff had been trained in infection control. We saw that all of the wheelchairs were clean and had their footplates attached. We saw in peoples care plans that they were to be offered wheelchairs if they wanted to move around the home. We saw that the upstairs windows had their opening restricted to reduce the risk of people falling out. The home was cleaned to a high standard including those areas not always visible. We detected no unpleasant odours at any time during the inspection. There were two housekeepers on duty, one on each floor, during the mornings including the weekends. Staff would deal with any emergency cleaning at other times. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient staff are on duty at times when people need them. Staff are well trained. People who use the service are protected by the homes robust recruitment process. Staff had developed good relationships with people. Evidence: The duty rota showed that there are a minimum of four care staff during the mornings and three staff during the afternoons and evenings. At night there two waking night staff. Within the last year Mr and Mrs Butchers have employed a training manager across both of their homes. They have set up systems to ensure that all new staff complete the Learning Skills Council induction training. This takes place over twelve weeks. Mrs Butchers, the deputy manager and a senior staff member give practical sessions as part of learning about good care practices. The induction is geared to each of the different staff roles. The training manager told us that other staff were also completing the induction training module, regardless of experience. Mrs Butchers had developed her own set of modules for staff to complete on standards and expectation of good care practice and carrying out staff different roles. Systems are in place to record all mandatory training that staff have undertaken and Care Homes for Older People Page 24 of 30 Evidence: when they need updating. They are working to a training pack purchased by the providers as well as accessing external courses where needed. The training manager is a qualified trainer and provide training either in groups or individually with staff. Some training takes the form of staff watching a DVD followed by discussion and a test paper. Mrs Butchers is qualified to train staff in moving and handling and first aid and keeps staff regularly updated in those subjects. Staff have received training in safeguarding vulnerable people, equal opportunities, infection control, tissue viability, the Mental Capacity Act, fire safety and medication. The Salisbury Hospital has provided a list of training to be provided and staff will access relevant courses. Staff have attended a course on communication at a local hospice. An expert in dementia care is to provide more training to staff. Mrs Butchers agrees the budget for training. All staff are encouraged to undertake NVQs. One of the housekeepers told us about commencing NVQ Level 2. They told us they had also received training in dementia care, first aid, moving and handling and fire safety. They said they had regular supervision with Mrs Butchers and attended the monthly staff meetings. One staff has NVQ Level 3, nine staff have NVQ Level 2 and two staff are undertaking NVQ level 2. Staff had recently undertaken training in the Mental Capacity Act 2005 and deprivation of liberty. A robust recruitment process was in place. No one commences duties until their suitability to work with vulnerable people has been checked. All the documents and information required by regulation were in place. Staff have terms and conditions and contracts of employment. Those staff who may have transferred from the providers other home still go through this homes recruitment process. All staff are expected to sign up to the homes policies and procedures. We saw that staff interacted well with people who use the service. It was clear that good relationships had been established. One member of staff responded promptly to us activating one persons call alarm. The staff member attended to the persons needs in a kindly and professional manner. All of the people we spoke with told us about the good care and support they received from staff. One person told us that staff were hard working, I enjoy their banter. Ill give them ten out of ten. One of the visiting relatives described the staff as extremely affectionate to their relative. In a survey form one person told us that staff were always kind and understanding. 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. People benefit from a home that is well run in their best interests. Mrs Butcher is qualified, competent and experienced in running the home. People are regularly consulted on different aspects of the home and their comments taken into consideration. People can keep small amounts of cash at the home and know that it is safe. Staff are well supervised. Systems are in place to ensure the continued health and safety of people who use the service and staff. Evidence: Mr and Mrs Butchers have owned the home for more than ten years. It is one of the two homes that they run in Salisbury. Mrs Butchers is the registered manager and has a background in nursing and management. She has NVQ Level 4 in management and care and the Registered Managers Award. Mrs Butchers and the deputy manager have a qualification in dementia care. Although Mrs Butchers holds a nursing qualification, no nursing care is provided, except by the district nurses. Mrs Butchers keeps herself up to date with current good practice with regular training and seminars. Mr and Mrs Care Homes for Older People Page 26 of 30 Evidence: Butchers have recently attended a conference on dementia care. The deputy manager has attained the Registered Managers Award. People can keep small amounts of cash in the homes safe. Records and receipts are kept of all transactions including two signatures. Only Mrs Butchers, the administrator and the deputy manager have access to these monies. One of the visiting relatives told us that the home pays for any expenditure and will invoice monthly. Mr and Mrs Butchers regularly review and revise the homes policies and procedures. All staff have to sign up to these. Although Mrs Butchers carries out an annual quality audit of the service she seeks peoples viewed regularly through out the year. There are regular meetings with people who use the service. Questionnaires are sent to people who use the service, relatives and various stakeholders every three months. Each time a different aspect of the service is highlighted. Issue arising from complaints may also prompt a quality review. The results are collated and an action plan implemented. Mrs Butchers was in the process of collating the most recent questionnaires. We advised that staff should also be included in this process. Mrs Butchers told us about changes to the environment and activities following comments in the surveys. From discussion it was clear that Mrs Butchers continues to look at ways of improving the service for people. Mrs Butchers or the deputy manager notify us of any events that happen in the home as they occur. Mr and Mrs Butchers have shown us that they manage issues well. They always let us know how they are addressing requirements or recommendations made at our inspections. All staff received regular supervision either with Mrs Butchers or the deputy manager. We saw evidence of supervision notes on staff files but did not look at them in any detail. Mrs Butchers carries out three monthly maintenance audits of different parts of the building. An action plan is then put into place for any repairs or refurbishment. Any emergency maintenance is carried out as needed by the homes maintenance manager. Contractors had carried out a health and safety audit and a fire risk assessment. Staff receive regular training in moving and handling, fire safety, first aid, food hygiene and infection control. 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 1 2 7 8 The care planning files should be rationalised so that only current information is available. Fluid charts should identify the amounts that people should be drinking each day. The totals should be entered each day so that staff can monitor whether people are drinking enough. The home should keep their own record of treatments and not rely on the district nursing notes. Care plans should identify why people must take medication that is prescribed to be taken only when they need it. Where medication has specific prescribing instructions, these should be included in their care plan. Preparations that have a limited shelf life should have the date they were opened on the container rather than the box. When mistakes are made in recording controlled medication, the reasons why should also be recorded. Staff views should be sought and included in the quality audit. 3 4 8 9 5 9 6 7 9 33 Care Homes for Older People Page 29 of 30 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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