Care Home: Geel And Hitchen Court

What the care home does well People who come to live at Geel and Hitchen can be confident that all aspects of their daily lives will be thoroughly assessed enabling their needs to be met. People who live at Geel and Hitchen have their needs met by the way the service devises and reviews care plans. People`s health is maintained by the way in which the service ensures that people have access to medical services and through the safe management of medication. People are supported in a respectful and dignified manner. The people who live at Geel and Hitchen are provided with activities that directly match their interests and are tailored to their abilities. They are able to maintain contact with their families and friends and in some cases, families are able to be involved directly with the care of their relative. Individuals are are encouraged to be as independent as possible where they are still able. The nutritional needs of individuals are met. People who live at Geel and Hitchen and their families can be confident that any concerns they have about the service will be investigated thoroughly. Individuals are protected form abuse. The people who use the service live in a pleasant, well maintained and hygienic environment. The people who live at Geel and Hitchen are supported by staff who are employed in sufficient numbers to meet their needs, who are well qualified and who receive a wide variety of training to meet the individuals needs of people. Staff are recruited in a thorough manner which protects the interests of individuals. People living at Geel and Hitchen can be confident that they are receiving a service managed by an experienced and qualified individual. Their views are taken into account through the way in which the service reviews the quality of the care it provides. The financial interests of individuals are safeguarded and their health and safety is promoted through the practices of the service. We did receive comments form one person who lives st Geel and Hitchen. The person commented on the decoration saying she liked the colour. She also commented on the plants in the garden saying that `it makes it look like a home` The Annual Quality Assurance Assessment sent to us by the service identified the following as what it does well: `The views of service users and their families, friends and carers are considered central to the provision of, and the development of services at Geel and Hitchen. Service user views are sought and acted upon on an ongoing basis. Service users are encouraged to pursue leisure activities of their choice which are specific to each individual in line with their life history, aspiration and level of dementia. Nugent Care Complaints procedure is in place and there are posters and leaflets available in the home. Any complaints/concerns are acted upon and documented, theinformation then being collated by the Performance Management Unit and used as a Quality Assessment Tool. Contact with CSIP to ensure up to date practices in line with Dementia Strategy. We follow the Liverpool End of Life Care Path way and use this tool to support interventions as required at the right time and the right level for each individual. Mental Capacity and DOLS policies and assessment tools in place. Annual Quality Assessment and monitoring by the Nugent Care Performance Management Team in line with the NMS and KLORA assessment tools. Involvement in CARITAS national dementia project to promote meeting spiritual needs of service users` What has improved since the last inspection? There were no requirements raised at our last visit. It is noted that there have been improvements to the garden areas of the service. The gardens to the rear of the building have been decked and plants and shrubs placed in raised beds to create a pleasant area for individuals to relax in. It is proposed that the garden area will be extended further in the near future. The service considered through its Annual Quality Assurance Assessment that it has improved in the following areas: `Further developed service user surveys and pre admission assessments to enable the Mental Capacity Best interest DOLS and advanced decisions to be incorporated. Concern Sheets introduced into each service user care file to monitor any concerns and action taken reviewed monthly Review of menus Introduced nutritional assessment tool to inform and ensure that nutritional needs are met including liquid diets supplements preferences medical needs Introduced Liverpool End of Life Care Pathway as a tool to improve practice and to better respond to the needs and desires of those service users and their families at the end of life Nugent Care has developed Equality and Diversity policies and procedures and hold within its value base the respect of all cultures and religious backgrounds Individual and group activities are planned and carried out in a way that service users feel comfortable in participating the activities music and art are specific to their era Newspapers and magazines radio and television are means of informing and engaging service users in community news and events Increased individual outings that reflect the culture preferences and diversity of the individual The environment and decor has had significant improvement Dining area and lounge decorated and floor coverings replaced Small walkways developed from the dining room External grounds developed to create small sensory garden Recent audit and review of the service,carried out by the PCT gave very positive feedback regarding the standard of care and documentation at Geel What the care home could do better: No requirements or recommendations are raised as a result of our visit. The service considers it could improve in the following areas as identified in its Annual Quality Assurance Assessment: To fully promote dignity in dementia we will identify a local Dignity in Care Champion Further promote service user carer involvement by involving service user carer at staffinterviews Involve younger people in the lives of service users by increasing opportunities for intergenerational activity e.g. art Need to include all ancillary staff in Mental Capacity Act and Deprivation of Liberty Training programme for all staff to be implemented To ensure that all spiritual needs not purely religious are assessed and met in our service users with dementia we are going to participate in an action learning research programme we are currently liaising with Aberdeen University Need to further develop individual life plans and memory boxes involve families friends in the process Inspecting for better lives Key inspection report Care homes for older people Name: Address: Geel And Hitchen Court Woodlands Road Aigburth Liverpool Merseyside L17 0AN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Paul Kenyon     Date: 2 9 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 29 Information about the care home Name of care home: Address: Geel And Hitchen Court Woodlands Road Aigburth Liverpool Merseyside L17 0AN 01517290117 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) : geel@nugentcare.org Nugent Care care home 24 Number of places (if applicable): Under 65 Over 65 24 dementia Additional conditions: 0 The registered person may provide the following category of service only: Care home with nursing: Code N, to people of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Dementia over 65 years of age: Code DE(E) The maximum number of people who can be accommodated is: 24. Date of last inspection Brief description of the care home The Geel and Hitchen Care Home is part of the Nugent Care Society and is a purpose built nursing home that offers single accommodation on a ground floor level. All bedrooms have hand wash facilities and there are several assisted baths, showers, and toilets. There is a large lounge, quiet room and a separate dining room. There are long corridors for residents to wander in. There is access to a patio area and secure garden. The interior and exterior of the home is well maintained. The home is set in grounds shared with another home owned by the Nugent Care Society, however, both homes have separate amenities and staff. Fees are currently charged at 500 to 537 pounds per week. Care Homes for Older People Page 4 of 29 Brief description of the care home Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection of Geel and Hitchen. The service were not aware that the visit would take place. During the visit, we examined records relating to the care provided to people as well as held a tour of the building and spoke to staff. The nature of the disability of people is such that it is not always possible to gain a direct view of their experiences. In order to assist with this visit, we conducted an observation of care practice for an hour during the visit; observing the lounge and dining room areas. We have used information in this report from the Annual Quality Assurance Assessment sent to us by the service before this visit. We also sent surveys out to staff and families. None have been received at the time of writing this report although any information subsequently received will be used as part of our ongoing assessment of the service. Care Homes for Older People Page 6 of 29 Care Homes for Older People Page 7 of 29 What the care home does well: People who come to live at Geel and Hitchen can be confident that all aspects of their daily lives will be thoroughly assessed enabling their needs to be met. People who live at Geel and Hitchen have their needs met by the way the service devises and reviews care plans. Peoples health is maintained by the way in which the service ensures that people have access to medical services and through the safe management of medication. People are supported in a respectful and dignified manner. The people who live at Geel and Hitchen are provided with activities that directly match their interests and are tailored to their abilities. They are able to maintain contact with their families and friends and in some cases, families are able to be involved directly with the care of their relative. Individuals are are encouraged to be as independent as possible where they are still able. The nutritional needs of individuals are met. People who live at Geel and Hitchen and their families can be confident that any concerns they have about the service will be investigated thoroughly. Individuals are protected form abuse. The people who use the service live in a pleasant, well maintained and hygienic environment. The people who live at Geel and Hitchen are supported by staff who are employed in sufficient numbers to meet their needs, who are well qualified and who receive a wide variety of training to meet the individuals needs of people. Staff are recruited in a thorough manner which protects the interests of individuals. People living at Geel and Hitchen can be confident that they are receiving a service managed by an experienced and qualified individual. Their views are taken into account through the way in which the service reviews the quality of the care it provides. The financial interests of individuals are safeguarded and their health and safety is promoted through the practices of the service. We did receive comments form one person who lives st Geel and Hitchen. The person commented on the decoration saying she liked the colour. She also commented on the plants in the garden saying that it makes it look like a home The Annual Quality Assurance Assessment sent to us by the service identified the following as what it does well: The views of service users and their families, friends and carers are considered central to the provision of, and the development of services at Geel and Hitchen. Service user views are sought and acted upon on an ongoing basis. Service users are encouraged to pursue leisure activities of their choice which are specific to each individual in line with their life history, aspiration and level of dementia. Nugent Care Complaints procedure is in place and there are posters and leaflets available in the home. Any complaints/concerns are acted upon and documented, the Care Homes for Older People Page 8 of 29 information then being collated by the Performance Management Unit and used as a Quality Assessment Tool. Contact with CSIP to ensure up to date practices in line with Dementia Strategy. We follow the Liverpool End of Life Care Path way and use this tool to support interventions as required at the right time and the right level for each individual. Mental Capacity and DOLS policies and assessment tools in place. Annual Quality Assessment and monitoring by the Nugent Care Performance Management Team in line with the NMS and KLORA assessment tools. Involvement in CARITAS national dementia project to promote meeting spiritual needs of service users What has improved since the last inspection? What they could do better: No requirements or recommendations are raised as a result of our visit. The service considers it could improve in the following areas as identified in its Annual Quality Assurance Assessment: To fully promote dignity in dementia we will identify a local Dignity in Care Champion Further promote service user carer involvement by involving service user carer at staff Care Homes for Older People Page 9 of 29 interviews Involve younger people in the lives of service users by increasing opportunities for intergenerational activity e.g. art Need to include all ancillary staff in Mental Capacity Act and Deprivation of Liberty Training programme for all staff to be implemented To ensure that all spiritual needs not purely religious are assessed and met in our service users with dementia we are going to participate in an action learning research programme we are currently liaising with Aberdeen University Need to further develop individual life plans and memory boxes involve families friends in the process 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 set out 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 10 of 29 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 11 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who come to live at Geel and Hitchen can be confident that all aspects of their daily lives will be thoroughly assessed enabling their needs to be met. Evidence: We looked at the way the service assessed the needs of people before they came to live at Geel and Hitchen Court. We looked at information relating to five people. In all cases, the service had assessed their needs before they had come to live there. These assessments included details on their physical and mental health, the risks they faced in every day life, their medication, the ways they communicate and any other social needs that were individual to each person. In addition to this, the service had obtained information from the authorities that pay for the care of each person. Geel and Hitchen does not provide intermediate care at present. Care Homes for Older People Page 12 of 29 Care Homes for Older People Page 13 of 29 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 at Geel and Hitchen have their needs met by the way the service devises and reviews care plans. Peoples health is maintained by the way in which the service ensures that people have access to medical services and through the safe management of medication. People are supported in a respectful and dignified manner. Evidence: We looked at five care plans relating to people who have come to live at Geel and Hitchen since our last visit in 2007. Each care plan included details of the needs of each person and how staff could best act to meet these needs. There was evidence that families had agreed to the content of the care plans and all care plans had been reviewed by the service each month to ensure that people were being supported as effectively as possible. We looked at how people are kept healthy. There was evidence that people are able to access medical services. Records showed that a number of health professionals had been involved with people. These included, Doctors, Community Nurses, Opticians, Care Homes for Older People Page 14 of 29 Evidence: Dietitians, Chiropodists and Speech Therapists. Records also showed that when medical professionals were involved, the outcome of their visits were recorded so that any progress could be determined. The service also uses an assessment which is designed to assess any pain or discomfort that people, who are unable to communicate due to their dementia, are experiencing. We looked at how medication is managed. There was evidence that medication is stored securely and that records maintained by the home showed that the receipt of medication was recorded as well as when medicines were given to people and when they were returned to the pharmacy. The pharmacy also checks from time to time to make sure that medication is safely managed and writes a report outlining its findings. No one is able to manage their own medications given the nature of their disability. This judgment of peoples abilities is included within their risk assessments. A list of medication is included within the personal records of individuals. The service is a nursing home and as a result the administration of medicines is the responsibility of nursing staff. They are bounded by the guidelines of their professional body in managing medication. Other information on medicines is also available for reference to nursing staff. We looked at the manner in which people were supported by staff. We spent some time observing care practices within Geel and Hitchen. We found that staff interacted with people in a very positive, friendly and respectful manner. People were given choices as to what they wanted to do and reassurance was provided at all times. Individuals were given the time and the freedom to pursue their own routines and at times staff were able to sit down and talk to people on a one to one basis. Staff were witnessed knocking on bedroom doors before they entered. All rooms at the service are single and as a result privacy is able to maintained for each person. The laundry area was viewed and this noted that clothing for each person is stored in individual boxes to ensure that the right clothing is returned to their owner after washing. Clothing was also noted to be discreetly marked. The service uses a number of assessments in order to determine the changing health needs of people. These included an assessment designed to show how likely it is that people will develop pressure sores, nutritional assessments and manual handling assessments. Records showed that the health needs of people on admission are recorded in detail. The weight of people are also monitored on a monthly basis. Care Homes for Older People Page 15 of 29 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. The people who live at Geel and Hitchen are provided with activities that directly match their interests and are tailored to their abilities. They are able to maintain contact with their families and friends and in some cases, families are able to be involved directly with the care of their relative. Individuals are are encouraged to be as independent as possible where they are still able. The nutritional needs of individuals are met. Evidence: We looked at the activities provided to people. An activity programme is available for all people and contains a combination of in house activities as well as activities within the local community. The interests of people have been assessed at the point at which they come to live at the service but also on an ongoing basis. This assessment is linked to the communication needs of each person. As a result, three activities groups have been formed including people of similar interests or similar abilities. The activities these individuals receive are then linked to their needs and interests. Records were available which provided a profile of peoples interests in details. Events are also held within the service to mark certain times of the year. These Care Homes for Older People Page 16 of 29 Evidence: included celebrations for Easter, St Patricks Day and St Georges Day. The service has an activity room. This is known as a quiet room and contains evidence of art work done by individuals as well as art and craft materials. The service operates a open door visiting policy. Visitors came during our visit and were either able to see their relations to private or wherever they wished. The visitors book should evidence of visitors coming on a regular basis. One visitors was noted to be directly involved in supporting their relation during lunch time. It was reported that this was a daily occurrence and the visitors was enabled to support their relation by the staff team. The service has recently had garden areas re-designed following the involvement of volunteers and this has improved the external environment of the building. Staff interactions with visitors was friendly and it was clear that a positive relationship had developed. All visitors were offered a drink on arrival. The nature of the disability of people at Geel and Hitchen is such that they are not able to make main decisions about their daily lives although some decisions are able to be made by them at a basic level. Many individuals are able to mobilise through the building and outside into garden areas. They were noted throughout the visit to be freely able to do this. Individuals are able to decide where they wish to sit, who they wish to speak with and what they want to do. Staff were noted to ask people first what they wanted and to offer them a level of choice, for example asked if they wanted to come for lunch, asked if they had had enough to eat and asked if they wanted a drink. Many families are now responsible for the finances of people with the exception of four. The service is seeking to relinquish their appointee status for these people by either passing responsibilities on to the families or the Local Authority. Information is available on Independent Mental Commission Advocates. Rooms are personalised including photographs of when people were younger or of members of their family. One person was an artist and examples of their work are on display in their room. Another person was brought up in the Muslim faith. Pictures of Muslim and religious text have been included in this persons room. We sampled the care of five people during the visit. Out of this sample, only one had a a specific dietary need. We had a discussion with catering staff and this noted that they were aware of this condition and maintained records in the kitchen. Some individuals require the assistance of speech therapy given that they have issues with swallowing and one person needed assistance from a dietitician. All people have their nutritional needs assessed and this was evidenced. A dining room is available and lunch was run over two sittings. Individuals were given the choice if they wanted to go first or second and the use of two sittings enabled individuals who require support Care Homes for Older People Page 17 of 29 Evidence: from staff to be assisted with eating. Some individuals are able to eat independently and this was observed. As a result, lunch was unhurried and staff attended to the needs of people and their preferences were determine. Staff consulted with them if they needed anything else. The Dining room is a pleasantly decorated room and a menu is on display for the day on a notice board. The kitchen is a well organised facility with sufficient foods in stock. It is clean and temperatures of freezer/fridge appliances are taken through the day. A cook and kitchen assistant were on duty during the visit. A menu is present in the kitchen as well as information on whether individuals require normal diets, food that is softer or food that has been pureed. Drinks were available through the day. Staff supported those who require assistance with feeding in a courteous and supportive manner and as result the lunch was unhurried and people were enable to take their time. Care Homes for Older People Page 18 of 29 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 at Geel and Hitchen and their families can be confident that any concerns they have about the service will be investigated thoroughly. Individuals are protected form abuse. Evidence: We looked at the ways individuals or their families could make a complaint about the service. A complaints procedure is available which contains details of how to make a complaint and includes our role in this and how we can be contacted. Complaints records are available and these suggested that two complaints had been received since we last visited in 2007. Records suggested that these complaints and been investigated and action taken. We have not received any complaints about the service. We looked at the way the service safeguards individuals. The service has information on how to refer any allegations of abuse to the Local Authority. Since our last visit, an allegations had been made but after investigation, this was unfounded. The service provided evidence to us at the time of how it had safeguarded the interests of the individuals involved. The nature of the disability of the people living at Geel and Hitchen is that sometimes they may display aggression. The service identified this at the point of assessment when they are admitted and includes information for staff on how to deal with this Care Homes for Older People Page 19 of 29 Evidence: through care plans and risk assessments. We spoke to two members of staff. They confirmed that they had the information needed to safeguard individuals form abuse. They also confirmed that they had received training of late in the protection of vulnerable adults. Staff are also provided with information on abuse, its nature and their role in the safeguarding of peoples financial interests. Care Homes for Older People Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service live in a pleasant, well maintained and hygienic environment. Evidence: We toured the building. Externally the building is well maintained with ramps providing access to the main door. A car park is available to the side of the building and external close circuit television cameras monitor the front and side of the building. Entry to the main building is via a door with a coded lock which enables security to be maintained for those who live in the building. All individuals have access to a garden area to the rear. The garden areas have been developed since the last visit and now offer the opportunity for individuals to sit outside around the rear of the building. This area has been provided with colourful plants and a pleasant area has been created. The garden area is to be further extended shortly to provide more seating areas for individuals. Two link ways which provide access to other parts of the building have also been decked and contain planters and seating. This again means that utility areas has been altered to provide more opportunities for individuals to relax outside. All garden areas receive sufficient sunlight and all areas are accessible to people who use wheelchairs. The building is subject to a refurbishment programme which has resulted in the recarpetting of corridor areas and redecoration of bedrooms. The decoration of bedrooms continues. There are two main lounge areas in the building,a lounge and a Care Homes for Older People Page 21 of 29 Evidence: conservatory. The conservatory has been fitted with electric ceiling fans to enable a pleasant temperature to be maintained. A dining room is available and some corridor areas have had chairs included in them for the people who use the service. Some individuals were using these through the visit. A number of pictures and photographs have been put up in corridor areas showing the heritage of the city of Liverpool as well as photographs of the city around the time when individuals living at Geel would have been younger. There are also wedding photographs of some people located on their bedroom door to serve as a reminder that it is their room. Other bedroom doors include photographs of people before they came to live at Geel or during their working lives. Personal possessions such as photographs have been included in bedrooms. No offensive odours were noted at any time during the visit. A laundry is available separate from food preparation and storage areas. Domestic and laundry staff are employed. The laundry is well equipped facility with industrial appliances and an impermeable floor. Hand washing facilities are available. The service did have a infection outbreak since our last visit and had been subject to a deep clean. Infection control hand dispensers are available throughout the building and personal protective equipment is available for staff. Soap and towels are available in all areas hand wash and toilet areas. Care Homes for Older People Page 22 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Geel and Hitchen are supported by staff who are employed in sufficient numbers to meet their needs, who are well qualified and who receive a wide variety of training to meet the individuals needs of people. Staff are recruited in a thorough manner which protects the interests of individuals. Evidence: During our visit there were two members of the management team, five carers, one administrator , one laundry assistant, one domestic staff and two catering staff on duty.This mix of staff enabled the care staff to concentrate on their role of supporting individuals. Maintenance staff are also available to the service.A plan is devised for each shift of what part of the building staff will be deployed. the staff team is a mix of ancillary staff, care staff and qualified nurses. A rota is available and showed that there are sufficient staff to meet the needs of the people who use the service. The service submitted an Annual Quality Assurance Assessment (AQAA) to us before we visited. This confirmed that 95 of care staff had achieved at least a National Vocational Qualification at Level 2 and this exceeds what we expect. Staff interviews confirmed that this qualification had been attained and that for one member of staff this had been done in a short period of time since their recruitment earlier in 2009. Care Homes for Older People Page 23 of 29 Evidence: We looked at five files relating to care staff to had come to work at Geel and Hitchen over the past twelve months. In all cases, there was information about the persons identity, criminal record checks, checks made against the vulnerable adults register, application forms and contracts of employment. Three references are undertaken before staff are recruited. One staff member told us that they had had to wait until the police check had come through before they started working there. One member of staff was a European national. This person is to work in this country through European Union laws and the service had ensured that this person had been registered under a home office scheme as a registered worker. There was also evidence that staff had been medically assessed to do the job and that any gaps in employment history had been thoroughly pursued and questioned to their satisfaction. We interviewed two members of staff. Both confirmed that they had received a lot of training. This was a mix of mandatory health and safety training and training linked to the needs of people such as dementia awareness, epilepsy awareness and the protection of vulnerable adults. Training records were viewed. These confirmed that staff had received training in Health and wellbeing, Health and Safety, First Aid, Mental Capacity Act, Safeguarding Adults, Infection Control, Medication Awareness. Challenging Behaviour Awareness, Complaints, Pandemic Influenza Infection, Rights and Risk Taking, End of Life care, Food Safety, Common Induction Standards and Stroke Awareness. The Organisation which runs Geel and Hitchen has its own training department and this provides training programme and a system of nominations for staff which was available during our visit. Care Homes for Older People Page 24 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Geel and Hitchen can be confident that they are receiving a service managed by an experienced and qualified individual. Their views are taken into account through the way in which the service reviews the quality of the care it provides. The financial interests of individuals are safeguarded and their health and safety is promoted through the practices of the service. Evidence: The Manager Mary Bellmon was registered with previous regulator. She has worked with Nugent Care for a number of years and has experience and qualification to do the job. Staff consider her to be approachable, straight and honest and excellent-the right person to do the job. The Manager always informs us of any incidents within the service through telephone calls and notifications. There was evidence through training records that she keeps her training up to date. She has introduced information for staff in respect of the Mental Capacity Act and Deprivation of Liberty Standards. Staff interviews confirmed their awareness of the mental capacity act confirmed that they Care Homes for Older People Page 25 of 29 Evidence: had information on the main issues and had received training. Two individuals files sampled noted that deprivation of liberty assessments had been done on two people in respect of medication. There was evidence that a Representative of the Organisation visits monthly to report on the quality of care provided by the service. There was also evidence of ongoing progress of the home in respect of national minimum standards undertaken by representative of the Organisation. There was evidence that questionnaires are sent to families in respect of the quality of care provided. We were able to see all records during the visit and interview the people who use the service and staff in private as well as access all parts of the building. No requirements were generated at the last inspection. For most individuals, families look after their financial interests. Some are subject to court of protection. Service has been appointee for four people but moves are in place to either ask families to become court of protection or pass them on to the Local Authority to assist in this given that these people have no next of kin. Some monies are used for items such as hairdressing and then invoices to sent to families. There is a safe available for the storage of monies. The service is becoming increasingly uninvolved in finances of individuals. We looked at how the service promotes the health and safety of people. A health and safety policy is in place outlining the arrangements within the Organisation. Training has been received by staff in mandatory topics as confirmed through interviews and training records. There was evidence that Fire Alarms and Emergency lighting has been tested and portable hoists being serviced in April 2009. Fire extinguishers have been tested within the past twelve months, Water temps monitored monthly.The security of the building is maintained via coded locks. Individuals are able to move into garden areas and throughout the building safely. An Accident log book is maintained, radiators are covered and there is information on action to take during heat waves from the Department of Health given that the visit coincided with a spell of hot weather. There are no window restrictors given that the building is single story. There are assessments on the control of substances hazardous to health. Information provided to us form the service before our visit confirmed that portable electrical appliances had been tested as well as electrical wiring and the gas supply. Care Homes for Older People Page 26 of 29 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 29 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 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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