Care Home: Fir Villa

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What the care home does well The home provides people with a very comfortable, well maintained and homely environment and since taking over the home, the new provider has implemented a programme of refurbishment and redecoration to improve and enhance the environment. Each person has their own bedroom which they can personalise. The home has been fitted with a range of aids and adaptations to assist people with their mobility needs. People have access to a very pleasant and well maintained garden where many people have enjoyed growing vegetables. People benefit from a very stable staff team with no agency use. Staff morale was noted to be very good and people commented on the kindness of staff. Staff told us that the home was a `very happy place to work`. We noted staff interactions to be very kind and respectful. The home ensures that staffing levels are appropriate to the needs of the people living there. People told us that the staff were always available when they needed them and staff told us that they were able to spend quality time with people living at the home. The home ensure that staff have the skills and training needed to enable them to meet the needs of people using the service. Health care professionals were positive about the skills and ability of staff. NVQ training is promoted and the home already exceed the recommended 50% of staff with a minimum of an NVQ level 2 in care. It is the home`s intention to ensure that 100% of care staff have this qualification. Staff told us that they were very well supported and that they received regular supervisions. Regular meetings are held for both staff and people living at the home where their views are encouraged. People have access to a range of activities within the home. There are also provided with regular opportunities for trips out. Relatives/visitors are made welcome at the home and can visit at any reasonable time in line with the wishes of the people living there. We were able to see evidence that people are supported to exercises choice and control over their lives. The home have established very good links with health care professionals and ensure that peoples` health care needs are met. Health care professionals told us that the home liaises very well with them. Each person has a plan of care which identifies their needs. People confirmed that they received person centred care though we have made some recommendations that the home reviews its` current documentation to reflect this. People told us that they knew how to make a complaint and would feel confident in doing so. They also told us that they felt confident that their concerns would be listened to and responded to. The management arrangements at the home ensure that people benefit from a well run home which promotes an open and inclusive style of management. There are systems in place to monitor and improve on the quality of the service delivered and the home actively seek the views of people using the service, their representatives and other stakeholders. Systems are in place to reduce the risk of harm or abuse to people using the service. The home have ensured that staff have received appropriate training in the protection of vulnerable adults. Staff also have access to a range of up to date policies and procedures. The home`s health and safety procedures were found to be up to date. What has improved since the last inspection? This is not applicable as this is the home`s first inspection since the Commission approved an application for change of provider in March of this year. What the care home could do better: This was a positive inspection and no statutory requirements were raised. We highlighted some good practice recommendations which will help in improving the quality of the service delivered. Key inspection report Care homes for older people Name: Address: Fir Villa Fir Villa Camel Street Marston Magna Yeovil Somerset BA228DB     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: kathy McCluskey     Date: 0 7 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Fir Villa Fir Villa Camel Street Marston Magna Yeovil Somerset BA228DB Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Jane Alison Booth Type of registration: Number of places registered: care home 20 Marston Care Ltd Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who may be accommodated is 20. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Fir Villa is registered with the Care Quality Commission to provide personal care for up to 20 people over the age of 65 years. The home is not registered to provide nursing care nor is it registered to provide care to people who require specialised care to meet their dementia or mental health needs. Care Homes for Older People Page 4 of 31 Over 65 20 0 Brief description of the care home The Commission approved an application for Mrs Denise Reed to be registered provider in March 2009. The registered manager is Mrs Jane Booth. The home is not purpose built but has been suitably adapated to meet the needs of older people. The home promotes a homely feel and is well maintained. People have their own bedrooms which they can personalise. Stair lifts and assisted bathing facilities are available and a call bell system is installed. We were informed that current fees are between £425 and £525 per week. Additional costs include personal items, hairdressing, newspapers and chiropody. Further information about fees should be obtained from the home. 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: This unannounced key inspection was conducted over one day (6hrs) by regulation inspector Kathy McCluskey. This was the homes first inspection since the Commission approved an application for change of provider. The home submitted its Annual Quality Assurance Assessment (AQAA) and returned this to the Commission within agreed timescales. The AQAA is a self assessment which focuses on how well outcomes are being met for people using the service. It also provides us with some numerical information. Extracts from the AQAA have been included in this report as appropriate. As part of this inspection we sent surveys to a number of people using the service, staff and health care professionals to seek their views on the quality of the service provided. We received completed comment cards from 10 people using the service, 4 health care professionals and four members of staff. Comments were positive and have Care Homes for Older People Page 6 of 31 been included in this report as appropriate. The registered manager was available throughout this inspection. We were given unrestricted access to all parts of the home and all records requested for this inspection were made available to us. We were informed that, at the time of this inspection, 18 people were residing at the home and this included one person who was currently in hospital. We were able to meet with a number of people living at the home, staff and one visitor. Throughout the day we were able to observe staff interactions with people using the service. We would like to thank all those involved for their time and cooperation with the inspection process. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Care Homes for Older People Page 7 of 31 What the care home does well: The home provides people with a very comfortable, well maintained and homely environment and since taking over the home, the new provider has implemented a programme of refurbishment and redecoration to improve and enhance the environment. Each person has their own bedroom which they can personalise. The home has been fitted with a range of aids and adaptations to assist people with their mobility needs. People have access to a very pleasant and well maintained garden where many people have enjoyed growing vegetables. People benefit from a very stable staff team with no agency use. Staff morale was noted to be very good and people commented on the kindness of staff. Staff told us that the home was a very happy place to work. We noted staff interactions to be very kind and respectful. The home ensures that staffing levels are appropriate to the needs of the people living there. People told us that the staff were always available when they needed them and staff told us that they were able to spend quality time with people living at the home. The home ensure that staff have the skills and training needed to enable them to meet the needs of people using the service. Health care professionals were positive about the skills and ability of staff. NVQ training is promoted and the home already exceed the recommended 50 of staff with a minimum of an NVQ level 2 in care. It is the homes intention to ensure that 100 of care staff have this qualification. Staff told us that they were very well supported and that they received regular supervisions. Regular meetings are held for both staff and people living at the home where their views are encouraged. People have access to a range of activities within the home. There are also provided with regular opportunities for trips out. Relatives/visitors are made welcome at the home and can visit at any reasonable time in line with the wishes of the people living there. We were able to see evidence that people are supported to exercises choice and control over their lives. The home have established very good links with health care professionals and ensure that peoples health care needs are met. Health care professionals told us that the home liaises very well with them. Each person has a plan of care which identifies their needs. People confirmed that they received person centred care though we have made some recommendations that the home reviews its current documentation to reflect this. People told us that they knew how to make a complaint and would feel confident in doing so. They also told us that they felt confident that their concerns would be listened to and responded to. The management arrangements at the home ensure that people benefit from a well Care Homes for Older People Page 8 of 31 run home which promotes an open and inclusive style of management. There are systems in place to monitor and improve on the quality of the service delivered and the home actively seek the views of people using the service, their representatives and other stakeholders. Systems are in place to reduce the risk of harm or abuse to people using the service. The home have ensured that staff have received appropriate training in the protection of vulnerable adults. Staff also have access to a range of up to date policies and procedures. The homes health and safety procedures were found to be up to date. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 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. The home ensure that people who are thinking about using the service are provided with information which helps them make an informed decision about moving to the home. The home ensure that peoples needs are assessed before a placement is offered. People are provided with a contract which detiles the terms and conditions of occupancy. Evidence: The home have produced a Statement of Purpose and Service User Guide which, the homes completed AQAA tells us, has been updated since the change in ownership of the home. These documents are available in the home and are sent to people who are thinking about using the service. Care Homes for Older People Page 11 of 31 Evidence: The homes completed AQAA told us that people are encouraged to visit the home before making a decision to move there. It also told us that their representatives are also invited to visit the home. We examined three care plans at this inspection and were able to see evidence of pre-admission assessments. In order to promote a more person centred approach to care, we have recommended that the home enures that individuals and/or their representatives, are fully involved in the pre-admission assessment process as we were unable to see evidence to support this. The home need to ensure that more information is recorded as to peoples abilities and preferences. We were able to see evidence that the home had obtained assessments from health care professionals as appropriate. Ten people using the service completed comment cards for the Commission and all confirmed that they had received a contract which deteiled the terms and conditions of occupancy. We were also able to see evidence of this in the care plans examined. 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. The home ensure that people receive person centred care in line with their assessed needs and preferences. Care planning procedures should be updated to reflect this. The home ensures that peoples health care needs are met. People are treated with respect and their right to privacy is upheld. The homes procedures for the management and administration of peoples medication are generally good. Evidence: Three care plans were examined at this inspection and whilst peoples needs had been identified, we found that the homes use of generic documentation did not demonstrate that the home were able to provide a person centred approach to care. We were however able to speak with a number of people using the service and they were able to confirm that staff were aware of their preferences. We were told, the staff are very kind and they know how I like things done. We observed staff Care Homes for Older People Page 13 of 31 Evidence: interactions with people and these were noted to be very kind, professional and respectful and it was evident that staff were aware of peoples preferences. We received four completed comment cards from health care professionals and comments were very positive. They told us the home; really cares about the residents as individuals and that, the home consistently provides a very high quality person centred service to its residents. Person centred care was highlighted under the heading of what does the service do well?. Completed risk assessments were in place in the care plans examined but again, the use of generic forms did not fully reflect the risks to each individual. We were able to see evidence that people have access to a range of health care professionals. Details on each persons contact with a health care professional, including the outcome, were seen to be recorded in the plan of care. The home confirmed that they had excellent links and support from health care professionals. The home monitors peoples weights on a monthly basis so that any concerns can be highlighted. In completed comment cards, health care professionals told us that the home seek advice and act upon it to ensure peoples health care needs are met. They also made the following comments; The home are keen to work with us in meeting needs and maintaining the well being of the residents, The home works incredibly well with the adult social care team and other agencies, I am happy with the care our clients receive, In short, the home offers an excellent service. We received ten completed comment cards from people using the service. They made the following comments; They do everything well and we get wonderfully looked after, They look after me very well, This is a very happy place to live, it is my home, The staff are very kind and make me laugh, I am very happy here. People spoken with during the inspection told us that they were treated with respect and that staff respected their privacy. They told us that they could choose to lock their bedroom doors and that staff always knocked before entering their rooms. During the inspection we found staff interactions with people to be very respectful and people appeared very comfortable in the presence of all staff. We were able to meet with a visitor who told us that their relative was very well cared for and that the staff and management team were fantastic. We examined the homes procedures for the management of peoples medication. The home uses the monitored dosage system (MDS) with pre-printed medication administration records (MAR). We found medicines to be securely stored with no excess stocks. Appropriate records are maintained for all medicines received into the home and returned to the pharmacy. Care Homes for Older People Page 14 of 31 Evidence: We examined all available MAR charts and found these to be generally well completed. The home do need to ensure that the actual dose administered for medicines which have been prescribed with a variable dose, is recorded. We found that some hand written entries had not been confirmed with two staff signatures. This practice will help to reduce the risk of any errors. Care Homes for Older People Page 15 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. The home ensures that people have opportunities for social stimulation both within the home and local community. People are supported to exercise choice and control over their lives. The home ensures that visitors are welcome in line with peoples wishes and preferences. The home offers a wholesome and varied menu in line with peoples preferences. Evidence: A varied programme of activities is available and information is displayed in the home for people. We were able to see photographs of recent events at the home which included trips out, a barbecue at the home and the well attended gardening club. People were positive about the opportunities available to them. Ten people using the service completed comment cards for the Commission and in response to the question, Does the home arrange activities that you can take part in if you want, all responded Always. We were told, I think this home provides plenty of trips and activities unlike other homes. Care Homes for Older People Page 16 of 31 Evidence: The homes completed AQAA told us that All social and cultural needs are documented in the individuals plan of care. It also told us that the home maintains good links with the local community and that peoples religious needs are met. It stated, The local vicar visits regularly as does the local priest/nuns It also told us that activities and outings are always discussed at the resident forums. We were able to see evidence of this and that peoples views and ideas are sought and responded to. The home welcomes visitors at any reasonable time in line with the wishes and preferences of people using the service. To comply with fire regulations, all visitors to the home are required to sign in on arrival and when leaving the home. People told us that their visitors were always made to feel welcome and that they could choose where to spend time with their visitor. We were able to meet with one visitor during this inspection and they were very positive about home and staff. Through discussion with people using the service and staff members and by observation during the day, it was apparent that people are supported to exercise choice over their lives. We observed people moving freely around the home and we were also able to observe staff offering people choices. The homes completed AQAA stated, Fir Villa is everyones home and we provide a relaxed environment with no actual rules or regulations unless they are legislative, moral or health and safety requirements. All meals are freshly prepared and cooked at the home by designated catering staff. We were able to examine the homes four week menu and this looked wholesome and varied. We were also able to see evidence that people are able to make choices. During this inspection we were able to observe people having lunch. The majority of people chose to have their meal in the very pleasant dining room. Tables were attractively laid and seating appeared comfortable. The meal of roast pork with all the trimmings, was served by staff. The meal looked wholesome and plentiful. People told us that the food was very good, and that there was always plenty to eat. The lunch time experience appeared relaxed and unhurried. Peoples dietary preferences had been recorded in their plan of care. Care Homes for Older People Page 17 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. The homes complaints procedures ensure that people feel confident in raising concerns. Procedures are in place to ensure that people are protected from the risk of harm or abuse. Evidence: The home has an appropriate complaints procedure displayed within the home. People spoken with during this inspection told us that they would feel confident in raising concerns if they had any. They told us that they found the owner, manager and staff very approachable. People who completed comment cards for the Commission told us that they knew how to make a complaint. The home have not received any formal complaints and no concerns have been raised directly with the Commission. We were able to see that people are encouraged to express their views as required and through regular resident forums. The homes completed AQAA stated, We operate an open door policy to encourage anyone to talk freely in the knowledge that any issues will be dealt with in the appropriate manner. The home have a range of policies and procedures in place to reduce the risk of harm or abuse to people using the service. We spoke with staff and examined records and this confirmed that staff had received up to date training in the protection of Care Homes for Older People Page 18 of 31 Evidence: vulnerable adults. The home do need to ensure that they obtain an up to date copy of Somersets policy on safeguarding adults as this details the current procedures for reporting abuse. Care Homes for Older People Page 19 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. The home provides a very comfortable and homely environment for the people living there. An on-going programme of refurbishment and redecoration is in place which will ensure that standards are maintained and improved as required. The home has a range of aids and adaptations to assist people with their mobility needs. People have their own bedrooms which they can personalise. The standard of cleanliness is very good and procedures are in place to reduce the risk of the spread of infection. Evidence: During this inspection we viewed all communal areas and a number of bedrooms. We found all areas to be decorated and furnished to a very good standard and it was evident that people are encouraged to personalise their rooms. All areas promoted a comfortable and homely feel. We were able to see evidence that there is an on-going programme of routine Care Homes for Older People Page 20 of 31 Evidence: maintenance and refurbishment. The homes completed AQAA stated, Since the change in ownership, much investment has taken place to improve the fabric of the home and this is to continue. Ramps and grab rails are appropriately sited to assist people with their mobility. A call bell system is installed. Stair lifts give access to the first floor. Assisted bathing and shower facilities are available. We were informed that the home has a mobile hoist although there is nobody at the home who currently requires a hoist to transfer. We were informed that the home have a good supply of moving and handling belts. All areas of the home were free from malodours and the standard of cleanliness was noted to be very good. We were able to see that staff had access to appropriate hand washing facilities, sanitising gel and protective equipment to reduce the risk of the spread of infection Care Homes for Older People Page 21 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. Peoples needs are met by appropriate numbers of staff who have been appropriately trained. Staff morale was noted to be very good and the home ensure that staff are appropriately supported. NVQ training is actively promoted by the home. The homes procedures for staff recruitment are generally good though would benefit from further improvements. Evidence: At the time of this inspection 17 people were residing at the home, with one person currently in hospital. We were informed that minimum staffing levels consisted of 3 carers during the day/evening and 1 waking and 1 sleep-in carer at night. The registered manager informed us that she is very much hands-on and regularly covers shifts. She informed us that she works in addition to the care hours four days a week. We were also informed that staffing levels were appropriate to the dependency levels of people currently using the service and that staffing is increased where required to meet peoples needs. Care Homes for Older People Page 22 of 31 Evidence: We were able to speak with staff and they confirmed that staffing levels were safe and that they were able to meet peoples needs and also have time to spend quality time with people. This was evident during observations throughout the day. People using the service told us that staff were always available when they needed them and that they responded promptly to call bells. We were informed that the home have a stable staff team and that the home have not had to use agency staff. Staff morale was noted to be very good and we were informed that the home was a very happy place to work. The home promote NVQ training for staff and we were informed that of the 17 permanent care staff employed, 10 have a minimum of an NVQ level 2 in care. This equates to 59 which exceeds the recommended 50 of the National Minimum Standards. Records indicated that a further three care staff were working towards this award. We were able to see evidence that newly appointed staff follow an induction programme which follows the Skills for Care Common Induction Standards. The home has produced a training matrix which confirmed that all staff have received up to date mandatory training. The homes completed AQAA stated, All staff have completed certificated mandatory training in the last six months including first aid, moving and handling, food hygiene, health and safety, POVA, infection control, fire safety. It told us that training in dementia awareness is planned to take place in November of this year. Staff spoken with were positive about training opportunities available to them and all confirmed that they had received the training needed to enable them to meet the needs of people using the service. Four health care professionals completed comment cards for the Commission and these confirmed that they were confident staff had the skills needed to meet the needs of people using the service. The home is always the first we consider when looking to place somebody due to the commitment of the staff and skills they employ. We looked at the homes procedures for staff recruitment and examined recruitment files for three staff most recently employed. Recruitment files contained all required information. In one file we found that a reference was not available from the most recent employer. We were informed of the reasons for this which although acceptable, the reasons had not been formally documented. The home need to ensure that applicants are prompted to give full dates for the start and end of previous employment as this will enable the home to explore the reasons for any gaps in employment. We were able to see evidence that appropriate criminal record checks Care Homes for Older People Page 23 of 31 Evidence: (CRB) and checks against the Protection of Vulnerable Adults register had been obtained. We have recommended that the home complete a risk assessment for any staff member commencing employment on a POVAFirst pending a full CRB. This should identify the restrictions imposed on the employee during this period and the arrangements for how the individual will be supervised. This should be signed by the staff member and the home. Care Homes for Older People Page 24 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. The home have effective management procedures in place and an open and inclusive style of management is promoted. Systems are in place to seek the views of people using the service and other stakeholders on the quality of the service delivered. The home has up to date procedures in place to ensure the health and safety of persons at the home. Evidence: The registered manager Jane Booth has been in post since 2001 and remains as registered manager following the recent change in ownership of the home. The registered manager has completed the registered managers award and the NVQ level 4 in care. She is also an NVQ assessor and moving and handling trainer. The homes completed AQAA stated that, the registered manager is supported on a Care Homes for Older People Page 25 of 31 Evidence: daily basis by the owner/responsible individual who has extensive experience in the care sector and running of a home. It also stated that, the manager receives good support from a suitably qualified deputy manager and head of care. The AQAA also told us that the manager and owners have an open approach which encourage discussion and resolves issues. Staff and people using the service were very positive about the management of the home. The home has systems in place to monitor and improve the quality of the service delivered. Quality questionnaires are made available to people using the service, visitors and health care professionals to seek their views on the quality of the service provided. We were able to see a number of completed comment cards from the homes first survey since the change in ownership. Comments were noted to be very positive. Regular forums are held for people using the service with the registered manager and provider in attendance. We were able to view the minutes of recent meetings and it was apparent that people are encouraged to express their views on a range of topics and of life at the home. These meetings are also used to ensure that people are provided with up to date information about health and safety matters and of how to make a complaint. People spoken with told us that they found the meetings useful. We were also able to see evidence that staff are provided with opportunities for regular staff meetings. The home ensure that staff receive formal supervision at least six times a year. Documented evidence was seen in the staff recruitment files examined and was also confirmed by staff spoken with. The home assists people to manage small amounts of pocket money where required or requested. We examined records and found these to be well maintained with systems in place to ensure that they are regularly audited. Individual records are in place and receipts are obtained for all transactions. To further protect people using the service we have recommended that the home obtains two staff signatures to confirm all transactions. We examined the homes procedures for health and safety and found these to be up to date. These included fire safety, electrical safety, equipment servicing, accidents, and mandatory training for staff. We were able to see that systems were in place to ensure that these were appropriately updated. We have recommended that the home record the content of staff fire training. Care Homes for Older People Page 26 of 31 Evidence: We found the premises to be well maintained and free from unnecessary hazards. We have recommended that the home check all free standing wardrobes and secure to the wall as necessary so as to reduce the risk to people using the service. Care Homes for Older People Page 27 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 28 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 1 3 The home should ensure that pre-admission assessments contain more information about peoples abilities and preferences and that individuals and/or their representatives are involved in the assessment process. Risk assessments should be individualised so that they clearly identify the level of risk for each individual. The home should ensure that care plans reflect the person centred care delivered. The use of generic care planning documentation should be reviewed. To reduce the risk of errors, the home should ensure that hand transcribed entries on medication administration records are confirmed with two staff signatures. Where variable dose medication is prescribed, the home should ensure that the actual dose administered is recorded. The home need to ensure that people applying for employment identify their last or most recent employer as a referee. Where this is not possible, reasons should be documented. 2 3 7 7 4 9 5 9 6 29 Care Homes for Older People Page 29 of 31 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 7 29 To further protect people using the service, the home should complete risk assessments for staff who commence employment on a POVAFirst pending a full CRB. This should include the restrictions imposed on the individual during this period and should also identify the arrangements for ensuring the individual is supervised at all times. This should be signed by the home and the employee. The home should ensure that applicants are prompted to provide full start and end dates of previous employment on the application for employment as this will enable the home to explore any gaps in employment. To further protect people using the service, the home should ensure that two staff signatures are obtained to confirm all financial transactions for people the home are assisting to manage their pocket money. The home should record the content (subjects covered) relating to fire safety training for staff. 8 29 9 35 10 38 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). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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