Care Home: Hawthorne Court Nursing Home

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What the care home does well The home provides a purpose built environment and each person who comes to live there has a full assessment of their needs completed before admission. People who use the service have access to a wide range of healthcare specialists. Staff treat people who live at the home with respect and understand their needs and individual preferences. Visitors are welcome and there is an excellent and developing activities programme. The home carries out thorough checks on new staff members before they are allowed to work in the home and there is a comprehensive training programme. The home is well run and the management and staff listen to people who use the service and act on what they say. Comments from people who use the service and their relatives included: "Very friendly staff" and "Pleasant room, spacious". "All staff very helpful". "Welcoming atmosphere. Excellent facilities, equipment and environment". "There is always help on hand". "Care for me well". What has improved since the last inspection? There is an improved and updated information pack about the service. A new system of care planning and risk assessment has been put in place to identify and meet each individuals` needs. An improved system of monitoring falls has been developed with other health agencies. The service has new written policies and procedures for managing peoples` medication, which serves to better protect people who use the service. The staff and managers have worked hard and improved the programme of activities in order to provide mental stimulation for all the people who live in the home. What the care home could do better: Some people told us that they think the food menus could improve. The service has identified areas for further improvement and the actions they are going to take. For example, increasing communication with relatives and developing the courtyard garden. Key inspection report Care homes for older people Name: Address: Hawthorne Court Nursing Home Hawthorn Court Nursing Home Coldeast Way Sarisbury Green Southampton Hampshire SO31 7LX     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: Laurie Stride     Date: 1 1 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Hawthorne Court Nursing Home Hawthorn Court Nursing Home Coldeast Way Sarisbury Green Southampton Hampshire SO31 7LX 01489556720 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: vicky.biggs@hants.gov.uk Hampshire County Council care home 80 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: 80 The registered person may provide the following category/ies of service only: Care home with nursing - 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 - OP Dementia - DE Date of last inspection Brief description of the care home Hawthorn Court is a purpose built nursing home accommodating up to 80 older persons, including people with dementia. The home can accommodate people under and over the age of 65 years. The registered provider is Hampshire County Council. The home was first registered on 24 February 2005. The home is located within the former grounds of Coldeast Hospital, Care Homes for Older People Page 4 of 28 80 0 Over 65 0 80 Brief description of the care home Fareham and is surrounded by open countryside. There are good parking facilities and a large enclosed garden. Accommodation is provided on two floors serviced by two passenger lifts. There are 8 units each comprising of a lounge/dining room, kitchenette and ten single bedrooms with en-suite toilet facilities. Other facilities include a visitors lounge, activities lounge, hairdressing salon, smoking lounge and medical rooms. Fees for accommodation and care at the home are in line with Hampshire County Councils fees of 483 pounds per week. This information was obtained at the time of the inspection visit. People who use the service are expected to pay for chiropody, hairdressing, newspapers, magazines and any other personal items. 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: We (the commission), carried out an unannounced visit to the home on 11/06/09. This visit was part of a key inspection of the service, which takes into account all the information we have received about the service since the last key inspection on 26/06/07. The information includes the homes Annual Quality Assurance Assessment (AQAA), which the homes manager sent to us prior to this visit. We had sent survey questionnaires to the home for the manager to distribute to people who use the service, staff members and health and social care professionals. At the time of writing this report we had received completed questionnaires from seven of the people who use the service, two health professionals and eight staff members. Some of the people who use the service were assisted by a relative in completing the survey form. During this key inspection visit we spoke with three of the people who use the service and a visiting relative, three staff members and the homes manager. We also observed the interaction between staff and people who use the service and looked at Care Homes for Older People Page 6 of 28 samples of the records held in the home. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? 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. People who use the service will have their needs assessed prior to admission so that the home can be sure of being able to meet these needs. Evidence: The AQAA stated that the service had improved the information pack and the Service User Guide had been updated. We saw that this information was available in the reception area of the home. We received comments through our survey from seven of the people who use the service. Six of them indicated that they received enough information to help decide if this home was the right place, before they moved in. The other person said they did not know. Five people told us they had been given written information about the homes terms and conditions of residence. One person said they had not and another said they did not know. The previous inspection report for 26/06/07 identified that a comprehensive assessment was carried out prior to any admission to ensure that the home only Care Homes for Older People Page 10 of 28 Evidence: admitted people whose needs the service could meet. The AQAA told us that the manager conducts the pre-admission assessment and all new residents have a care management assessment and are admitted for a six week trial period. During this visit we saw the pre-admission and care management assessment for one recently admitted person. The information from this initial assessment had been used to generate a detailed care plan. The AQAA told us that following the admission of a couple to Hawthorne Court, arrangements were made, at their request, to accommodate them in one room for sleeping using the second room as a sitting room. A person who uses the service told us about her positive experience when coming to the home for the first time. Despite this persons initial reluctance to live in a care home, staff had shown her round, made her feel welcome and helped her to settle in. 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. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: The previous inspection report identified one requirement, which was in relation to the service continuing to develop the care planning system. In particular this was to ensure that the care plans set out in detail the action to be taken by staff in respect of identified risks and how these will be managed. The AQAA told us that revised personalised care plans have been introduced for all residents. During this visit we spoke with three people who use the service and looked at their care plans. The care plans contained detailed information about the individuals health and social care needs, identified risks and risk management guidance, up to date monthly review records and daily diary notes. The service had introduced a new colour coded format for care plans, making it easy to find information. There is also a summary care plan for each individual, a copy of which is kept in the service users room and this gives staff members a quick reference guide to meeting the persons needs. This is particularly helpful for new staff members or agency staff members. This meets the Care Homes for Older People Page 12 of 28 Evidence: previous requirement. Four of the people who completed our questionnaire said the home always make sure they get the medical care they need and the other three said it usually does. Each persons records that we saw included the dates and outcomes of visits by external healthcare professionals. A speech and language therapist visited one of the people we spoke to, following up an issue that had been referred by the home. The senior nurse on duty checks that such visits are recorded and that care plans are updated. A doctor from a nearby surgery visits the home on three days of the week. The manager said that this arrangement works well and confirmed that people who use the service can choose to keep their own doctor if they wish to. One health professional who completed our survey said the service does well at looking at both physical and mental health issues. Another health professional told us that the service has well motivated and professional staff and that there is good attention to detail and good liaison with the GP surgery. The second health professional also commented on the good caring for people, often improving nutritional status and outcomes of people that have been discharged from hospital. Between inspections the home had sent us notifications about any incidents affecting people who use the service, the majority of which related to falls. The AQAA told us that a falls protocol had been agreed with local health professionals and put in place. We saw a copy of the format used by staff to ensure that a if anyone has a fall it is recorded, reported and monitored in line with detailed guidance. The people whose records we saw told us that they felt well cared for and praised the staff. One person said she did not like having agency staff providing her care and support. Another person who provided comment through our survey said this is a lovely nursing home and the majority of staff work hard to keep up the standard of care but could do with extra permanent staff to complete team work. (See also the section on Staffing). Care plans showed what was important to the individuals receiving care. For example, the importance of personal belongings or of having their bed set at a height so the person can see out of the window. Another persons care plan described how to approach and speak to the individual to assist communication and also the way the person liked their hair brushed. During our visit we spoke with two care assistants who were key workers for two of the service users whose records we had seen. Both staff members demonstrated a thorough knowledge of the individual care plans and of the agreed ways of meeting the persons needs. Both staff members spoke in a way that showed sensitivity and understanding of the individuals they supported and Care Homes for Older People Page 13 of 28 Evidence: expressed a committed and enthusiastic attitude to the service they provided. Throughout our visit we observed staff providing support to people in a respectful, friendly and professional manner. Six of the people who completed our questionnaire told us that staff are usually available when they need them and one said they always are. A person who uses the service who we spoke with told us that if staff members are busy and unable to respond immediately they will put their head round the door and say they wont be a minute. Since the last inspection Hampshire County Council have implemented a new policy and procedures for the management and administration of medications. During our visit we looked at a sample of medication administration records, which were up to date and signed. Trained nurses administer all medications in the home and the manager told us that the senior nurses carry out weekly audits to ensure the records are completed correctly. The medication records also contained a photograph of the person receiving the medication and additional information in relation to their medical condition and preferred way of taking medication (for example with a biscuit). One person had a self-medication assessment on their file to enable them to maintain semi-independence with some of their treatment. There are systems in place to check that the home does not become overstocked with medicines and a contract is in place for the collection and disposal of clinical waste. There are purpose built cabinets and trolleys for the storage of medication including any controlled drugs. We saw the controlled drug register for one persons medication and the record matched the amount of medication held. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides an excellent and innovative programme of activities, designed so that people who use the service are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. The dietary needs and preferences of the people who use the service are generally well catered for. Evidence: Since the last inspection the role of activities coordinator has continued to be developed. There are now two part-time coordinators, who make up their full-time hours as carers. The manager told us that a bid has been made for a dedicated budget for activities staff. The AQAA stated that care staff are allocated two hours per week to support the activities in the home and this was confirmed by the staff members we spoke with. One of the activities coordinators showed us the records that are kept to ensure that each person who uses the service is given opportunities to be involved in activities of their choosing, whether this is a group activity or one-to-one time with a member of staff. Activities were advertised around the home, for example a latin moods musical event, reminiscence groups and church services. People who use the service who took part in our survey gave their views about daily activities in the home. Asked does the home arrange activities that they can take part Care Homes for Older People Page 15 of 28 Evidence: in if they want, four said always, three said usually and one said sometimes. Additional comments included: They are slowly doing more activities. Very good. There is now something going on each day during the week. We watch good films and do a lot of painting which is on the walls around the home. The two activities coordinators have worked really hard to build up a routine of daily events over the last 6 months. The newsletter which is now sent to relatives is new as well. Well thought out activities centre and involvement of patients. Comments from staff and from a health professional who returned questionnaires also pointed out that activities had improved for people who live in the home. There is a well equipped sensory room that was being decorated at the time of our visit. An activities room has been developed into the Tree Tops Cinema Club, which was named by people who use the service and we observed this room was in frequent use throughout the day. We saw that time is given in the morning to give people who find it more difficult to access the activities room a chance to do so. In the afternoon a film was being shown and this event was well attended. A hairdressing salon has been decorated to look like a shop and the two hairdressers who come in to the home were busy at work there and singing with their customers. The walls and windows in the corridors are decorated with residents art and craft work, showing changing themes such as Easter and a strawberry tea event. The manager told us that the care and kitchen staff link up for special theme days, a recent example being a D-Day event. There are meetings of the Friends of Hawthorne Court, friends and relatives of people who have used the service who raise funds for the home, for example through a popular bric-a-brac trolley. The manager said that a BBQ was planned and also another visit to the home by a mobile farm. The visitors book showed that there are a large number of visitors to the home. A person who completed our questionnaire commented on the welcoming atmosphere on entering the building. One visiting relative we spoke with confirmed they feel welcome in the home and told us that the staff are wonderful. A person who uses the service showed us a specially adapted mobile phone that enables them to keep in touch with relatives. Another person who lives in the home described the staff as friendly and laid back and that there are no restrictions. During our visit we observed that people can choose how to spend their day, where they wish to sit and eat their meals and that they have autonomy over their daily lives. One person we spoke to has chosen to have a small garden allotment outside her bedroom window, which her key worker supports her with. Hampshire County Councils catering department H3CS provide the catering in the home. There is a large kitchen in the home where H3CS prepare and cook the meals Care Homes for Older People Page 16 of 28 Evidence: and we saw there is a four week rolling menu. One person who uses the service told us that they did not always like the food. Another resident said the food was OK and another person who lives in the home told us the food is very good with plenty of variety. There were some suggestions for improvement from people who took part in our survey, such as Always difficult to have brown bread which I would have thought could or should be an option; and More flavour or options of sauces with main meal. Another person wrote Kitchen staff are very involved and mindful of patients needs regarding food likes and dislikes. We observed lunch being served from hot trolleys in one of the wings, then taken to people at the table or in their rooms. The atmosphere was relaxed and friendly and the care staff made themselves available to support those individuals who required help with eating. 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. People who use the service are encouraged to express any concerns and have access to an effective complaints procedure. People who live in the home are protected from abuse. Evidence: The AQAA told us that the home had received eight complaints in the last twelve months, seven of which were resolved within 28 days. We saw the complaints logbook, which showed the date the complaint was received, the details of the concern, action taken by the service and the outcome. For example, a persons relative had expressed concern about someone missing a meal. The home had responded by introducing a tick list for staff to complete at mealtimes to ensure that no one can be missed. The home has a written complaints procedure that is included in the Service User Guide and in the information pack for new residents. Four of the people who use the service, who completed our survey, told us they know how to make a formal complaint. Three said they did not and one of these added my daughter does. Six people said there is someone they can speak to informally if they are not happy. One person said they were not sure. Seven of the eight staff members who returned questionnaires indicated that they know what to do if someone has concerns about the home. One said they did not know. Two health professionals who took part in the survey told us the home had always/usually responded appropriately if they or another person have raised any concerns. Care Homes for Older People Page 18 of 28 Evidence: The home has policies and procedures for safeguarding people and we saw that the staff training programme includes safeguarding. We spoke with two of the care staff who demonstrated a good understanding of the procedures for reporting and recording any incidents of suspected abuse, neglect or self-harm. 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. The design and layout of the home enables people who use the service to live in a well-maintained and comfortable environment, which encourages independence. Evidence: Hawthorne Court is a purpose built care home that was opened in February 2005. Living areas are divided into eight separate units, each of which can accommodate ten people. Each unit has a lounge/dining area with facilities for staff to make drinks and snacks for people who use the service. In addition there are three quiet lounges, a smoking lounge, activity rooms and further seating areas around the home. The home is furnished to a good standard. Each bedroom has en-suite toilet and hand washing facilities and there are sufficient communal bathing and toilet facilities to meet the needs of people who use the service. Bedrooms are individually and naturally ventilated. The enclosed garden area is landscaped with level walking areas and seating. The AQAA told us there are plans to improve the outside space for people who live in the home. Plans to create a kitchen garden for the catering team had been carried out and redecoration of public areas was underway. At the time of our visit the premises were clean throughout. A team of cleaners have Care Homes for Older People Page 20 of 28 Evidence: responsibility for maintaining the cleanliness of the home. Systems are in place to control the spread of infection and staff receive relevant training. 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. Staff in the home are trained, skilled and deployed in suitable numbers to support the people who use the service. Evidence: We carried out an annual service review of the home on 19/06/08, which included comments recieved from staff and people who use the service and their relatives through a survey questionnaire. While comments were positive overall, they identified issues in relation to staffing shortages, especially at weekends and the impact this had on activities. The AQAA acknowledged that there had been staff recruitment/retention issues and stated the home has had an ongoing recruitment process and was now almost fully recruited. Staff members are allocated to each of the four 20 bedded wings, so that regular staff are working with the same group of residents giving continuity of care. The level of care staff working on each wing is based on the dependency of the residents. We discussed the staffing levels with the manager, who told us that normally morning shifts on a wing are covered by 1 nurse and 4 carers and late shifts are covered by 1 nurse and 3 carers. Overnight the home is staffed by a minimum of 2 nurses with up to 8 carers. The manager said there are 12 residents who have continuing care arrangements and this means that additional staff members are available on the wings when most needed. The manager also told us that the use of agency staff had been reduced, which further improves the continuity of care for people. Throughout our visit we observed good levels of staff support for people who Care Homes for Older People Page 22 of 28 Evidence: use the service. The previous inspection report identified that the service operated a robust recruitment procedure in order to protect the people who live in the home. During this visit we looked at the recruitment records for two recently employed staff. The manager was awaiting confirmation of a Criminal Records Bureau check from the Human Resources Department for one staff member who had transferred from another care service run by Hampshire County Council. The staff member confirmed that the check had been completed. All other records, such as written references were in place. The AQAA told us that the staff induction pack had been improved and there is a minimum of 60 of care staff in the home who are trained to National Vocational Qualification (NVQ) level 2 or above. All staff members are required to undertake a core training programme and are additionally trained in specific areas of need. We saw further evidence of this on the office notice board, which showed the names of staff and dates of scheduled training for a wide range of courses. We also looked at the individual training records of two carers and spoke with them about the training. Both staff members confirmed that in addition to their induction and mandatory training they receive additional training to meet the needs of people using the service. The training programme includes health and safety, practical care skills, dementia foundation training, adult protection awareness and the Mental Capacity Act. Eight staff who completed questionnaires said that their induction covered everything they needed to know to do the job before they started, either mostly or very well. All told us that they are being given training that is relevant to their role and helps them understand and meet the individual needs of people. All but one said the training keeps them up to date with new ways of working and gives them enough knowledge about health and medication. One staff member said that there are always enough staff to meet the individual needs of all the people who use the service. Three staff said there usually are, while another three said there sometimes are. One staff member said there are never enough staff. All confirmed that their employer carried out checks, such as their CRB and references, before they started work. Additional comments from staff indicated that many felt that the activities for people who use the service have greatly improved. Some felt that areas the home could improve on are staffing levels/continuity and some aspects of communication between staff. 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. The management of the home is based on openness and respect and has effective quality assurance systems to ensure the service is run in the best interests of those who use it. Safe working practices are promoted and upheld. Evidence: The registered manager, Mrs Victoria Biggs, has been working in another capacity for Hampshire County Council since April 2008 and a covering manager has been in post since then. The covering manager is a registered nurse and has worked at the home since November 2005. The manager told us that she has undertaken some management training and there are plans for her to do further NVQ4 management training. The manager meets with the service manager once a month and is supported in the running of the home by the Operations Head of Care Manager, the Operations Facilities Manager and the senior team. The manager had submitted a detailed and informative AQAA for this inspection and we found her approach to managing the service to be enthusiastic, committed and Care Homes for Older People Page 24 of 28 Evidence: well organised. This approach encourages the creativity of staff and staff we spoke with said the manager is very supportive. The home has a quality audit system in place. We saw that monthly reports were on file for regulation 26 monitoring visits undertaken by another service manager. The reports show sampling of all areas of the home and service user care. The manager said that she sends a response report to the head office in relation to any actions raised by these visits. We saw that the report for the preceding month had not identified any issues or concerns. We saw the minutes of one of the residents and relatives meetings, which are attended by managers of the home. The record for April showed that the Head of the kitchen had also attended and there had been discussion about the food provided. Since January 2009 the home has been producing a three monthly newsletter for friends and relatives of people who use the service. The first newsletter was given to people who attended the meetings. The manager told us that, as the result of relatives feedback, the most recent newsletter had been sent out to people so that those who do not attend the meetings are also kept informed. There is now a suggestion slip that is attached to the newsletter to encourage feedback about the service. The AQAA stated that a secure facility is provided for all monies held on behalf of the residents. The manager said that the majority of service users financial affairs are managed by their relatives, or arrangements can be made for these to be handled through Hampshire County Councils administration. We spoke with two staff members who confirmd that they receive regular supervision. Four staff who took part in our survey said that their manager gives them enough support and meets with them regularly to discuss how they are working. Two said this was often and the other two said this happens sometimes. The AQAA stated the home has health and safety policies in place and these are reviewed regularly. Staff records showed that they receive training and refresher courses in moving and handling, emergency aid, fire safety, food hygiene and infection control. Senior staff members are trained as fire co-ordinators and records are kept of regular tests of the fire equipment and alarm systems. We had received a notification from the home telling us about a fault in the staff pager system. The manager told us that the technician had been to the home and the system was being relaunched on 15/06/09. In the interim the home had completed a risk assessment and put in place a system of regular checks on all service users. 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 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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