Care Home: Furze Hill Lodge

What the care home does well Residents live in an excellently decorated, well maintained, homely environment with their bedrooms furnished and individualised to a high standard, with access to local shops and amenities. A resident fedback "the home is very fresh and clean and the laundry service is excellent" A relative said "very pleasant environment always cleaned and never smells unpleasant. The bedrooms are very homely and you can take anything that will fit in the room mum was encouraged to bring in items to make her bedroom feel like it is hers". A sample of comments made by residents and relatives experiences at the home included "mum is happy there as she can do as she pleases, you could not find anywhere better" "very happy with Furze Hill my mother is very happy and settled there and most importantly she likes it there herself" "So far its really nice really enjoying it here I do not have to worry about a thing" and "such a happy place very comfortable and a warm atmosphere to the place". Links with families and the local community continue to be valued and supported by the home. Personal support is offered in ways, which promotes and protect resident`s privacy and dignity and provides for a good standard of health care support and palliative care. Resident`s lives are enriched by the provision of excellent, creative and varied opportunities for occupation and leisure. A relative said "The activities co-ordinator is excellent she has made a real difference she is a great asset to the home she tries really hard to get mum involved. She sat in the garden with her for a few hours which she really enjoyed". The meals are excellent offering both choice and variety and catering for special dietary needs. A sample of comments made about the food included "food delicious every day fantastic" "food and the care is very good" "food very good as I am on a soft diet and they are very accommodating". Staff make a positive contribution in residents lives as they benefit from a well trained, stable staff team that know them and who are employed in sufficient numbers as is necessary to meet their needs. Residents consistently spoke of the kindness and friendliness of staff. A relative said "staff very pleasant friendly helpful do their best to encourage her to remain independent and most importantly they are kind to her. The best bit about the home is the staff always smiling pleasant from the minute they open the door". Resident`s continue to benefit from an experienced and established manager who promotes a clear ethos and values of the home that enables staff to provide good quality care to residents. The home has an effective quality assurance and monitoring system in place which seeks the views of the residents and changes its services accordingly. A range of regular health and safety checks helps to promote the health and safety of residents and staff. What has improved since the last inspection? Increased staffing levels and with the majority of current residents assessed as having low to medium needs, enables staff to be able to address resident`s needs in a more timely manner and provide a wider range of support and services. Additional staffing has also enabled the manager to focus further on improving administration and management effectiveness. Mixer values have been fitted to all baths which now regulate hot water within a recommended safe temperate range. This helps to ensure that residents are protected from the risk of accidental scolding. The manager reported that residents have now been provided with copies of terms and conditions at the home. This helps to ensure that they are aware of their roles and responsibilities while residing at the home. Improvements in training opportunities and administration enables staff to gain a greater understanding of the range of residents needs and helps to ensure that staff undertake a variety of training necessary to work safely with residents. Some improvements have been made to the care planning process, this includes the assessments of the risks faced and posed by residents and the actions needed to manage or reduce risks. What the care home could do better: The arrangements for planning care did not always ensure that resident`s needs were identified and which provided staff had the guidance to meet these needs in a consistent and individual way. Potential safeguarding issues and significant events are not always being reported promptly to the relevant authority under safeguarding guidelines to ensure residents protection. Key inspection report Care homes for older people Name: Address: Furze Hill Lodge Furze Hill Lodge Furze Hill Kingswood Surrey KT20 6EP     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: Jane Jewell     Date: 0 8 0 9 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: Furze Hill Lodge Furze Hill Lodge Furze Hill Kingswood Surrey KT20 6EP 01737351023 01737352982 furzehill@mmcg.co.uk www.mariamallaband.co.uk Maria Mallaband Ltd care home 29 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 29 The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home Furze Hill lodge is a well established care home that has been operating as a residential home for a number of years. The home is registered to provide personal care for up to twenty-nine older people which includes long and short term placements. The home was purchased in January 2008 by Maria Mellaband care group. Maria Mallaband is a national company which operate a wide range of registered services across the United Kingdom. Furze Hill lodge is a large converted tutor style property, which has been extended Care Homes for Older People Page 4 of 30 Over 65 29 0 2 5 0 9 2 0 0 8 Brief description of the care home over the years. The home is located on the outskirts of kingswood village and its local amenities, including shops, cafes, pubs, Doctors surgery and train station. The home is presented across three floors with a shaft lift providing level access to most parts of the building with additional chair lifts providing access to some parts of the building. Residents accommodation consists of twenty-seven bedrooms, including one potential double bedroom, the majority of bedrooms provide toilet en-suite with some also providing bathing en-suite facilities. Communal space consists of a dining room, conservatory and two lounges. There is a patio terrace, which overlooks an attractive garden. The homes literature states Furze Hill aims to provided a very high standard of care to all residents. The fees for residential care are currently £660 to £1,030 per week, depending on the services and facilities provided. Extra such as newspapers, transport, toiletries are additional costs. 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: 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 information contained in this report has been comprised from an unannounced inspection undertaken over seven hours and information gathered about the home before and after the inspection. The manager had completed an Annual Quality Assurance Assessment form within the timescales requested. This gave information about what the home was currently doing and their future plans, this information was used to inform the inspection process. The inspection was facilitated by the Carol Harringan (Registered Manager). The focus of the inspection was to look at the experiences of life at the home for people living there and to confirm the progress made towards addressing the shortfalls noted at the previous inspection. The inspection consisted of being shown around the communal areas, being invited into residents bedrooms, examination of the homes documentation and observations of residents daily routines and residents interactions with staff. Eight residents, six staff and three relatives were consulted as part of the inspection process. Care Homes for Older People Page 6 of 30 Feedback surveys were sent to the home for distribution in order to obtain the views on the quality of the services and facilities being provided prior to the inspection. Ten were returned in total, four from residents, three from staff, and three from a health care professional. Their feedback is included in this report. There were twenty three residents living at the home at the time of the inspection. Care Homes for Older People Page 7 of 30 What the care home does well: Residents live in an excellently decorated, well maintained, homely environment with their bedrooms furnished and individualised to a high standard, with access to local shops and amenities. A resident fedback the home is very fresh and clean and the laundry service is excellent A relative said very pleasant environment always cleaned and never smells unpleasant. The bedrooms are very homely and you can take anything that will fit in the room mum was encouraged to bring in items to make her bedroom feel like it is hers. A sample of comments made by residents and relatives experiences at the home included mum is happy there as she can do as she pleases, you could not find anywhere better very happy with Furze Hill my mother is very happy and settled there and most importantly she likes it there herself So far its really nice really enjoying it here I do not have to worry about a thing and such a happy place very comfortable and a warm atmosphere to the place. Links with families and the local community continue to be valued and supported by the home. Personal support is offered in ways, which promotes and protect residents privacy and dignity and provides for a good standard of health care support and palliative care. Residents lives are enriched by the provision of excellent, creative and varied opportunities for occupation and leisure. A relative said The activities co-ordinator is excellent she has made a real difference she is a great asset to the home she tries really hard to get mum involved. She sat in the garden with her for a few hours which she really enjoyed. The meals are excellent offering both choice and variety and catering for special dietary needs. A sample of comments made about the food included food delicious every day fantastic food and the care is very good food very good as I am on a soft diet and they are very accommodating. Staff make a positive contribution in residents lives as they benefit from a well trained, stable staff team that know them and who are employed in sufficient numbers as is necessary to meet their needs. Residents consistently spoke of the kindness and friendliness of staff. A relative said staff very pleasant friendly helpful do their best to encourage her to remain independent and most importantly they are kind to her. The best bit about the home is the staff always smiling pleasant from the minute they open the door. Residents continue to benefit from an experienced and established manager who promotes a clear ethos and values of the home that enables staff to provide good quality care to residents. The home has an effective quality assurance and monitoring system in place which seeks the views of the residents and changes its services accordingly. A range of regular health and safety checks helps to promote the health and safety of Care Homes for Older People Page 8 of 30 residents and staff. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 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. The home provides both prospective and existing residents with a range of accessible information about what services are provided and what to expect when living at the home. There is a process in place to ensure that residents needs are assessed prior to them entering the home, with minor adjustments needed to ensure that the assessment process is in line with the homes admission criteria and registration. The home is able to demonstrate that it can meet the range of residents needs. Evidence: The homes statement of purpose, which is a book that tells people who the home is for and the service users guide, which is the book that tells people how the home works, provides a wide range of information about the home and its services and facilities. This information is made available at the home and given to prospective Care Homes for Older People Page 11 of 30 Evidence: residents, their representatives and other interested parties. A relative confirmed that they had been given some information about the home in advance. The vast majority of residents and relatives consulted with said that they knew the home through its good reputation and therefore did not need any additional information to help them make choices about the home. The manager confirmed that residents are now being provided with a written contract of terms and conditions of residency with the home. This can be used with residents and their families to make explicit the placement arrangements and clarify mutual expectations around rights and responsibilities. The assessment process for a recently admitted resident was viewed. The documentation used to assess residents although comprehensive was in the main clinically based and did not provide all of the necessary social care information needed for the manager to make an informed judgement as to whether the home could meet the needs of residents in need of residential care. This manager agreed to further review the assessment documentation to ensure that all none essential clinical based information was replaced with information necessary for residential based care. There is a range of needs being accommodated with most residents assessed as having low to medium needs, including some residents who have developed mild dementia. Since the previous inspection there are considerable fewer residents with higher level needs. Through observation, looking at records and speaking to residents, staff and relatives, evidence was gathered that the home is meeting the needs of residents. A sample of comments made by residents and relatives experiences at the home included mum is happy there as she can do as she pleases, you could not find anywhere better very happy with Furze Hill my mother is very happy and settled there and most importantly she likes it there herself So far its really nice really enjoying it here I do not have to worry about a thing and such a happy place very comfortable and a warm atmosphere to the place. A Residents spoke of being provided with the opportunity to visit the home in advance to assess the quality, facilities and suitability of the home. Intermediate care is not offered at the home therefore this standard is not assessed 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. The arrangements for planning care did not always ensure that residents needs were identified and that staff had the guidance to meet these needs in a consistent and individual way. Residents receive a good standard of health care support, including end of life care. Medication practices are well managed promoting good health. Personal support is offered in ways, which promotes and protect residents privacy and dignity. Evidence: Much work had been undertaken since the previous inspection to improve the care planning process. This has involved the use of the organisations care planning documentation. Six care plans were looked at, which were largely standardised, bulky and contained many blank documents as these were not relevant to the needs of residents being accommodated at the home. The actions described by staff to meet the needs of particular residents were not noted in their care plan. A resident Care Homes for Older People Page 13 of 30 Evidence: described their personal preference for their daily routine and spoke of their frustration that not all staff were aware of their individual routine. This information was not recorded on their care plan. Although comprehensive information is gathered about residents social and food preferences when first admitted this information was not always noted in care plans for staff to follow. Staff members commented upon how complicated and confusing the care plans were and how apprehensive they were about recording on them as they were not sure where to record information. Although it was clear that progress has been made towards improving the care planning process further work is still necessary in order to ensure that residents individual needs are identified and staff have the appropriate guidance to be able to meet these needs in a consistent and individual way. In line with the previous requirement risk assessments are in place which highlights risks faced and posed by residents and the actions to manager or reduce these risks. The home continues to provide good health care arrangements with evidence of regular input from a range of health care professionals. The home retains a local GP, who holds a surgery once a week at the home and visits if needed in between. Residents confirmed that when they have requested medical advice or intervention this has been sought promptly. Staff were also seen to act proactively in seeking medical intervention. The medicine administration practice observed were seen to be safe and medication records demonstrated that systems have been established to ensure staff are appropriately trained and records are accurate and provide a history of what was given by who and when. Staff practices preserved residents privacy and dignity. Observation of such practices included staff using residents preferred names, knocking on bedroom doors prior to entry and in the respectful tone of language used during interactions with residents. A resident described how thoughtful a staff member was when assisting them to bath to ensure that their privacy was always maintained. A relative spoke of the care taken by staff to ensure that their relative maintained their personal appearance through regular hairdressing appointments, nail care and being well dressed. The dignity of one resident was observed to be compromised during the inspection and the manager agreed to review being able to accommodate the residents wishes when it compromised their dignity. Care Homes for Older People Page 14 of 30 Evidence: The home has experience in providing end of live care. A relative spoke of the importance that the homes reputation had in providing good quality palliative care when they were choosing the home. The manager spoke of the support they had received in the past from Health Care professionals during the care of residents who were receiving palliative care. Staff spoke sensitively and knowledgeable about the care and support provided to residents and their families when residents have become terminally ill. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents lives are enriched by the provision of excellent, creative and varied opportunities for occupation and leisure. The meals are excellent offering both choice and variety and catering for special dietary needs. Links with families and the local community are valued and supported by the home. Daily routines are largely determined by residents needs, however some residents personal preferences need to be recorded to ensure these can be carried out consistently. Evidence: Without exception all those consulted with spoke of the excellent range of activities and events held at the home. A full time activities co-ordinator is employed who was extremely motivating and knowledgeable about suitable activities for older people. A weekly activities plan is drawn up and a copy provided for each resident, it was clear that the plan is developed based on residents preferences. The activities co-ordinator spoke of there being some flexibility in the weekly plan depending upon the weather Care Homes for Older People Page 16 of 30 Evidence: or residents preferences at the time. Residents spoke of undertaking a wide variety of activities including, scrabble, quizzes, gardening and numerous craft based sessions as well as external entertainers. There have been several outings arranged over the summer to nearby places of interest. Residents spoke of a further upcoming outing to a nearby farm. A relative said the activities co-ordinator is excellent she has made a real difference she is a great asset to the home she tries really hard to get mum involved. She sat in the garden with her for a few hours which she really enjoyed. Residents and relatives continue to comment upon how welcomed visitors are made to feel this included being offered beverages or meals and staff being friendly and approachable. Several residents spoke of the importance of having their own phone in order to keep in regular contact with their family and friends. Residents are supported to maintain their links with the local community which includes any social groups they were involved in prior to staying at the home. A list of local events is displayed for residents interest. Observation of the daily routines and discussion with residents confirmed that staff largely accommodate residents personal wishes with regard to meal times, going to bed and rising. As previously noted not all of residents personal preferences were noted in order for staff to be able to provide consistent support. Two relatives raised concerns that their relative would prefer to have more baths per week, and felt strongly that baths had been limited in the past due to staffing levels, but felt that with the recent increase in staff this situation would improve. One resident requested an additional bath per week and this request was passed onto the manager who confirmed that this would be actioned. Another resident said I have a bath as often as I want. The inspector observed part of the lunch time meal which was served in a well decorated and pleasantly set dining room. The meal served was well presented with a variety of choices provided with residents preferences respected and any specialised diets catered for. Staff were observed providing gentle discrete encouragement to those residents who needed support to eat. A relative spoke of the lengths the chef goes to, in ensuring that their relative receives the varied specialist diet they need. The chef spoke of developing the menus based on feedback from food surveys send to residents annually. He confirmed that recommendations made from the last Environmental Health visit have been addressed. A sample of comments made the food included food delicious every day fantastic food and the care is very good and food very good as I am on a soft diet and they are very accommodating. Care Homes for Older People Page 17 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. There is an effective complaints system with evidence that both residents and relatives feeling that their views are listened to and acted upon. Potential safeguarding issues and significant events are not always being reported promptly to the relevant authority under safeguarding guidelines to ensure residents protection. Evidence: There is an accessible complaints procedure for residents, their representatives, and staff to follow should they be unhappy with any aspect of the service. Residents, staff and relatives continue to state that they feel confident to share any complaints they had with the manager and that where they have done so their concerns have been addressed promptly and satisfactorily. Records of complaints showed that the homes complaints procedure was followed and issues dealt with in a timely manner. The home has written policies covering safeguarding adults and whistle blowing, with most staff having undertaken this training either as part of their induction or as a stand alone course. However, not all staff and management demonstrated a clear understanding of their roles and responsibilities under safeguarding adults guidance. This is with particular reference to reporting procedures, with examples noted whereby issues raised and significant events had not been appropriately reported to Care Homes for Older People Page 18 of 30 Evidence: the relevant agency. Once directed however, management then followed the safeguarding process and ensured that they undertook any action requested of them to promote residents protection . It has been required that further training is provided to ensure that when events occur or residents raise concerns relating to potential safeguarding issues that these are appropriately reported to the relevant agency. Care Homes for Older People Page 19 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in an excellently decorated, well maintained, homely environment with their bedrooms furnished and individualised to a high standard. Residents continue to have a range of specialist equipment and adaptations to aid mobility and independence around the home. Standards of hygiene remain good creating a pleasant odour free environment in which to live, work and visit. Evidence: The home is set in its own excellently maintained grounds on the outskirts of a small village. The home continues to be decorated and maintained to a high standard with full time maintenance staff on site. Some refurbishment work was being undertaken on the roof and building works in the grounds with a view to building some domestic properties. Residents confirmed that these works did not provide a disturbance or create additional noise other than the loss of a few car parking spaces. Feedback regarding the environment continues to be extremely positive and a sample of the comments included the home is very fresh and clean and the laundry service is excellent and very pleasant environment always cleaned and never smells unpleasant. The bedrooms are very homely and you can take anything that will fit in the room mum was encouraged to bring in items to make her bedroom feel like it is Care Homes for Older People Page 20 of 30 Evidence: hers. All residents consulted felt that their bedrooms provided everything they needed. The manager was mindful of the suitability of bedrooms to meet residents individual needs, with a resident confirming that they are regularly offered the choice of different bedrooms due to their decreasing mobility and the access arrangements to their accommodation. Communal space is spacious and consists of two lounges, conservatory, hairdressing room and dinning room, with each room providing for different activities and events to be undertaken. Much effort has been made to create a homely environment throughout. Many residents spoke of how much they enjoy sitting in the garden and enjoying the flowers and the view. A passenger lift provides level access to the first floor and parts of the second floor, a chair lift then provides access to the remaining part of the second floor. Portable ramps provide level access to the garden area. There was a range of individual aids and adaptations to assist residents mobility and independence, including hoists, assisted bathing, walking aids, ramps and grab rails. Fitted throughout the home are call points, which enable assistance to be summoned when pressed. Residents fedback that when pressed the call bell staff always respond quickly and have responded to all my calls promptly. There is sufficient number of toilets and bathrooms located around the home, including the majority of bedrooms providing en-suite facilities. All areas inspected were observed to be cleaned to a high standard. Systems are in place for the control of infection with staff observed to be working in ways that minimised the risk of infection, by wearing gloves and aprons when required. Care Homes for Older People Page 21 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. Staff make a positive contribution in residents lives as they benefit from a well trained, stable staff team that know them and who are employed in sufficient numbers as is necessary to meet their needs. Evidence: Staff were observed providing gentle discrete sensitive support to residents often using appropriate humour or affection to effectively communicate with some residents. The staffing structure is currently for a minimum of three care assistance and a person in charge during the waking day. Staff, relatives and residents felt that there are now sufficient numbers of staff on duty for staff to undertake their roles in a timely manner and for residents to receive the support they needed, when they wanted it. The manager confirmed that staffing levels have been increased since the previous inspection. Staff confirmed that the increase in staffing during the afternoon period has enabled them to provide more baths, further personal care and occupation for residents. A sample of comments made about staff included staff are kind day staff very cheerful and friendly and happy to give a hug when I need it and to talk to and staff very nice helpful respond to anything you ask of them. A sample of comments made by relatives included extremely nice staff on the hole friendly very chatty and pleasant, I have nothing but praise for them and staff very pleasant friendly helpful do their best to encourage her to remain independent and most importantly they are Care Homes for Older People Page 22 of 30 Evidence: kind to her. The best bit about the home is the staff always smiling pleasant from the minute they open the door. The home remains proactive in ensuring that the majority of staff have undergone National Vocational Qualification (NVQ ) in Care. The manager commented that there is little staff turnover, with the majority of staff having worked at the home for a number of years. There have been several new members of staff recently recruited. Three staff files were viewed and this showed that a recruitment process is followed, which includes an application form, criminal records bureau checks and references to help ensure that only people who are suitable to work with vulnerable people are employed. However, copies of documents needed to confirm an individuals identity were not retained once viewed as part of the recruitment process. This is necessary to ensure that the home can evidence the persons identity and entitlement to work at the home. The manager subsequently confirmed that copies have now been obtained. A newly appointed member of staff spoke of the thorough interview process they went through which enabled them to gain much understanding about the ethos and running of the home. There is a commitment to improving staff skills through an ongoing training programme both in practical matters and the broader aspects of working with older people. Including dementia care, pressure area care and Parkinsons awareness. Staff consulted with spoke of undertaking all of the mandatory areas of training, or about to undertake, in order for them to work safely with residents. As previously noted, further training must be undertaken in safeguarding adults in order to improve staffs and management understanding of their roles and responsibilities to report any concerns they have to the relevant authority. Training administration has improved with a training matrix having now been developed. This clearly identifies the training undertaken and due to be undertaken by each member of staff. Newly appointed staff reported that they undertook the industry recommended minimum inductions standards. This is designed to help ensure that all new staff entering into the care industry have a minimum level of initial training. Care Homes for Older People Page 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents continue to benefit from an experienced and established manager who promotes a clear ethos and values of the home that enables staff to provide good quality care to residents. The home has an effective quality assurance and monitoring system in place that is based on seeking the views of the residents. A range of regular health and safety checks helps to promote the health and safety of residents and staff. Evidence: The manager has considerable experience in working with older people and became the registered manager in 2007, prior to this they were the deputy manager of the home for nine years. They have undertaken the recommended management qualification and have undergone some training since the previous inspection to keep Care Homes for Older People Page 24 of 30 Evidence: themselves updated in changes in legislation and good practices. However they acknowledged the need for them to undertake additional training in safeguarding adults to ensure that any concerns are being reported appropriately and in accordance with relevant guidance. The manager reported that increased staffing in the afternoon has enabled them more administrative time which has clearly helped improve the overall effectiveness of their time and improved standards of administration. Without exception all persons consulted spoke positively about the manager with particular reference to their approachability, hands on approach and their gentle and calm nature. A staff member fedback the manager is very supportive always there for advice a resident described the manager as very caring. A relative commented that they found the manager to be very helpful and understanding. The manager is supported by an area manager who visits the home most weeks and undertakes a comprehensive monthly review of the service on behalf of the registered provider. The home seeks the views of residents on the quality of its services and facilities through annual feedback surveys and residents meetings. A resident said you are always encouraged to tell them anything that you would like or how to improve things, but I can not think of anything. The manager reported that as a result of feedback changes to menus and activities have been undertaken. In additional internal audits are being undertaken on various procedures at the home. Recent audits included medication and health and safety, which helped to highlighted any further areas for service improvement. Staff are in the main supervised by the manager working along side them each shift with staff continuing to state that they feel well supported by the manager. Staff spoke of undertaking some formal supervision which involved some evaluation of their performance. The manager reported that the home does not manage finances on behalf of residents. Written guidance is available on issues related to health and safety. Records submitted by the home prior to the inspection stated that all of the necessary servicing and testing of health and safety equipment has been undertaken. Maintenance staff undertake a robust system of monitoring and reporting health and safety matters. Systems are in place to support fire safety, which include regular fire alarms and emergency lighting checks, staff training and maintenance of fire equipment and fire drills were reported to have been undertaken. Care Homes for Older People Page 25 of 30 Evidence: The manager reported that a fire risk assessment had been undertaken by a fire safety expert, which records significant findings and the actions taken to ensure adequate fire safety precautions in the home and that recommendations made from this are in the process of being addressed. This includes bedroom doors becoming fire doors. Following the previous inspection hot water mixer values were fitted to all baths which regulates hot water within the recommended safe temperate range. Care Homes for Older People Page 26 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 27 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 1 7 15 That care plans provide clear 02/11/2009 guidance for staff on all aspects of the health, personal and social care needs of service users and which make explicit the actions needed to meet these needs. To ensure that residents needs are identified so staff can provide the support necessary in a consistent and individual way 2 18 18 That management and staff receive further training on Adult Protection guidelines and are aware of their roles and responsibilities under safeguarding adults guidelines. To ensure that when residents raise concerns that these are properly addressed by the 20/11/2009 Care Homes for Older People Page 28 of 30 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 appropriate external agencies. 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 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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