Care Home: Fairholme

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What the care home does well All of the people spoken with and who were able to comment directly about the care and attention they receive said they were very happy in the home. They described staff as kind, caring and competent. Those people with confusion who were unable to comment directly appeared contented and well cared for: staff were seen to interact with people gently and in a very friendly manner. People`s individual health, personal and social care needs are set out in detailed care plans, so that staff are aware of how they should be cared for. These are regularly reviewed and updated as their needs change. People said they were aware of the contents of their care plans and all of them agreed that the staff were kind and caring to them. One person said "I`m very happy here" and another, "the staff are lovely". Those people who are able to are encouraged to come and go from the home as they please: people are encouraged to maintain contacts with friends and family outside of the home as well as to visit the local shops and facilities. There are qualified nurses on duty at all times and people have good access to external healthcare providers, such as general practitioners when they need them. There are safe systems in place to ensure medicines are properly managed. An activity coordinator is employed and people are offered a wide range of activities on offer. There is also a private Chapel where people can receive religious services of their choosing according to their faith or visit there for quiet contemplation. A Newsletter keeps people informed of events and people are encouraged to contribute with poems, articles and quizzes. Visitors are made to feel welcome in the home and were observed coming and going from the home throughout the inspection, so that people maintain valued contacts. One person said her husband joins her for lunch and the evening meal everyday. People said that they enjoy mealtimes and were complementary of the food and choices provided to them. They said that they are offered a choice of food and their preferences are taken into account. Staff have been employed to provide dedicated support during mealtimes to ensure people who need assistance are supported in an unhurried manner: staff said this had improved how well people had eaten. When asked what would make life more comfortable for them at the home, people answered, "nothing", "I can`t think of anything" and "I`ve got everything I need". People said they felt confident in speaking to any of the staff and the Registered Manager about any concerns they may have, but stressed they had no complaints. There are always qualified staff on duty, including qualified nurses. They are recruited fairly and on the basis that they are suitable to work in a care setting and undertake regular training so that they keep their knowledge and skills updated. The Quality Assurance processes are thorough to ensure people`s views are sought and people`s needs are met in a manner satisfactory to them. The home is commended for its commitment to providing high quality services. What has improved since the last inspection? One requirement for improvement and five good practice recommendations were made at the previous inspection. All of these have been addressed and include medication administration records being completed at the time the medicine was given, the home`s Statement of Purpose and complaints procedure have been amended to include the current contact details of the Commission, care plans and staff files have been tidied to make the information easier to review and the windows in the conservatory have been replaced. Mrs Burnham, the home`s manager has successfully registered with the Commission. She and her staff team have worked hard to ensure Fairholme provides a comfortable and safe home for people. Management structures have been developed which are thorough and allow for an audit of the service delivery in general and people`s satisfaction. What the care home could do better: Mrs Burnham and her staff team have ensured the nursing care and associated services provided at the home are of a high standard and meets people`s needs, providing them with a safe and caring environment in which to live. No requirements or recommendations for improvement have been made at this inspection. Key inspection report Care homes for older people Name: Address: Fairholme Roskear Camborne Cornwall TR14 8DN     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: Jane Gurnell     Date: 2 8 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Fairholme Roskear Camborne Cornwall TR14 8DN 01209714491 01209711169 fairholmeuk@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Bhupender Kaur Mangat,Mr Jaspal Singh Mangat care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 60. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP - maximum 60 places Physical disability - Code PD maximum 57 places Date of last inspection Brief description of the care home Fairholme Nursing Home has been operating since 1988. The home is registered to provide residential and nursing care to sixty residents who are in need of personal care by virtue of being elderly, or adults some of whom may have a physical disability or a terminal illness. The home provides long term and respite placements. The home aims to avoid emergency admissions wherever possible. Accommodation is provided over two floors with a passenger lift allowing access to the first floor. The home has ramps Care Homes for Older People Page 4 of 25 Over 65 60 0 0 57 Brief description of the care home to allow access for people with a physical disability but some parts are difficult to access in a wheelchair due to the narrow corridors and size of rooms. There are four lounge rooms and a pleasant dining room with a kitchen area where staff and people living in the home, if safe for them to do so, can make drinks and snacks. One of the lounge rooms has a snooker table and can be used by people who wish to smoke during the night. The grounds have been developed to improve access to the garden areas with doors that open onto the garden and paved pathways that lead to the greenhouse where some residents like to grow tomatoes and other produce. Fairholme is located near the town centre of Camborne and has access to local amenities with good transport links. Information about the home is available directly from the home. A copy of most recent inspection report is available in the main entrance hall. Fees range from 353 to 700 pounds per week dependent upon peoples needs. Additional charges are made in respect of private healthcare provision, escort services and personal items such as newspapers, confectionary and toiletries. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The previous inspection of Fairholme was undertaken on 8th August 2007 and the overall judgement was that the home provided good outcomes to people living in the home. Since then further improvements to the management of the home have resulted in this inspection judging the home as providing excellent outcomes to the people who live there. This unannounced inspection was undertaken on 28th July 2009. Mrs Burnham was present and she and her staff team assisted the inspector through discussion and demonstration. Several people living in the home as well as two visitors were spoken with. A tour of the building was made and staff were observed and spoken with whilst going about their daily duties. Information received from and about the home since the previous inspection has also been taken into consideration in making judgements about the quality of outcomes for Care Homes for Older People Page 6 of 25 the people living there. This information included the comprehensively completed Annual Quality Assurance Assessment (AQAA), which is a document provided by the Commission to the home allowing them to tell us what they do well and what their future development plans are. Improvements to the service include increased staff available during mealtimes to ensure people are offered support in an unhurried manner, the introduction of a Newsletter which people living in the home contribute to and more in-house entertainment and trips out of the home. During the inspection the care plans for 4 people were looked at in detail to ensure they accurately reflected peoples needs as well as records relating to medication practices, staff recruitment and training and health and safety management. Care Homes for Older People Page 7 of 25 What the care home does well: All of the people spoken with and who were able to comment directly about the care and attention they receive said they were very happy in the home. They described staff as kind, caring and competent. Those people with confusion who were unable to comment directly appeared contented and well cared for: staff were seen to interact with people gently and in a very friendly manner. Peoples individual health, personal and social care needs are set out in detailed care plans, so that staff are aware of how they should be cared for. These are regularly reviewed and updated as their needs change. People said they were aware of the contents of their care plans and all of them agreed that the staff were kind and caring to them. One person said Im very happy here and another, the staff are lovely. Those people who are able to are encouraged to come and go from the home as they please: people are encouraged to maintain contacts with friends and family outside of the home as well as to visit the local shops and facilities. There are qualified nurses on duty at all times and people have good access to external healthcare providers, such as general practitioners when they need them. There are safe systems in place to ensure medicines are properly managed. An activity coordinator is employed and people are offered a wide range of activities on offer. There is also a private Chapel where people can receive religious services of their choosing according to their faith or visit there for quiet contemplation. A Newsletter keeps people informed of events and people are encouraged to contribute with poems, articles and quizzes. Visitors are made to feel welcome in the home and were observed coming and going from the home throughout the inspection, so that people maintain valued contacts. One person said her husband joins her for lunch and the evening meal everyday. People said that they enjoy mealtimes and were complementary of the food and choices provided to them. They said that they are offered a choice of food and their preferences are taken into account. Staff have been employed to provide dedicated support during mealtimes to ensure people who need assistance are supported in an unhurried manner: staff said this had improved how well people had eaten. When asked what would make life more comfortable for them at the home, people answered, nothing, I cant think of anything and Ive got everything I need. People said they felt confident in speaking to any of the staff and the Registered Manager about any concerns they may have, but stressed they had no complaints. There are always qualified staff on duty, including qualified nurses. They are recruited fairly and on the basis that they are suitable to work in a care setting and undertake regular training so that they keep their knowledge and skills updated. The Quality Assurance processes are thorough to ensure peoples views are sought and peoples needs are met in a manner satisfactory to them. The home is commended for its commitment to providing high quality services. Care Homes for Older People Page 8 of 25 What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 25 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 25 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. Admission to the home is on the basis of an assessment so that people considering moving to Fairholme can be confident it will be suitable to meet their needs. The home does not provide intermediate care but will accept people for short-term admissions and has suitable facilities for this. Evidence: The Registered Manager confirmed that admission is on the basis of an assessment and people considering moving to the home and their relatives are encouraged to provide as much information about themselves as possible, so that the home has background information on which they can personalise subsequent care planning. Other health care professionals such as nurses and social workers also contribute to the assessment process to enable the home to gather as much information about the person as possible. People are encouraged to visit the home prior to making a decision to move in however should they be unable their families are encouraged to visit on their behalf. Following the assessment, the Registered Manager writes to the person Care Homes for Older People Page 11 of 25 Evidence: or their family/representative confirming whether the home is able to meet their needs. The assessment and care plan documents for someone newly admitted to the home were looked at and these provided very detailed information about the persons care needs, as well as how the persons family wished to continue to be involved in her care. This persons health posed a high risk of sudden deterioration and this was well documented along with actions to take to reduce the risk. The assessments give consideration of peoples religion and cultural background. Needs relating to their age, gender and sexual orientation are also taken into account, with appropriate sensitivity. The Registered Manager also takes risks relating to any history of falls and specific behavioral problems into account and monitors it closely. The homes Statement of Purpose clearly states that the home does not provide specialist rehabilitation or intermediate care services although it will accept people for short-term and respite care. Facilities available in this respect are clearly set out in the information available from the home. Care Homes for Older People Page 12 of 25 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 health, personal and social care needs are clearly set out in individual care plans ensuring consistency in care giving. People are treated with respect and due regard for their dignity so that they enjoy a good quality of life in the home. There are good systems in place to ensure that peoples healthcare needs are met and medication practices are safe. Evidence: People said they were well cared for and had a good relationship with the staff, not just the care and nursing staff, but the ancillary staff such as the housekeepers as well. When asked if there was anything that would make their stay at the home more comfortable, all answered no, nothing. or I cant think of anything. Its very good here: people said they felt they were in the best possible place. The care plans for four people were looked at. All contained very detailed information about the persons personal and health care needs, as well as their leisure and social interests and their preferred routines, both day and night. The care plans gave staff clear instructions on how to offer assistance to ensure peoples needs were met to Care Homes for Older People Page 13 of 25 Evidence: their satisfaction and to keep people safe. There was evidence that people were regularly asked about how they wished to be cared for and whether they were comfortable and pain free. Several risk assessments contributed to the care planning process, for example, relating to continence management, nutrition, mobility and skin care, and these assessments were reviewed each month along with the care plans. The home employs a physiotherapist to provide specialist advice with regard to moving and handling, exercises to improve general limb strength and to increase independence: this is particularly important for younger people who may be able to regain some skills thus decreasing their dependence on staff. As Fairholme is a nuring home, it is able to provide care to people with terminal illnessnes. The home follows the protocols set out in the Gold Standards Framework, a recognised good practice protocol that identifies the persons wishes at the end of the life as well as that of their family. Staff were observed to treat people with kindness at all times and it was clear staff had developed close and respectful relationships with people. There are clear written guidelines for staff on the safe handling of medicines and only the qualified nurses manage medicines. Records of all medicines received into the home and disposed of were maintained to enable an audit of all medicines held in the home. Administration records were fully completed and records of when and why as required medicines had been given were clearly recorded. The home has safe storage for controlled medicines and a sample was checked against the records and found to be accurate. Care Homes for Older People Page 14 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are encouraged and supported to make decisions to maintain control over aspects of their lives that are important to them. Their social, cultural, religious and recreational interests are respected. Relatives and visitors are made to feel very welcome enabling people to maintain valued contacts and not to feel isolated in the home. Meals varied and nutritious. Evidence: Peoples assessments and care plans provide information that their social, cultural, religious and recreational interests are taken into consideration. The home employs an Activities Coordinator who is supported by a number of volunteers who organise and facilitate many of the group and individual activities. Trips out of the home are arranged periodically and people said they are looking forward to the Mystery Tour organised for later in the week. One person described the Gardening Club and that the home was growing vegetables and salad. Other activities include quizzes, Bingo, music and singing at least every week, reminiscence books and general conversation with staff. A Summer Garden Fete has been organised for 15th August. The Registered Manager produces a regular Newsletter which several people living in the home contribute to with poems, articles of interest and quizzes. The chapel provides an area for people and their relatives for quiet contemplation. The chapel is multi Care Homes for Older People Page 15 of 25 Evidence: denominational and there are several visiting religious ministers. People said their friends and relatives are made very welcome in the home and they are invited to join in activities and to share a meal. Visitors were observed coming and going, unrestricted, from the home during the inspection. People are able to receive visitors in the privacy of their own rooms if they wish. People said they are able to make decisions about things that are important to them, such as whether to take part in social activities in the lounge or remain in their own rooms and when to get up and go to bed for example. Assessment, care plans and daily care records indicate that peoples choices and preferences are well accounted for and respected. All of those spoken with said they enjoyed the meals and confirmed they are always offered a choice. Nutritional needs are assessed to reduce the risk of malnutrition and dehydration through ill health or confusion. Likes and dislikes are recorded, preferences respected and special diets are provided. People are able to take their meals in the dining room or in the privacy of their rooms. The home employs staff specifically to assist people with their meals throughout the day. People were seen to be assisted unhurriedly, and the staff and the Registered Manager confirmed that this had greatly enhanced peoples dining experience as well as their diet and fluid intake. Care Homes for Older People Page 16 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home and their relatives can be confident that any concerns or complaints they may have will be treated seriously and resolved promptly. Evidence: People said they felt very comfortable talking to the care staff, nurses and the Registered Manager about any concerns they may have, however all those spoken with stressed they had no complaints about the care and support they receive. The Registered Manager said there had been one complaint made since the last inspection: this related to an untidy room and was resolved immediately. The Commission has not received any complaints about the home. People newly admitted to the home and their families are provided with a copy of the homes formal complaints procedure in their information packs upon arrival in the home. There are formal systems in place to protect people from abuse, including written guidance for staff and access to training internally and externally to the home. There are records to show that staff are recruited on the basis that they are suitable to work with vulnerable adults in a care setting. All of the people spoken with said they felt safe in the home. Care Homes for Older People Page 17 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Fairholme provides a pleasant, spacious and comfortably furnished home for people. Evidence: There was evidence that continued substantial financial investment in the decoration and fabric of the home continues: a bedroom has been enlarged and en suite facilities installed, the windows in the conservatory have been replaced and a small extension adjacent to the dining room has been built to accommodate wheelchair storage. The home looked nicely decorated and furnished throughout and was found to be very clean and tidy, with no unpleasant odours. The Registered Manager said the Housekeeping team take great pride in their work and this was obvious through talking to people and observation. The Registered Manager described the systems in place to maintain good hygiene, including written procedures to guide staff, access to training in infection control and provision of suitable equipment to maintain good hygiene. Bedrooms are decorated in readiness for newly admitted people, and as and when needed. Maintenance tasks are undertaken promptly to ensure the home is maintained in good order. People expressed satisfaction with the accommodation provided to them and confirmed that they can personalise their own bedrooms in accordance with their own tastes. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by kind and competent staff is sufficient numbers to meet their needs. Staff are recruited fairly and on the basis that they are suitable to work with vulnerable adults in a care setting so that people can feel safe in their care. Evidence: People said the staff were very kind and caring with nothing being too much trouble for them. They said they were assisted promptly indicating there are sufficient staff on duty to meet the needs of those currently living in the home. The Registered Manager said she has been able to increase the staffing levels in response to peoples needs and gave examples of increasing the staff dedicated to providing mealtime support, as well as increasing the number of nurses on duty during the night from one to two due peoples increasing needs. Staff were observed working in different capacities such as catering, housekeeping, care work and nursing so that they are able to work effectively within their own area of expertise. At the time of the inspection there were 52 people living in the home. The Registered Manager and staff confirmed there were 2 qualified nurses on duty throughout the day and 1 or 2 during the night, dependent upon peoples needs. In addition there are 7 care staff on duty during the day and early afternoon, 6 care staff during the afternoon and evening and 3 or 4 care staff on duty during the night. These numbers do not include the Registered Manager when she is working in the home in a Care Homes for Older People Page 19 of 25 Evidence: management capacity, although she does work as one of the qualified nurses from time to time to cover annual leave and to work alongside the other nurses and care staff. The recruitment and training files for 3 staff, including nursing staff, were looked at in detail. All three contained the necessary documents to ensure the staffs suitability to work with vulnerable adults in a care setting. Staff from all departments, from catering, housekeeping and nursing said they have good access to ongoing training so that they maintain and develop their knowledge and skills. A training overview provides evidence of the range and frequency of training available and indicated staff had received training in first aid, manual handling, the protection of vulnerable adults, fire safety and infection control to ensure peoples safety, as well as topics specifically relating to the care needs of the people living in the home such as continence care, pressure are care, nutrition and Dementia care. All care staff are expected to undertake National Vocational Qualifications and the Registered Manager confirmed all staff either had a qualification or were in training. Staff are offered regular formal supervision to allow them to discuss their work performance and training and development needs. Newly recruited staff have a comprehensive induction training programme which includes working alongside an experienced member of staff as well as the Registered Manager for at least 4 weeks before being assessed as capable to move forward to the Skills for Care induction training programme which introduces staff to the principles and values of good care giving. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is very well managed for the benefit of the people who live there. There are formal systems to ensure that peoples best interests are taken into account in the planning and development of the service. There are systems in place to ensure that the health, safety and welfare of people are protected. Evidence: Mrs Elizabeth Burnham, the homes Registered Manager is a qualified nurse and is highly competent to run the home. She has undertaken periodic training to maintain her professional qualification and improve the service to people, including a 2year End of Life project with Warwick University. Staff as well as people living in the home expressed confidence in her abilities. Mrs Burnham has a good understanding of financial planning and there was evidence that Mrs Burnham works closely with the homes owners to ensure the quality of the service is consistently high, that peoples needs are well met and the home is financially viable. Quality Assurance process are very comprehensive and includes reviews of all services Care Homes for Older People Page 21 of 25 Evidence: provided in the home. All Heads of Departments, i.e. catering, housekeeping, maintenance/health and safety and nursing, undertake audits of their area of responsibility with further monthly checks undertaken by the Registered Manager. With regard to peoples satisfaction with the services they receive, there are five levels of formal consultation in additional to meeting with the nursing staff and Registered Manager on a daily basis. Firstly, senior care staff consult with people at least every 2 months about how they wish to be cared for and their preferences: this information is included in the care plan updates. Secondly, the Head of Nursing Care speaks with people about whether staff are meeting their needs and that there are no unmet needs regarding health and nursing care. The Registered Manager also formally consults with people individually to assess the service overall. Written surveys for people and their families to complete allow people to comment anonymously if wished, regarding their satisfaction and to make suggestions for improvement and finally there are regular Resident and Relative Meetings. All this information is collated and included in the homes development plan and shared with people living in the home and their families. The home is commended for its level of consultation with people and the staff teams commitment to ensuring people receive the best possible service. Reviews are regularly undertaken of staff work performance as well as their training and development needs with the responsibility for this delegated throughout the staff team. Supervision and training records indicate staff are provided with 1:1 support and formal training sessions to ensure they have the knowledge and skills necessary to care for people who require nursing care. The home offers safe keeping for peoples money when they are unable to manage this themselves. Individual records, with receipts for all expenditure, are maintained and money is stored securely in the safe. Only the administrator and the homes owners have access to this money, and should someone require their money outside of office hours, a balance of the homes petty cash is made available thereby protecting peoples money. A selection of health and safety records were inspected including the homes fire safety risk assessment and records of equipment tests and checks, which were up-todate and complete, ensuring the system is maintained in good working order. Care Homes for Older People Page 22 of 25 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 23 of 25 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 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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