Care Home: Hatfield Nursing Home

What the care home does well The standard of direct care observed was good, with positive interaction between care staff and people using the service. The service provides a caring environment where everyone appeared to be happy. An example of comments were " The staff here are the best" and "Staff really know and understand my Mum". "If there are any concerns, we just mention them and they are done". The building has been built to a high specification and provides the very highest standards of accommodation, specialist equipment and facilities, with a variety of areas being decorated and upgraded since the last inspection was carried out. People`s bedrooms reflect their diverse range of interest and have been personalised to a high standard. Staff spoke positively about the supportive and inclusive management style provided by the registered manager and considered since being in post. They have created a positive effect on both the staff team and the people using the service. The service has further improved both the assessment and the care planning systems, which will provide a detailed profile and working document for individuals living, once this process has been completed. Risk assessments are in place and are reviewed. The managers carries out all pre-admission assessments and there is an interim care plan devised within two days of the person being admitted into the home. A detailed care plan is devised once the six week review has been completed. Health and safety practices are carried out effectively and monitored by both the managers, senior staff and hotel management services. Hatfield Nursing home creates a welcoming atmosphere to everyone who lives within the service or who is visiting. This is reflected by the comments received from people using the service, staff, visiting professionals and families. " My relative has been happy here since moving in from their own home ". This has been further enhanced by the open door policy of the new manager and the creation of a monthly "surgery" offered to give relatives and carers the opportunity to raise concerns or issues at the very earliest stage. The service has worked hard since the last inspection to improve and strengthen links with the local GP surgeries, other Health Services and Social Care Services. The range of activities provided offers people a diverse range of choices generated from the social history information provided within the individual care plans. There are two full time activity workers dedicated to providing a seven day activity programme and care staff also endeavour to support people with one to one time. The staff have worked hard to improve the opportunities for daytime activities with a particular focus on people with dementia. Memory boxes have been created throughout the home and "interest corners, located on each of the dementia units. There is also a sensory room for people to enjoy and relax in. There has been the creation of a "pub/lounge" on the first floor, which is an example of how the staff team and managers have taken time and consideration to create a homely and familiar environment for people to enjoy. What has improved since the last inspection? The current manager has been in post since November 2009 and has worked hard, along with the whole staff team, to improve care planning using a more person centered approach. The environment has been improved throughout , with a focus on creating several areas of reminiscence and reflecting people`s varied interest and hobbies. There has been a reduction in the use of agency staff with the appointment of more registered nurses and experienced care staff. Quality assurance systems are in place throughout the service, monitoring all aspect of care. Communication systems with both families and outside professionals have improved, with the managers operating an open door policy and relocating their offices to areas within the main units.Thus making them more accessible and enabling the managers to monitor the care provision. The manager has also removed uniforms for staff working within the residential unit, thus creating a more relaxed and informal environment for residents. The deputy manager has completed their "Dementia Champion" training and is now in the process of cascading this training to all staff within the home. To improve security and to further protect service users there is now a policy that all entry and exit codes on the "key pad" system are changed on a monthly basis. Generally the home has a more welcoming atmosphere, with a more stable, and permanent staff team. The induction programme has been improved and is linked to "Skills for Care" induction standards providing a comprehensive and detailed framework for all new staff. The AQAA states that " A night box containing snacks, fruit and sandwiches is now present on every floor every night for service users who find it difficult to settle at night become hungry overnight, particularly those with dementia who may not eat very well at normal meal times. This is documented each night and audited daily to monitor who requires additional meals or benefit more from small but regular snacks day and night. This also helps with weight monitoring and is an additional aid for dementia and diabetic service users". This statement is an example of how the service has listened to people who use the service and respond accordingly. This is an improvement since the last inspection was carried out where there had been some concerns raised about What the care home could do better: The current system of managing people`s laundry should be reviewed with regard to the size of the laundry facility, as there is inadequate space to ensure that the soiled/clean areas remain completely separate. The manager should also review the size of the dining rooms and the amount of people they are expected to seat as some areas appeared quite cramped. One inspector who sampled the mid day meal found the meal meal to be cold. Therefore regular monitoring of meals served should be carried out with a view to improving these standards and ensuring people receive their meals at a satisfactory temperature. Key inspection report Care homes for older people Name: Address: Hatfield Nursing Home Tamblin Way Hatfield Herts AL10 9AX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Julia Bradshaw     Date: 1 5 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Hatfield Nursing Home Tamblin Way Hatfield Herts AL10 9AX 01707255270 01707255270 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sanctuary Care Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 118 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 118 The registered person may provide the following categories of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Hatfield Nursing home is situated on the outskirts of Hatfield and near to the Galleria shopping centre. The home provides nursing, dementia and residential care . The home is arranged on five floors and can accomodate a total of 118 men and women. The home was opened in 2008 and is purpose built with a range of extensive specialist equipment and modern facilities. Each room has an en-suite facility with ample bathing Care Homes for Older People Page 4 of 28 Over 65 0 118 118 0 0 9 0 7 2 0 0 9 Brief description of the care home and communal areas throughout the home. The reception area is located on the ground floor with the managers offices located on the second and third floors respectively. Transport links are approximately ten minutes away from the home. The information relating to the service is avalaible in the Serice User guide and Statement of purpose, which are displayed within the reception area of the home. The range of fees for Hatfield Nursing home are £450 to £950 per week. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of the inspections undertaken by the Care Quality Commission is based upon outcomes for the people using the service. We looked at three care plans and tracked the individual care for those people. As part of the planning we look at information we received including the Annual Quality Assurance Assessment (AQQA) This is a self assessment document required by law in which the provider tells us how well they think they are meeting outcomes for individuals. We also looked at any concerns and also feedback from relatives, staff and the people using this service. The last key inspection was carried out on the 9th July 2009. We observed staff at work and how they interacted with the people living at within the home. There was also a tour of the building in which the inspectors had the chance to talk to the staff and manager of the service. Care Homes for Older People Page 6 of 28 What the care home does well: What has improved since the last inspection? The current manager has been in post since November 2009 and has worked hard, along with the whole staff team, to improve care planning using a more person centered approach. The environment has been improved throughout , with a focus on Care Homes for Older People Page 7 of 28 creating several areas of reminiscence and reflecting peoples varied interest and hobbies. There has been a reduction in the use of agency staff with the appointment of more registered nurses and experienced care staff. Quality assurance systems are in place throughout the service, monitoring all aspect of care. Communication systems with both families and outside professionals have improved, with the managers operating an open door policy and relocating their offices to areas within the main units.Thus making them more accessible and enabling the managers to monitor the care provision. The manager has also removed uniforms for staff working within the residential unit, thus creating a more relaxed and informal environment for residents. The deputy manager has completed their Dementia Champion training and is now in the process of cascading this training to all staff within the home. To improve security and to further protect service users there is now a policy that all entry and exit codes on the key pad system are changed on a monthly basis. Generally the home has a more welcoming atmosphere, with a more stable, and permanent staff team. The induction programme has been improved and is linked to Skills for Care induction standards providing a comprehensive and detailed framework for all new staff. The AQAA states that A night box containing snacks, fruit and sandwiches is now present on every floor every night for service users who find it difficult to settle at night become hungry overnight, particularly those with dementia who may not eat very well at normal meal times. This is documented each night and audited daily to monitor who requires additional meals or benefit more from small but regular snacks day and night. This also helps with weight monitoring and is an additional aid for dementia and diabetic service users. This statement is an example of how the service has listened to people who use the service and respond accordingly. This is an improvement since the last inspection was carried out where there had been some concerns raised about What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 28 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 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is provided to help people make decisions about their care and a thorough assessment takes place, which helps to ensure that their needs can be met. Evidence: The service has developed a statement of purpose, which sets out the aims and objectives that the person can expect to receive. This includes a guide which provides basic information about the service and the specialist care that is available. The guide details what the prospective people using the service can expect and gives an account of the specialist services provided, quality of the accommodation, qualifications and experience of staff and how to make a complaint. Everyone who uses the service are given a copy of the guide. When requested the service can provide a copy of the Statement of Purpose and Service User guide in a format which will meet the capacity of the person. The AQAA states that comprehensive written information is provided to all prospective clients, outlining the ethos of Sanctuary Care and the home, as well as vital information to help with the process of choosing a care home. The homes CQC Care Homes for Older People Page 10 of 28 Evidence: reports, the Service User Guide and Statement of Purpose are made available in reception. Several people spoken to who are using the service stated that when they moved here the staff were both kind and caring, they helped me settle in and helped me sort out my affairs at home. Questionnaires sent out to people who use the service were generally returned with positive comments, with the exception of some concerns raised about the standard of the laundry service, missing items of clothing and three questionnaires stated that people would like more activities. However the manager stated that this could be due to one of the full time activity workers being on long term sick leave. Admissions are not made to the service until a full needs assessment has been undertaken. The homes manager or care manager always completes the assessment prior to admission to the service. A number of pre assessments were seen as part of the case tracking process and were detailed and complete . The assessment explores areas of diversity including preferences, religion, gender, age and cultural needs, involvement from family, partners and advocates, race and disability. It was evident that the service strives to seek the information and assessment through care management arrangements, prior to admission. The service has the capacity to support people who use the service and respond to diverse needs that may have been identified during the assessment process. Care Homes for Older People Page 11 of 28 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. All care needs are set out in a comprehensive plan which is reviewed and ensures that people using this services have their needs met. Evidence: A total of six care plans were case tracked fully. The manager stated that there is a new care planning system currently being implemented and therefore not all all care plans had been updated but this process is expected to be fully implemented within the next two months. Three out of the six care plans inspected did however present in the new person centered format and the remaining three could benefit from being reduced in capacity and presented in a more user friendly format. The care plans evidenced that personal health care needs including specialist health, nursing and dietary requirements are recorded in each persons care plan. The care plan provides clear information and a comprehensive guide for staff to know how to support the person. The care plan is generated from the pre admission assessment and includes, risk assessments for the management of falls, bed rails, manual handling and self medication. The care planning format explores and outlines the individual needs and preferences of a person. The care plan is written from the perspective of the individual Care Homes for Older People Page 12 of 28 Evidence: and throughout documents the persons own preferences and wishes. For example the persons choice of clothes, personal hygiene preferences and style of hair. It was observed that personal support is responsive and tailored to meet the individual choices, needs and preferences. Staff were observed to respect the privacy and dignity of all people. A good practice example of this was seen at the service, where two staff were seen on separate occasions sitting with residents, chatting and assisting one person with a crossword puzzle. One person using the service stated, they are like my family here, so friendly and so kind. The service listens and responds to individual choices and decisions about who delivers their personal care. People are supported and helped to be independent and can take responsibility for their personal care needs as appropriate. A number of comments were received directly from people that use the service. One person commented that, The service does everything to make the peoples stay here comfortable in every way they can, such as caring staff, a homely environment and the food is lovely. The AQAA tells us that We aim to ensure that equality and diversity is promoted and incorporated in our service delivery, by promoting individuality and person centered care from the point of the pre admission assessment process, the care planning process and ongoing care reviews, taking into account individual preferences according to individual needs, desires and beliefs. This is evidenced in the individual and personal care plans of each service user and each care plan is agreed and signed by the reviewing staff member, the service user wherever possible or an appropriate relative. The AQAA also stated that We ensure that people who use our services are protected from risk of abuse and that their human rights are respected by balancing the need for preference and choice with safety, against safety and effectiveness. Residents have access to health care and remedial services. The health care needs of residents unable to leave the service are managed by visits from local health care services. Clear evidence was seen in the care plans of specialist health care support services visiting the service and in addition to the care plan there were detailed notes made by the specialist visiting the service for example the visiting General Practitioners. The AQAA states that In the last six months we have concentrated on improving care plan documentation, through the next twelve months we will be ensuring that the standard of the care plans is maintained and wherever possible improved. This will be monitored via the ongoing auditing process weekly, monthly and via Regulation 26 visits and Clinical Audits. There was evidence on the day of this inspection to confirm that care plans are audited on a monthly basis. The service has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. Medication records are fully completed, Care Homes for Older People Page 13 of 28 Evidence: contain required entries, and are signed by appropriate staff. A total of three peoples medication was case tracked in order to ensure compliance. Room temperatures were being recorded where the medication is stored. Ordering and returns documentation was up to date and accurate. The people using the service are given the support they need to manage their medication, where appropriate. Thought has been given to providing safe but sensitive facilities for keeping medication. The service has a good record of compliance with the receipt, administration, safekeeping, and disposal of controlled drugs. Staff have completed and passed an appropriate medication course. An assessment has been carried out to ensure each member of staff is competent to handle, record and administer medication properly. On the day of the inspection it was directly observed that people who use the service were being supported and provided with specialist treatment in their own rooms and in private. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use services are able to make choices about their life style, and supported to develop their life skills. Social, educational, cultural and recreational activities meet individuals expectations. Evidence: People who use the service have the opportunity to develop and maintain important personal and family relationships. Feedback from people using the service determined that they are able to receive visit from friends and family at any reasonable hour. A number of people that use the service have stated that the staff practices promote individual rights and choice, but also consider the protection of individuals in supporting them to make informed choices. The staff team help with communication skills, both within the service and within the local community, to enable residents to fully participate in daily living activities. One person using the service commented I am happy here and all the staff are very kind and the food is very tasty. Residents are involved in meaningful daytime activities of their own choice and according to their individual interests, diverse needs and capabilities. They have been Care Homes for Older People Page 15 of 28 Evidence: involved in the planning of their lifestyle and quality of life. On the day of this inspection several people were observed joining in with ball games, one person was having their nails manicured and there was a sing- a-long session being conducted by one of the residents, within one of the dementia units. The AQAA tells us that Choices and preferences are recorded in the pre-admission assessment under social interests, hobbies, these include indoor and outdoor activities. The Home Activities Coordinator has been proactive in the role. They have tried to create a varied and interesting programme of activities based on individual one to one discussions and group meetings to ensure that the programme meets the desires and preferences of all service users. It is unfortunate that one of the full time activity organisers has been on long term sick leave which has led to some activities being postponed. However the service has endeavoured to ensure that activities have still been provided and there has also been the appointment of an additional activity worker within the past month to enhance the activity programme and increase the hours provided, in particular within the dementia units. The manager has taken the format of one to one therapy for people who maybe less able or reluctant to join in group activities and those who may lack cognitive ability or have some cognitive impairment and are included in the programme of reminiscence, thus ensuring that these service users also benefit and feel included. The weekly activity programme is distributed to all service users within the home and is displayed both within peoples bedrooms and also on the activity notice boards. Service users seem to enjoy the planned programme as is evidenced by the photographs taken during different activities. The AQAA states that Our service users are encouraged to make choice within their capabilities concerning their day to day activities and this includes receiving visitors at times preferred by themselves, maintaining family and friends and local community contact as they prefer. The menu is varied and incorporates healthy eating. The meals are balanced and nutritious and cater for the varying cultural and dietary needs of individuals. People using the service commented that they have choices of the meals they are provided with and are supported to draw the menu up. One survey returned stated that The food is always nice and if we dont like whats on the menu, the chef cooks me something else. The lunchtime meal was observed by all three inspectors and people were being assisted in a kind and unrushed manner, on a one to one basis. The vegetables were presented in small side dishes so people could serve themselves rather that staff plate the meals up. The inspectors also sampled the lunchtime meal. Although the meal provided a nutritionally balanced meal the vegetables were cold. This was fedback to the manager who agreed to monitor the serving of meals to ensure meals are served both promptly and at an acceptable temperature. Menus are also being produced in a pictorial format to ensure that everyone has the same opportunities to receive the meals of their choice, with a particular focus on people Care Homes for Older People Page 16 of 28 Evidence: who have dementia. The inspectors also observed the mid morning drinks being served,which were delivered in a individual and thoughtful way, with milk being served in small milk jugs and biscuits offered in biscuit tins and not just plated up. Care Homes for Older People Page 17 of 28 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. The service has a robust complaints procedure in place, good staff awareness and attitude towards safeguarding issues so people who use the service are safe and protected. Evidence: The service has a culture that allows people who use the service to express their views and concerns in an supportive environment. Complaints leaflets were on display within the service, it was observed that a detailed record of all compliments is maintained at the service and the AQAA determines that four complaints have been made and 2 of these have been resolved and two are awaiting a final outcome. There were also 2 safeguarding referrals and 2 safeguarding investigations. These have all now been closed. A number of comments received determined that people who use the service and relatives and friends are aware of what to do if they have any concerns. One person using the service commented that the new manager and the majority of the staff are friendly and caring, they are always able to help to sort out any problems I may have. The manager also holds a surgery on the last Thursday of every month for relatives and carers to raise any issues or concerns they may have about the service, in an attempt to resolve these concerns at the very earliest possible stage. The AQAA determines that All our staff are trained on SOVA issues and dealing with complaints. The company has a robust policy which is applied in all cases where an allegation is made and complies with local authority policies. This policy is held throughout departments in the home and is available on our Internet. Training is Care Homes for Older People Page 18 of 28 Evidence: mandatory and frequently reviewed. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Three staff spoken to commented that they have received training in safeguarding and felt confident in reporting any issues as they occurred. As part of the inspection process, we reviewed a random selection of staff files. Four staff files were audited to ensure suitable checks had been conducted. It was found that all of the staff files contained the required information. Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using this service can be reassured that the home in which they live is safe, comfortable and clean. ` Evidence: The service provides a physical environment that is appropriate to the specific needs of the people who live there. The well-maintained environment provides specialist aids and equipment to meet their needs, where necessary. The service is pleasantly decorated throughout and both the bedrooms and communal rooms provide a personal homely feel. Several people were happy to show the inspector their rooms, all of which appeared comfortable and had been personalised in order to make them more homely. Improvements to the environment since the last inspection was carried out include the re-location of the dementia and nursing units to the second and third floors respectively. The top floor of the home is still unoccupied. The managers and staff team have worked hard to improve the communal areas of the home, specifically with a focus on improving the areas within the dementia units. These include the introduction of activity stations, objects of memorabilia within the corridor areas and also memory boxes. There has also been a pub created on the first floor!. The managers offices have now been re-located to the second floor and the deputies office is now on the third floor, thus enabling service users, visitors and staff to have easier access to the managers of the service and more of a visible presence. The ground Care Homes for Older People Page 20 of 28 Evidence: floor now accommodates solely residential service users who can gain easy access to the garden areas, through the patio doors located around the building. The service has an effective system in place to ensure all health and safety standards are maintained. Fire records on the day of this inspection confirmed that regular checks are being carried out. These included, both the fire alarm checks and emergency lighting checks. Due to some concerns regarding residents personal safety and security of the home the manager now ensures that all the codes for the key pad entry systems are now changed on a monthly basis. There have some on going issues relating to the current arrangements for managing peoples laundry. The original system that the new manager inherited involved a colour coded button system. However this has proved ineffective and caused some peoples laundry to be mislaid or lost. Therefore the manager is in the process of ensuring that all new residents have personlised labels stitched into all their garments, upon admission. For existing residents it will be the responsibility of the staff to ensure that these labels are stitched into all individual clothing. The other issue relating to the current laundry facilities is that there is inadequate space allowed to ensure that there is an effective system in place to keep dirty laundry separate from the clean sections of the laundry rooms. The manager stated this problem will hopefully be resolved with the request for building works to extend the laundry room into the large staff room next door without compromising this staff facility but to greatly improve the current laundry facilities. The manager ensures that all COSHH checks are carried out regularly and new data sheets are provided when necessary. The recently completed AQAA states that Safe storage regarding COSHH, regular servicing and maintenance of equipment e.g. boilers, hoists, water temperatures, Legionella. We ensure compliance with relevant legislation, e.g. Health and Safety at work Act, COSHH, RIDDOR, Moving and Handling. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has effective management systems in place to support staff by providing the necessary supervision and training to ensure an effective staff team are able to support people living within the service to lead safe and fulfilling lives. Evidence: The people spoken with and from information gathered from a number of surveys returned to the Commission determines that they have confidence in the staff who care for them. Rotas were seen and displayed adequate staffing numbers on duty to meet the needs of the people using the service. Specific attention was given to the busier periods of the day. The manager workers a variety of hours that cover both the day and the evening to ensure they have a regular overview of the service being provided. This has included waking night care audits over recent months. Accurate job descriptions and specifications clearly define the roles and responsibilities of staff. People who use the service report that staff working with them are skilled in their role and are consistently able to meet their needs. The managers have worked hard to reduce the number of agency hours used within the service to 200 hours and they are hopeful that this will be further reduced with the appointment of some new permanent members of care staff. There is a good recruitment procedure that clearly defines the process to be followed. Care Homes for Older People Page 22 of 28 Evidence: This procedure is followed in practice with the service recognising the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. A total of four staff files were audited and were seen to contain all the required documentation. Recent training includes, moving and handling, infection control, fire awareness, first aid, safeguarding of vulnerable adults, nutrition, supervision, appraisals and person centered care. The managers should be congratulated on providing a diverse and extensive range of training courses for their staff team. A total of 43 training courses have been delivered from June 2009 to date. The manager stated in the AQAA that We aim for a minimum 50 NVQ trained care staff at level 2. All new care staff are recruited either with NVQ level 2 or with a view to commencing them on the NVQ training programme on completion of their 6 month probationary period. The aim is to have at least 110 plus trained at NVQ level by the end of 2010. Staff confirmed that they receive supervision at least six times per year and they also attend staff meetings on a two monthly basis. The managers have also improved the induction programme which now provides All new staff undergo a comprehensive induction programme, have supervision at specific points throughout the 6 month probationary period and a final probationary meeting at the end of that period. This induction process is a new process to the home with more close monitoring and supervision points to enhance the probationers experience and to ensure that any issues that require closer monitoring or action are picked up earlier and prior to the end of that period. It is also important for forward planning in regard to retention of staff and future recruitment and training needs. There was an up to date record maintained of all regulation 26 visits carried out by a Representative of Sanctuary Care. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can feel assured that the manager is suitably qualified and competent to run the service and provide trained competent staff in a safe and well managed environment. Evidence: The Registered Manager has the required qualifications and experience and is competent to run the service. The Registered Manager has a clear understanding of the key principles and focus of the service, based on organisational values and priorities. They work to continuously improve services. The AQAA tells us that The home has an appropriately experienced and qualified nurse manager who has over 12 years experience in a relevant care setting and has the RMA qualification. There are clear lines of communication and accountability between the manager and any external management. The manager has autonomy on the day to day management of the home.. Any requirements resulting from inspections are acted on promptly. Service users financial interests are safeguarded. The Company carry out regular audits of all finances in the home. There are safe working practices within the home. Care Homes for Older People Page 24 of 28 Evidence: The manager manages as far as is practicable the health safety and welfare of the service users and the staff. This was also confirmed in the 15 questionnaires that were returned to the Commission prior to the inspection being carried out. One person using the service commented that the managers are always here if we to talk to them. The manager was directly observed throughout the inspection to lead by example and manage the service efficiently. The Registered Manager leads and support a stable staff team who have been recruited and trained satisfactory levels. The manager promotes equal opportunities, has good people skills and understands the importance of person centered care and effective outcomes for people who use the service. The service has sound policies and procedures, which are internally reviewed and updated, in line with current thinking and practice. The manager ensures staff follow the policies and procedures of the home. The staff team are positive in translating policy into practice and showed good knowledge of care principles, health and safety and safeguarding issues. The manager in conjunction with both the Director of Older People and the management team have created some innovative systems and practices within the service since their appointment in November 2009, these have been highlighted throughout this report and these have been clearly appreciated by both the service users and their families. A variety of positive comments were passed on to the inspectors via surveys received by the Commission or during the inspection process itself. And examples of these were Staff are the best, If there are any concerns we just mention them and they are done. The seniors are excellent. I cannot fault them. There are a variety of Quality Assurance systems in place to ensure that standards are both monitored, reviewed and maintained regularly. These are delegated out amongst a variety of staff including Hotel management staff, senior care staff, maintenance staff and managers. These checks include, medication checks, environmental checks, care plan reviewing and updating on a monthly basis of all health and safety checks. Care Homes for Older People Page 25 of 28 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 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 24 16 The manager must review 30/07/2010 the current arrangements for the management of service users laundry as this area is too small to be fully functional and effective. To ensure peoples laundry is managed more effectively. 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 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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