Care Home: Ford Place Nursing Home

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What the care home does well There was a good admission process. People thinking of moving into the home, and their families, were given good information to help them to make a decision. Everyone who completed a survey indicated that they received enough information. New people were assessed to ensure that Ford Place could provide the right service to meet their needs. Residents who returned surveys and those we spoke to said they were looked after very well. One wrote, "The staff are always willing to help you in any way possible." We found that the health care in the home was good, including end of life care. A visiting professional commented that they had received good feedback from residents and their families about the care at Ford Place.Ford Place Nursing HomeDS0000067712.V377119.R01.S.docVersion 5.2Staff encouraged people to make whatever choices they could about their daily lives. The routines in the home were very flexible and revolved around the people who lived there. A resident wrote, "They make every effort to make it as much a home from home as possible." Residents had a choice of group activities and there was time set aside to spend with residents who preferred one to one time with staff. There was open visiting, which meant that people could see their families and friends at times that were convenient to all. Visitors said that they were made to feel welcome. The lunchtime meal on the day of our visit was a relaxing and social occasion. Residents said they liked the meals. One commented, "It`s very nice food and we get a choice." The service had a clear complaints procedure, which was available to residents and visitors. The manager responded well to any complaints and took action to prevent incidents happening again. Ford Place provided residents with a high standard of accommodation. The building was well maintained. It was clean and fresh smelling and residents told us that it was always like that. Several people commented that they liked their rooms, which they were able to personalise. The manager made sure that new staff all had background checks before they started working at the home. This was to make sure that they were suitable to work with residents. Staff had training to help them to understand the needs of the residents and to protect their health and safety. Over half of the care staff held an NVQ, which is a nationally recognised qualification in health and social care. The home had a competent and qualified manager. There were good management systems in place to ensure that the home was run safely and in the best interests of the people who lived there. What has improved since the last inspection? Following a requirement at the last inspection, all residents had a nutritional assessment and care plans were in place for anyone who may be at risk of poor nutrition. At the last visit we also made a recommendation to make improvements to care plans. At this inspection the care plans were more detailed and told staff exactly what care the person needed and how they preferred to be helped. The way medicines were managed was more organised and provided safeguards for residents. The manager carried out regular checks to make sure that the good practice continued. There had been improvements in the level and choice of activities available to residents. Most people who returned surveys said that there was usually enough activities to suit them.Ford Place Nursing HomeDS0000067712.V377119.R01.S.docVersion 5.2 What the care home could do better: Although the standard of care plans had improved, we made a requirement that they must be reviewed regularly. This would help to ensure that the directions for staff were always accurate and up to date. Key inspection report CARE HOMES FOR OLDER PEOPLE Ford Place Nursing Home Ford Street Thetford Norfolk IP24 2EP Lead Inspector Jane Craig Key Unannounced Inspection 12th August 2009 09:30 DS0000067712.V377119.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Ford Place Nursing Home DS0000067712.V377119.R01.S.doc Version 5.2 Page 2 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 Ford Place Nursing Home DS0000067712.V377119.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ford Place Nursing Home Address Ford Street Thetford Norfolk IP24 2EP Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01842 755002 01842 750964 www.barchester.com Barchester Healthcare Homes Ltd Mrs Denise Hubbard Care Home 49 Category(ies) of Old age, not falling within any other category registration, with number (49), Physical disability (49) of places Ford Place Nursing Home DS0000067712.V377119.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th September 2008 Brief Description of the Service: Ford Place is a 49 bedded nursing home caring for older people. The home, originally a family mansion, was refurbished in 1997 and an extension was added in 1999 with a further extension in 2005 It is situated in the market town of Thetford and is a short walk from shops and other local amenities. The gardens are a positive feature of this home, with landscaped views over the lawns and river, (which runs along the rear boundary of the property). There is a car park at the front of the home with easy access from the road. The older part of the building is on two floors and is accessed by a small shaft lift. Information about the home, including the latest inspection report, is available from the manager. In August 2009 the fees ranged from £441.00 to £750.00 per week. There were extra charges for chiropody, hairdressing, personal toiletries and personal newspapers. Ford Place Nursing Home DS0000067712.V377119.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means that people who use the service experience good quality outcomes. The last key inspection on this service was completed on 11th September 2008. This key (main) inspection includes information gathered since the last inspection and an unannounced visit to the home. The visit was carried out on 12th August by one regulatory inspector. At the time of the visit there were 43 residents in the home. We met with a few of them and asked about their views of Ford Place. We spent time observing daily routines in the home and how staff interacted with residents. Four residents were case tracked. This meant that we looked at their care plans and other records and talked to staff about their care needs. We talked to the registered manager and two other members of the staff team. We looked around the home and viewed a number of documents and records. As part of the key inspection surveys were sent out to residents, relatives, staff and visiting professionals. Their responses have been taken into account when making judgements about the service. This report also includes information from the annual quality assurance assessment (AQAA), which is a selfassessment report that the manager has to fill in and send to the Commission every year. What the service does well: There was a good admission process. People thinking of moving into the home, and their families, were given good information to help them to make a decision. Everyone who completed a survey indicated that they received enough information. New people were assessed to ensure that Ford Place could provide the right service to meet their needs. Residents who returned surveys and those we spoke to said they were looked after very well. One wrote, “The staff are always willing to help you in any way possible.” We found that the health care in the home was good, including end of life care. A visiting professional commented that they had received good feedback from residents and their families about the care at Ford Place. Ford Place Nursing Home DS0000067712.V377119.R01.S.doc Version 5.2 Page 6 Staff encouraged people to make whatever choices they could about their daily lives. The routines in the home were very flexible and revolved around the people who lived there. A resident wrote, “They make every effort to make it as much a home from home as possible.” Residents had a choice of group activities and there was time set aside to spend with residents who preferred one to one time with staff. There was open visiting, which meant that people could see their families and friends at times that were convenient to all. Visitors said that they were made to feel welcome. The lunchtime meal on the day of our visit was a relaxing and social occasion. Residents said they liked the meals. One commented, “It’s very nice food and we get a choice.” The service had a clear complaints procedure, which was available to residents and visitors. The manager responded well to any complaints and took action to prevent incidents happening again. Ford Place provided residents with a high standard of accommodation. The building was well maintained. It was clean and fresh smelling and residents told us that it was always like that. Several people commented that they liked their rooms, which they were able to personalise. The manager made sure that new staff all had background checks before they started working at the home. This was to make sure that they were suitable to work with residents. Staff had training to help them to understand the needs of the residents and to protect their health and safety. Over half of the care staff held an NVQ, which is a nationally recognised qualification in health and social care. The home had a competent and qualified manager. There were good management systems in place to ensure that the home was run safely and in the best interests of the people who lived there. What has improved since the last inspection? Following a requirement at the last inspection, all residents had a nutritional assessment and care plans were in place for anyone who may be at risk of poor nutrition. At the last visit we also made a recommendation to make improvements to care plans. At this inspection the care plans were more detailed and told staff exactly what care the person needed and how they preferred to be helped. The way medicines were managed was more organised and provided safeguards for residents. The manager carried out regular checks to make sure that the good practice continued. There had been improvements in the level and choice of activities available to residents. Most people who returned surveys said that there was usually enough activities to suit them. Ford Place Nursing Home DS0000067712.V377119.R01.S.doc Version 5.2 Page 7 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. Ford Place Nursing Home DS0000067712.V377119.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ford Place Nursing Home DS0000067712.V377119.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was a thorough admission process, which helped to ensure that the home was suitable to meet the needs of the people who moved in. EVIDENCE: Residents who completed surveys all indicated that they received sufficient information about the home to help them to make a decision about moving in. There was an ‘evidence’ folder available in the entrance hall which contained various pieces of information about the home, including resident and relative survey results. The welcome pack in each bedroom provided clear and uncomplicated information about the service and facilities people could expect at Ford Place. Ford Place Nursing Home DS0000067712.V377119.R01.S.doc Version 5.2 Page 10 Anyone who was thinking of moving into the home was assessed by the manager to make sure that their needs were understood and could be met. The assessments we saw showed that prospective residents, or their families, were involved in this process. This helped to make sure that issues that were important to them would be taken into account. Visiting professionals indicated that the assessment arrangements ensured that accurate information was gathered and the right service was planned for people coming into the home. The home had a four places set aside for people who needed intermediate care. People admitted via this pathway were identified by the hospital staff. The manager did not formally assess these prospective residents but she was consulted about who was to be admitted and had the final decision as to whether or not the home would be suitable. Due to the small numbers, it was not practical to have a separate unit, therefore intermediate residents used the same facilities as residents who received long term care. We were told that this did not create any difficulties for either group of people. The manager had regular meetings with the multi disciplinary team to ensure that the care pathways for intermediate residents were understood and followed. The annual quality assurance assessment (AQQA) told us that the home received good feedback from people who had received intermediate care. Ford Place Nursing Home DS0000067712.V377119.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was a clear care planning system in place, which provided staff with the information they needed to meet peoples needs. EVIDENCE: Since the last inspection, several staff had received training in person centred care and care planning. As a consequence we found care plans were written in a more individualised way. Although the standard varied slightly, we saw some good examples of plans that incorporated the resident’s preferences and wishes in all areas of daily living. A number of plans also encouraged staff to help residents to maintain their independence and dignity. However, daily progress notes were not as person centred and tended to focus on physical care and daily tasks, which could hinder the evaluation process. Ford Place Nursing Home DS0000067712.V377119.R01.S.doc Version 5.2 Page 12 Not all plans and associated records were reviewed every month. There were no evaluation notes to show the residents progress towards meeting their goals or summarise the care given. The amount of detail on care plans about residents’ preferences and choices indicated that they were consulted about their wishes. Some residents had a care profile review, which they, or their family, signed to show agreement with their care. A recent audit of care documents had highlighted the lack of evaluation and the disparity in the standard of plans. Further training and supervision was planned to address the issues and bring all plans up to a high standard. Residents had a set of assessments to monitor risks to their health, for example, from falls, pressure sores or poor nutrition. With one exception, there were plans in place to reduce the identified risks but the standard varied. For example, a moving and handling plan had not been changed when the resident’s needs had temporarily increased. Plans to minimise the risk of pressure sores did not always include the equipment to be used. We saw a good example of a wound care assessment and plan. Residents who completed surveys indicated that they received the care and medical support they needed. One commented, “They care for me very well,” Those we spoke to on the day of the visit were pleased with the care they received. One said, “What is good is the way they look after you.” Visiting professionals indicated that residents’ health and social care needs were usually monitored, reviewed and met at the home. Records showed that residents were referred to other professionals where necessary and advice was incorporated into daily care. Senior staff had monthly discussions with the dietician if they had concerns about a resident’s nutrition. Care plans were in place to support residents with health related needs. We saw a good example of a plan to support an ongoing health need, which also included directions for psychological support and emergency aid. There were a small number of residents who had mild cognitive impairment, their plans gave an insightful description of needs but were generally lacking in interventions for support. The annual quality assurance assessment (AQAA) told us that the service provided good end of life care. The comments from a visiting professional confirmed this and an independent assessment carried out by the Liverpool Care Pathway had identified some areas of good practice. The manager taught and worked with staff to help them to understand the psychological and emotional aspects of end of life care, as well as the physical care. Ford Place Nursing Home DS0000067712.V377119.R01.S.doc Version 5.2 Page 13 At the time of our visit none of the residents administered their own medication. The manager told us that people who received intermediate care were encouraged to do so, especially if they planned to manage their own medication when they returned home. Medicines were administered by registered nurses who had received refresher training and had their competency assessed. There were weekly audits of medication and staff did a daily check of controlled drugs. Medicines were administered from locked cabinets in individual bedrooms. Central storage for other stock was safe and kept at the appropriate temperature. There were safe systems for ordering medication. There were complete records of medicines received and disposed of. Medicines not in the monitored dose system were usually dated on opening, which helped to complete the audit trail. We looked at a small sample of medicines and found that the amount in stock matched the records, which indicated that residents were receiving their medication as it was prescribed. Appropriate codes were used to show why medicines were omitted. Handwritten MAR charts were signed and witnessed to reduce the risk of transcribing errors. However, some staff used medical abbreviations, which were not on the medication labels and could be confusing to staff who were not familiar with the terms. Some medicines were prescribed with a variable dose but staff did not always record what dose they had administered. This meant that staff would not always know what medication had been administered or evaluate how effective the dose was. Controlled drugs were stored safely and records of administration were complete. Ford Place Nursing Home DS0000067712.V377119.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Daily routines and meals suited the majority of people living at the home. Improvements in the level of activities meant that more people were being assisted to meet their social and recreational needs. EVIDENCE: Assessments and care plans recorded residents’ social interests, past and current. The standard of plans varied, some were quite specific about the resident’s preferences for activities but plans did not generally provide directions for staff about what support the person needed to pursue their individual interests. The home employed two activity co-ordinators. There was a varied and imaginative activity programme, which showed there was a group activity every day. One to one time for residents who did not like, or were not able, to join groups was also built in to the programme. There were also shopping trips Ford Place Nursing Home DS0000067712.V377119.R01.S.doc Version 5.2 Page 15 for people who were able to go out. Most residents who returned surveys indicated that there were usually activities they could join but one person commented that this was an area where the home could do better. The AQAA acknowledged that residents’ ongoing frailty meant that more people needed one to one time and this was being addressed. Relatives who completed surveys indicated that they were kept up to date with important issues affecting their relative’s care. We heard the manager reassuring a relative that there were no restrictions and they were welcome to visit whenever they wanted. The open visiting arrangement was convenient and helped people to be able to stay in touch. One visitor told us they enjoyed coming to the home, it was such a lovely place. The manager was working towards the home being run in a person centred way and as such the routines in the home were flexible. A resident who completed a survey commented, “They make every effort to make it as much as a home from home as possible.” Throughout the course of our visit we observed residents being given choices about aspects of their day and care. One resident told us that although she preferred to stay in bed staff still asked her just in case she changed her mind. Staff said, “We give people choices about everything but they usually have their own routines.” One also wrote, “We always respect what the residents would prefer to do on a daily basis, their choice is very important to our daily performance.” We observed the lunchtime meal being served. The meal looked hot and appetising. People were given a choice at each course. Staff who assisted in the dining room were skilled at supporting people without being intrusive. In general the mealtime experience was a pleasant and relaxed occasion. A number of people chose to have their lunch in their rooms and there were sufficient staff available to assist if necessary. The majority of residents who returned surveys indicated that they usually liked the meals. A resident also told us, “I had cottage pie for lunch, it was lovely.” The manager told us that meals and mealtimes were being reviewed, with the aim of creating ‘fine dining’. A new, restaurant trained, chef had been appointed. The menus were under review, with residents having input via their regular meetings and through general feedback. Ford Place Nursing Home DS0000067712.V377119.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and visitors could be confident that their concerns would be listened to and acted upon. Procedures and training were in place to help to ensure that residents were safeguarded. EVIDENCE: A clear complaints procedure was on display in various areas of the home and each person received a copy in their welcome pack. There was also a suggestions box in the hall, which enabled residents or visitors to make, either positive or negative comments without going through the formal procedure. Residents who returned surveys indicated that they had someone to speak to if they were not happy with the service and they knew how to make a complaint. Staff said they knew what to do if anyone had concerns about the home and relatives and visiting professionals indicated that the service always responded appropriately if they raised concerns. The manager told us that she discussed the content of complaints within staff meetings, and used the issues as a learning exercise. The AQAA told us there had been five complaints in the last year. All had been investigated and responded to within the timescales stated in the policy. They had all been upheld or partially upheld and action taken to prevent the Ford Place Nursing Home DS0000067712.V377119.R01.S.doc Version 5.2 Page 17 situation happening again. On looking at the records of complaints, we noted that within four of the complaint letters, there were complimentary comments about the staff team and the general care. Staff received training in safeguarding adults and had regular refresher training. They also had the company procedure and the Norfolk Social Services procedure available for reference purposes. Staff we spoke to said they would be able to recognise if a resident was the victim of abuse. One said they had reported suspicions in the past and would definitely do the same again. Some staff had received training about the Mental Capacity Act and more was planned for September. This helped to ensure that staff were clear about how the legislation may impact on their practice. The manager said she had referred a resident, who was in conflict with their family, to an independent advocacy service. Ford Place Nursing Home DS0000067712.V377119.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a high standard of accommodation. EVIDENCE: From looking round the home we could see that the environment was well maintained and in a good state of repair. Safety measures, such as low surface temperature radiators, were in place. The communal areas were decorated and furnished to an excellent standard. There were flowers, books and other finishing touches, which made them comfortable and homely. Residents had a choice of lounges, whether they wished to watch TV, listen to music or be in a quiet environment. There was a 60s room, which had been furnished in that period as a project. The manager told us it was popular with the residents and had been kept like that. Ford Place Nursing Home DS0000067712.V377119.R01.S.doc Version 5.2 Page 19 The dining room could not accommodate all residents in one sitting but there was a second room that could be used. As a large number of residents chose to eat in their rooms, this was not currently needed. The manager told us that she changed the environment around from time to time to fit in with the needs of the residents that were accommodated. The bedrooms were also of a good standard. Most residents had brought in small items of furniture, ornaments and pictures to personalise their rooms. One resident told us, Its a very nice room, I am more than happy with it. Another said, It is comfortable and I have everything I need. There were five shared rooms. The manager told us that people only shared if they were agreeable and their pre-admission assessment took into consideration whether they would be compatible with their prospective roommate. At the time of the inspection the home was clean and free from unpleasant odours. Most of the people who returned surveys indicated it was always like that and a resident commented. I have never been in such a clean place. Staff had received infection control training and there was written guidance for them to refer to. A member of staff confirmed that they definitely followed the correct procedures to keep residents and themselves safe. Ford Place Nursing Home DS0000067712.V377119.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were protected by the recruitment practices and there were sufficient, appropriately trained staff to meet their needs. EVIDENCE: Residents who completed surveys had mixed views about whether staff were available when they needed them. Most indicated that they usually were but two people said only sometimes. One resident we spoke with said that staff sometimes took a long time to answer the buzzer. Most staff who sent in surveys indicated they thought there were usually enough staff and one we spoke to said, “If everyone shows up there are enough.” The staffing rosters showed that the planned staffing numbers gave a satisfactory ratio of staff to residents. However, there were times when the numbers fell short because of unplanned absences. The manager talked about the systems she had put into place to monitor and reduce sickness and absence. We had no concerns during the course of the visit that residents’ needs were not being met due to lack of staff. There was a clear recruitment procedure, and staff were recruited with regard to equal opportunities guidance. We looked at the files of two recently appointed staff. All the required pre-employment checks were carried out to Ford Place Nursing Home DS0000067712.V377119.R01.S.doc Version 5.2 Page 21 make sure that staff were suitable to work with residents. Their files were complete and contained all the relevant documents and information. All the staff who returned surveys indicated that they had pre-employment checks before they started work at the home. There was a system in place for checking and ensuring that nursing staff remained registered with the Nursing and Midwifery Council. We talked to the training manager who told us that Barchester, and Ford Place in particular, had a strong commitment to staff training. New staff went through an induction programme that covered the common induction standards. The programme included taught subjects and e-learning. Staff were mentored throughout and their practice was assessed to ensure that they had the appropriate skills to meet residents’ needs. Staff surveys indicated that the induction training covered everything very well. The training report for the home showed that training was well planned and implemented. In addition to the mandatory topics, staff had opportunities to attend in-house and external training in a wide range of subjects relevant to the resident group. Nurses had extra training to help them to meet the requirements of their registration and to keep them up to date with current good practice. Staff who returned surveys indicated that they always received relevant training. Most surveys from relatives and visiting professionals indicated that they thought that the manager and staff usually had the skills and experience to support residents’ needs. The AQAA showed that over 50 of the care staff held an NVQ at level 2 or above. Ford Place Nursing Home DS0000067712.V377119.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and staff benefited from a safe and well managed home. EVIDENCE: Ford Place is owned by Barchester, who also own a number of other services across the country. The company has a clear management structure, providing support and supervision to their registered managers. The manager has several years experience in managing the home. She is a registered nurse and she also holds a relevant management qualification. From reading the AQAA and talking to the manager it was evident that she is committed to providing a good quality service and has clear plans for future development. For example, she told us she wants to move completely to person centred care as oppose to Ford Place Nursing Home DS0000067712.V377119.R01.S.doc Version 5.2 Page 23 task driven care. Staff who completed surveys indicated that they received regular support from their line manager. A member of staff told us, “It is a well run home and a nice place to work.” There were a range of methods in place to monitor the quality of the service. The results of the annual satisfaction survey were discussed with staff, residents and relatives during meetings. The action plan to address issues for improvement had been completed. There were a number of internal audits of procedures and practices. The manager tried to involve staff in the audits to help them to understand the process and the reasons for change and development. Staff received regular supervision and appraisals to ensure continuing good practice. Information from each source of quality monitoring fed into the development plan for the service. The manager did not act as agent or appointee and did not hold any money on behalf of residents. There was a comprehensive health and safety policy. Key health and safety policies and procedures were summarised in the staff handbook for reference purposes. The service had an independent health and safety audit earlier this year. The audit had concluded that most areas were satisfactory and the manager told us that the recommendations for improvements to the kitchen records had been carried out. Staff had received fire safety training and been involved in practice drills. There was a clear procedure to follow in the event of a fire. Fire alarms were tested regularly and other fire safety equipment had been serviced. The AQAA told us that maintenance and servicing of other installations and equipment was up to date. Ford Place Nursing Home DS0000067712.V377119.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Ford Place Nursing Home DS0000067712.V377119.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Care plans and risk assessments must be reviewed regularly to ensure that staff have accurate and up to date information to refer to. Timescale for action 30/09/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP9 Good Practice Recommendations Daily progress notes should be more person centred to provide an overview of the resident’s individual daily care. Variable dose medication should be recorded to ensure staff have a complete audit trail and can evaluate the effectiveness of the dose. Ford Place Nursing Home DS0000067712.V377119.R01.S.doc Version 5.2 Page 26 Care Quality Commission East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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