Care Home: Glengariff Residential Home

What the care home does well We conducted a SOFI as part of the inspection process. The SOFI took place in an open plan living area where a number of people were sitting. The SOFI showed a high level of positive staff engagement and showed that many of the people using the service were able to enjoy engaging with one another also. Results also determined that those people who were observed for the specified period of time generally experienced a positive state of well being. Staff were directly observed to interact well with those people being observed, with dignity and respect for the individuals. The SOFI tool is able to show how people using the service experience the services provided. It is able to show how person centred a care worker may be whilst engaging with a person. On a number of occasions positive manual handling practices were observed to occur. Staff were directly observed talking and engaging with people in a respectful and dignified manner. The service offers a nutritional, well balanced menu, meeting the needs of the people using the service. People using the service are able to make active choices over the foods they are consuming. It was well displayed with a good consistency and taste. People were directly observed to be enjoying the food available. One person using the service stated "the food is nice and always hot". The staff working at the service were directly observed engaging with all people in a respectful and dignified manor. Many people commented on the staff. One person using the service stated "the staff are all so lovely, kind and caring". The service has been redecorated and is well maintained. People`s rooms are personalised to individual tastes and reflective of their personalities. Health and safety is well managed with systems for sound management are in place. What has improved since the last inspection? Improvements have been made to the internal decoration and maintenance of the service since the last inspection. Improvements have been to the pre admission assessment and the care planning process. The management team have introduced clear audit systems to ensure and monitor staff completion of essential documentation. The service has introduced a new training system. Details of this were observed throughout the inspection process. staff are able to access training from a variety of sources to ensure that there are trained and skilled to meet the needs of the people using the service. What the care home could do better: Improvements could be made to the service through the introduction of signage to meet the needs of people with dementia. Medication administration Records should display a photo of the individual to reduce the possible risk of errors in administrations. Key inspection report Care homes for older people Name: Address: Glengariff Residential Home 45 Freeland Road Clacton On Sea Essex CO15 1LX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Louise Bushell     Date: 1 1 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Glengariff Residential Home 45 Freeland Road Clacton On Sea Essex CO15 1LX 01255220397 01255220880 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Glengariff Company Limited Name of registered manager (if applicable) Ms Julie Ann Bleeze Type of registration: Number of places registered: care home 55 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 15 persons) Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 55 persons) The total number of service users accommodated in the home must not exceed 55 persons Date of last inspection Brief description of the care home Glengariff is a care home for older people accommodating a maximum of 56 service users. The property is a three-storey converted hotel close to the town centre and seafront. Care Homes for Older People Page 4 of 30 0 4 0 6 2 0 0 9 0 0 Over 65 15 55 Brief description of the care home The upper floors are accessed via a passenger lift. Most bedrooms are single occupancy and all have en-suite facilities. There is a choice of communal areas and a large garden at the rear of the building. The home provides written information about the service to prospective service users. Inspection reports are displayed on notice boards and in the managers office. 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 focus of the inspections undertaken by the Care Quality Commission is upon outcomes for the people who use the service and their views of the service provided. The primary method of inspection used was case tracking which involved selecting a number of people and tracking the care they received through looking at their care records, discussion where possible with the people who use the service, the care staff and observation of care practices. The last key inspection took place on the 4th June 2009 The visit was unannounced and planning for the visit included assessment of the notifications of significant events, which had been received from the service to the Care Quality Commission. We looked at the last Inspection Report and information on safeguarding and complaints since the last inspection. We also looked at the Annual Quality Assurance Care Homes for Older People Page 6 of 30 Assessment (AQAA) and reviewed what the service has improved in the last twelve months and its plans for the next twelve months. During the visit information was gathered directly from the staff and people who use the service. The visit took place between 9:30am and 14:00pm. This enabled the inspector to directly and indirectly observe the care practices and the day to day operations of the service. The inspection was conducted by two inspectors. A selected tour of the building was conducted during which we spoke with people who use the service, staff and visitors and the manager. Part of the inspection process invloved a Short Frame Observation Inspection (SOFI). The SOFI is a tool we can use to observe people using the service every five minutes. The aim of the observation is to observe the experiences of the individuals. The findings from the SOFI were fed back to the manager of the service at the end of the inspection. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Improvements could be made to the service through the introduction of signage to meet the needs of people with dementia. Medication administration Records should display a photo of the individual to reduce the possible risk of errors in administrations. Care Homes for Older People Page 8 of 30 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be assured that their individual needs will be meet and recorded for all staff to access how they prefer to receive their support. Evidence: A Statement of Purpose has been developed, which sets out the aims and objectives of the service, and includes a guide, which provides basic information about the service and the specialist care the service offers. The Statement of Purpose had recently been reviewed and reflected the up to information regarding the service. The guide details what the prospective individuals can expect and gives a clear account of the specialist services provided, quality of the accommodation, qualifications and experience of staff and how to make a complaint. The details regarding how to make a complaint were out of date. The document is available in the entrance hall way of the service for all to access. When requested the service can provide a copy of the Statement of Purpose and guide in a format which will meet the capacity of each person. Care Homes for Older People Page 11 of 30 Evidence: Admissions are not made to the service until a full needs assessment has been undertaken. A skilled and trained person always completes the assessment prior to admission to the service. The assessment explored areas of diversity including preferences, religious and cultural needs, involvement from family, partners and advocates, race and disability. It was evident that the service strives to seek the information and assessment through care management arrangements, prior to admission. Pre-admission assessments examined contained a range of information relating to the persons abilities and needs. Issues included the persons ability to maintain a safe environment, whether they were disorientated or confused, their appetite, their abilities and needs around personal hygiene and continence, mobility. There was a comprehensive assessment of the persons lifestyle and interests. One person enjoys television comedy programmes, musical films, knitting, food and outings. The level of detail in the assessments was good, detailing what the person could do independently. Good examples were seen where people had completed the assessment in a person centred way, gaining information in relation to each persons preferences. The AQAA tells us that we actively encourage prospective residents and their families to visit the home as often as required to help in the decision making process. The service has the capacity to support individuals who use the service and respond to diverse needs that may have been identified during the assessment process. Comment cards were received from people who use the service, all determined that they had enough information to make informed choices about the service. One person commented all the staff are nice and friendly, I like it here. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can feel assured that their health care needs and medical needs will be met by the staff working at the service. Evidence: Since the last inspection the deputy manager explained that the care plan system has been updated and reorganised. The care plans are divided into colour co-ordinated sections to make them easy and clear for staff to negotiate. The first section contains personal details including information from the pre-admission assessment, a resident profile, lifestyles and interests, property list and valuables. The second section contains care plans relevant to the individual. Section 3 relates to nutrition and includes a MUST (Malnutrition Universal Screening Tool) assessment. Section 4 covers medical issues including a drug profile and body map, section 5 covers risk assessments and section 6 covers activities. The AQAA tell us that falls risk assessments have been completed for all residents and where necessary a referral is made to the falls prevention service,....new system in place to record clients weight, a new nutritional chart is in place and nutritional training undertaken by some staff. Care Homes for Older People Page 13 of 30 Evidence: A sample of three service user care plans was examined, two of them in detail. Each care plan records the persons identified needs, what outcome is expected from the care provided and actions to implement the planned care. One care plan examined relating to the persons ability to maintain a safe environment stated the planned care action was, I am unable to maintain a safe environment due to my dementia. I need guidance from staff to ensure safety. There were no further details as to what this entailed. However, staff spoken with were able to demonstrate an awareness of peoples needs. Another care plan relating to one person eating and drinking preferences contains more information. The care action stated, I have a small diet and need encouragement.... Due to my small appetite, my doctor has prescribed me Fortijuice. Carers to ensure to give this to me up to 3 times a day. The nutritional assessment sheet for this person was not completed. However, weight was monitored monthly and recorded on a weight monitoring chart which indicated that the persons weight is stable. In addition daily records indicated that on most days the person eats a small diet; one day recorded that no diet was eaten but fluids were encouraged. Overall each care plan repeats the statements from the assessment but does not have a high level of additional detail in the Planned Care Action section. An example of this is one care plan that states, I need guidance and encouragement to maintain oral hygiene. However there is no information as to whether the person can independently clean their teeth, how often or do they just need verbal prompting. Another care plan relating to mobility stated, I can mobilise independently but need assistance with getting up from chairs / bed. I need the assistance of 1 to 2 carers. The risk assessment relating to the persons risk of falling stated, is able to mobilise with one carer. Additional detail would clarify when one person is required for support and went to are required. The deputy manager explained that all staff now I have a responsibility for updating care plans. The management team have an audit process in place to monitor the information in the care plans. Care plans examined contained evidence of visits from a range of healthcare professionals including district nursing services and doctors. On the day of the inspection a district nurse visited the home, as did a GP. The sample of care plans examined on the day of the inspection contained evidence that peoples healthcare needs were assessed and they were supported to access appropriate health care to meet their individual needs. There were a range of charts in place for recording fluids, nutrition, weight or other specific health needs. We examined the services processes around medication. The deputy manager Care Homes for Older People Page 14 of 30 Evidence: explained that they have recently changed to a new provider using a Monitored Dose System. Medication is securely stored in a dedicated room which is kept locked. There is a controlled drugs cabinet for the storage of medication that requires a more robust level of security. Controlled drugs and recorded in an appropriate ledger. Medicines Administration Record (MAR) sheets examined were completed appropriately and drugs that had been administered were signed for. The MAR sheets folder would benefit if individual records were separated in the file with the divider bearing the persons photograph. This would reduce the risk of accidental wrong administration. The service has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. A total of three peoples medication was case tracked in order to ensure compliance. Fridge and room temperatures were being recorded in all the medication rooms. Ordering and returns documentation was up to date and accurate. The service works with individuals regarding any refusal to take medication. Staff have completed and passed an appropriate medication course. An assessment has been carried out to ensure each member of staff is competent to handle, record and administer medication properly. On the day of the inspection it was directly observed that people who use the service were being supported and provided with specialist treatment in their own rooms and in private. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be assured that they rare provided with an extensive and diverse range of meaningful activities and social opportunities. Evidence: People who use the service have the opportunity to develop and maintain important personal and family relationships. Feedback from people using the service determined that visitors are welcomed to the service. One person using the service stated My children often visit me and bring the grandchildren to, they are always made welcome. A number of people that use the service have stated that the staff practices promote individual rights and choice, but also consider the protection of individuals in supporting them to make informed choices. One person commented they always look after me very well and are respectful. In addition to this another person using the service commented the carers are all happy and take good care of me. They have nice food and drink. They have a laugh with us which is good The noticeboards throughout the home contained evidence of regular activities that take place. These include armchair exercises every fortnight, and visiting singer every month and a representative from a local church who comes in to lead hymns and prayers. Downstairs in the Willow View Lounge staff were observed doing arts and Care Homes for Older People Page 16 of 30 Evidence: crafts work with people in the home, including drawing and card making. On the day of the inspection there was a choice of two hot meals at lunchtime. People could have either beef casserole or fish in parsley sauce with mashed potatoes, green beans and carrots. Pudding was a choice of either mixed fruit cocktail or sponge and custard. Some people sat in the dining areas at tables, whilst others chose to eat at individual tables in the lounge area. We observed one person who needed full support to eat their meal. The member of staff supporting the person explained what they were having, commented on the food and gave the person ample time to eat in a relaxed manner. They asked the person what they wanted to drink and offered them a choice of different squashes. We observed that this was a sociable experience. A carer spoken with explained that carers go round in the afternoon to ask people what their choice is for the following day. The the carer further explained that there is also a choice in the evenings such as a range of sandwiches, soup or a hot snack. One person living in the home spoken with told us they had, no complaints about the food. Care staff are sensitive to the needs of those residents who find it difficult to eat and give assistance as required. They are aware of the importance of offering support at the pace of the individual, making them feel comfortable and unhurried. Direct observations occurred during the lunch time meal. The atmosphere was jolly, with people talking to one another and engaging with staff on an equal basis. People were offered protective aprons if they wished, but where they choose not to wear an apron this was not insisted upon. The service respects the human rights of people using the service with fairness, equality, dignity, respect and autonomy underpinning the care and support being provided. The AQAA tells us that the routine of daily living is flexible to allow residents the choice about how they spend their day. A varied choice of menu is available. One person using the service stated the food is lovely. It includes a variety of dishes that encourage individuals to try new and sometimes unfamiliar food. The meals are balanced and nutritious and cater for the varying cultural and dietary needs of individuals As part of the inspection process we conducted a Short Frame Observational Inspection (SOFI). The SOFI took place over an hour and a half and involved directly observing a number of identified people using the service and recording every five Care Homes for Older People Page 17 of 30 Evidence: minutes their experiences of using the service. The persons experiences were recorded by identifying their state of being, any engagement they received or had and with what or who and the level of staff interaction. Five people were identified as part of this SOFI. The SOFI took place in an open plan living area where a number of people were sitting. The SOFI showed a high level of positive staff engagement and showed that many of the people using the service were able to enjoy engaging with one another also. Results also determined that those people who were observed for the specified period of time generally experienced a positive state of well being. Staff were directly observed to interact well with those people being observed, with dignity and respect for the individuals. On a number of occasions manual handling practices were observed. The staff team help with communication skills, both within the service and in the community, to enable residents to fully participate in daily living activities. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be assured that their complaints and concerns are listened to and that staff are able suitably trained in safeguarding issues in order to protect them. Evidence: The service has an open culture that allows all people to express their views and concerns in a safe and understanding environment. People who use the service have commented that they are happy with the service provided, feel safe and well cared for. A number of comments received determined that people who use the service are aware of what to do if they have any concerns. The Statement of Purpose did not contain a reviewed complaints procedure and provided incorrect contact details of the care Quality Commission. One person using the service commented I do feel my complaints are listened to and always acted upon. The AQAA tells us that a folder for informal concerns is set up. For concerns these are then able to be dealt with at time raised. Staff have now received training in the Mental Capacity Act and Deprivation of liberties and safeguards. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Staff commented that they have received Care Homes for Older People Page 19 of 30 Evidence: training in safeguarding and felt confident in reporting any issues as they occurred. Staff had a clear understanding of whistle blowing and when the use of this policy may be put into practice. The service understands the procedures for safeguarding adults and attends meetings or provides information to external agencies when requested. Training of staff in safeguarding is regularly arranged by the Service. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are able to reside in a safe, maintained homely environment. Evidence: The service provides a physical environment that is appropriate to the specific needs of the people who live there. The service is a pleasant, safe place to live the bedrooms and communal rooms providing a personal homely feel. The layout of the building enables people to move freely with several different seating areas throughout to encourage socialising or enabling the person to have privacy. Glengariff is set in attractive grounds and some individual rooms have views over the gardens. Accommodation is offered over three floors accessed by a lift. During the inspection a number of rooms were observed and were seen to be well equipped with furniture and were personalised with pictures and memorabilia. One person using the service stated I love my room, I like all my teddys and the girls always make my bed up lovely each day. The AQAA tells us that the home is very well maintained by both domestic and maintenance staff. During a tour of the premises we noted that the home was well maintained with a good standard of furnishings, fixtures and fittings. There was evidence that some areas had recently been repainted. All areas were cleaned to a good standard and there was no evidence of odours throughout the premises. Care Homes for Older People Page 21 of 30 Evidence: In the Willow View Lounge a small group of service users were watching television and socialising. Two people were chatting and interacting with a staff member, who offered cups of tea. The room had some old-style memorabilia including an old Singer sewing machine. There were a display boards around the room containing pictures of Hollywood stars and singers from the 40s and 50s. The top floor of the premises is primarily used for people with dementia. The deputy manager explained that they have started to look at signage. The bathroom had an appropriate laminated picture on the door. Signage needs to be further developed if people who are becoming forgetful because of the ageing process or people who have dementia are to be able to make good sense of their surroundings. The people who use the service appear like the changes and were settled and relaxed. One person using the service commented its nice. The people who use the service are encouraged to personalise their bedrooms. All the services fixtures and fittings meet the needs of individuals and can be changed if their needs change. The dining rooms are laid out to encourage communal dinning with a calm relaxed atmosphere. People are able to eat in their rooms, in the dinning area or sitting in the communal lounge areas. In addition to this people are able to choose to eat their meals in the Willow view area. The environment promotes the privacy, dignity and autonomy of residents. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in private. The service has a sound infection control policy. The manager of the service has identified works throughout the forthcoming twelve months that will be completed. The AQAA tells us that over the last twelve months that they have set up a reminiscence area is now set out in the Willow View lounge containing memorabilia from past years to allow residents, relatives and staff to converse about changes throughout the years. The service is clean, well lit and in general smells fresh. There was an infection control policy in place and in discussion with the staff and observation of care practice demonstrated that the infection control practices were being followed. There was restricted access to high risk areas such as the main kitchen and the laundry areas to reduce the risk of cross infection. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can feel assured that the staff supporting them are available in fully inducted and trained in order to meet their needs at all times. Evidence: The people spoken with and from information gathered from a number of surveys, determines that they have confidence in the staff who care for them. Rotas were seen and displayed adequate staffing numbers on duty to meet the needs of the people using the service. Specific attention was given to the busier periods of the day. A deputy manager was usually on shift and supernumerary to the care staff. This enable the service to ensure that numbers were maintained for the safety of all and that record keeping was completed and monitored as required. During the inspection it was observed that staff were available in adequate numbers to meet the current needs of the people living at the service. One person using the service stated the staff are always nice and friendly, they are great. Through discussions the deputy manager explained that they now have a stable staff team. In view of the fact that service user numbers are down they are not currently recruiting. The manager and deputy manager explained they have new training providers. Some of the training courses involve using workbooks that are marked by the training Care Homes for Older People Page 23 of 30 Evidence: provider (distance learning). One person living in the home spoken with told us, carers are very good. They are angels, angels without wings. Throughout the course of the inspection we observed staff interactions with people living in the service. Staff were seen to be polite, sociable, demonstrated a caring attitude and followed good practices in manual handling and hand washing. A member of staff told us that in the afternoon there is usually sufficient time to chat to people. A member of staff spoken with told us that they feel well supported in the home. They told us, of all the homes I have worked in this is the most welcoming. Staff members are offered the opportunity to undertake external qualifications beyond the basic requirements. The managers encourage and enable this and recognise the benefits of a skilled, trained workforce. One person using the service stated that the staff always seem to be on training which can only be a good thing. The AQAA tells us that we ensure a good skill mix of staff and the amount of staff on duty, allocation of staff to specific duties and areas of the home throughout the day and night and encourage staff to undertake National Vocational Qualification (NVQ) training. Accurate job descriptions and specifications clearly define the roles and responsibilities of staff. People who use the service report that staff working with them are very skilled in their role and are consistently able to meet their needs. There is a good recruitment procedure that clearly defines the process to be followed. This procedure is followed in practice with the service recognising the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. A total of five staff files were audited. All files were seen to contain all the required documentation. Staff commented on the strong team culture of the service and felt that following recent recruitment that there are enough staff on duty to meet the needs of the people who use the service. Staff recruited confirmed that the service was clear about what was involved at all stages and was robust in following its procedure. There are clear contingency plans for cover for vacancies and sickness. Staff receive training and induction once recruited. The induction programme is designed around the needs of the service and is signed off at each stage of the process. Discussions occurred with the manager regarding the Skills For Care Care Homes for Older People Page 24 of 30 Evidence: Induction Programme. The manager sated that they are starting to use these for the care staff. The manager and the deputy manager spoke about the supervision process and stated that they had improved. Records reflected that improvements had been made, although records show that some staff had not received regular supervision. Staff meetings take place regularly. Notes and action points are taken of meetings and sessions, and progress is regularly reviewing. The mix of staff is suitable to meet the cultural needs and mix of people that use the service. Staff reported that they felt supported in their roles and that they were to discuss issues with a member of the senior team if required. Care Homes for Older People Page 25 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. People using the service can be assured that the management is effective and well organised to ensure the smooth running of the service, improving outcomes and experiences for individuals at all times. Evidence: The Manager is obtaining the required qualifications and is competent to run the service. The Manager and deputy manager have a clear understanding of the key principles and focus of the service, based on organisational values and priorities. They work to continuously improve services. The Manager is awaiting confirmation of successful application to become Registered with the Commission. The Manager and deputy manager lead and support a stable staff team who have been recruited and trained to satisfactory levels. The manager promotes equal opportunities, has good people skills and understands the importance of person centred care and effective outcomes for people who use the service. The AQAA tells us that the service does well and all staff receive regular training in manual handling, Care Homes for Older People Page 26 of 30 Evidence: fire safety, health and safety and safeguarding of vulnerable adults. The Manager is near completion of the national occupational standards for leadership and management of care services and the deputy manager is completing the NVQ level 4. The service has sound policies and procedures, which are corporately and internally reviewed and updated, in line with current thinking and practice. The manager ensures staff follow the policies and procedures of the home. The staff team are positive in translating policy into practice and showed good knowledge of care principles, health and safety and safeguarding issues. One person using the service commented I feel safe here. All of the surveys returned from staff determined that they are always provided with enough information in order to support the people using the service. The staff also confirmed that they are provided with adequate support and guidance, that there are enough staff to meet individual needs and that they know what to do if some one has concerns about the service. There was some evidence on staff records that staff have supervision but this is not always carried out on a regular basis where staff have the opportunity to discuss their personal development. Other staff confirmed that supervision does occur. The service works to a clear health and safety policy. Safeguarding is given high priority and the service provides a range of policies and guidance to underpin good practice. Recent in house training has occurred regarding safeguarding issues. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 9 16 photos should be present on the Medication Administration Record to identify people. The complaints procedure should contain the correct contact details for the Commission. 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. 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