Care Home: Forest Place Nursing Home

Similar services:

• Claremont House
• Coopers Mill Ltd
• Sun Court Nursing Home
• Bramley Avenue (73)
• Paradise Lodge
• Grangewood
• Upaya Ananda
• 15 Bramble Close

What the care home does well The service is currently offering a wide range of activities for the people using the service and had sought additional information, training and advise from NAPA (National Association For Providers of Activities For Older People). There is a regular and varied activity programme. This is displayed on notice boards and in a folder in the Activity Room. Activity staff have undertaken training offered by NAPA and receive regular support from NAPA. Forest Place offers a warm friendly environment where residents feel relaxed and at home. As part of the inspection process we conducted a Short Frame Observational Inspection (SOFI). The SOFI took place over an hour and a half and involved directly observing a number of identified people using the service and recording every five minutes their experiences of using the service. The persons experiences were recorded by identifying their state of being, any engagement they received or had and with what or who and the level of staff interaction. Five people were identified as part of this SOFI. The SOFI took place in an open plan living area where a number of people were sitting. The SOFI showed a high level of positive staff engagement and showed that many of the people using the service were able to enjoy engaging with one another also. Results also determined that those people who were observed for the specified period of time generally experienced a positive state of well being. Staff were directly observed to interact well with those people being observed, with dignity and respect for the individuals. The SOFI tool is able to show how people using the service experience the services provided. It is able to show how person centred a care worker may be whilst engaging with a person. On a number of occasions positive manual handling practices were observed to occur behind a curtained room divider, further respecting and dignifying people. The service offers a nutritional, well balanced menu, meeting the needs of the people using the service. People using the service are able to make active choices over the foods they are consuming. A sample of the food available was tasted. It was well displayed with a good consistency and taste. People were directly observed to be enjoying the food available. One person using the service stated "the food is lovely". The meals are balanced and nutritious and cater for the varying cultural and dietary needs of individuals. The service uses a system called NUTMEG. This ensures that the menu`s are nutritionally balanced for all people and can be adapted if some one has a specific need, whilst maintaining the nutritional values. NETMEG is used by ensuring that all meals provide specific nutritional values for people. If a person has a specific dietary requirements the use of NUTMEG enables the menu for that person to be adapted without loosing any nutritional value. The staff working at the service were directly observed engaging with all people in a respectful and dignified manor. Many people commented on the staff. One person using the service stated "the staff are all so lovely, kind and caring". What has improved since the last inspection? A number of improvements have been made to the service since the last inspection and this includes the updating of the Statement of Purpose and Service Users Guide. The assessment process has been reviewed and some of the paper work updated. The service has introduced an "All About Me" document which strives to adopt a person centred approach and care plan for all people. The AQAA tells us that improvements have been made to the risk assessment and care planning process. This was evident throughout the inspection of the service. A rolling programme of renewal and redecoration is in place. A number of individual bedrooms have been re painted including some communal room carpets and paintwork within communal areas refreshed. During the inspection a number of maintenance jobs were being completed to improve the environment for the people using the service. The service has implemented the NUTMEG principles in relation to nutritional values for the meals served at the service. Feedback received from the people using the service was positive. One person stated "the food is lovely here". The service has further expanded on the resources available for activities and has increased the level of activity being provided at the service. Positive feedback was received from a number of people regarding the provision of activity within the service. Staff at the service have also received training in dementia care needs. This enables staff to further support people using the service with specialist skills and training that they have received. What the care home could do better: The service must ensure that specialist equipment is readily available to all people using the service in such numbers that they are not affected and have to wait unacceptable lengths of time to receive support. Staff must receive suitable supervision on a regular basis to ensure that they are fully supported, monitored and offer further development within their roles. All staff should complete the Skills for Care Induction Programme. The service should also consider whether the doors to the sluice rooms require locking and consider implementing the use of memory box`s throughout the service where people would benefit from this. Key inspection report Care homes for older people Name: Address: Forest Place Nursing Home Roebuck Lane Buckhurst Hill Essex IG9 5QL     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: Louise Bushell     Date: 1 3 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 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 32 Information about the care home Name of care home: Address: Forest Place Nursing Home Roebuck Lane Buckhurst Hill Essex IG9 5QL 02085052063 02085590193 admin@forestplacenursinghome.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Martlane Limited care home 90 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability physical disability terminally ill Additional conditions: One named person, under the age of 65 years, who requires care by reason of a learning disability Persons of either sex, aged 50 years and over, who require nursing care by reason of a physical disability (not to exceed 5 persons) Persons of either sex, aged 50 years and over, who require nursing care by reason of a terminal illness (not to exceed 5 persons) Persons of either sex, aged 50 years and over, who require nursing care by reason of dementia (not to exceed 5 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 90 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of dementia (not to exceed 60 persons) The total number of service users accommodated in the home must not exceed 90 Care Homes for Older People Page 4 of 32 5 1 5 5 Over 65 60 0 90 0 persons Date of last inspection Brief description of the care home Forest place is registered to provide nursing care for 90 older people who need nursing care due to physical illness or dementia. This home is a three-storey building with a large extension at the rear of the property. All rooms are single some with en-suite facilities. The home has its own gardens to the side and rear and car parking for visitors. The local shops are a mile away as is the railway station and London transport underground services. A statement of purpose and service user guide is available from the manager. The service user guide advises that the current fees at Forest Place range between £550 and £700 per week, inclusive of personal and nursing care, food and laundry services. Items not included in the fees and that attract additional charges included hairdressing, dry-cleaning, toiletries, newspapers and magazines. 2 3 0 2 2 0 0 9 Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of the inspections undertaken by the Care Quality is based upon outcomes for the people who use the service and their views of the service provided. The primary method of inspection used was case tracking which involved selecting a number of people and tracking the care they received through looking at their care records, discussion where possible with the people who use the service, the care staff and observation of care practices. The last key inspection took place on the 23rd February 2009. The visit was unannounced and planning for the visit included assessment of the notifications of significant events, which had been received from the service to the Care Quality Commission. We looked at the last Inspection Report and information on safeguarding and complaints since the last inspection. We also looked at the Annual Quality Assurance Care Homes for Older People Page 6 of 32 Assessment (AQAA) and reviewed what the service has improved in the last twelve months and its plans for the next twelve months. The AQAA is a legal document which the care service has to complete on an annual basis. During the visit information was gathered directly from the staff, people who use the service and relatives and or visitors to the service. The visit took place between 9:30am and 16:45pm. This enabled the inspector to directly and indirectly observe the care practices and the day to day operations of the service. A selected tour of the building was conducted during which the inspector spoke with people who use the service, staff and visitors and the manager. Part of the inspection process invloved a Short Frame Observation Inspection (SOFI). The SOFI is a tool we can use to observed people using the service every five minutes. The aim of the observation is to observe the experiences of the individuals. The findings from the SOFI were fed back to the manager of the service at the end of the inspection. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? A number of improvements have been made to the service since the last inspection and this includes the updating of the Statement of Purpose and Service Users Guide. Care Homes for Older People Page 8 of 32 The assessment process has been reviewed and some of the paper work updated. The service has introduced an All About Me document which strives to adopt a person centred approach and care plan for all people. The AQAA tells us that improvements have been made to the risk assessment and care planning process. This was evident throughout the inspection of the service. A rolling programme of renewal and redecoration is in place. A number of individual bedrooms have been re painted including some communal room carpets and paintwork within communal areas refreshed. During the inspection a number of maintenance jobs were being completed to improve the environment for the people using the service. The service has implemented the NUTMEG principles in relation to nutritional values for the meals served at the service. Feedback received from the people using the service was positive. One person stated the food is lovely here. The service has further expanded on the resources available for activities and has increased the level of activity being provided at the service. Positive feedback was received from a number of people regarding the provision of activity within the service. Staff at the service have also received training in dementia care needs. This enables staff to further support people using the service with specialist skills and training that they have received. 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 32 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 32 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. People using the service can be assured that their individual needs will be meet and recorded for all staff to access how they prefer to receive their support. Evidence: A Statement of Purpose has been developed, which sets out the aims and objectives of the service, and includes a guide, which provides basic information about the service and the specialist care the service offers. The Statement of Purpose had recently been reviewed and reflected the up to information regarding the service. The guide details what the prospective individuals can expect and gives a clear account of the specialist services provided, quality of the accommodation, qualifications and experience of staff and how to make a complaint. All people are given a copy of the guide. When requested the service can provide a copy of the Statement of Purpose and guide in a format which will meet the capacity of each person. Admissions are not made to the service until a full needs assessment has been Care Homes for Older People Page 11 of 32 Evidence: undertaken. A skilled and trained person always completes the assessment prior to admission to the service. The assessment explored areas of diversity including preferences, religious and cultural needs, involvement from family, partners and advocates, race and disability. It was evident that the service strives to seek the information and assessment through care management arrangements, prior to admission. During the inspection we reviewed three care plans and three separate assessment documents to ensure that a full needs assessment had been completed prior to admission. The service uses a standardised pro forma for the assessment called Standex. The assessment explores each individuals areas of need. Of the three assessments reviewed al of them were completed in full. Good examples were seen where people had completed the assessment in a person centred way, gaining information in relation to each persons preferences. For example one person preferred to receive personal care support from a female care worker and this was identified in the assessment and the care plan. In addition to the Standex assessment in place the service has further developed the information gathering process in order to ensure that the outcomes for people using the service are positive. A document called All About Me, is now in place for people using the service. It was directly observed that this document had been completed with the individual and their family, friends or representatives where possible. The document is a person centred working tool, ensuring hat the specific needs of an individual have been explored in order to offer care and support in a person centred way meeting peoples wishes and preferences. The AQAA tells us that Forest Place has a well planned process for assisting prospective residents and their families to make an informed choice in terms of placement. This entails providing them with concise, up to date and accurate information in brochure format, a familiarisation visit with a tour of the home, inspection of available rooms, a meet and greet with staff and refreshments are offered. Following this a comprehensive assessment is undertaken to determine care needs and any perceived gaps in provision. This is followed wherever possible by a trial visit. The service has the capacity to support individuals who use the service and respond to diverse needs that may have been identified during the assessment process. A total of nine comment cards were received from people who use the service, all determined that they had enough information to make informed choices about the service. One person commented all the staff are nice and friendly, I like it here. During the inspection we spent time with any relatives that were willing to talk to us. One relative commented we had plenty of information when my X moved in. We have Care Homes for Older People Page 12 of 32 Evidence: a service users guide also in X room which is quite helpful. Care Homes for Older People Page 13 of 32 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. People using the service can feel assured that their health care needs and medical needs will be met by the staff working at the service. Evidence: A total of three care plans were case tracked fully, it was established that people who use the service receive personal and healthcare support using a person centred approach. Personal healthcare needs including specialist health, nursing and dietary requirements are clearly recorded in each persons care plan. The service uses a standardised care planning process called Standex. The care plan is devised using the information and details gathered from the All About Me document and the assessment. In addition to the care plan the service completes a number of assessments as a tool to ensure that the specific nursing and safety needs of the people using the service are monitored and met at all times. This includes a dependency rating scale which is completed monthly to review a persons over all level of dependency. A nutritional risk assessment is completed and reviewed monthly to ensure that a person who may be at risk of associated nutritional risks, including pressure sores are monitored and reviewed at regular intervals. Where a person has Care Homes for Older People Page 14 of 32 Evidence: developed a pressure sore or who has been admitted to the service with a pressure sore, additional risk assessments and monitoring occurs. A wound assessment is in place where required, this details the information needed for all people caring for the wound and includes a plan of action for monitoring, dressing, reviewing and progress. The service also refers all pressure sores to the Primary care Trust Tissue Viability Nurse for further assessment and advise. This was seen as good practice and evidence that the service works well with other professionals in the best interest of the individual using the service. People using the service have access to healthcare and remedial services. The health care needs of people unable to leave the service are managed by visits from local health care services. Clear evidence was seen in the care plans of specialist health care support services visiting the service and in addition to the care plan there were detailed notes made by the specialist visiting the service for example the Tissue Viability Nurse and General Practitioners. A number of comments were received directly from people that use the service, their relatives and friends. One person commented that, I feel very well cared for here. A number of comments have been received that have determined that the care is provided to meet the needs of the people who use the service. One relative commented that I went through my Xs care plan and assessment with my X and the RGN (Registered General Nurse) when X moved in, so we are aware of it all. The service has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. Medication records are fully completed, contain required entries, and are signed by appropriate staff. The management of controlled drugs is effective with records being accurate and stock balances being correct. A total of three peoples medication was case tracked in order to ensure compliance. Fridge and room temperatures were being recorded in all the medication rooms. Ordering and returns documentation was up to date and accurate. The service works with individuals regarding any refusal to take medication. The people using the service are given the support they need to manage their medication. If individuals prefer or where they lack capacity, care staff can manage medication on their behalf. A service contract is in place for the disposal of medications. The service has a good record of compliance with the receipt, administration, safekeeping, and disposal of controlled drugs. Staff have completed and passed an appropriate medication course. An assessment has been carried out to ensure each member of staff is competent to handle, record and administer medication properly. On the day of the inspection it was directly observed that people who use the service Care Homes for Older People Page 15 of 32 Evidence: were being supported and provided with specialist treatment in their own rooms and in private. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be assured that they rare provided with an extensive and diverse range of meaningful activities and social opportunities. Evidence: People who use the service have the opportunity to develop and maintain important personal and family relationships. Feedback from relatives determined that they are able and welcomed to visit the service. One person commented I am always made welcome. A number of people that use the service have stated that the staff practices promote individual rights and choice, but also consider the protection of individuals in supporting them to make informed choices. One person commented they always look after me very well and treat me like a person. In addition to this another person using the service commented the carers are all happy and take good care of me. They have nice food and drink. Nice atmosphere. The service respects the human rights of people using the service with fairness, equality, dignity, respect and autonomy underpinning the care and support being provided. The AQAA tells us that the commitment of Forest Place to meet Equality and Diversity needs of the residents, relatives, staff and other stakeholders is contained within the Service users Guide for the home. The document is available at Care Homes for Older People Page 17 of 32 Evidence: reception and in each residents bedroom. Before offering a placement at Forest Place, an initial assessment is undertaken to ascertain the equality and diversity needs of the prospective resident. The assessment form has been updated to ensure all needs are recorded. A judgement by the assessor is made as to whether or not these needs can be met appropriately. The activities programme reflects the diverse needs of residents, with targeted activities for residents with physical, sensory and mental impairments. The commitment of Forest Place to equality and diversity within the staff group is clearly stated in the staff handbook, a copy of which is given to all staff on appointment and kept in the personnel file in the main office. This document has been undated in 2009 and all staff were issued with the new updated version. As part of the inspection process we conducted a Short Frame Observational Inspection (SOFI). The SOFI took place over an hour and a half and involved directly observing a number of identified people using the service and recording every five minutes their experiences of using the service. The persons experiences were recorded by identifying their state of being, any engagement they received or had and with what or who and the level of staff interaction. Five people were identified as part of this SOFI. The SOFI took place in an open plan living area where a number of people were sitting. The SOFI showed a high level of positive staff engagement and showed that many of the people using the service were able to enjoy engaging with one another also. Results also determined that those people who were observed for the specified period of time generally experienced a positive state of well being. Staff were directly observed to interact well with those people being observed, with dignity and respect for the individuals. On a number of occasions manual handling practices were observed to occur behind a curtained room divider. The staff team help with communication skills, both within the service and in the community, to enable residents to fully participate in daily living activities. Residents are involved in meaningful daytime activities of their own choice and according to their individual interests, diverse needs and capabilities. They have been fully involved in the planning of their lifestyle and quality of life. Where appropriate, education and occupational opportunities are encouraged, supported and promoted. Other support may be offered in the service by a skilled and trained team. The AQAA tells us that facilities are made available for key events and festivals to be celebrated on the premises, either privately or communally, to encompass birthdays (recent 100th birthday) , anniversaries, Christmas and other religious festivals. While completing this form a relative came into the office to offer the services of the choir at her church to come and sing carols in December. The activities co-ordinator spoke to her and a date was arranged. The relative said that they would like to support residents at this time of the year and add to the programme of events. Also stated Care Homes for Older People Page 18 of 32 Evidence: that felt that the home cares for her relative very well. We have 4 activity coordinators (2 part time and 2 full time). There is a regular and varied activity programme. This is displayed on notice boards and in a folder in the Activity Room. Activity staff have undertaken training offered by NAPA (National Association For Providers of Activities For Older People) and receive regular support from NAPA. Forest Place offers a warm friendly environment where residents feel at home. There have been 6 external outings for different residents this year (includes seaside, nature reserve, pub lunch, theatre shows, limousine ride). The service offers a nutritional, well balanced menu, meeting the needs of the people using the service. People using the service are able to make active choices over the foods they are consuming. A sample of the food available was tasted. It was well displayed with a good consistency and taste. People were directly observed to be enjoying the food available. One person using the service stated the food is lovely. It includes a variety of dishes that encourage individuals to try new and sometimes unfamiliar food. The meals are balanced and nutritious and cater for the varying cultural and dietary needs of individuals. A sample of menus were seen. As already noted the service uses a system called NUTMEG. This ensures that the menus are nutritionally balanced for all people and can be adapted if some one has a specific need, whilst maintaining the nutritional values. The AQAA tells us that as a company we have also had intensive training from Dr B S-M. This training and the new Nutmeg system ensures that are standards within the kitchen are high , meals provided are nutritional and residents get choice and a high standard of cooking. The consultant visited the home week commencing 2nd November 2009 to ensure that the new management system is being operated at the required standard. Care staff are sensitive to the needs of those residents who find it difficult to eat and give assistance as required. They are aware of the importance of offering support at the pace of the individual, making them feel comfortable and unhurried. Direct observations occurred during the lunch time meal. The atmosphere was jolly, with people talking to one another and engaging with staff on an equal basis. People were offered protective aprons if they wished, but where they choose not to wear an apron this was insisted upon. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be assured that their complaints and concerns are listened to and that staff are able suitably trained in safeguarding issues in order to protect them. Evidence: The service has an open culture that allows all people to express their views and concerns in a safe and understanding environment. People who use the service have commented that they are happy with the service provided, feel safe and well cared for. A number of comments received determined that people who use the service and relatives and friends are aware of what to do if they have any concerns. The manager provided us with a recent letter sent to all people using the service and their representatives, relatives or friends informing them of the revised complaints procedures and process to follow if they had any concerns. A relative commented I do feel my complaints are listened to and always acted upon. The AQAA tells us that the manager treats complaints seriously and looks to respond and resolve quickly. Complaints are recorded in a book in the managers office. The book in reception is checked on a regular basis. Verbal and written letters sent to the manager are recorded and dealt with appropriately. If the complaint is verbal and complainant does not wish it to be recorded the manager always investigates and responds to the complainant. We support residents, staff and relatives to make a complaint. The complaint is dealt with professionally. All staff Care Homes for Older People Page 20 of 32 Evidence: receive training in Safeguarding of Vulnerable Adults. Recorded on training matrix and personal file. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Staff commented that they have received training in safeguarding and felt confident in reporting any issues as they occurred. Staff had a clear understanding of whislte blowing and when the use of this policy may be put into practice. The service understands the procedures for safeguarding adults and attends meetings or provides information to external agencies when requested. Training of staff in safeguarding is regularly arranged by the Service. Care Homes for Older People Page 21 of 32 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. People using the service are able to reside in a safe, maintained homely environment. Evidence: The service provides a physical environment that is appropriate to the specific needs of the people who live there. The service is a pleasant, safe place to live the bedrooms and communal rooms providing a personal homely feel. The layout of the building enables people to move freely with several different seating areas throughout to encourage socialising or enabling the person to have privacy. Forest Place is set in large attractive grounds and some individual rooms have views over the gardens. Accommodation is offered over three floors accessed by shaft lift. The newer unit, Nightingale, is divided into two wings, Maple and Beech, and there are a number of lounges and dining rooms. This unit was well maintained and decorated and many individual bedrooms were spacious and personalised. During the inspection a number of rooms were observed and were seen to be well equipped with furniture and were personalised with pictures and memorabilia. One relative commented we really like this room, it is much better for my X now, very homely and clean. Kingfisher is divided into two units or four areas based on the different colours of the corridors. Since the last inspection the service has made improvements to the decoration of the old part of the building and introduced more signage for those people with dementia. Care Homes for Older People Page 22 of 32 Evidence: The AQAA tell us that the home has benefited from some refurbishment this year. Some rooms have been redecorated, updated nursing station on ground floor, new floor and carpets in some areas of the home. Kitchen area updated to reflect recommendation from consultant when implementing Nutmeg system. Many rooms have en-suite facilities. We do not have a manual book to record maintenance issues this goes on the computer to head office. We can track the progress on the computer. The computer log is updated by the housekeeper. If a bedroom becomes available it is completely re-decorated regardless of when redecorated previously. During the summer months the gardens were kept tidy and lawns mowed on a regular basis. The people who use the service appear like the changes and were settled and relaxed. One person using the service commented its nice. The people who use the service are encouraged to personalise their bedrooms. All the services fixtures and fittings meet the needs of individuals and can be changed if their needs change. The dining rooms are laid out to encourage communal dinning with a calm relaxed atmosphere. The environment promotes the privacy, dignity and autonomy of residents. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in private. In general the people who use the service say that they like the decoration and that there is a nice garden to relax in. The garden has been adapted with time spent making separate seating areas and areas of interest for all the people who use the service. The service has a sound infection control policy. The manager of the service has identified works throughout the forthcoming twelve months that will be completed. The AQAA tells us that over the last twelve months that they have updated the pictures on corridor walls to be more reflective of the residents. Put in bed side lights where resident has requested. Residents rooms have been refreshed. The front entrance has been made more attractive with potted plants. The service is clean, well lit and in general smells fresh. There was an infection control policy in place and in discussion with the staff and observation of care practice demonstrated that the infection control practices were being followed. There was restricted access to high risk areas such as the main kitchen and the laundry areas to reduce the risk of cross infection. It was noted that the sluice doors were not locked. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can feel assured that the staff supporting them are available in fully inducted and trained in order to meet their needs at all times. Evidence: The people spoken with and from information gathered from a number of surveys determines that they have confidence in the staff who care for them. Rotas were seen and displayed adequate staffing numbers on duty to meet the needs of the people using the service. Specific attention was given to the busier periods of the day. A deputy manager was usually on shift and supernumerary to the care staff. This enable the service to ensure that numbers were maintained for the safety of all and that record keeping was completed and monitored as required. During the inspection it was observed that staff were available in adequate numbers to meet the current needs of the people living at the service. One person using the service stated the staff are always nice and friendly, they are great. Staff members are offered the opportunity to undertake external qualifications beyond the basic requirements. Forest Place provides a range of in house training every week on a Tuesday. The training is provided by a qualified trainer working for Abbey Total Care Group. Records show that a high number of staff have attended training in Dementia, health and safety, safeguarding of adults, infection control, moving and handling, fire awareness, food hygiene, first aid, slips, trips and falls as well as Care Homes for Older People Page 24 of 32 Evidence: equality and diversity. A number of staff have also completed a course in deprivation of liberty and safeguards. The managers encourage and enable this and recognise the benefits of a skilled, trained workforce. One staff member commented they provide up to date training for the staff and serve as a learning place especially in health related courses. The AQAA tells us that we provide places for three nurses on the Overseas Nursing Programme, working with the City University to support and assess their programme. The manager feels that three staff on this programme is the correct ratio for the home and will benefit the staff, residents etc. A high level of staff have completed or are on the NVQ programme. The core management team is stable. The off-duty rota is flexible to the needs of staff and residents. Due consideration is given to staff from overseas that wish to take extended holidays back to their home country. Accurate job descriptions and specifications clearly define the roles and responsibilities of staff. People who use the service report that staff working with them are very skilled in their role and are consistently able to meet their needs. One staff member commented Forest Place is a well balanced environment for both staff and residents. The AQAA further tells us that staff have or are being offered training on the Person Centred Care approach. We are training staff to focus on the positives, give respect to the past and see each resident as unique. The company in-house trainer ensures that every staff member who attends a training session has understood the content of the training and is able to put into practice knowledge and skills learnt. In December 2009 the company are employing an additional training officer to concentrate on Person Centred Care which will help with continuity of care within the home and company. Her role will be to ensure care plans are of a high standard and to train staff in this aspect of their work. There is a good recruitment procedure that clearly defines the process to be followed. This procedure is followed in practice with the service recognising the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. A total of five staff files were audited. Four files were seen to contain all the required documentation. One file did not contain two references. This was discussed with the manager of the service. It was established that the reference had been sent to the referee, however not returned. The manager was informed and agreed to take remedial action. Four individual staff commented on the strong team culture of the service and felt that Care Homes for Older People Page 25 of 32 Evidence: following recent recruitment that there are enough staff on duty to meet the needs of the people who use the service. Staff recruited confirmed that the service was clear about what was involved at all stages and was robust in following its procedure. There are clear contingency plans for cover for vacancies and sickness and no use of agency staff. Staff receive training and induction once recruited. The induction programme is designed around the needs of Forest Place and is signed off at each stage of the process. Discussions occurred with the manager regarding the Skills For Care Induction Programme. The manager sated that they are starting to use these for the care staff. Staff confirmed that the senior team provide supervision, however records showed that formal supervision was not occurring at regular intervals. The manager of the service had also identified on the Annual Quality Assurance Assessment, that the supervisions had improved. Records show that some staff had not received regular supervision. Staff meetings take place regularly. Notes and action points are taken of meetings and sessions, and progress is regularly reviewing. The mix of staff is suitable to meet the cultural needs and mix of people that use the service. The AQAA tells us that Before offering employment at Forest Place, language skills, and ability to communicate with residents is ascertain to ensure they will be able to work effectively within the environment and role. Evidence of this was seen during the inspection process. Staff reported that they felt supported in their roles and that they were to discuss issues with a member of the senior team if required. One staff member commented the manager is very hands on and we can always talk to them if there are any issues. Care Homes for Older People Page 26 of 32 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. People using the service can be assured that the management is effective and well organised to ensure the smooth running of the service, improving outcomes and experiences for individuals at all times. Evidence: The Registered Manager has the required qualifications and experience and is competent to run the service. The Registered Manager and deputy manager have a clear understanding of the key principles and focus of the service, based on organisational values and priorities. They work to continuously improve services. With the introduction of the new person centred care planning format and training around its completion and implementation within the service, there is a focus on person centred thinking, with the people who use the service becoming increasingly more involved. The Registered Manager and deputy manager lead and support a stable staff team Care Homes for Older People Page 27 of 32 Evidence: who have been recruited and trained to satisfactory levels. The manager promotes equal opportunities, has good people skills and understands the importance of person centred care and effective outcomes for people who use the service. The AQAA tells us that the service does well and provides a safe environment that aides each residents quality of life. All staff are helpful, friendly, professional and well trained. Prospective residents are greeted and supported in a professional and welcoming way. Relatives are made welcome and supported. Activities programme is varied. Administration and head office support is very good and supports the smooth running of the home. The service has sound policies and procedures, which are corporately and internally reviewed and updated, in line with current thinking and practice. The manager ensures staff follow the policies and procedures of the home. The staff team are positive in translating policy into practice and showed good knowledge of care principles, health and safety and safeguarding issues. One person using the service commented I feel safe here as the staff are very attentive and trained. All of the surveys returned from staff determined that they are always provided with enough information in order to support the people using the service. The staff also confirmed that they are provided with adequate support and guidance, that there are enough staff to meet individual needs and that they know what to do if some one has concerns about the service. There was some evidence on staff records that staff have supervision but this is not always carried out on a regular basis where staff have the opportunity to discuss their personal development. Other staff confirmed that supervision does occur. Staff meetings take place and minutes of the meetings are available on each area. The service works to a clear health and safety policy. Safeguarding is given high priority and the service provides a range of policies and guidance to underpin good practice. Recent in house training has occurred regarding safeguarding issues. Staff confirmed that this was productive and showed a sound working knowledge of action to take in such an event. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 22 23 The service must ensure that commodes and hoists are available in suitable numbers. To ensure that the individuals needs of the people using the service can be met as required with out delay. 01/04/2010 2 29 19 The registered manager must ensure that all staff working at the service have fully completed recruitment checks made and that these are held on file. To ensure that the people using the service are kept safe and protected. 26/02/2010 3 36 18 The registered manager must ensure that staff working at the service are supervised on a regular basis. 31/03/2010 Care Homes for Older People Page 30 of 32 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 To ensure that they are supported, guided and monitored at regular intervals. 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 2 3 19 26 27 The service should consider the use of memory boxs. The service should assess whether the sluice doors require a lock. Care staff should complete the Skills For Care Induction Programme. Care Homes for Older People Page 31 of 32 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!