Care Home: Far End

Similar services:

• St Vincents
• The Cotswold Home
• Winton House
• Rush Court
• Hillyfield Rest Home
• The Maypole Nursing Centre
• The Briars

What the care home does well Residents` right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. Residents spoken with expressed their satisfaction with their quality of life at the home. Comments received from residents included: `They are so kind, I am very happy here` and `I am so lucky my family found this home for me, they knew it was just right for me and it is.` During this inspection we spent time with both residents who confirmed that they feel they have a full and interesting life at Far End, one resident told us that her social life had improved since moving to the home and both residents told us how much they enjoyed going to the day centre and spending time with their friends there. Menus sampled showed that the home offers a varied and well balanced menu, with residents able to choose alternatives if they do not want the dish that has been planned on that day. Both residents confirmed to us that they always liked the meals at the home and both residents described how the staff are always open to suggestion and willing to provide meals and snacks that they have asked for. If residents have concerns with their care, they or people close to them know how to complain. Both residents told us that they always knew who to talk to if they were not happy and both confirmed that action is always taken on any of their suggestions or concerns. One resident told us: `We only have to say and it is done.` Residents can have confidence in the home because it is led and managed appropriately. They get the right support from the home because the manager runs it appropriately with an open approach that makes them feel valued and respected. All interactions observed between the staff member and residents were inclusive, caring and respectful. What has improved since the last inspection? All six requirements made at our last inspection have been met. Residents can now be confident that any carers supporting them have access to accurate and up to date information regarding their needs, any action needed to minimise identified risks and their preferences as to the way their care is delivered. Information recorded on the medication administration record sheets now accurately shows the time medication was taken and who administered it. Residents can now have confidence in any staff employed to work at the home because checks have been done to make sure they are suitable to care for them and can now be confident that they are cared for by staff who are competent and who receive the relevant training. All required records and documents are now in place at the home. In their AQAA to demonstrate improvements made since the last inspection the manager told us: `We have implemented all requirements of our improvement plan following our last inspection. An extensive overhaul of all policies has been made and new policies and guidance put into place. New pre admission questionnaires ensure that we gain sufficient knowledge of prospective residents and that we have confidence in the knowledge that we can meet their needs. Revised care plans have been initiated to ensure we cover the entire daily living needs of our residents and comply with their personal choices. Staff and residents are secure in the knowledge that these plans are a living document and, as such, subject to change reflecting the changes in our residents` needs, like and dislikes. We have taken up the opportunities to subscribe to e-learning packages and Skills for Care newsletters so we can keep abreast of changes and proposed changes in legislation and guidance. Risk assessments throughout Far End have been carried out for both Health & Safety purposes and Fire Risk and evacuation. We have fitted an automated outside light, as requested by one of our resident`s relatives, to ensure that out doorway is lit and easily accessible.` These statements were fully supported by our findings on the day of this inspection. What the care home could do better: No requirements were made as a result of this inspection. The information given in the AQAA demonstrated that the manager and co-owner look for and identify areas for improvement at the home and have clear plans in place to achieve their goals. Key inspection report Care homes for older people Name: Address: Far End Sandhurst Lodge Wokingham Road Crowthorne Berks RG45 7QD     The quality rating for this care home is:   two star good 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: Denise Debieux     Date: 2 5 0 5 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 31 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 31 Information about the care home Name of care home: Address: Far End Sandhurst Lodge Wokingham Road Crowthorne Berks RG45 7QD 01344772739 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): tddundas@talktalk.net Ms Dorinda Trezise-Dundas,Ms Patricia Trezise-Dundas Name of registered manager (if applicable) Ms Patricia Trezise-Dundas Type of registration: Number of places registered: care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 3 The registered person may provide the following category/ies of service only: Care home only - 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 - OP Dementia - DE Date of last inspection Brief description of the care home Far End provides care and accommodation for up to three older people and is situated in a peaceful location close to the village of Crowthorne. The home adjoins a large Victorian property with 14 acres of surrounding land, which is also owned by the Care Homes for Older People Page 4 of 31 Over 65 0 3 3 0 2 7 0 7 2 0 0 9 Brief description of the care home providers. The providers live on the ground floor of the home, which they share with a variety of animals, including both large and small dogs, cats and a caged bird, and though residents are said to be able to share the lounge/diner/kitchen with them, they do not opt to do so, preferring instead to spend their time in their bed sitting rooms. The residents each have their own single bedrooms on the first floor, where there is also a toilet and a bathroom/toilet, there is also a kitchenette but this is not used as such at present. Access to the first floor is via stairs, fitted with two chair lifts for those who need them. The dogs remain in the ground floor areas, but the cats are popular visitors to the residents bedrooms. Residents are able to have pets of their own, if they wish. Current fees are £454 per week. This information was provided on 25 May 2010. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This unannounced visit formed part of a key inspection and was carried out on 25 May 2010 starting at 9.30am. One of the carers was present as the representative for the establishment. It was a thorough look at how well the service is doing. It took into account detailed information provided by the home and any information that CQC/CSCI has received about the service since the last inspection on 27 July 2009. The people who live at Far End prefer to be referred to as residents. For clarity and consistency this term will be used throughout this report. On the day of this visit both of the two residents were involved in the inspection and information was gained from the on duty member of staff, with additional information provided by one of the co-owners over the telephone. Prior to the inspection, survey Care Homes for Older People Page 6 of 31 forms were sent to all residents and members of staff employed at the home. Survey forms were returned by two residents and two members of staff. Some of the comments made to us on the day of this visit and the results of our survey are quoted in this report. The home sent us their annual quality assurance assessment (AQAA) when we asked for it. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. The AQAA was well written and contained clear, relevant information that was supported by the evidence seen on the day of our inspection. Residents care plans, staff recruitment and training records, menus, health and safety check lists, activity records, policies, procedures, medication records and storage were all seen and assessed on the day of this visit. We looked at how well the service was meeting the standards set by the government and have in this report made judgements about the standard of the service. We would like to thank the residents and staff for their time, assistance and hospitality during this visit and the residents and staff who provided additional information and participated in the surveys. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? All six requirements made at our last inspection have been met. Residents can now be confident that any carers supporting them have access to accurate and up to date information regarding their needs, any action needed to minimise identified risks and their preferences as to the way their care is delivered. Information recorded on the medication administration record sheets now accurately shows the time medication was taken and who administered it. Residents can now have confidence in any staff employed to work at the home because checks have been done to make sure they are suitable to care for them and can now be confident that they are cared for by staff who are competent and who receive the relevant training. All required records and documents are now in place at the home. In their AQAA to demonstrate improvements made since the last inspection the manager told us: We have implemented all requirements of our improvement plan following our last inspection. An extensive overhaul of all policies has been made and new policies and guidance put into place. New pre admission questionnaires ensure that we gain sufficient knowledge of prospective residents and that we have confidence in the knowledge that we can meet their needs. Revised care plans have been initiated to ensure we cover the entire daily living needs Care Homes for Older People Page 8 of 31 of our residents and comply with their personal choices. Staff and residents are secure in the knowledge that these plans are a living document and, as such, subject to change reflecting the changes in our residents needs, like and dislikes. We have taken up the opportunities to subscribe to e-learning packages and Skills for Care newsletters so we can keep abreast of changes and proposed changes in legislation and guidance. Risk assessments throughout Far End have been carried out for both Health & Safety purposes and Fire Risk and evacuation. We have fitted an automated outside light, as requested by one of our residents relatives, to ensure that out doorway is lit and easily accessible. These statements were fully supported by our findings on the day of this 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 31 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 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are confident that the 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. This home does not offer intermediate care. Evidence: In the AQAA, to demonstrate what the home does well, the manager told us: We try to ensure that any prospective resident has the opportunity to visit Far End and meet other residents and staff so they have a full picture of what we can provide, including the room that they will be occupying, if this is not possible we will visit them with our photograph album to give them a fuller picture of our home. Family, friends or representatives are always welcome to visit on behalf of residents should that need arise and they are welcome to take photographs of the facilities and grounds. We have a comprehensive pre-admission form which we complete with the resident their family and or their representative, this helps both us and the prospective resident to enter Care Homes for Older People Page 11 of 31 Evidence: into discussions regarding whether Far End is able to meet their needs. All residents are admitted on a trial 6-week basis to ensure that our home meets their expectations and that we are able to meet their needs. We do not, due to the size of the home, accept intermediate care residents. This statement is supported by the findings on the day of this inspection. The care plan for the one new resident who has moved into the home since our last visit was sampled during this visit. We saw that a comprehensive pre admission assessment had been carried out to ensure that the home could meet the residents identified needs, prior to them being offered a place at the home. We also spoke with the resident during our visit, who confirmed that she knew all about the home before moving in. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health, personal and social care needs are met. Each resident now has a plan of care that they, or someone close to them, have been involved in making and any potential risks to their health and welfare are fully assessed and minimised or prevented where possible. Where residents cannot manage their medicine, the home now supports them with it, in a safe way. Residents right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. Evidence: At the last inspection in July 2009, requirements were made relating to care plans and individual risk assessments for each resident. Following that inspection we requested and received an improvement plan from the provider. In that improvement plan the providers told us: We have initiated and completed new care plans for each resident with their full input and that of their family and advocates. We have also used our knowledge of their likes and dislikes and perceived needs. Incorporated in these plans are all of our residents needs regarding their healthcare and support required, both Care Homes for Older People Page 13 of 31 Evidence: physical and psychological, to ensure that they feel they are well supported and their day to day lives are happy and catered for in the way they prefer. Our risk assessment has been re written in a more understandable and comprehensive way, and incorporated in all care plans. We have included skin breakdown risk and nutritional screening. Fall hazards have been assessed and risks regarding moving and handling are taken into consideration. We ensure that any changes that are made are communicated to any staff member as soon as practicable. In the AQAA, to demonstrate what has improved since the last inspection, the manager told us: We have redesigned our care plans so that they are more of a living document and owned by the resident as a complete record of their needs. This now gives our residents more confidence that they will have the support and care that is individual to their needs and that they have a role to play and a voice in the way that Far End is run thus increasing their independence. Our other aim in producing this new procedure and paperwork is to ensure that, if there were an emergency anyone could come to Far End and support our residents with confidence, which would reassure our residents. Each care plan has additional sheets that can be used to record information that needs to be considered for briefer periods of time e.g. minor illness that can have an outcome concluding the incident, for example a cold, and the short term changes in their daily living that were made. We have introduced a new Nutritional Screening record to ensure that we are sure we are monitoring our residents weight and can address any changes, and new skin screening documentation. Residents keep their care plans in their rooms and both residents gave us permission to look at them. Both care plans were well written and easy to follow and supported the statements given by the providers and quoted above, meeting the requirements made at the last inspection. The care plans set out the actions which need to be taken by staff to meet the health, personal and social care needs of the residents and included appropriate risk assessments. Care plans are reviewed on a monthly basis and daily notes are kept that reflect the care given. These daily notes demonstrated that any changes or new concerns are promptly acted upon. For example, the risk assessment for one resident indicated concerns related to the risk of skin breakdown, the care plan evidenced that a referral had been sought from the community district nurse service, who had visited and made recommendations. The resident now has a new adjustable bed and pressure relieving mattress and has regular visits from the district nurse. The resident said how comfortable the new bed is and how pleased she is with how the home had managed this area of her care and commented Nothing is too much trouble for them, they are wonderful. The home has a small and close care team and the staff demonstrate an in depth Care Homes for Older People Page 14 of 31 Evidence: knowledge of each individual residents needs, abilities and preferences in how they wish their care to be delivered, resulting in both residents stating that they always receive the care and support they need. One resident told us: They are so kind, I am very happy here. At the last inspection in July 2009 we found that the home were not keeping accurate records in relation to the administration of medication and a requirement was made. Following that inspection we requested and received an improvement plan from the provider. In that improvement plan the providers told us: We have adjusted our process with regard to medication and a policy has been attached to the folder regarding this and the use of the medication administration record sheets. A signature sheet has also been initiated. We have liaised with our Pharmacist and taken his advice and acted in accordance with the Royal Pharmaceutical Society guidelines. We have also purchased a trolley, that can be secured to the wall if necessary, so we can take the medication to our residents and administer as per the RPS guidelines. All staff are aware of our new procedures and are happy and confident in following our new policies. Residents are confident that any medication they receive is properly administered and accurate records are kept. In the AQAA, to demonstrate what has improved since the last inspection, the manager told us: We now have a lockable mobile medication trolley that can be secured to a wall should this become necessary. We also have a new Guidance to Medication policy document that follows guidelines of the Royal Pharmaceutical Society of GB. We have also introduced a signature sheet so that we and others can immediately be aware of who has signed any of the charts concerned with medication. The medication administration records, medication storage, policies and procedures were all sampled during this inspection and were found to be in order. The member of staff explained how the new system works and was confident and knowledgeable about the new procedures in place at the home. The evidence seen supported the statements given by the provider and quoted above, and the previous requirement has been met. Data provided in the homes AQAA does not identify any residents with specific religious, racial or cultural needs at this time. However, from the evidence seen and comments received, we consider that the home would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. On the day of this visit staff were observed to always knock before entering the Care Homes for Older People Page 15 of 31 Evidence: residents bedrooms and all interactions observed between staff and residents were seen to be caring and respectful. Both residents told us they felt their privacy and dignity was always respected. In their AQAA the manager told us of their plans for improvement over the next twelve months: Although we have a policy and procedure re end of life care I feel we could do better both in guides regarding possible terminal or palliative care and in a supporting role towards relatives and friends. and they plan to: Obtain information that can help guide residents, relatives and us with regard to end of life care for our residents. Our knowledge of bed sores and their care is basic, mainly due to the fact that we have had no residents that have been immobilised for any time. and they plan to: Improve knowledge of the causes of and treatment of bed sores and associated problems. Care Homes for Older People Page 16 of 31 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. Each resident is treated as an individual and the home is responsive to their individual needs and preferences. The home supports residents to follow their own personal interests and activities. Residents 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. Residents have nutritious and attractive meals and snacks, at a time and place to suit them. Evidence: The routines of daily living are arranged to suit individual residents preferences and choices. This was confirmed by both residents spoken with. In the AQAA, to demonstrate what the home does well, the manager told us: We strive to ensure that residents feel they have some control over their daily lives once they have made the choice to take up residence here, and that we can satisfy daily living needs. Our aim is that our residents feel that this is their home and that they have some control over their lives to live as independently as possible and to be treated fairly and that they are treated as an individual. Residents are aware we take into consideration their social needs, and are aware that as a small home there is Care Homes for Older People Page 17 of 31 Evidence: limited social interaction, to compensate for this we encourage our residents to attend the local day centre which provides social interaction and activities. All of our residents enjoy their attendance at the day centre, particularly the activities and hobbies they can participate in. Residents have the size of room were they can entertain comfortably in private if wish to. Visitors are welcome at all times and at present all our residents are in regular contact with family and friends and are taken out regularly. This statement was supported by the findings on the day of this inspection. During this inspection we spent time with both residents who confirmed that they feel they have a full and interesting life at Far End, one resident told us that her social life had improved since moving to the home and both residents told us how much they enjoyed going to the day centre and spending time with their friends there. Menus sampled showed that the home offers a varied and well balanced menu, with residents able to choose alternatives if they do not want the dish that has been planned on that day. Both residents confirmed to us that they always liked the meals at the home and both residents described how the staff are always open to suggestion and willing to provide meals and snacks that they have asked for. In their AQAA the manager told us of their plans for improvement over the next twelve months: Although we verbalise the choices available for our residents it would assist residents in making choices if they had a reminder of what was available. and they plan to: Compile a list of choices of food/drink available within the home so residents can make an informed decision regarding mealtimes. Care Homes for Older People Page 18 of 31 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. If residents 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 home safeguards people from abuse and neglect and staff know what action to take to follow up any allegations. Evidence: The home has a complaints procedure in place that is available to all residents and their relatives and is also included in the residents individual care plan folder. Both residents told us that they always knew who to talk to if they were not happy and both confirmed that action is always taken on any of their suggestions or concerns. One resident told us: We only have to say and it is done. In the AQAA, to demonstrate what the home does well, the manager told us: We have robust policies and guidelines with regard to safeguarding adults, complaints procedures and logs including whistle-blowing, Mental Capacity Act and Deprivation of Liberty Safeguards. We have reviewed, rewritten and introduced new policies and procedures regarding all aspects of the safeguarding and well being of our residents over the last nine months to ensure that there is no doubt about how to address any of the factors in this element. This statement is supported by the findings on the day of this inspection. Staff members who returned survey forms told us they knew what to do if anyone Care Homes for Older People Page 19 of 31 Evidence: raised concerns about the home and the member of staff spoken with on the day of this inspection was fully conversant with procedures to follow in the event of any suspicion or allegation of potential abuse. Both residents spoken with said that they felt very safe at the home with one resident adding they make sure we are safe. Care Homes for Older People Page 20 of 31 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. Residents live 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. Evidence: Residents spoken with expressed their satisfaction with the accommodation provided at the home. Residents surveyed all said that the home was always fresh and clean. In the AQAA, to demonstrate what the home does well, the manager told us: All rooms are of a size that residents are afforded sufficient room to have a comfortable private space in which they can place their own personal items and furnishings. The rooms are lockable if to ensure privacy, there is a call system in place should residents need assistance. To ensure freedom of choice for disabled residents we have a ramp and stairs lifts in place to ensure access to the building, we also have handrails and other aids in place to make sure that all residents have equal access to all parts of the building and can live independently. There is a bath lift in operation to assist access to the bath. We seek the advice of our local authority occupational therapist to assist us in ensuring we do everything we can to assist in the daily living of our residents. There is easy access to the grounds, which are well maintained and extensive, and residents and their families/friends are welcome to use them; benches are provided as is a Care Homes for Older People Page 21 of 31 Evidence: spacious covered area should the weather be too hot or inclement. This statement was supported by the findings on the day of this inspection. On the day of this visit we were shown around all areas of the home. The furniture and furnishings were seen to be of a good quality and personal bedrooms were seen to be personalised to the individual residents wishes. The home was found to be warm and bright with a homely atmosphere and a good standard of housekeeping apparent. It was noted that, at present, the home do not provide staff or visiting health professionals with single-use towels, in line with best practice guidance on safe hand washing techniques, and we asked that this information be passed to the providers for action. All bedrooms have views over the extensive grounds and both residents told us how much they liked their rooms and the grounds and how they felt Far End was very much their home. Care Homes for Older People Page 22 of 31 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. Residents have safe and appropriate support as there are enough competent staff on duty at all times. They can 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. Evidence: In their AQAA to demonstrate how the home is staffed, the manager told us: we provide the following ratios of staff to residents 1:3 = 5 ; 2:3 = 87 and 3:3 = 8 . With this high ratio of staff we are able to care for our residents and meet their needs without any need to rush, thus preserving our residents dignity and adhere to their choices regarding their day-to-day living, and staff have the time to complete tasks efficiently. Due to the size of the home and the proximity of staff living area and residents living area there is no necessity for waking staff as a permanent role, residents have call systems within their rooms. However should there be a need, as the majority of the time we have 2 staff present, this would not be a difficulty. At present the home use a system where the part time staff use a sign in book to record their attendance. However, the home is mostly staffed by the two co-owners, who do not add their names to this book, and it was not possible to verify the staffing numbers quoted in the AQAA. It is important that the home keep a clear and accurate record of all staff who have worked at the home each day, together with the hours Care Homes for Older People Page 23 of 31 Evidence: they have worked. This record must include all staff who have worked, including the owners. This was discussed with one the owners over the telephone. A requirement has not been made as we were assured that a system will be put in place. Of the four care staff, two have just finished their National Vocational Qualification (NVQ) level 2 training in care. They are waiting for their work to be assessed by an external assessor before their certificates can be issued. At the last inspection in July 2009, concerns were identified and requirements were made relating to staff recruitment practices and staff training. Following that inspection we requested and received an improvement plan from the provider. In that improvement plan the providers told us: We have implemented a recruitment policy to ensure that any persons employed by us is properly checked and cleared to be employed at Far End as prescribed in the amended Care Home regulations. We have implemented a full training programme in accordance with Skills for Care and Schedules contained in the amended Care Home regulations to ensure we have suitably trained personnel through an induction process. No person who is nor adjudged by us as having the necessary skills and competencies are cleared to work unsupervised with our residents. The residents form part of the training process and are aware that a person is being trained to competently cater to their needs, giving them security and confidence in our members of staff. In the AQAA, to demonstrate what they do well, the manager told us: All staff are CRB checked to ensure the safety of our residents, they can work at Far End towards their common induction standards, however they will not be allowed to be alone with our residents during this stage of their employment. All our staff have followed and been assessed for suitability for working at Far End by completing the common induction standards issued by Skill for Care, we also make sure that we are aware of and take advantage of training opportunities when they arise. We have now become members of Bracknell Forest Log on to Care and made use of their e-learning packages, we have also logged into and set up admin for common induction standard assessment so that we can assess the learning needs for our staff and ourselves. We have attended Skills for Care workshops and have found these to be very helpful and a useful opportunity to meet others in the care industry and discuss our needs as a small home. This statement was supported by the findings on the day of this inspection and we found that the previous requirements have been met. In addition to the manager and the other co-owner of the home there are three part time members of staff. The recruitment files for these three members of staff were sampled and all were found to contain all the required documents and checks. The Care Homes for Older People Page 24 of 31 Evidence: training records were also checked for these members of staff and all had worked through and completed the common induction standards log book since the last inspection. Additional training has been sourced and provided and it was seen that all staff were up to date with their mandatory health and safety training. Additional training included: safeguarding adults, Mental Capacity Act, Deprivation of Liberty Safeguards and investing in quality. In their AQAA the manager told us of their plans for improvement over the next twelve months: In the past we have not been pro-active with regard to sourcing training for all staff at Far End, this will be addressed in the future. We will be making proper use of the training opportunities as they arise, we will also be taking advantage of e-learning packages that are available on the common induction standards website and the local authority websites. We will ensure that we adhere to any mandatory training that is required with regard to our home. Both residents spoken with said that the staff always listen and act on what they say and both said that staff are available when they need them. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can have confidence in the home because it is led and managed appropriately. They get the right support from the home because the manager runs it appropriately with an open approach that makes them feel valued and respected. Residents control their own money and choose how they spend it. If they cannot manage their money, a relative or someone close to them manages it for them. Residents are safeguarded because the home now keeps records appropriately and ensures their staff understand the way things should be done. The environment is safe for people and staff because appropriate health and safety practices are carried out. Evidence: In their AQAA we were told that: The manager has two NVQ level 4s in Care and Management, and has over 20 years experience of managing a care home. Training is ongoing in all relevant aspects to ensure that the skill set and knowledge that she has is up to date and pertinent to her role both as manager and principle carer. This statement was supported by the findings on the day of this inspection. The residents Care Homes for Older People Page 26 of 31 Evidence: benefit from the ethos, leadership and clear management approach of the home. The home has an effective quality assurance and monitoring system in place that is based on seeking the views of the residents and their relatives. In their AQAA, to demonstrate what they do well, the manager told us: We encourage everyone to verbalise any comments they have regarding Far End, we work hard at ensuring that there are open lines of communication between us and any resident and their families or friends, enquiring how our residents appear to them and if they themselves see any changes that we need to address or changes to the good - showing that we are achieving our goals. We are also in close contact with the day centre and work closely with them to ensure the happiness of our residents. In our discussions with the residents it was clear that they both feel that the manager is always open to comments and invites their suggestions for any improvements that could be made. Policies and procedures are in place to protect residents financial interests. Residents are provided with lockable storage in their own rooms and we were advised that the home do not undertake to store or handle any valuables or financial items for their residents. At the last inspection in July 2009, concerns were identified and a requirement was made relating to record keeping at the home. Following that inspection we requested and received an improvement plan from the provider. In that improvement plan the providers told us that they had put all required records in place and that: All policies and procedures within Far End are in the process of being reviewed to ensure the well being and safety of our residents. We have informed our residents of this ongoing process and where possible are involving them in the reviews. In their AQAA the providers told us: Apart from the 2 NVQs mentioned the manager has attended courses in Deprivation of Liberty Safeguards, Fire and Safety, Dementia Awareness, Medication, Health and Safety and Food Hygiene. New Health and Safety policy and guidance has been compiled along with risk assessments (including Fire). New induction / recruitment policy. Up to date and relevant records and record keeping. These statements were all supported by the findings on the day of this inspection, with the exception of having a clear and accurate record of the staff duty roster worked, as discussed in the previous section of this report. In their AQAA that manager told us of steps they take to ensure the safety of residents, staff and visitors, these steps included: We complied with recommendations given to us by the fire authority and there are smoke and fire detectors in all relevant positions. Smoke and fire retardant strips are in place. Care Homes for Older People Page 27 of 31 Evidence: Detailed fire risk assessments have been carried out this reporting year and we have drawn up comprehensive plans for all of Far End including buildings in the grounds to which anyone has either access or can be in close proximity to. These plans also indicate which other part of the building (s) are most at risk from secondary fire. Fire evacuation procedure is in place and known to all parties. The Heath and Safety of all persons within Far End on a permanent basis and those visiting is paramount. We have extensive guidance and policy regarding Health and Safety, including risk assessments. We have an Emergency Guidance document that contains all relevant contacts that may be needed, pharmacist, doctors surgery, other staff members, plumbers etc. Policy/guidance regarding the processes when there is an accident or an emergency has been produced to enable any member of staff to quickly and efficiently deal with many situations should they arise. These statements were supported by the findings on the day of this inspection. The providers have worked hard since the last key inspection to meet the requirements made and to make sure they develop and maintain a clear and full understanding of the requirements and legislation that apply to running a care home. In their AQAA, the manager set out plans for improvement over the next twelve months: We plan to implement a guide to policies in place and indicate what part of life at Far End these should apply to. Clearly the policies and guidance within Far End is an ongoing process and outside advice will be monitored and our documentation updated accordingly. All interactions observed between the staff and residents were inclusive, caring and respectful. Care Homes for Older People Page 28 of 31 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 29 of 31 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 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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