Care Home: Harts House Nursing Home

Similar services:

• Henry Nihill House
• Birchwood
• The Infirmary
• Orchard House Nursing Home
• St Josephs Rest Home
• Red Court Nursing Home
• Spinney (The)
• Queen Elizabeth House

What the care home does well The professionals contacted stated,"all patients seem to be happy, they(staff) always act on recommendations made." The expert by experience stated in her report, "Harts House seemed to be a clean, efficiently run home,well staffed who seemed motivated and felt that they were trained well to carry out their roles." Residents comments received by the expert by experience were,"staff very kind" "Tasty food" "Very good here". A reviewing officer commented that the residents are always clean and well presented. All care plans are detailed and updated. They involve other health care professionals if required. There are approppriate risk assessments as well as sufficient and suitable specialist equipment. The staff do discuss things with others. Hence effective communication was highlighted as a particular strength of all staff. Other comments from officers contacted stated that the staff are friendly and approachable, and she had no concerns about the level of care provided, she has always received positive feedback from the residents and their relatives. There is always a core group of staff and they also spend 1:1 time with the residents. She said that she has no concerns about the residents placed there. The following comments were received from relatives," absolutely faultless, staff are wonderful, do everything they can for her. The home never smells and is spotlessly clean." "Their minds are kept busy with something to do" "My mother is 90 with terminal illness, its a wonder she keeps going --- its down to the care she receives." "My mother is very poorly at present and they are looking after her very well. Very clean, very well cared for. If there are ever any problems, they always contact me." What has improved since the last inspection? The requirements from the previous inspection have been met. The initial pre-admission assessments record the religious, cultural and social care needs of the residents and this is reflected in detailed care plans. The manager is now registered with the Commission. Residents and relatives are involved in personal care planning. Residents are consulted regularly so that their views can be incorporated in the planning of the service, for example, a vegetable garden has been developed as a result of consultation, a wishtree was developed in the spring where residents could make/write their wish on a green paper leaf. This was hung on a wish tree. When the wish is fulfilled the green leaf turns to gold. Regular communication and newsletters are produced to keep residents and relatives informed of developments with in the home. The AQAA states that the service continually invole staff residents, their relatives and visitors in developing Harts House. An early warning audit tool (EWAT) has been developed and used by the regional manager to carry out monthly audits for documentation, medication, pressure sores,complaints, compliments and concerns to deal with any issues arising. What the care home could do better: The manager and staff team continue to work hard to meet the residents` needs. There are no requirements or recommendations made from this inspection. The management team and staff must ensure that they continue to operate the service in the residents` best interests in order, to maintain the current excellent standard of care provided in the home. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Harts House Nursing Home Harts Grove Woodford Green Essex IG8 0DP     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Harina Morzeria     Date: 0 8 0 9 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Harts House Nursing Home Harts Grove Woodford Green Essex IG8 0DP 02085029111 02085029444 HartsHouseALL@bupa.com www.bupa.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: BUPA Care Homes (GL) Ltd care home 61 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: 2 beds may be used for respite care for residents aged between 50 and 65 years To include one named person under 65 years of age. Date of last inspection Brief description of the care home Harts House Nursing Home is owned and operated by BUPA Care Homes. The home is registered to provide care with nursing for up to 61 elderly people over the age of sixty-five years. The home is situated in a quiet residential area of Woodford in the London Borough of Redbridge. There are good transport links and the home is close to shops and other amenities and community facilities. All the rooms have en-suite facilities and the premises have been fully adapted to accommodate service users with a range of physical disabilities associated with old age and are suitably equipped. The external grounds and the premises are well maintained and secure. The home employs 0 Over 65 61 Care Homes for Older People Page 4 of 31 Brief description of the care home activities co-ordinators, catering, domestic, maintenance, laundry and administrative staff, as well as registered nurses and care staff. On the day of the inspection the range of fees for the home was between #800.00 and #900.00 per week. A copy of the Statement of Purpose and Service User Guide to the home are made available to both the resident and the family. Copies of both of these documents are available at the main reception. Copies of the most recent inspection report are available on request from administrative staff. Care Homes for Older People Page 5 of 31 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 was an unannounced key inspection and took place over approximately seven and a half hours. The inspector was accompanied by an expert by experience who specifically focused on seeking the residents views about the service provided at Harts House. Discussion took place with the manager, head of care, as well as nursing and care staff. The expert by experience spoke at length with some residents and sent a report of her findings to the inspector. Some comments from her report have been incorporated in to this report. A tour of the premises took place with the manager. All areas seen were clean and tidy with no offensive odours. The files of several residents were case tracked, together with examination of staff and home records. Information was taken from an Annual Quality Assurance Assessment (AQAA),which was fully completed and returned by the manager. This is a self assessment process, which all providers are required to complete once a year. Additional information Care Homes for Older People Page 6 of 31 relevant to this inspection was obtained from monthly Regulation 26 monitoring reports and Regulation 37, notification of events. As part of the inspection process contact was made with two commissioning officers as well as two community health professionals who provide a service to residents in this home. The Commission has not received any complaints about this service. The inspector had a discussion with the manager about the broad spectrum of equality and diversity issues and she was able to demonstrate an undersytanding of the varied needs of the residents around religion, sexuality, culture, disability and gender. What the care home does well: What has improved since the last inspection? What they could do better: The manager and staff team continue to work hard to meet the residents needs. There are no requirements or recommendations made from this inspection. The management team and staff must ensure that they continue to operate the service Care Homes for Older People Page 8 of 31 in the residents best interests in order, to maintain the current excellent standard of care provided in the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 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 31 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. Information about the home is available so that prospective residents can make an informed decision about where to live. This is available in different formats upon request. People who use the service can be assured that their needs will be properly identified and met. Prospective residents are provided with a written contract or a statement of terms and conditions. The home does not provide intermediate care. Evidence: Harts House have a Statement of Purpose and Service Users guide which are reviewed annually. These documents are given to prospective residents and are also made available in different formats and languages upon request. Referrals are received from Primary Care Trusts and the home also accomodate a number of privately funded individuals. The files examined showed evidence of a comprehensive pre - admission assessment carried out by a skilled person, before an individual moves in to the home. This is carried out by staff with skill and sensitivity and significant time and effort are Care Homes for Older People Page 11 of 31 Evidence: spent planning to make admission into the home personal and well managed. Prospective residents and their families are treated as individuals and with dignity and respect for the life -changing decisions they need to make and are provided with good information, support and re-assurance by the manager. From records examined, it was clear that the assessments cover all of the required areas and include information about the physical nursing care needs of the individual, mobility, nutrition, religious, cultural and spiritual needs. For individuals who are self funding, the full assessment is carried out by a qualified person. Individuals are supported and encouraged to be involved in the process. The assessment focuses on achieving positive outcomes for people and this includes ensuring that the facilities, staffing and specialist services provided by the home meet the ethnic and diversity needs of the individual. Before agreeing admission the service considers carefully the needs assessment for each individual prospective person and the capacity of the home to meet their needs. Individuals are only admitted if the home can meet the prospective residents needs, otherwise referrals are forwarded to a more appropriate facility. Evidence was seen on new residents files that they can visit the home and enter the home for a trial period of stay before deciding to move in permanently. The home does not provide intermediate care. Care Homes for Older People Page 12 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health, personal and social care needs are set out in individual care plans and provide staff with the information they need to satisfactorily identify and meet residents needs. There are medication policies and procedures for staff to follow and medication records are being completed correctly which safeguards the residents with regard to the administration of medication. Residents are treated with respect and the arrangements for their personal care ensures that their right to privacy is upheld. Residents wishes in relation to their funeral arrangements are identified on their care plans and end of life care plans are developed for each resident, which will ensure that residents wishes in relation to death and dying are clearly identified. Evidence: Residents receive effective personal and healthcare support using a person centered approach. The AQAA states that all residents have comprehensive personal plans produced with the help of a detailed assessment tool. Prospective residents are aware through information provided to them, about the competencies and specialist services Care Homes for Older People Page 13 of 31 Evidence: the home offers and that this will be delivered effectively through a skilled, trained and knowledgeable staff group who work in a person centered way. The records of six residents were examined. The individual care plans examined for each resident clearly recorded peoples personal and healthcare needs and detailed how these will be delivered. The manager has reviewed and updated all current residents care plans and considerable work has taken place to ensure that care plans truly reflect the residents needs. The care plans examined were detailed and comprehensive, identifying the residents personal, social, cultural, religious and health needs and how these should be met. The manager informed the inspector that staff are responsible for understanding their role in completing and updating the residents care plans as the need arises. It was clear that staff respect peoples preferences and have knowledge about individual personal needs when providing support, including intimate care which is conducted in private and at a time and pace directed by the person receiving the care. Care plans detailed individual preferences regarding the gender of staff providing their personal care and also how their particular needs are to be met. For example, ensure --- Hs glasses are clean at all times as he needs them to watch TV observe Hs facial expression such as eyebrow movement to indicate his preferences and to show his needs/feelings.Another care plan stated ----has history of watery red eyes, use warm flannels placed over eyes. If infected refer to GP. A monthly review of this persons care plan takes place. Staff are trained and competent in healthcare matters particularly in the care of individuals who remain immobile for long periods of time. For example, for residents using a special mattress to prevent skin breakdown, care plans state Turn H---- four hourly, apply barrier cream, pay attention to skin integrity. The residents also have a map of life in place beginning from birth and chilhood memories through to adulthood, interests, working life,family life, holidays and dreams. A lifestyle profile is in place for each person which outlines a persons daily routines and rituals starting from morning through to bedtime routines,for example, assist with personal hygiene followed by breakfast at 8.30am,likes to have lunch in her room, prefers to have shower every other day, self medicates. The home arranges training on healthcare topics that relate to the health care needs of the residents. Staff members are very alert to changes in mood, behaviour and general well-being of residents and fully understand how they should respond and take action as/when required. Records indicate that health professionals including opticions, dentists, chiropodist, GP, district nurse, dieticians and physiotherapists are involved as required. The home arranges for health professionals to visit residents at home when necessary. Residents are being weighed monthly, as well as water flow and nutritional charts being kept to ascertain well-being. Monthly health audits are also carried out. Care Homes for Older People Page 14 of 31 Evidence: The inspector contacted two reviewing officers who were both satisfied with the level of care provided in the home. They stated that the staff are always approachable and knowledgeable about individual residents including their needs and act upon any recommendations made. They also said that there are always a core group of staff in the home which ensures consistency of care given. Risk assessments are in place and are reviewed monthly or when a change in care plan/risk is identified. The risk assessments are detailed and covered areas such as moving and handling, bathing, breakdown of pressure areas, use of cot sites (permission in place), self medication, continence and falls. The documentation/health records relating to wound management, management of insulin dependent diabetes, catheter care were examined and were found to be detailed and being adequately maintained. Aides and equipment are provided to encourage maximum independence for people using services, these are regularly reviewed and replaced to accommodate changing needs. Specialist advice is sought by the home to ensure effective use of equipment. The organization have developed an efficient medication policy, procedure and practice guidance. Staff have access to this information and understand their role and responsibilities. Quality assurance systems confirm that the policy is put into practice. The home strongly promotes independence and those individuals assessed as being able, are encouraged and supported to manage their own medication within a risk assessment framework.This was evidenced on one residents file who self administers her medication. Guidance on homely remedies, error reporting and administration of medication are in the place. Medication audits are undertaken by the Head of care on a regular basis. The home has a sustained record of full compliance with the administration, safekeeping and disposal of controlled drugs. Only nursing staff administer medication. Hence,the homes policies, procedures and guidance support and inform practice. Staff were observed to treat residents in a respectful and sensitive manner. They understood the need to promote dignity through practices such as the way in which they addressed residents and when entering bathrooms and bedrooms. The home fully respects the right of people in the area of healthcare and medication. They recognize and work with the decisions made by the individual regarding any refusal to take medication, or any specific requests about how their health care is managed. Hence, the service is highly efficient when caring for residents who are terminally ill or dying. The wishes of individuals about dying and terminal care and the arrangements they want after death are openly and sensitively discussed during the development of a person centered plan of care. Staff are proactive and are sensitive to the particular religious or cultural needs of the individual or their family. These are clearly recorded, respected and known to the staff delivering the care. The home has a detailed policy, procedure and practice guidance to help staff when Care Homes for Older People Page 15 of 31 Evidence: caring for residents with degenerative conditions, terminal care and death. All staff receive in-house training and practical advice and have continuous support and opportunities to discuss any areas of anxiety and concern. Facilities are provided to allow relatives and friends to stay at the home if the resident wants them to be present and help with their care. The home works closely with external professionals and specialists for advice and support to help the resident, their family and the homes staff. Care Homes for Older People Page 16 of 31 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. There is a general programme of activities available, which is varied to suit individual interests, preferences and capabilities. The nutritional needs of the residents are well considered so that food and meal times are seen as being important for all residents. The residents are assisted to exercise choice and control over their lives. The meals in the home are well presented and nutritionally balanced offering choice and variety to the residents. Evidence: The home employs one full time and one part time activity co-ordinator and they are viewed as valued members of the staff team. One of the activity co-ordinators has undertaken training in association with NAPA (National Association for Providers of Activities for Older People). The inspector spoke to the activities co-ordinator and noted that she clearly enjoys her job and plans activities according to the interests and needs of the residents. The activity programme is regularly reviewed and much consideration and time is given to providing a range of activities that support residents individuality and their social preferences. Activities include pampering sessions such as aromatherapy; manicures, music and movement; and professional entertainers. The Care Homes for Older People Page 17 of 31 Evidence: local horticultural society visit at regular intervals to give lessons in floral arrangement, children from the local primary school were invited for an Easter egg hunt and will return during autumn to celebrate the harvest festival. The historical society visits to give talks and there is also a debate society. An annual garden party, Christmas social and travelling pantomime are held, which are all very popular with the residents and their families. The Macmillan nurse comes in to hold charity events and at present residents were busy knitting tea cosies for the sale. There is a separate hairdressing room and three people have their own visiting hairdresser. The expert by experience noted that there was a notice board which listed activities held everyday in the ground floor lounge. A particularly interesting one she stated was songtime by an experienced cabaret singer. Other activities listed were reading, social skills, listening to and appreciating different types of music. In her report the expert stated that she particularly liked the garden area and the fact that they have a vegetable patch which the residents can get involved in. She observed a carer taking a resident out to the garden in a wheelchair. A resident commented that she enjoys buying the clothes and cosmetics sold in the lounge. Some residents also attend communion and church services held once a month and every six weeks respectively. The expert by experience spoke to residents and observed staff allowing time for residents to express their wishes and supporting individuals to make choices in their everyday lives, for example, she commented that, a number of residents on the top floor were discerning in that most chose not to get involved in the activities run on the ground floor. They liked to create their own activities. The staff accomodated this. She also observed that lunch was served with little fuss. Residents were treated with respect and dignity. They were offered a sherry or fruit juice prior to lunch. Carers accompanied residents to the dining room and talked and joked with them until lunch was served. However, one resident the expert spoke to stated a variety in the menu would be welcomed, there is always fish and chicken, Id like a steak and kidney pie sometimes. This comment was passed on to the manager. All staff including administrative and ancillary staff are very aware that Harts House is the home of the residents and try to make this as pleasant as possible. Visiting times are flexible and relatives/ friends are encouraged to visit whenever possible. Relatives are involved in the lives of the residents by attending relatives meetings which are held twice a year, also accompanying them on outings and completing customer satisfaction questionnaires or via the suggestion and comments book which is kept on every floor . Relatives/ residents meetings are held twice a year and are generally well attended. People who use the service are also kept informed via regular resident and relatives newsletters. Meals are served in dining rooms on all floors or residents may choose to eat in their rooms. In all dining rooms tables are laid with cloths, napkins, condiments, cutlery Care Homes for Older People Page 18 of 31 Evidence: and glasses and the settings are very congenial. Meals served to residents in their rooms were nicely presented on trays laid with cloths. The food served was seen to be appealing, wholesome and nutritious and there is a wide variety to choose from. The manager stated that the views of the residents informed menu choices. Comments/observations about mealtimes made by the expertare incorporated above. Care Homes for Older People Page 19 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints procedure in place and residents and relatives feel confident that their complaints and concerns are listened to and acted upon. The home has a satisfactory policy and procedures regarding safeguarding adults. The staff have undertaken safeguarding adults training to ensure that there is an appropriate response to any safeguarding allegations. Evidence: The home welcomes complaints and suggestions about the service, and they use these positively to learn from them. There is a written complaints policy and procedure which meets the National Minimum Standards and Regulations. Relatives and representatives of people who use the service, say that they are extremely satisfied with the service, feel safe and well supported. Staff working at the service know the importance of taking the views of residents seriously and of listening to and responding to issues raised. Residents and others associated with the provision understand how to make a complaint. The complaint procedure is displayed in the home. The complaints book was checked, all complaints made and the actions taken in response to them are fully recorded. A review of the number and nature of complaints made is used as part of the quality assurance procedures in use at the service. The home learns from complaints in order to improve its service. They pay particular attention to any themes within complaints that refer to dignity, respect, fairness, autonomy and equality. The residents are aware of how to complain and to whom. There is also suggestions/comments book at reception and on each floor, Care Homes for Older People Page 20 of 31 Evidence: available for any visitors, residents to complete. There is a written policy and procedure for dealing with safeguarding issues and whistleblowing. Policies and procedures regarding safeguarding adults are available to staff and give them clear guidance about what action should be taken. Residents and/or their representatives are made aware of what abuse is and the safeguards which exist for their protection. Access to external agencies or advocacy services is actively promoted. There is a clear system for staff to report concerns about colleagues and managers which ensures that concerns are investigated in line with local policies and procedures. All staff working in the home are fully trained in safeguarding adults and know how to respond in the event of an alert. All staff understand what restraint is and alternatives to its use in any form are always looked for. Equipment which may be used to restrain individuals, such as, key pads, recliner chairs, cot sides and wheelchair belts are only used when absolutely necessary, within a risk assessment framework, with the home promoting independence and choice as much as possible. The home fully respects the human rights of people using the service. Individual assessments are always completed which involve the individual where possible, their representatives and any other professionals such as the care manager or GP. Care Homes for Older People Page 21 of 31 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. The home is welcoming and provides the residents with a clean, safe and comfortable environment in which to live. There are sufficient, suitable toilets and bathrooms for the number of residents with appropriate aids and adaptations available to meet residents needs. Residents bedrooms suit their needs. Evidence: The building was toured by the inspector, accompanied by the manager and the expert by experience who was assisting the inspector at the time of the visit. The living environment is appropriate for the particular lifestyle and needs of the residents. It is homely and clean. The home is safe,comfortable, well maintained and reflects the individuality of the people using the service. Some bedrooms were seen either by invitation of the residents, whilst others were seen because the doors were open or being cleaned. Bedrooms visited were appropriately furnished and personalised with residents photographs, pictures and ornaments from their own homes. They were found to be clean and free from odour. Bedrooms have en - suite facilities and are fully able to meet the changing needs of people, along with their specialist and cultural needs. The environment is fully accessible throughout to people with physical disabilities. Adaptations and specialist equipment are designed to fit within the environment. The AQAA lists a number environmental improvements which have been made as part of ongoing refurbishment, such as repainting communal washrooms, Care Homes for Older People Page 22 of 31 Evidence: replacing items of furniture, purchase of new sit down scales, air mattresses and profiling beds and as well as a mechanical shower chair for residents unable to sit upright and have lower limb contracture. The external grounds and attractive secluded gardens are secure and well-maintained. Residents are fully involved in decisions about the decor and any changes in their communal and personal accommodation. There is a selection of communal areas both inside and outside the home, which means that people using the service have a choice of place to sit quietly, meet with family and friends or be actively engaged with the people who use the service. The expert by experience commented, all rooms I saw were clean and some had residents belongings to make their rooms more theirs all had TVs. Vacant rooms had a post card on the door to inform everyone in the home that it was empty. A picture of a rose on the door was a subtle indication that the resident had MRSA. There are sufficient and suitably adapted toilets and bathrooms for the number of residents accommodated. Specialist equipment such as hoists, mattresses and walking aids are available to meet the needs of the residents. Systems are in place to control infection in accordance with relevant legislation and published professional guidance. The management has a pro-active infection control policy and they work closely with the staff and external specialists to ensure that infections are minimised. Care Homes for Older People Page 23 of 31 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. Sufficient staff are on duty who have the skills and training to meet the individual needs of the residents. The home has a clear recruitment policy and procedures and appropriate checks are undertaken, which ensures the protection of the residents. Evidence: There is a good recruitment procedure that clearly defines the process to be followed. Evidence was seen on staff files examined that this procedure is followed in practice and the manager recognises the importance of an effective recruitment procedure in the delivery of good quality services for the protection of individuals. On the day of inspection, the staffing levels and skill mix of qualified nurses and care staff on all floors, were sufficient to meet the assessed nursing and personal care needs of the residents. The manager was able to arrange for bank staff to cover shifts due to absences. Staffing levels reflect the needs of the residents and rotas are flexible to cater for individual needs. The AQAA indicates that the home continues to retain a stable group of core staff and there is little use of agency staff. Two activities co-ordinators are also employed who job share to support residents needs and aspirations in relation to individualised activities. A reviewing officer spoken to stated that when she visits,there is always someone receiving one to one attention from staff either in one of the lounges or the bedroom. One relative also stated that the staff do make good effort to stimulate the residents Care Homes for Older People Page 24 of 31 Evidence: to keep them alert. Staff have the skills to communicate effectively with the residents including all care staff and ancilliary staff who come into regular contact with them. Ancilliary staff are also included in the basic trainig programme. The expert stated in her report, the staff were friendly,motivated and happily involved in their duties to help residents in their day to day activities. They worked well as a team in the lounge during the activities periods and were friendly to all visitors. One resident stated, very good,lovely people,glad to be here. Wish them good health because they look after us. Another person stated they look after me well. Evidence was seen on care plans examined that staff demonstrate a thorough understanding of the particular needs of individuals, and can deliver highly effective person centred care. Relatives spoken to stated,the home is absolutely faultless, staff are wonderful.They do everything they can for ---. It never smells and is spotlessly clean Staff are friendly and approachable, always available to discuss things. The staff and manager reported that a training matrix specific to the home is used to identify the training requirements of staff. Hence, management prioritise training and facilitate staff members to undertake external training beyond basic requirements. The home has internal developmental training, to complement formal training as part of an on-going plan which is delivered by the head of care for the home. Staff spoken to at the time of inspection reported that the team support each other and share skills and knowledge with colleagues. They also stated that the manager is very supportive,is available whenever needed and that they receive regular supervision from a senior person. Relatives spoken to on the phone, stated that whenever they visit the home they find that staff are communicative and are always available to discuss any issues with. Professionals stated that staff act on any recommendations made and are knowledgable about individual residents and their particular needs. Regular staff meetings, which are minuted, take place and are used for consultation and training. Care Homes for Older People Page 25 of 31 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 managed and provides a safe environment for the residents. The manager and the staff team work well together and receive appropriate support to make sure that residents are safe and secure whilst living at Harts House. The manager sets an example of good practice to her team and is keen to continue to develop the service at the home for the benefit of the people who use the service. Evidence: The registered manager has the required qualifications and experience, is highly competent to run the home and to meet its stated aims and objectives. The manager communicates a clear sense of direction and is able to describe a clear vision of the home based on the organizations values and corporate priorities via the application of best practice operational systems particularly in relation to continuous improvement, customer satisfaction, and quality assurance. The Annual Quality Assurance Assessment (AQAA) states, that the home is supported by a national team of Quality and Compliance Officers whose role includes supporting quality issues within the home, auditing and providing guidance on policies, procedures and practice. There are Care Homes for Older People Page 26 of 31 Evidence: dedicated Health and Safety staff within BUPA, who support and monitor Health and Safety issues with in the home, in order to promote and protect residents and employees health and safety. The manager understands that it is her responsibility to ensure residents and staff health and safety by conducting regular risk assessments and acting on the findings of these, which is underpined by promoting independence, choice and autonomy. The manager ensures that all staff are trained, understand and consistently follow the health and safety procedures. Individual training records reflect this and regular updates are planned ahead. Safeguarding is given a high priority and the home provides a range of policies and guidance to staff to underpin good practice. The staff interviewed on the day of inspection, confirmed their understanding of the safeguarding procedures and the action they would take if there were any safeguarding issues with in the home. From viewing staff records and talking to staff, it was evident that staff were knowledgable. They receive regular supervision, which is formal as well as observational. A supervision record is kept for all staff. The manager understands and values opportunities for continuous professional development. There is strong evidence that the ethos of the home is open and transparent. Staff spoken to, spoke highly of the manager stating that she listens and acts upon the views of people who use the service and staff. The manager provided comprehensive information in the AQAA which was fully supported by appropriate evidence. The home demonstrates a high level of self-awareness and recognized the areas that still need to improve and how this will be done. For example, by continuing to listen to the requirements of their residents and relatives and to review the care delivery and the running of Harts House. The Annual Quality Assurance Assessment is used to inform its own quality assurance as well as via the BUPA SOP ( surveying Our People) which is conducted annually. The manager and the administrator also spend half a day each week at reception to meet the relatives and interact with residents. Residents and relatives are kept further informed about any issues via news letters, charity coffee mornings, gardening, outings and other social activities. An annual report is then compiled reporting the findings of various consultations. Record keeping is of a consistently high standard. Records are detailed, kept secure and staff are aware of the requirements of the Data Protection Act. Residents know they can gain access to their records and contribute to them. The head of care works full time supernumerary hours and is also the training and development co-ordianator. Her supernumerary role enables her to work with individuals and staff teams, undertake training, supervise and improve clinical practise. The manager, senior team and staff at all levels have a good understanding of the risk assessment process which is underpinned by promoting independence, choice and autonomy. These principals are taken into account in all aspects of the running of the home. The responsible individual undertakes Regulation 26 monitoring visits on a monthly basis to monitor and report on the quality of the service provided in the home. Copies of these reports are Care Homes for Older People Page 27 of 31 Evidence: available at the home and a sample were viewed at the time of this inspection. It was clear that the manager acts upon the findings and recommendations made in these reports. Care Homes for Older People Page 28 of 31 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 29 of 31 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 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 31 of 31 - 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!