Care Home: Foxholes Nursing Home

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What the care home does well The relative of one person living in Foxholes told us; "The home provides all round generally good care" People living in Foxholes told us that one of the key areas of strength is the staff team; "Staff are helpful" and "Very kind staff who listen" were some typical comments. Staff themselves told us that Foxholes; "Meets the needs of the service users in every way it can and provides a homely atmosphere". When we spoke to people living in the home, to care staff and to visitors and as we observed the routines of the home during these inspection visits we were told about and saw for ourselves good care interactions between staff and people living in the home and a warm and homely care environment. What has improved since the last inspection? "I enjoy coming to work now, before I used to dread it" was a striking comment made by one member of staff that we spoke to that is typical of very many indicators that suggest Foxholes has significantly moved on in the period since the last inspection in March 2009. One health care professional we consulted told us; "Significant improvement since recent new manager" and this reflects the findings of this report, which has recognised the impact of the new management team throughout the home, with improved care planning documentation, improved medication administration and the beginning of changes in several areas of the home`s routines and organisation. What the care home could do better: People who live in Foxholes told us in answer to the question; "What could the home do better?, "More activities, greater variety of meals", "Have more staff working at weekends", "The meals could be improved". One health care professional told us that ;"Some of the staff need better training". The current activity programme effectively runs for only weekdays and it is questionable if care or nursing staff have the time available to consistently provide meaningful activities as well as carrying out their main caring duties. In guidance issued by the CQC it says; "It must be possible for a service to be excellent. In other words the expectation is not for perfect services but for particularly good services, well managed, with a sustained track record of high performance"... " Where areas for improvement emerge the service recognises and manages them well" Whilst we have acknowledged in this report several areas of progress since the last inspection, the new rating is a result of the `rules based approach` of the CQC which attempts in an open and transparent way to show how we arrive at our judgements and ratings for care services. The significant improvement in the management and administration outcome area and other improvements in key outcome areas has resulted in the current rating. There is no cause for complacency and there remain areas of the home`s operation that require further improvement and the maintenance of improvements already made if the new rating is to be sustained. Key inspection report Care homes for older people Name: Address: Foxholes Nursing Home Pirton Road Hitchin Hertfordshire SG5 2EN     The quality rating for this care home is:   three star excellent 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: Jeffrey Orange     Date: 0 3 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 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 30 Information about the care home Name of care home: Address: Foxholes Nursing Home Pirton Road Hitchin Hertfordshire SG5 2EN 01462459899 01462458956 care@foxholesnh.freeserve.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Foxholes Nursing Home Limited Name of registered manager (if applicable) Mrs Jill Shepherd Type of registration: Number of places registered: care home 37 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: This home may accommodate 37 older people who have physical disability and require nursing care. This home may accommodate 37 older people who need post-operative and respite nursing care. This home may accommodate 7 older people who require personal care. This home may accommodate 7 older people with physical disability who require personal care. Date of last inspection Brief description of the care home Foxholes is a privately owned care home providing nursing care and accommodation for 37 older people. The home is situated on the outskirts of Hitchin and is set in 18 Care Homes for Older People Page 4 of 30 Over 65 37 37 0 0 2 4 0 3 2 0 0 9 Brief description of the care home acres of landscaped gardens with far reaching views over the countryside. Accommodation is provided on the ground floor, first and second floors in bedrooms of varying style and size. There are both assisted and non-assisted bathrooms on the upper floors with a shower facility on the ground floor. The home has large central halls on each floor where service users can sit. The main sitting areas are on the ground floor where there is a linked lounge, conservatory and dining area. The majority of the homes bedrooms are single accommodation and 6 are with en-suite facilities. There is a passenger lift provided and the home has well maintained gardens, which are accessible to all service users. The home is currently in the early stages of a significant development programme which may lead to temporary reductions in capacity as the work progresses. Details of the development plans are available in the home. Current charges are from £550 to £650 for residential care and £650 to £750 for nursing care. Charges for hairdressing, personal toiletries and chiropody are additional. A copy of the most recent inspection report can be found in the reception area, the home has a service users guide which includes contact details for the Care Quality Commission (CQC). Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place over the course of two days, the first of which was spent with the registered manager discussing progress and developments in the home since her appointment in May 2009 and looking at associated care records including a detailed inspection of the homes medication administration and monitoring records. The second day provided further opportunities to talk to people living in the home, visitors and to care and nursing staff. We also looked at care plans, recruitment records and staff supervision and training records as well as having the opportunity to discuss development plans for the home with the proprietor and director of Foxholes. This inspection draws on any information received about Foxholes since the last key inspection in March 2009. This could be from health and social care professionals associated with the home, people who live in Foxholes or those responsible for them. We also receive routine notifications from the home about significant events affecting Care Homes for Older People Page 6 of 30 the people who live there. We have also received a significant number of surveys returned to us by or on behalf of people who live in Foxholes, from health care professionals associated with the home and from care staff. This report also makes use of the information provided to us by the home in their Annual Quality Assurance Assessment or AQAA. The AQAA is a self-assessment document that assesses how well care outcomes are being achieved for people living in Foxholes. It also includes some useful statistical information, for example about complaints and staff training. This inspection was carried out by one inspector, where this report refers to we it recognises that it is written on behalf of the Care Quality Commission. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: People who live in Foxholes told us in answer to the question; What could the home do better?, More activities, greater variety of meals, Have more staff working at weekends, The meals could be improved. One health care professional told us that ;Some of the staff need better training. The current activity programme effectively runs for only weekdays and it is questionable if care or nursing staff have the time available to consistently provide meaningful activities as well as carrying out their main caring duties. In guidance issued by the CQC it says; It must be possible for a service to be excellent. In other words the expectation is not for perfect services but for particularly good services, well managed, with a sustained track record of high performance... Where areas for improvement emerge the service recognises and manages them well Whilst we have acknowledged in this report several areas of progress since the last inspection, the new rating is a result of the rules based approach of the CQC which attempts in an open and transparent way to show how we arrive at our judgements and ratings for care services. The significant improvement in the management and administration outcome area and other improvements in key outcome areas has resulted in the current rating. There is no cause for complacency and there remain areas of the homes operation that require further improvement and the maintenance of improvements already made if the new rating is to be sustained. Care Homes for Older People Page 8 of 30 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 30 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 30 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 considering Foxholes as a home for themselves or someone they are responsible for can be confident that they will only be admitted once a thorough assessment of their needs has been carried out and it has been established that those needs can be met. The assessment process will include opportunities for them to visit the home. Evidence: When we spoke to people living in the home and/or to their relatives, they confirmed that they had been able to visit the home before admission if they had chosen to, in order to see if it would be somewhere they felt that they or their relative would be happy and their care needs met. When we asked people living in the home Did you receive enough information to help you decide if this home was the right place for you, before you moved in? 70 said that they had and 30 that they did not. Care Homes for Older People Page 11 of 30 Evidence: When we asked Have you been given written information about the homes terms and conditions (sometimes called a contract) 30 said that they had, 60 that they had not and 10 did not know. When we looked at the pre-admission documentation for some of those people who had most recently been admitted to the home we found that a full needs assessment had been completed by a senior member of staff and that the process of assessment included the person concerned and their family or representative as appropriate. We saw a comprehensive guidance document for care staff covering all aspects of the admission of a service user to the home. This was detailed and included good practice in terms of equality and diversity and making the transition as easy as possible for the person coming into the home, for example; We emphasize that it is very important for the service user to feel at home when they arrive so we always ask the family to come in a few days early with their personal possessions and clothes and to make the room look as familiar as possible. We are very flexible with the furniture and can adjust the room to suit their taste. In their AQAA, the home give details of the various pieces of literature that are prepared for people considering Foxholes as a home for themselves or someone they are responsible for. These include a brochure, statement of purpose and service users guide and also a contract with terms and conditions, although as above we have found that the individual living in the home does not always have or remember having those specific documents. The level of satisfaction with the care received expressed to us in surveys or when we spoke to people living in the home suggests that staff have the skills, ability and qualifications to meet the care needs of people in line with the assessment made prior to their admission. In their AQAA the home set out how they determine specific needs arising from the ethnic, cultural or personal backgrounds of people considering Foxholes as their home. We were able to talk to the families of people living in the home from diverse ethnic backgrounds who were involved in ensuring their relatives needs were being met appropriately, for example in the provision of food prepared in line with their specific requirements. Care Homes for Older People Page 12 of 30 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 who live in Foxholes can be confident that their care needs will be accurately identified and met and that there is a robust and effective sytem in place for the monitoring and administration of medication where they require assistance with this. They can also be confident that they will be treated with dignity and respect. Evidence: When we asked people who live in Foxholes if the home makes sure that they get the medical support they need 54 said they always did, 38 that they usually did and 8 that they sometimes did. When we asked do you receive the care and support you need? 62 said that they always do, 30 that they usually do and 8 that they sometimes do. In their AQAA the home explained that; On admission we complete a social assessment to establish interests and preferred lifestyle. This is particularly important for those with dementia as it helps us to understand the person and may lead to reasons for certain behaviour patterns. A care plan is then drawn up. Care Homes for Older People Page 13 of 30 Evidence: When we looked at care plans for people who had recently been admitted into Foxholes or who we had case-tracked during the inspection, we found that the care plan format that was beginning to be introduced at the time of the last inspection is now used throughout. The homes AQAA tells us that they intend to; continue to improve upon our care plans. We saw detailed information provided to care staff responsible for drawing up, updating and entering information routinely onto care plans that sets out clearly what information must be included and where in the care plan it must be recorded. This, together with care plan training, evidence of which was seen, has led to a significant improvement in the standard of care plan documentation since the last inspection and means that people receiving care can be confident that their changing needs are being identified and recorded and that the way care is provided will reflect the changes. Care plans include details of the wishes of people around the end of their lives where they have been prepared to provide these and the manager told us that specialist palliative care training is to be provided to care staff to build expertise and understanding of this important and sensitive area of care. When we looked at care plans we found good evidence that people who live in Foxholes have appropriate access to healthcare services in the home and community. When we looked at records for the administration of medication we found a very much improved standard since the last inspection. We saw records of enhanced medication training, monitoring and stock control. The manager recognises that there is still further room for improvement. The CQC were notified of one medication error in September and a copy of the homes medication audit was seen for the 01.09.2009 which was comprehensive and thorough and detailed action staff should take to address any areas of actual or potential weakness identified. The manager told us that attempts had been made to build a better relationship with both the homes pharmacy and G.P. practice with mixed success. This relationship building is to be encouraged as it directly benefits the healthcare experience of people who live in the home. When we asked people who live in Foxholes if the staff listened to them and acted on what they said 15 said that they always did, 62 that they usually did, 15 that Care Homes for Older People Page 14 of 30 Evidence: they sometimes did and 8 that they never did. Comments received included; Excellent attention to medical needs, The standard of care is good Not satisfied with my dental care, Medication is given regularly and Very kind staff who listen. Throughout the inspection as we observed the care and social routines of the home we always saw care staff treat people living in the home with consideration, patience and respect. One healthcare professional associated with the home told us; Significant improvement since recent new manager Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Foxholes can be confident that they will be able to take part in meaningful activities on weekdays and that the home will increasingly offer them choices as to when and what they eat throughout the day. They can be assured that visitors will be made welcome and that they will be actively encouraged to maintain important family and social relationships. Evidence: When we asked people who live in Foxholes;Does the home arrange activities that you can take part in if you want? 46 said that they always did, 24 that they usually did, 15 that they sometimes did and 15 that they never did. When we spoke to the activities organiser they told us that as well as a daily programme of events each weekday between 10 am and 4 pm, there are various regular special activities like entertainers from outside the home such as Old Time Musicals, Pat the dog and trips out of the home, for example for pub lunches, picnics and shopping trips. The regular programme includes daily armchair exercises and quizzes, together with craft like making lavender bags and pickling onions. The people living in Foxholes have Care Homes for Older People Page 16 of 30 Evidence: been able to make use of the extensive grounds and facilities that have been created for them to grow their own vegetables. The activities organiser told us that in addition to communal activities, they provide one to one sessions, particularly for anyone who prefers to remain in their own rooms. These activities include hand massage and scrabble. The home are members of a recognised national organisation that promotes best practice in activities for care providers. The activities organiser has undertaken a six month course in the provision of activities in a care setting and told us that they were increasingly making use of this in the development of the homes activity programme. When we looked at the records and care plan sections associated particularly with activities we found that since the last inspection these have been greatly improved and now include a very good standard of information to help inform an individual approach to activity. We looked at the personal life story of one person living in the home and found that it was detailed and informative. We were told that this process can only be as good as the information that is obtained by the home from the people living there and their families and that sometimes information is not always provided. In their AQAA the home told us that on admission they complete a social assessment to try and establish interests and preferred lifestyle. We saw minutes of residents meetings held in March, June and October which included comments about activities and food. In the surveys returned to us, when we asked people living in Foxholes Do you like the meals in the home? 24 said that they always did, 7 that they usually did, 62 that they sometimes did and 7 that they never did. We were told that there have been changes in catering arrangements at the home, with more flexibility and choice being introduced. This was described to us as being work in progress and it was acknowledged that there was still some way to go. One very positive development was the ability of people living in the home to grow some of their own food and to be able to watch its progress from seed to table. We tasted the lunchtime meal on the day of the inspection which was well presented and appeared to be nutritious. Care plans seen included a nutritional assessment Care Homes for Older People Page 17 of 30 Evidence: completed on admission, with weights of people living in Foxholes being recorded monthly. We met several people visiting the home and they confirmed that they were always made to feel welcome and that there were no unreasonable restrictions on times of visiting. Some of the comments received from people living in Foxholes when asked what does the home do well? were; Meals, Food is good Visits from the activities organiser. Some of the comments made when asked What could the home do better were; The meals could be improved more activities, e.g. music and one to one. Greater variety of meals Talk to me about international affairs, the economy, scientific matters Care Homes for Older People Page 18 of 30 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 who live in Foxholes can be confident that care staff have the training they require to enable them to recognise abuse if it seen and what action they should take in order to protect them. Although there is a complaints policy and procedure in place, people do not always appear to be aware of it and may not be able to voice their concerns formally as a result. Evidence: When we spoke to the manager they told us that the next phase of staff training in the Hertfordshire Safeguarding policy and process was booked for December 2009 and January 2010. Staff training records seen included details of safeguarding of vulnerable adults training that had been completd by staff. The manager informed us that there had already been some training on the Mental Capacity Act and the Deprivation of Liberty Safeguards and that more thorough and detailed training was being sourced. We found that complaints are being more fully recorded which is important as it enables the manager to identify trends and patterns of complaints. When we asked people living in Foxholes if there was someone they could speak to informally if they were not happy, 85 said that there was, whilst 15 said that there was not. Care Homes for Older People Page 19 of 30 Evidence: When we asked them if they knew how to make a formal complaint, 46 said that they did, with 54 saying that they did not. When we looked at the homes service user guide we saw that it includes details of how to make a complaint and the homes complaints policy and procedure is on display in the home which should mean that anyone who wants to make a complaint is able to find out how to do so, however from survey responses made to us this does not always appear to be the case. Complaints records have improved since the last inspection and now include more realistic recorded numbers for complaints than was the case previously. In their AQAA the home told us that they had received 4 complaints in the last 12 months, 50 of which were resolved within 28 days and of which one was upheld with another awaiting information from an external agency before it can be determined. Care Homes for Older People Page 20 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Taking into account the work that has now begun on the enlargement of the home, people who live in Foxholes benefit from a safe, comfortable and reasonably well maintained and decorated environment, with particularly good outdoor provision for activities and relaxation. Evidence: When we asked people who live in Foxholes if the home is fresh and clean, 46 said that it always is, 46& that it usually is and 8 that it sometimes is. One comment received in a survey simply said; Its clean. On the days we visited the home as part of this inspection we found that domestic staff were in evidence and there was no significant problems with odour or lack of cleanliness. We found that the tidiness and attention to hygiene of storage was much improved since our last report. This helps prevent people living in the home acquiring infections because of poor storage and hygiene. The communal areas of the home are effectively set out and include reminiscence areas to help in the care of those people who are living with dementia. The outside communal grounds have been further developed and now offer a significant facility for people living in the home to enjoy the gardens, grow vegetables Care Homes for Older People Page 21 of 30 Evidence: and generally benefit from being outdoors. Internally there are some bedrooms that need redecoration, however it is recognised that comprehensive refurbishment is due to take place as part of the planned extension of the home, some work for which has already begun. We were given a project plan for the refurbishment and this included a good range of risk assessment and comprehensive details of how the projected build was to be managed safely and with the minimum disruption to the people living in Foxholes. When we saw individual bedrooms, with the permission of the people concerned, we found that they were able to personalise their rooms to reflect their own taste, interests and personality. A new ramp has been installed to improve access to the building for people using wheelchairs or with impaired mobility. The home has recently been judged as 4 star following an environmental health inspection. Care Homes for Older People Page 22 of 30 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 living in Foxholes receive care from a well-trained staff team, who have been subject to a thorough recruitment process and who are well- supported through team meetings and supervision. Evidence: When we looked at the recruitment records for the most recently recruited care staff we found that the required checks to prevent the employment of unsuitable people to provide care to people living in the home are undertaken and are supported by a good standard of recording and administration of the recruitment process. When we looked at training records we found that nursing and care staff receive the basic training they need to build and maintain the essential care skills they need. One of the health care professionals contacted told us; Some care staff need better training and in their AQAA the home assessed that as part of their plans for improvement over the next 12 months they would; Improve the availability and choice of training available. They also indicated that they planned to concentrate on achieving increased skill levels in palliative care, which would benefit those people living in Foxholes who may be approaching the end of their life. In their AQAA the home told us that out of the then 15 permanent care workers, all Care Homes for Older People Page 23 of 30 Evidence: had completed the required induction training and 12 had already achieved NVQ 2 in care. When we considered the match of care staff to people living in the home we found that where possible consideration had been given to building a workforce that reflected the diversity of the people living in the home. This has enabled the home to provide, for example, Punjabi speaking staff to a Punjabi speaking service user. When we asked people living in Foxholes if staff were available when they needed them, 15 said that they always were, 54 that they usually were and 31 that they sometimes were. One comment received suggested that people living in the home would benefit from additional staff being available at the week-end. Comments made to us included; The majority of staff are patient with the residents, I would like to be helped, everyday to try and walk better, so I am more mobile, Very kind staff who listen, Staff are helpful When we spoke to staff they confirmed that regular supervision takes place and this was confirmed by records seen. Without exception all staff who we spoke to or who returned surveys to us were positive about the changes and improvements they had seen in the home since the new manager was appointed. The manager is beautiful, Huge difference, Lots of changes, lots of training We saw minutes of staff meetings and also detailed instructions and guidance issued to staff in their handbook and through specific guidance on, for example completing care plans and the administration of medication. Care Homes for Older People Page 24 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living and working in Foxholes benefit from it being well managed. Evidence: The AQAA was exceptionally well completed. It was thorough and detailed and gave a realistic appraisal of where the service had improved and where it could still improve further. There was a remarkable degree of consensus that the recently registered manager had achieved significant success in most if not all of the areas of operation of the home under her control. As one health care professional said; Significant improvement since recent new manager and one staff member told us; I enjoy coming to work now, before I used to dread it. The manager has been registered as a fit person to manage a care service by the CQC. The report on that process included an assessment that the manager was highly qualified and experienced and that she demonstrated an impressive knowledge of Care Homes for Older People Page 25 of 30 Evidence: current care issues and best practice. We were given evidence of the recent quality assurance monitoring exercise carried out by the home and importantly the action plan that the home drew up in response to information received from stakeholders. This demonstrates a determination to make changes where they are needed in order to improve the care outcomes experienced by people living in Foxholes. In the homes AQAA the manager informs us that; The medication system has been improved through staff training, discussions with the Pharmacist and GP and frequent audits. When we looked at other audits being routinely undertaken we found that they covered care planning, complaints, accidents, bed rails and beds and mattresses. We have previously established that the financial best interests of people living in the home are protected by its record keeping and administration systems. The standard of recording and record keeping has improved in the period between this inspection and the last. Risk assessments are in place in individual care plans and the standard of risk identification and plans to minimise disruption to people living in the home included within the project planning documentation seen for the new build are exceptionally detailed and comprehensive. We have seen policies and procedures in place covering among other things, equality and diversity, health and safety and safeguarding. When we spoke to staff and saw a copy of the staff handbook we found that there was a good understanding of the basic policies and how they are implemented in practice. One example is equality and diversity where the AQAA informs us; Pre admission assessments determine individual needs and choice. We have residents from many different backgrounds. Several are unable to speak English. If possible we allocate them a key worker that can speak their language. We encourage their families to describe their cultures and beliefs, so that we can ensure that they are respected. Staff supervision is now being undertaken at the required frequency and staff and residents meetings are being held so that people who live or work at Foxholes can influence the way the home is run. When we spoke to the proprietor and directors of Foxholes and to the manager we found that they were supportive of one anothers roles and responsibilities and that any previous confusion over this has now been settled, which benefits all staff and people living in the home as was made clear to us by all the positive comments Care Homes for Older People Page 26 of 30 Evidence: received. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 16 Consideration should be given as to how to make the complaints policy and procedure more clearly understood and readily accessible to those people living in the home who say that they do not know how to make a complaint. This is so that anyone who wants to make a complaint can do so. Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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