Care Home: Ferfoot Care Homes

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What the care home does well People had the information they needed to make an informed decision about whether the home was the right place for them. There was a statement of purpose and there was a service user guide. These were available in large print and on disc. There was a brochure about he home with pictures. The manager also provided leaflets about other information of interest such as funding or advocacy. People`s needs were assessed so that their diverse needs would be met. Each person had a very detailed assessment of their needs which included information about any diversity needs such as culture or disability. People`s personal, social, diverse and health care needs were set out in a plan so that their needs would be met. The plans were very detailed and included information about how to meet the needs identified in the assessments. People`s health care needs were met. Each person was registered with a GP and they saw other health care professionals as needed. The home received good support from the community mental health team. Medication was stored safely and appropriate records were kept. Medication was given to people in a sensitive and discreet way and people were protected by the medication practices. People`s privacy and dignity were respected. There was a variety of activities suited to individual needs for people to enjoy. The activities organiser provided activities suited to people`s individual needs. People went out into the community on a daily basis and were supported to go to shops, cafes and church activities. People kept in contact with family and friends and family members could visit any time and were always welcome. People were helped to have choice and control over their lives. People were given varied nutritious meals, which they enjoyed. A choice of meals was always offered and special diets were catered for. People were protected by the policies and practices for complaints and safeguarding. There was a complaints procedure and people knew how to make a complaint. Any complaints were investigated and action was taken to put things right. There were procedures about protecting people from abuse and staff had received training about prevention of abuse. People lived in a pleasant environment, which was clean and hygienic and suited to their needs. The accommodation was in the process of being redecorated. There was ample communal space and people could walk about freely. The bedrooms were individually furnished and decorated and several of them had en suite facilities. They had individual pictures on the doors of items or scenes of interest to the occupant so that they could recognise their rooms. There were bathrooms with adjustable baths and sufficient shared toilets. These rooms had clear signs on them so that people could identify them. People were supported by enough staff who were appropriately trained and qualified. There was a range of training provided for staff. They had all the basic training including first aid and manual handling and more specialised training such as medication and dementia. More than half of the staff had a National Vocational Qualification (NVQ) at Level 2 and more were working towards NVQ. People were generally protected by the recruitment practices.The home was well managed. The registered manager had decided to step down and was taking the post of deputy manager which provided continuity for people. A temporary manager was running the home and a new manager had been appointed. There was a quality assurance system and people`s views were collected so that the home was run in people`s best interests. There were comprehensive health and safety systems and checks so that people`s health safety and welfare were protected. People said in their surveys:`Overall - the service offered by Ferfoot is excellent.` `Dad is very happy living at Ferfoot.` `The staff are always very pleasant and helpful.` `The care of my husband is really good. Ferfoot is a wonderful care home. I am so grateful he is there.` `I am happy here and the staff are good to you.` `A very caring home with caring staff under difficult situation sometimes.` What has improved since the last inspection? Changes had been made to the assessment process and a new life history had been introduced. This meant that the home had more detailed information to develop the care plans and make sure that people`s diverse needs were met. Significant changes had been made to the building since the last inspection. A new extension had been built to link the two houses. This gave people more shared space and made it possible to walk for one side of the building to the other. People were walking freely from one room to another. The gardens had been made secure with fencing so that people could go out into the garden independently and be safe. A new call bell system had been installed and the exit doors into the garden were linked to this so that staff could know when people had gone out. Some of the double rooms had been converted into single rooms and en suite shower and toilet facilities had been installed. The manager had reviewed the staffing levels and increased them to meet the needs of the people who lived in the home. He had put an extra member of staff on early in the morning and in the evening as these were busy times. The home had introduced a specialist training package for staff about dementia care. Almost half the staff had done this training and there was a plan for all the staff to complete it. This would help to make sure that the staff understood the needs of people with dementia and how they could support them. What the care home could do better: Care plans should be signed by the person concerned, or a representative if they are unable to sign, to show that they have been involved in developing them and are in agreement with them. Two written references must be obtained before a new member of staff starts work to make sure that people are cared for by suitable staff. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ferfoot Care Homes Old and New House, The Folly Old Hardenhuish Lane Chippenham Wiltshire SN14 6HH     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Elaine Barber     Date: 2 3 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Ferfoot Care Homes Old Hardenhuish Lane Old and New House, The Folly Chippenham Wiltshire SN14 6HH 01249658677 01249445972 tinanovik@ferfootcarehome.wanadoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ferfoot Ltd care home 56 Number of places (if applicable): Under 65 Over 65 56 0 dementia mental disorder, excluding learning disability or dementia Additional conditions: 0 1 No more than 1 service user with Mental Disorder, under the age of 65. Date of last inspection Brief description of the care home Ferfoot Care Homes is a care home consisting of two buildings, which are linked by a new extension. The home is located in a quiet residential area, although is close to main roads and transport links. Ferfoot Care Homes is run by Caring Homes. A permanent staff team provides 24 hour care and support to people who live in the home. The home adopts a person centred approach to caring for people who have dementia. Information about the service is available to people in the statement of purpose and service user guide. Information about the fees is available from the home. Copies of inspection reports are also available from the home and from our website www.cqc.org.uk. Care Homes for Older People Page 4 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection peterchart Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: We asked the home to complete an Annual Quality Assurance Assessment, known as the AQAA. This was their own assessment of how they were performing. It also gave us information about what has happened during the last year, and about their plans for the future. We sent out surveys so that these could be completed by the people who lived in the home. We had surveys back from twelve people who lived in the home. We looked at all the information that we had received about the home since the last inspection. This helped us to decide what we should focus on during our inspection. We visited the home on the 16th April 2009 and again on 23rd April 2009. We talked to the temporary manager, the deputy manager, the activities organiser and the cook. We looked at some of the agencys records and talked to two members of Care Homes for Older People Page 5 of 29 staff. We met with six relatives and four people who lived in the home and asked them about their experience of living in the home. We looked around the home and sat in the communal areas and observed what happened during the day. The judgments contained in this report have been made from all the evidence gathered during the inspection, including the visits. The last inspection of the home was on 17th and 18th April 2007. What the care home does well: People had the information they needed to make an informed decision about whether the home was the right place for them. There was a statement of purpose and there was a service user guide. These were available in large print and on disc. There was a brochure about he home with pictures. The manager also provided leaflets about other information of interest such as funding or advocacy. Peoples needs were assessed so that their diverse needs would be met. Each person had a very detailed assessment of their needs which included information about any diversity needs such as culture or disability. Peoples personal, social, diverse and health care needs were set out in a plan so that their needs would be met. The plans were very detailed and included information about how to meet the needs identified in the assessments. Peoples health care needs were met. Each person was registered with a GP and they saw other health care professionals as needed. The home received good support from the community mental health team. Medication was stored safely and appropriate records were kept. Medication was given to people in a sensitive and discreet way and people were protected by the medication practices. Peoples privacy and dignity were respected. There was a variety of activities suited to individual needs for people to enjoy. The activities organiser provided activities suited to peoples individual needs. People went out into the community on a daily basis and were supported to go to shops, cafes and church activities. People kept in contact with family and friends and family members could visit any time and were always welcome. People were helped to have choice and control over their lives. People were given varied nutritious meals, which they enjoyed. A choice of meals was always offered and special diets were catered for. People were protected by the policies and practices for complaints and safeguarding. There was a complaints procedure and people knew how to make a complaint. Any complaints were investigated and action was taken to put things right. There were procedures about protecting people from abuse and staff had received training about prevention of abuse. People lived in a pleasant environment, which was clean and hygienic and suited to their needs. The accommodation was in the process of being redecorated. There was ample communal space and people could walk about freely. The bedrooms were individually furnished and decorated and several of them had en suite facilities. They had individual pictures on the doors of items or scenes of interest to the occupant so that they could recognise their rooms. There were bathrooms with adjustable baths and sufficient shared toilets. These rooms had clear signs on them so that people could identify them. People were supported by enough staff who were appropriately trained and qualified. There was a range of training provided for staff. They had all the basic training including first aid and manual handling and more specialised training such as medication and dementia. More than half of the staff had a National Vocational Qualification (NVQ) at Level 2 and more were working towards NVQ. People were generally protected by the recruitment practices. Care Homes for Older People Page 7 of 29 The home was well managed. The registered manager had decided to step down and was taking the post of deputy manager which provided continuity for people. A temporary manager was running the home and a new manager had been appointed. There was a quality assurance system and peoples views were collected so that the home was run in peoples best interests. There were comprehensive health and safety systems and checks so that peoples health safety and welfare were protected. People said in their surveys:Overall - the service offered by Ferfoot is excellent. Dad is very happy living at Ferfoot. The staff are always very pleasant and helpful. The care of my husband is really good. Ferfoot is a wonderful care home. I am so grateful he is there. I am happy here and the staff are good to you. A very caring home with caring staff under difficult situation sometimes. What has improved since the last inspection? What they could do better: Care plans should be signed by the person concerned, or a representative if they are unable to sign, to show that they have been involved in developing them and are in agreement with them. Two written references must be obtained before a new member of staff starts work to make sure that people are cared for by suitable staff. Care Homes for Older People Page 8 of 29 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had the information they needed to make an informed decision about whether the home was the right place for them. Peoples needs were assessed so that their diverse needs would be met. Evidence: We saw that there was a statement of purpose and a service user guide. These contained all the required information. We saw that these were available in large print and on DVD. There was also a brochure about the home with photographs. The manager told us that a new brochure would soon be printed with more up to date pictures. We saw that there were several leaflets available for example about funding and advocacy. The manager told us that he talked to people who made an enquiry about the home to find out what information they needed. He then gave them a copy of the statement of purpose, service user guide and the homes brochure and any of the other leaflets that they needed. He said that each person was also given a copy of Care Homes for Older People Page 11 of 29 Evidence: the contract and terms and conditions. Twelve people who lived in the home completed surveys. Nine people said that they had enough information about the home to decide if it was the right place for them. One person said they had no information and two said they moved from hospital and social services arranged it. Eleven people said that they had received a contract and one person did not answer that question. We looked at the care records for four people. We saw that each of these people had a very detailed assessment of their needs. One person had moved in in 2003, before Caring Homes took over the home. They had an assessment of their needs then including a manual handling assessment, an assessment for the risk of malnutrition and a pressure area risk assessment. They had been referred to the dietetic service following these assessments. Their needs had been reviewed several times since they moved in and we saw that this had been reflected in their care plan. Three of the people had had their needs assessed since Caring Homes took over the home. They each had an assessment devised by Caring Homes. These included information about social needs, such as food, hobbies, contact with family and friends and religion, daily living skills, mobility, manual handling needs, eating and drinking, nutrition, sensory needs, communication, breathing, medication, behaviour, continence, sleeping and skin condition. There were also risk assessments for example about falls, maintaining a safe environment, leaving the building, pressure areas and malnutrition. These three people also had detailed information about their life history and a biography. This included information about their likes and dislikes, how they liked to do things, preferred routines, childhood, adulthood, their work, retirement, cultural background, family, religion, first language, country of origin and dietary preferences. The fourth person did not have a completed life history and biography. A member of staff told us that the family had been asked to provide this information but had not done so. The manager told us that a care plan was developed for each area of need identified in the assessment. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal, social, diverse and health care needs were set out in a plan so that their needs would be met. Peoples health care needs were met and they were protected by the medication practices. Peoples privacy and dignity were respected. Evidence: The manager told us in the AQAA that they had made improvements to the assessment of peoples needs with the introduction of a far more comprehensive biography and lifestyle survey. They said that this had been done to imrove standards of care planning for each person to ensure the home met their needs, expectations and capacities. We looked at four care plans and we saw that the plans were very detailed. There was a separate care plan for each need identified in the assessments. These included, for example, communication, moving and handling, skin, eating and drinking, personal hygiene, sleeping at night, maintaining a safe environment, leaving the building, breathing, pain and spiritual care. Any needs in relation to culture, beliefs, gender and disability were included in the care plans. The plans contained the outcomes to be achieved by each action in the plan. They were signed by the member Care Homes for Older People Page 13 of 29 Evidence: of staff who had developed them and dated so it was possible to tell which information was up to date. They were not signed by the person or their representative to show that they were in agreement with the plans. The plans were reviewed once a month. Twelve people who lived in the home completed surveys. Eleven people said that they always received the support they needed and one said they usually received the support they needed. This person was a relative who filled in a form for the person. They said Staffing levels appear to have improved but there are still times when staff cannot be found especially at weekends. The manager told us that he had reviewed and increased the staffing levels recently. We spoke to six relatives five of whom said that there were always sufficient staff to meet peoples needs. One relative said that there were times when there had not been enough staff but this had not happened recently. All the relatives said that they were happy with the care. When we looked at the care records we saw that contacts with health care professionals were recorded. These included the GP, district nurse, chiropodist, optician and dietician. An optician visited people at the home on the first day of our visit. When we looked at the records we saw that people had assessments and care plans for their health care needs for example skin integrity and nutrition. One person had a risk assessment for the use of bedrails which was reviewed once every three months. The manager told us that they received good support from the local community mental health team. We met with the consultant psychiatrist, from the team, who was visiting the home. They told us that the home always worked co-operatively with the team. They said that the home knew their limitations and were willing to work with risky situations and managed them well. They also said that they had no concerns at all about the care in the home. Ten people who completed surveys said that they always received the medical support that they needed and two said that they usually did. There was a policy about medication. We looked at the arrangements for medication. We saw that a record was made in each persons care plan of the medication that they took. A monitored dosage system was used with printed medication administration record (MAR) sheets. Medication was kept in two trolleys in a locked room. There was also a controlled drugs cupboard. The deputy manager told us that they had just received the new requirements for the storage of controlled drugs and they were going to make sure that the controlled drugs complied with these and make changes if needed. There was a drugs fridge for medicines that required refrigeration. A record was taken of the temperature every day to make sure that they were stored at the right temperature. Care Homes for Older People Page 14 of 29 Evidence: We saw a member of staff taking medication to people on an individual basis from the medication room. They put the tablets from the blister pack into a pot, put a dot on the MAR sheet to show that they had put up the medication and took the tablets to the person. They then observed the person take their medication and returned and signed the MAR sheet over the dot. A member of staff told us that they took the medication to people individually in the new part of the building but gave medication from the trolley in the old part of the home. We looked at the MAR sheets and saw that these were being properly recorded. Some hand written editions had been made to the MAR sheets. These had two staff signatures to show who had written the addition and who had checked this. They were also dated so that it was possible to cross reference the changes with any instructions from a doctor recorded elsewhere. Medicines received into the home were recorded on the MAR sheets as part of stock control. We saw a separate record of medicines returned to the pharmacist. There were some homely remedies and there was a stock control system for these. The deputy manager told us that these had been agreed by the GP. We saw a letter of agreement from the GP about the homely remedies that could be used. We also saw individual protocols for as required medicines. When controlled drugs were given a record was made in a controlled drugs register and two staff signed the record. A staff member told us that there were designated staff who gave medication to people and all of them had received training. When we looked at the training records we saw that these staff ahd received training from Swindon college about the safe handling of medicines. The deputy said that there was a plan for four more staff to be trained to give medication and they were learning alongside the designated members of staff. We saw that each persons preferred form of address was recorded in their personal file. People wore their own clothes and were individually dressed. We observed staff to be attentive and to ensure that people were kept clean at all times. Staff spoke to people in a respectful way. We observed staff knock on doors and wait for a reply before entering. Personal care took place in the privacy of the bedrooms and bathrooms. There were sufficient communal rooms for people to receive relatives in private or they could receive visitors in the privacy of their own rooms if they chose. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was a variety of activities suited to individual needs for people to enjoy. People went out into the community and they kept in contact with family and friends. People were helped to have choice and control over their lives. People were given varied nutritious meals, which they enjoyed. Evidence: When we read the files we saw that each person had a record of activities that they had participated in. We saw that these were suited to the needs of the person. For example one person who was in bed had one to one activities with a member of staff on a daily basis. These included reading, looking at pictures, talking, massage and music. Three other people who were more mobile participated in group activities. We talked to the activities organiser. She showed us the schedule of activities. She said that she did things like hand massage and lights with people who were in bed. She also said that she took puzzles and books to people who liked to stay in one place. We saw books and puzzles left on tables. People moved around the home freely. When they sat down for a short time they looked at books and magazines when they wished. When people passed the tables with puzzles they would stop and do part of a puzzle. Care Homes for Older People Page 16 of 29 Evidence: The activities organiser told us that she took people out to the shop and to cafes. She said that they went to tea dances, to day time activities run by the church, to the garden centre and on trips out for example to Weston super Mare, to Bath and to a steam traction engine day. She showed us scrap books people had made with photographs of outings. The manager said that these provided a pictorial record to use for reminiscence. A member of staff told us that the activities organiser took people out in ones and twos. We saw her take one person out during our visits. She told us that she takes people out regularly so they are well known in the community. They used community facilities such as the shops, church and garden centre and had links with the local school. The manager said that she usually took at least half a dozen people out to the shop every day for about half an hour. Four people said in their surveys that there were always activities they could take part in. Comments included, Activities are excellent; I can go out with my husband which makes such a difference and the activities co-ordinator is first class. She is so good with them all. At Easter we will have an Easter egg hunt, she will go to any length to make everybody happy. Three said there were usually activities they could take part in The activities co-ordinator is dedicated and creative. She gets to know each resident individually and there are plenty of activities arranged inside and outside Ferfoot on almost a daily basis. Two said sometimes Because my mother is not mobile she cannot take part in some activities, but she enjoys taking part in others e.g. bingo, singing etc. Two relatives said that their relative was no longer able to participate in group activities and one did not answer that question. However, it was clear from looking at the records, observing practice and talking to the activities organiser and staff that everyone was able to participate in some kind of activity. Each person had their own bedroom which was individually decorated and furnished. People had brought items of furniture and their own belongings to make their rooms more homely. Peoples likes and dislikes and preferred routines were recorded in their files so that staff knew how they liked to do things. People were offered a choice of meals. Changes to the building meant that there were more shared spaces and people could choose where to spend their time. The garden was enclosed at the back and was being made secure at the front. There were several doors into the gardens and people could go in and out as they chose. There was an alarm on each exit door so that staff knew when people had gone out and they could be kept safe. We saw that the menu was displayed on a board in the dining room and there was a choice of lunch and tea. One relative told us that the food was very good and people Care Homes for Older People Page 17 of 29 Evidence: were always offered a choice. The person whom they were visiting told us that they enjoyed their meals. The cook told us that people can have a choice of meals at breakfast, lunch and tea. She said that if someone does not like what is on the menu she will cook them something else. She also said that Caring Homes provides a list of menus and she asks people what they like form these menus then draws up a menu to suit the people who live in the home. She told us that she purees the meals for people who require a softer diet. She also told us that she had copies of all the weight charts and could see when people were losing weight. She would then provide them with fortified foods. There were some people who required diabetic diets and some people were vegetarians and she provided a variety of meals to suit their needs and tastes. We looked at the menus and saw that a variety of meals were served to meet different needs. We asked people in their surveys do you like the meals at the home? Six people answered always and six said usually. Care Homes for Older People Page 18 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were protected by the policies and practices for complaints and safeguarding. Evidence: We saw that there was information in the statement of purpose and service user guide about how to complain and the procedure for responding to complaints. The manager told us in the AQAA that they had improved the management of complaints by introducing a more comprehensive and clear complaints procedure which is published and available to all. They said that they had also introduced and published to all staff a more comprehensive whistle blowing procedure. We saw that there was a complaints and compliments folder. This included details about the complaint and the investigation, the action taken and the response made to the complainant. Eleven people said in their surveys that they always knew who to speak to if they were not happy and one person did not answer. Twelve people said that they knew how to make a complaint. One person said Queries etc. are usually quickly dealt with. The home had a policy and procedure about vulnerable adults and the prevention of abuse. Other guidance for staff has been produced in related areas such as risk taking, the use of restraint and the reporting of bad practice, including whistle blowing. Staff received information about the No Secrets guidance about prevention of abuse. There was a notice board in the care office with information about protection of vulnerable adults posted on it. The management team had had experience of the adult protection Care Homes for Older People Page 19 of 29 Evidence: referral system. Training about abuse was included in the induction programme. Staff also received training about abuse as part of the course, which led to a qualification in dementia care. The training records showed that staff had received training about safeguarding of vulnerable adults. There was a folder recording all allegations or incidents that had been referred to the local vulnerable adults unit. These had not always resulted in an investigation. The professionals involved had been satisfied with how the home was managing the situation. Care Homes for Older People Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People lived in a pleasant environment, which was clean and hygienic and suited to their needs. Evidence: The property was in a residential area of Chippenham. The accommodation consisted of two houses. The manager told us in the AQAA about improvements that have been made to the accommodation since the last inspection. These included:- improved lounge and dining space with new extension between the wings. Improved provision of resident bedrooms with some new ensuite shower rooms. Improved bathing facilities with provision of another specialist bathroom. Improvements to some bedrooms ensuite facilities. Improved usable secure garden area. Renewed capital equipment such as washing machines, boilers etc. to improve service delivery for residents. Provided more specialist equipment such as additional hoists and pressure relief mattresses to improve quality of life and care delivery to residents. When we visited we saw that the building work to link the two houses was complete. There was a new entrance and a new office for the administrator. The manager also had an office downstairs. There was more communal space and several shared areas had become linked so that people could walk freely around the home. We saw people walking freely from room to room. The accommodation was in the process of being Care Homes for Older People Page 21 of 29 Evidence: redecorated. New furniture ahd been provided in the dining room. The garden at the rear of the home had been fenced and was enclosed so that it was safe for people to go in and out independently. On the second day that we visited the front garden was being fenced so that it was also safe and enclosed and people could go out into the garden safely. There were several garden areas that people could choose from. A new call bell system had been fitted and all the exit doors into the garden were alarmed so that staff knew when people went in and out. The call bell system was monitored by a computer so it was possible to tell how many calls there had been and the response times to calls. We saw that some of the bedrooms had been redecorated and recarpeted and ensuite shower and toilet facilities had been installed. New furniture had been provided in some of the rooms. Some people had brought their own furniture into their rooms. All the rooms were individually decorated and furnished. Each person had a picture on their bedroom door of a object or scene of interest to them so that they could identify their own room. There were assisted bathrooms with adjustable baths and all the toilets and bathrooms were clearly labelled so that people could identify them. There was a large laundry room. Each person had a named drawer in the laundry room. The clean clothes were put into these drawers after washing so that peoples clothes could be returned to them. A relative told us that when they visited people were always in clean clothes and looked well cared for. Another relative said that their relative always had clean clothes. When we looked at the staff records we saw that staff had training about infection control and control of substances hazardous to health (COSHH). When we visited the home was clean throughout. Eight people said in their surveys that the home is always fresh and clean. Three people said that it was usually fresh and clean. One said Any problems are acted on promptly. One relative said in their survey that there was sometimes an odour. The manager said that there were occasional odours but the staff clean up quickly to eliminate them. When we visited there were no odours. Care Homes for Older People Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were supported by enough staff who were appropriately trained and qualified. People were generally protected by the recruitment practices Evidence: The manager told us that he had reviewed the staffing of the home and increased the staffing levels. He told us that there were usually ten staff in the morning, nine or ten in the afternoon and evening and five at night. There were also manager, deputy and team leader. He said that he had introduced another member of staff on the early morning shift and the evening shift as these were busy times. The rota showed that there were nine or ten staff during the day and five at night in addition to the manager, deputy and team leader. There were also cooks, housekeepers, a maintenance person and an administrator. One relative told us that there were always plenty of staff and staff were very attentive. Another relative said that there had been times when there were not enough staff but this had not occurred recently. Two relatives said that they liked the way that staff spoke to people in a friendly way. Twelve people said in their surveys that the staff listen and act on what they say. One said Always there for you. Nine people said that staff were always available when they needed them and three said that they usually were. The deputy told us that there were forty three care staff and twenty four had a Care Homes for Older People Page 23 of 29 Evidence: National Vocational Qualification (NVQ) at level 2. The staffing records confirmed this. She said that she had identified more staff to start NVQ and the company was looking for a training provider. Care Homes for Older People Page 24 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was well managed, there was a quality assurance system so that it was run in peoples best interests. Peoples health, safety and welfare were protected. Evidence: The registered manager had decided to step down and become the deputy manager. The organisation had brought in a temporary manager to manage the home. This provided continuity for people who lived in the home. A new manager had been appointed but they had not started work at the time of the inspection. The temporary manager told us in the AQAA about what the service does well in managing the home. They said:- Brought a more professional and inclusive style of management to the home supported by a large professional care home group with all its available support services. Introduced more comprehensive accounting and financial procedures. Introduced more comprehensive employment policies and procedures supported by human resources department. Ensure that the home meets Care Homes for Older People Page 25 of 29 Evidence: all aspects of health and safety regulations and maintains the welfare of its residents. Caring homes conducted a series of audits to monitor the quality of the service that was being provided. These included audits of the care plans, the petty cash, the kitchen, the environment and health and safety. Caring Homes sent questionnaires to people who live in the home and their relatives. Their views were collected and development plans were written from these. The manager told us that the findings of the questionnaires were collated and discussed at a management meeting. At the time of our inspection the plan for 2009 was being developed. The manager told us in the AQAA that they had improved the quality of meal provision and menu choice and improved the quality and variety of activities provision as a result of listening to people who live in the home. The cook told us about changes she had made to the menus following feedback from people in questionnaires and residents meetings. The people who lived in the home had dementia and related needs, which reduced their capacity to manage their own financial affairs. Finances were mainly managed by relatives. The administrator looked after small amounts of money for people. Records were kept of all transactions and these were audited. Receipts were kept. The records were signed by two members of staff when money was withdrawn. We checked one purse and it tallied with the record. We spoke to the handy man who showed us the records of the health and safety checks that he carried out and told us about the checks. There was a monthly check of each room and a record was made of any corrective action needed. The manager told us that there was a system for logging all faults on the computer so that he could follow them up and make sure that they were put right. There was a fire risk assessment. Other risk assessments were being carried out in relation to specific hazards including the use of bed rails. The records of the fire safety checks were up to date. The fire alarm was checked during one of our visits. There were records of servicing and testing including for wheelchairs, hoists, baths, electrical wiring and portable appliances. Windows were restricted, there were thermostatic valves on taps to prevent scalding and radiators were covered to reduce the risk of burns. New boilers had been installed as part of the improvements to the building. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 19 Two written references must 30/06/2009 be obtained before a new member of staff starts work. To make sure that people are cared for by staff who are suitable. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Care plans should be signed by the person concerned, or a represetative if they are unable to sign, to show that they have been involved in developing them and are in agreement with them. Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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