Care Home: Greenacres

What the care home does well Each person has a detailed and comprehensive care plan , which they or their representatives have been consulted about. A number of positive comments were received from people or their representatives including, "The staff are very good and caring"; "Excellent home and first class management"; "The staff are really friendly and very caring and they always keep me informed about my relative"; "There is not much to improve they are very good";"Everything I need is taken care of"; "I am more then satisfied with everything". The service provides a wide range of recreational, social and leisure activities and people maintain links and participate in the local community. During this visit people told us they go out shopping, enjoy poetry afternoons and are helping to prepare Christmas cakes. A programme of activities was seen on display, which included reminiscence, monthly visits take place from a local flower club who assist and help people with flower arranging, ten pin bowling, a range of entertainers attend the home, ladies tea afternoons, mens clubs, some people attend an club for retired people outside of the home to meet friends and enjoy a range of social activities. Some people attend external day services,a mobile library, and children from local schools also visit the home. People living in the service are provided with a varied and balanced meals, which are based on people`s preferences and nutritional needs and snacks are available over twenty four hours. Comments from people living in the service included, "Good choices", "Excellent" and " very good". The service provides a good standard of accommodation , which is well maintained , furnished in a modern style, cleaned to a good standard and is accessible to people throughout . The home has implemented good quality systems ensuring that the views of people and/or their representatives are listened and acted upon including regular consultation meetings and feedback surveys . Staff receive a wide range training and development, which ensures that they are able to support the needs of people living in the home including dementia awareness and National Vocational Qualifications. There is an experienced manager in post who holds appropriate qualifications and has demonstrated that they undertake a range of training and development . What has improved since the last inspection? There were no requirements or good practise recommendations made at the last key inspection What the care home could do better: No requirements were made at this key inspection Key inspection report Care homes for older people Name: Address: Greenacres Greenacres The Horseshoe Banstead Surrey SM7 2BQ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lisa Johnson     Date: 0 5 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Greenacres Greenacres The Horseshoe Banstead Surrey SM7 2BQ 01737858990 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: jean.williamson@anchor.org.uk www.anchor.org.uk Anchor Trust care home 62 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: (1) The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either whose primary needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Mental disorder, excluding learning disability and dementia (MD) Dementia (DE) Physical disability (PD) The maximum number of service users to be accommodated is: 62 Date of last inspection Brief description of the care home Greenacres is an Anchor Trust care home for older people. The home is purpose built and offers well-equipped accommodation for sixty (62) residents. The accommodation Care Homes for Older People Page 4 of 29 Over 65 0 0 62 0 62 62 0 62 Brief description of the care home is divided into five units and all of the residents have single rooms with en-suite facilities. Communal facilities are arranged on each floor, these include dining rooms, lounges and small-equipped kitchens. Each floor also has suitable toilets, assisted bathrooms and walk in shower rooms. The home is located in a residential area of Banstead, with easy access to community amenities. The home has a car park at the front of the building, and is surrounded by an enclosed garden. The fees charged at this service range from £514- 900 per week. 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This site visit was part of a key inspection. The visit was unannounced. We arrived at 8.55am and left at 5:00pm. Information was provided to us by the service prior to this visit in the Annual Quality Assurance Assessment. (AQAA). This is a self-assessment that focuses on how well outcomes are being met for people using the service. We received the AQAA by the expected date, which was clear and gave us all the information we asked for. Reference is made to this assessment in this report. During this visit we met with ten people that live in the service and discussion took place with the registered manager and six members of staff . We received six surveys from people who live in the service or which had been completed by relatives on their behalf. We received three surveys from health and Care Homes for Older People Page 6 of 29 social care professionals and we received surveys from five members of staff. During this visit we observed activities, staff interaction and the arrangements for meals. We sampled staff recruitment, and training records, care plans, risk assessments complaint records, quality assurance systems, medication administration practises , health and safety records and sampled policies and procedures. We also reviewed other information that we have received since our previous including notifications. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: No requirements were made at this key inspection Care Homes for Older People Page 8 of 29 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 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 10 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. Prospective people considering the service as a place to live are provided with the information they need to know to enable them to make an informed choice about the suitability of the home as a place to live. Peoples needs are assessed prior to admission ensuring that the home will be able to meet them. The service does not provide intermediate care. Evidence: The service has a statement of purpose and service user guide, which can be provided in alternative formats. The service user guide has been reviewed and updated and a copy is also made available to people in their bedrooms. Six people surveyed and discussion held with a person who had recently moved into the service said that they were provided with enough information to help them decide if this was the right place for them to live. The service carries out pre admission assessments ensuring that peoples needs can Care Homes for Older People Page 11 of 29 Evidence: be met. This format has been updated, which we saw on peoples files, which we sampled and included information about equality and diversity. Further information is obtained through pre admission visits to the home, which includes weekends. The service is in the process of extending pre admission assessments to include twenty four hour stays. The service also obtains reports from care managers where this is applicable. The service does not provide intermediate care but can can provide respite, short term care. Care Homes for Older People Page 12 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. Peoples health and personal care needs are met and their preferences for support are respected. Peoples privacy and dignity is respected and the home supports people with their medication in a safe way. Evidence: Each person is provided with a detailed and comprehensive care plan, which is based on a range assessments and covered their health, personal, emotional, social, choices, , cultural and religious needs. During this visit we sampled four peoples care plans and information seen demonstrated how peoples needs are to be supported. Care plans were up to date, reviewed monthly and daily records relate to peoples identified goals. Care plans sampled had been signed by people to confirm their agreement. Peoples preferences for support were recorded in their care plan, which included, their life histories, likes, dislikes and preferred routines such as times of getting up. One person told us that they have a lie in , which is respected. The service has implemented a wide range of assessments, which were up to date and Care Homes for Older People Page 13 of 29 Evidence: included, environmental risks, bed rails where these are required, tissue viability, mobility, and use of the hoist. Information seen demonstrated that peoples weight is regularly monitored and nutritional assessments have been implemented. Falls risk assessments are completed and we were informed that any people identified at risk of falls are referred for further specialist advice. Health care interventions and health care professional appointments were outlined in their care plan, which included the General Practitioner, dentist, chiropodist, district nurse, physiotherapist, optician, community mental health nurse and hospital outpatient appointments. These consultations were documented and records were also maintained of any multi disciplinary forums or meetings. The service is supported by local GPss and people are encouraged to keep their GP if it falls under the same catchment area. Six people surveyed told us that their medical needs are met by the service. Information provided to us and seen during this visit confirms that staff receive a wide range of training ensuring that they are able to meet peoples needs including dementia awareness training resulting in some staff being recognised as dignity champions. At the time of these visit people were observed to be clean, well presented and appropriately dressed. Some people spoke positively about the homes laundry arrangements. People spoken with during this visit all stated that that they receive the care and support they need, which was also confirmed by feedback surveys received. Comments included, The staff are very good and caring; Excellent home and first class management; The staff are really friendly and very caring and they always keep me informed about my relative; There is not much to improve they are very good;Everything I need is taken care of; I am more then satisfied with everything; I feel Greenacres is perfectly suitable for me and I find the home much better then I could have hoped for after being very apprehensive about coming here. Two health and social care professionals stated that peoples social and health care needs are properly monitored, reviewed and met by the care service and that the the manager and staff have the right skills and experience to support their care needs. Comments included, The staff are doing a very good job looking after disabled people and they are inform us promptly of all incidents and They respect clients and are caring,although one health care professional said they could improve by gaining more information prior to the arrival of new people. Another health and social care professional said, that There was lack of understanding of therapy within the home, Care Homes for Older People Page 14 of 29 Evidence: None of the clients I have seen this year have been supported by staff to encourage exercises or mobility and are told my staff do not have time This matter was brought to the attention of the manager at the time of this visit who informed us that they had not been made aware of this concern. During this visit staff were observed to be respectful, caring and attentive towards people throughout this visit.People told us that staff respect their privacy and that they are provided with keys for their rooms if they wish to use them. People are consulted and their permission is gained to ensure they are in agreement for staff to carry out any night checks, which was confirmed by records maintained with the care plan. During this visit we looked at the systems in place for the administration of medicines in one of the living units. Medication was stored and locked away safely.Medication policies and procedures were in place and staff receive medication training, which includes, shadowing and competency assessments.A signatory list is maintained of all staff that are trained to administer medication and photographs of people were available for identification. Records were maintained for fridge temperatures containing medication and controlled medication was stored and recorded appropriately.Medication is dispensed using the monitored dose system (MDS). Quantities of medication received by the home were recorded. We sampled some peoples medication administration records, which were maintained in good order and contained no gaps. Daily and monthly medication audits take place to monitor practise and to identify any errors. Any errors that may have occurred have been pro actively reported and appropriate action and follow up has taken place. We were informed that currently there are no permanent people living in the home that are self administering their medication, although people would be supported to do so if this is their choice. We were informed a person receiving respite care undertakes this, which is supported by a risk assessment Information seen demonstrated that the service gains permission from people to administer their medication. Care plans include end of life plans and the service has been registered with the Liverpool care pathway and the service plans to continue to provide training in this subject. 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. Peoples recreational social, cultural, diverse and religious needs are met. People maintain contact with their family , friends , representatives and the local community. People are supported to exercise choice over their lives and they are provided with varied and well balanced meals. Evidence: The service places emphasis on providing a full range of meaningful recreational, social and activities. The home is a member of the National Association of Providers for Activities (NAPA)for older people, who also provide staff training. Peoples care plans contained information about their preferred social activities and how they like to spend their leisure time.Social interaction and activities are person specific and are outlined in their care plan. A programme of activities was seen on display in each unit throughout the home. The home employs activities coordinator and care staff were also seen involved in providing activities. During the morning activity sessions were taking place in each unit where good interaction was observed. In the afternoon a musical event was taking place provided by an external entertainer. The home was also preparing for a buffet and fireworks display, which was taking place in the evening. Care Homes for Older People Page 16 of 29 Evidence: Some of the activities provided include, reminiscence, craft mornings, film nights,ladies tea afternoons, mens clubs, crafts, musical entertainment and pamper days. There are opportunities to go out for walks and shopping ,which one person living in the service told us about .Two other people told us that they take part in a ten pin bowling club and gardening. One person told us that they particularly enjoyed The poetry afternoon. The home also has pets including, a cat, birds and they have a dog called sparkle. People are supported to maintain links and participate in the local community. Monthly visits take place from a local flower club who assist and help people with flower arranging, some people have joined a local club for retired people to meet friends and enjoy a range of social activities. Some people attend external day services,a mobile library and PAT dog visit and visiting children from local schools attend. We were informed that a remembrance service had been arranged, which the local mayor was invited to attend. The service has liaised and obtained membership with a museum in Surrey to develop memory activities with an accent on dementia care. During this visit reminiscence table displays were observed in the living units with items for people to browse. Peoples religious needs are respected and some people attend local church or supported to attend services if this is their preference and visits from the local priest take place. The service operates an opening visiting policy and relatives are encouraged to join people for meals and some families help set the dining room. Information supplied in the AQAA states that a quiz nights are held every six weeks, which is supported by family and friends. Two peoples visitors spoken with told us that they are always made to feel welcome. During this visit we spoke with a volunteer who attends the home to assist with activities. The manager holds regular resident and family support meetings and there is a monthly catering focus group , which provides people with the opportunity to raise issues and discuss decisions. Detailed minutes were kept of these minutes, which we sampled. The home has recently produced a news letter, which provides up to date information about developments in the home. Through consultation meetings and feedback questionnaires the home is able to demonstrate that peoples views have been listened to including, changes to meals , redecoration of bedrooms, increase in shopping outings and developments in the gardens. Six people surveyed confirmed that they are able to have their say about the home and staff listen and act on what they say. Care Homes for Older People Page 17 of 29 Evidence: Information was seen available on notice boards throughout the home to assist people in how to contact external agencies such as advocacy services.During this visit we were shown flash cards, which assists people with communication difficulties,which had also been adapted in another language to assist a person whos first language was not English. Information supplied in the AQAA states that individual screening takes place, which we saw evidence of in peoples care plans. This also feeds into the menu planning by the homes chef. Meals provided were varied, well balanced, provided choice and presented to a good standard. On arrival at the home people were observed enjoying a cooked breakfast, which is available everyday. Menus were displayed on each table and people are shown the meals for them to choose their preferred option at the time and does not use pre ordering systems. The home is intending to develop picture boards to assist people with communication difficulties particularly in the dementia units to assist them further to help and choose their meals. The main meal is served in the evening and a choice of snacks is available over twenty four hours, which provides flexibility and allows people choice to eat when they choose.As well as home made cakes and biscuits we saw a range of fresh fruit and smoothies being offered. Peoples cultural needs can be also be accommodated. The home celebrates a diversity day where people, families and friends attend where staff bring and share cultural dishes, which reflect their country of origin. Staff receive dining with dignity training. At the time of this visit the dining rooms were were attractively presented and tables were laid with table cloths and serviettes.Side dishes were served separately for people to help themselves to. People were observed to enjoy their meals in a relaxed and unrushed atmosphere. Discussions with all people at the time of this visit spoke positively about the meals. Comments included, Good choices, Excellent very good. 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. If people have concerns they know how to complain and they are safeguarded from abuse. Evidence: The service has a complaints procedure in place, which is available in the service user guide,in leaflets and was also seen on display on notice boards throughout the home. Discussion took place with a person living in the service who said that they had read the procedure and they were aware of whom they would speak to if they any concerns.A complaints and suggestions book was also available in the reception area, which the manager regularly monitors and follows up issues. Information supplied in the AQAA states that four complaints have been received and that response times to complaints are strictly adhered to.This was confirmed by the complaint records sampled, which recorded the details of the complaint,investigation and the outcome.One complaint was referred to the local authority, which the service was asked to respond to and at the time of this visit the manager was waiting feedback from them. Safeguarding vulnerable adults from abuse procedures were in place including the local authority multi agency procedure. Staff training records sampled confirmed that staff receive safeguarding training, which was also confirmed by staff spoken with during this visit. The manager informed us that they also attended the local authority safeguarding training. Care Homes for Older People Page 19 of 29 Evidence: Since the last inspection we have received seven notifications that have also been referred by the service to the locality authority. Four of these referrals were accepted by the local authority, which pertained to behavioural incidents between people living in the service. other matters have resulted in further information or action to be taken by the service.Information supplied in the AQAA states that organisation has appointed a specific person to support a consistent approach to safeguarding to ensure assurance processes are in place to monitor and feedback trends and lessons learnt. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in an environment that is safe, well maintained comfortable, homely and clean. Evidence: The home provides a good standard of accommodation which is safe, well maintained and provides comfortable surroundings for people to live in. Peoples living areas are divided in to five units. Each unit has their own sitting room, dining room and kitchen. The home was furnished and decorated in a modern style.There is a continuous refurbishment and maintenance plan in place. Since our last visit the homes lounges, dining rooms, kitchens and communal areas have been redecorated where people living in the service have had input in choosing the colour schemes. Each units sitting room has been provided with new, large plasma screen televisions. The homes dementia care units have been decorated using appropriate colours to meet their needs. We were informed that the service is planning to have a conservatory, which will allow people to meet socially in one place and will possibly provide a removable dance floor, which people will able to use for tea dances. The home is disability friendly and accessible through out and a lift is installed , hand rails are available and, assisted bathrooms are provided and ramps are in place. Bedrooms were observed to be comfortable and personalised and they were all Care Homes for Older People Page 21 of 29 Evidence: provided with en suite facilities. Since our last inspection the service has increased their beds to sixty two by providing a large double bedroom,which can accommodate two people who have made a choice to do so. There is an accessible garden , which provides a sensory garden and over the last year a new patio area has been installed with new garden furniture and a new memorial garden.We were informed that a landscape gardener has been employed. At the time of this visit the home was observed to be cleaned to a high standard and was hygienic. The home has robust infection control procedures in place based on department of health good practise guidance and regular audits take place. Hand disinfectant gels were sited throughout the home and staff are provided with infection control training with emphasis being placed on reiterating the importance of hand washing. Surveys received from people also confirmed that the home is always clean and fresh. 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. People using the service are supported by staff that are competent and trained to meet their needs and they are protected by the homes recruitment policies and practises. Evidence: At the time of this visit the staff numbers and skill mix appeared sufficient to meet the needs of people. During the day each unit is run by two members of care staff being supervised by one to two care team leaders and we were informed that there is always other senior members of the management team available in addition to this. We were informed that a floating member of staff is also available in the dementia unit to provide extra support, where this is required. At night time three carers and a team leader are provided. The home does not employ agency staff but has a bank system to cover any shortfalls. The manager informed us that staffing levels are under review and consideration is being given to increasing the numbers of team leaders in each units. The service is also supported by activity coordinator catering, housekeeping and administration members staff. Six people surveyed said that staff are available when they need them , which was also confirmed during discussion with people at the time of this visit. Staff surveys revealed that staff in the main felt that there were enough staff, although two people felt that improvement was needed in providing an extra member staff on night duty. Care Homes for Older People Page 23 of 29 Evidence: Information supplied in the AQQA states that out of fifty four care staff employed thirty five hold National Vocational Qualifications (level 2) and four team leaders have completed National Vocational Qualification (Level 3.) Housekeeping staff have completed National Vocational Qualifications (levels 1& 2) New staff receive induction following Skills for Care core induction standards.Two members of staff files sampled contained information to demonstrate this and staff surveys returned also confirmed that they had received induction, which covered everything that they need to know. Staff training schedules and files sampled demonstrate that staff receive a range of statutory and specialist training ensuring that they are able to meet and support the needs of people living in the service. Training is provided by the organisation, through E learning, which is supported by in house staff coaches and external training. As well as dementia training other specialist training includes, deafness awareness and sign language, challenging behaviour, non violent intervention crisis, falls prevention, stroke awareness, rights and responsibilities and equality and diversity. Three members of files sampled indicated they had attended a range of training including statutory and specialist including, dementia awareness one day and five day courses, diabetes, stroke awareness and Parkinsons. During this visit staff told us that they receive a range of training and development and five staff surveys returned confirm that they feel that they have enough support, experience and knowledge to meet the different needs of people living in the home. One member of staff said, Staff training is excellent. Staff recruitment follows an equal opportunities policy. People are supported by a staff team that are mixed ethnicity.The organisation has recruitment procedures in place. During this visit we sampled four members of staff personal files, which demonstrated that the required information is obtained including, a fully completed application form, two written references. Protection of vulnerable adult first check (POVA)and criminal records bureau check (CRB) 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run in the best interests of people living there and their financial interests, safety and wellbeing is protected. Evidence: The service is run by an experienced registered manager, who has obtained the registered managers award and has demonstrated they continue to undertake training and development to up date their skills and knowledge. There are also two appointed deputies who have also obtained the registered managers award. During this visit the manager was observed to have an open and accessible approach with both people living in the service and staff. The manager provided us with a detailed and comprehensive AQAA, which details the improvements that the service has made and future developments that they have identified. Information supplied in the AQAA and evidence seen at the time of this visit confirms that the manager has a good understanding about the importance of equality and diversity. Care Homes for Older People Page 25 of 29 Evidence: Five members of staff spoken with during this visit spoke positively about working in the home the home, which was also confirmed by staff surveys received. Comments included, The manager always makes time for you ;Helps out when needed; Fantastic;Regular meetings take place;excellent teamwork; and Good communication and a friendly staff team. Monthly quality monitoring visits are carried out by the organisation, which were available for viewing and were clear and detailed. Feedback surveys are provided to people and their relatives to gain their views, which we sampled and these included a number of positive comments. We were informed that the service was in process of sending out surveys to other stake holders including, care managers and health and social care professionals. The service also provides discharge questionnaires. As part of their quality assurance systems there is a continuous self monitoring programme and a quality assurance manual in place. Improvement plans are implemented, which are monitored on a monthly basis. The manager and senior staff have received deprivation of liberty safeguards training and the manager has good knowledge and understanding of this. Currently there are no people living in the service subject to deprivation of liberty safeguards authorisation. The home is able to hold small amounts of personal monies for people if this is their preference. Policies and procedures were in place, which safeguards their financial interests and regular financial audits are carried out. Good systems are in place to ensure the welfare and safety of people living in the service. Staff receive regular training in health and safety, moving and handling, first aid and infection control. Regular health and safety audits are carried out including, monthly infection control audits. Systems are in place for monitoring water temperatures. In house health and safety coordinators are in place and certificates and records sampled confirmed that regular servicing and maintenance of equipment is up to date. The service has also been awarded a safe site certification. Accident and incident records are maintained and the service and notifies the Commission of matters that we need to be informed about required by legislation. 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 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!