Care Home: Heath Mount Nursing & Residential Care Home

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What the care home does well The home ensures prospective residents receive sufficient information in accessible formats to help them to decide if the home is right for them. They support residents to bring their own furniture and personal effects to make their bedrooms homely and even allow small animals to accompany their owners. A resident`s representative wrote on their behalf, `we received full information and were able to visit the care home to decide if it was suitable. The care home also agreed to allow the prospective resident to have their pet cat with them, which was a tremendous help in settling them in.` The home takes the residents` rights to privacy and dignity very seriously by raising awareness and promoting these rights. They do not place residents in shared bedrooms unless this is a chosen preference. Transport was provided by the home and residents were enabled to maintain important relationships and community links. This was promoted by the home in creative ways to enhance the lives of the residents. Residents benefited from living in a pleasant, safe and well-maintained environment, which meets their needs by providing comfortable personalised bedrooms and abundant attractive communal accommodation. The staff had been safely recruited, well inducted and adequately trained, to meet the nursing and care support needs of the residents. The registered manager was well qualified and experienced and kept herself up-to-date by attending appropriate training. Residents benefited form living in a well managed home, in which their opinions and those of their representatives were sought, for the improvement of the service. What has improved since the last inspection? A requirement with respect to regular staff training in fire safety procedures, to enable them to respond appropriately in the event of an emergency, and to protect the residents and others from harm, had been completed since the previous site visit. The staff-training matrix confirmed that this training had been kept up to date for the safety of everyone. The AQAA noted many improvements over the previous twelve months in all outcome areas and some of these have been referred to in more detail in the report. What the care home could do better: The manager recorded planned improvement in all outcome areas over the next twelve months for the development of the service for the benefit of the residents. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Heath Mount Nursing & Residential Care Home Heath Mount Nursing & Residential Care Home Rake Liss Hampshire GU33 7PG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Christine Bowman     Date: 0 5 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Heath Mount Nursing & Residential Care Home Heath Mount Nursing & Residential Care Home Rake Liss Hampshire GU33 7PG 01730894485 01730891088 heathmount@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Jacquiline Govere Type of registration: Number of places registered: Ashbourne (Eton) Limited care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommotaed is 31. The registered person may provide the following category 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 wihtin any other category (OP) Physical disbability over 65 years of age (PD(E)) Date of last inspection Brief description of the care home The home provides nursing care for service users over the age of 55 years. It is also registered to accommodate service users with a physical disability. Heath Mount is situated on a site with two other homes, which are all part of the Southern Cross group. Accommodation is provided in 21 single and 5 shared rooms. The shared rooms are now mostly used for single occupancy only, to preserve the privacy and dignity of Care Homes for Older People Page 4 of 31 Over 65 31 0 0 31 Brief description of the care home the residents. All the bedrooms with the exception of one single have en suite facilities. These are located on three levels of the home. Communal space comprises two lounges, an annexe and a large well appointed dining room. Main meals are cooked and transported from one of the other main homes. Heath Mount contains the laundry for all the 3 care homes on the site. The home is situated in extensive grounds, in a rural area and close to Liss, a small town with shops and public transport links. The homes fees range from 347 pounds and six pence to 730 pounds per week. This does not include the cost of hairdressing, newspapers, chiropody and dry cleaning. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: This inspection report includes information gathered about the service since the previous site visit in August 2006 under the Commissions Inspecting for Better Lives (ILB) process. The registered manager, Mrs Jacquiline Govere, completed an Annual Quality Assurance Assessment (AQAA) giving some up-to-date factual evidence about the running of the home and informing us of what they think they are doing well, how they have improved the service and of their plans for further improvements. Residents completed eight service user surveys, with support from relatives, giving their views on the running of the home. Four staff and one healthcare professional also returned surveys, giving their views on the care and support given to the residents. An unannounced site visit was conducted on 5th December 2008, to assess the outcomes of the key inspection standards for older people with respect to the residents living at Care Homes for Older People Page 6 of 31 the home. The registered manager was interviewed and provided support for the inspection process by making residents and staff files and other documents available to be sampled. A partial tour of the premises was undertaken and some of the residents bedrooms and communal areas were viewed. A number of staff, residents, visitors and visiting professionals were spoken with throughout the day and observations were made of the residents and of staff as they carried out their duties. Residents and staff records, maintenance certificates and complaints and compliments records were sampled and the Statement of Purpose, the Service User Guide and policies and procedures were viewed. 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 set out on page 4. Care Homes for Older People Page 8 of 31 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are supplied with all the information they need to make an informed decision about moving into the home, the home ensures that individuals needs are assessed prior to the offer of a placement and care is taken over the introduction process to help new residents to settle into their new home. Evidence: The home had an up-to-date Statement of Purpose and Service User Guide giving prospective residents all the information needed to make a decision about the suitability of the service to meet their needs. The Service User Guide was also available on audio cassette to enable those with visual impairment to access the information. The philosophy of care included a statement of non-discriminatory practice, assuring prospective residents that they would be treated with respect regardless of their age, gender, sexual orientation, race or religious belief. These documents were well presented and included a photograph of the home, a list of Care Homes for Older People Page 11 of 31 Evidence: contents and were easy to read. The provider company also provides a website offering information about the home and responding to enquiries promptly. If prospective residents are unable to visit the home, the staff member, carrying out the pre-admission assessment takes a folder of photographs of all communal areas, gardens, and bedrooms to show them, as an introduction to the home. All of the eight residents, who completed surveys, confirmed they received enough information about the home before they moved in so they could decide if it was the right place for them. One resident commented, I was able to spend an afternoon in the home before I made my decision, and a residents representative wrote on their behalf, we received full information and were able to visit the care home to decide if it was suitable. The care home also agreed to allow the prospective resident to have their pet cat with them, which was a tremendous help in settling them in. The assessment documentation of two residents was sampled. This was a full nursing assessment and included important personal information, medical history, infection status, current medication, a full dependency assessment with levels of risk recorded, moving and handling, pressure area, nutritional, continence, and dementia assessments, and included an assessment of personal and social care needs. Individuals needs with respect to diet, specialist equipment, and other special requirements were recorded and information with respect to equality and diversity gathered, to be used in the compiling of a comprehensive care plan. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have care plans in place, which have been developed with input from themselves or someone close to them, and which are regularly updated to inform the staff. Safe arrangements are in place for the management of medication to protect the residents and the staff, and the home takes the residents rights to privacy and dignity very seriously by raising awareness and promoting these rights. Evidence: Care plans sampled contained a separate section for each identified need with advice to staff on maintaining safety and preventing identified risks. For each care need, the planned care was recorded to instruct the staff and an explanation given of the aim. When moving and handling equipment was used, there was a description of the type of equipment, the number of carers required and details of how the individual should be moved safely and to prevent injuries. Care plans had been reviewed in a timely manner to ensure the information was up to date to inform the carers. Three of the eight residents, who completed surveys or whose surveys were completed Care Homes for Older People Page 13 of 31 Evidence: by visiting relatives or representatives on their behalf, confirmed they always received the care and support they needed, and five that they usually did. Comments included, everyone is always unfailingly kind and helpful and sometimes the carers are in a rush and sometimes I would like them to slow down and give me more time. A healthcare professional, who completed a survey, recorded that the care service always seek advice and act upon it to manage and improve individuals healthcare and that the individuals health care needs are always met by the care service. They also thought that, the staff always had the right skills and experience to support the individuals social and healthcare needs and that they were friendly, cheerful and professional. The team of registered nurses specialised in areas such as moving and handling, infection control, the promotion of continence and tissue viability. Services were available, on referral from General Pratitioners (GP), via the primary care trusts or hospitals, for specialist nurses, physiotherapists, occupational therapists and speech and language therapists. The AQAA recorded that residents retain their GPs on admision if they wish, but where this is not possible, they are registered with the local practice to ensure continued medical treatment. Chiropody, dental, optical, aromatherapy and reflexology services were also available and the the service user guide was clear about which of these services incurred an additional cost. Medication was administered by trained nurses only, and the staff training matrix confirmed they had all received a recent up-date with regard to the safe handling of medication. Records confirmed that regular audits were carried out of medication held and that an audit trail of medication received into the home, administered and disposed of, was kept to confirm safe handling and to ensure the residents rights were protected. No residents had been assessed as able to take care of their own medication at the time of the site visit. Over the previous twelve months, the home had become involved in the dignity challenge campaign, which was designed to increase staff awareness on preserving residents dignity during personal care. A notice board in the home was dedicated to this project and comments from residents and staff, confirmed the home was putting this important aspect of care at the centre of everything they do. Comments included, treating people as individuals by offering personalised care, knocking before entering residents bedrooms, a good shave and looking smart with clothing and to be spoken to respectfully and for the staff to be patient. Another new initiative of the home was for, each resident to be resident of the day, on the day his or her care plan was under review. This involved the resident receiving special attention from all staff including choosing their favourite activity and having a thorough clean of their Care Homes for Older People Page 14 of 31 Evidence: bedroom. The manager stated that the five double bedrooms were being used for single occupancy only, to preserve the privacy and dignity of the residents, and that this had been agreed by the provider company, which would not bring pressure to bear to place new residents in them. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This home has innovative ways of supporting individuals to maintain links with their relatives and the local community and of encouraging experimentation in new interests, however more staff may be needed to fully support the residents to pursue their personal interests and activities. Much effort has been exerted to ensure the meals provided are well balanced, nutritious, attractively presented and served in pleasant surroundings, but some residents are not completely satisfied with the results. Evidence: The homes activities organiser produced a weekly agenda, which was posted on a notice board to inform the residents. In the week of the site visit, the activities advertised were, beauty care, a film, a trip out, the knitting club, arts and crafts and a trip to the Festival Hall. The manager recorded, in the AQAA, that the programme is devised in consultation with the residents and that residents are encouraged to maintain outside links within the community. The home takes residents on planned outings in the homes minibus. A popular recent trip had been to the Milestone museum in Basingtoke, which the residents had visited in small groups. The AQAA recorded that special themed events took place throughout the summer including a Care Homes for Older People Page 16 of 31 Evidence: couples day when all spouses of residents were asked to an afternoon tea party, and a grandparents day, when all the residents grandchildren were invited for a tea party. Music revolutionary workshops are organised every four to six weeks by the activities organiser to encourage residents to play a musical instrument of their choice. A PAT dog visits weekly, as does the hairdresser, which the residents can book for an appointment. Two of the eight residents, who returned surveys, thought there were always activities arranged by the home that they could take part in, two recorded that there usually were, and one commented that they did not usually want to take part. Four residents thought activities were sometimes organised and comments included, I would really like them to arrange Bingo sessions, and I have never been on an activity that entails leaving the home. Visitors spoken with on the day of the site visit confirmed they were always welcomed at the home. The November newsletter also on a notice board, informed residents and their relatives of the Christmas Fayre/Open Day, which included live music, a raffle, a buffet and various stalls. A Christmas Carol party led by the local vicar and a visit from a local school to sing Christmas Carols was also planned. Photographs of the Open Day showed the staff and visitors in Christmas fancy dress and the home beautifully decorated for Christmas with a Christmas tree and stalls full of Christmas food and presents. A visitor stated they were, looking forward to attending the carol service, which had been lovely last year, and that, local school children had visited the home in the summer to talk with residents about the war, which was an innovative and brilliant idea because some of the residents really enjoyed reminiscing about the war years. The dining room was set up for lunch, when viewed. Tables were laid for three or four residents, to promote socialisation, and were covered with damask tablecloths. There were small vases of fresh flowers on the tables to enhance the environment for the enjoyment of the residents. From the large windows, there were views over the gardens to the front of the building. There was a large open fireplace with a display of dried flowers, framed paintings displayed on the walls, original moulding on the ceiling and candelabra- style lighting, making this a pleasant and elegant room to dine in. A display cabinet contained a drinks bar and some residents took a glass of wine with their meal. However, here was not sufficient space at the tables for all the residents, should they choose to eat in the dining room. The manager stated that, although residents are encouraged to socialise, some preferred to eat in their rooms. There were mixed responses from the residents spoken with. One stated, the meal was very nice, and another thought, the meals are unimaginative and went on to comment that they would like their scrambled eggs to be made from real eggs. Three of the eight residents, who returned surveys, always liked the meals at the home, four usually did and one sometimes did. Comments included, sometimes the food is overCare Homes for Older People Page 17 of 31 Evidence: cooked, and I have a good appetite and eat everything. There was a four-week menu displayed on a notice board to inform the residents and the AQAA recorded that a nutritional analysis software programme, designed by dieticians to support flexibility, had been installed to support the chef in planning the menus. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents know how to complain and are confident they will be listened to, taken seriously and that their concerns will be acted upon. The home protectsits residents from abuse by raising staff awareness and taking appropriate action to safeguard them. Evidence: The AQAA recorded that eight complaints had been received over the previous year, that they had all been resolved within twenty-eight days, and that six had been upheld. The manager stated that complaints, whether they are verbal or written, are taken very seriously and investigated thoroughly and the complaints log viewed, confirmed this was so. Residents and their relatives and representatives were well informed of the policy and procedure in the Service User Guide and by copies of the complaints policy posted on notice boards throughout the home. Five of the residents, who completed surveys, confirmed they always knew who to speak to if they were not happy, and three that they usually did. All confirmed that they knew how to make a complaint. The home held a copy of the local authority Safeguarding Adults policy and procedure along with the whistleblowing policy, which demonstrated that staff would be well supported if they reported bad practice. The staff training matrix confirmed that the Care Homes for Older People Page 19 of 31 Evidence: staff from all departments had received up-dated training in the Protection of Vulnerable Adults to ensure they were aware of what consistutes abuse, and how and to whom, a referral should be made to protect the residents. Recruitment checks had been carried out on pospective new staff prior to the offer of a post, to ensure that only suitable people were offered a post working with vulnerable adults. There had been no Protection of Vulnerable Adults referrals over the previous twelve months. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a pleasant, safe and well-maintained environment, which meets their needs by providing comfortable personalised bedrooms and abundant attractive communal accommodation. The home is clean and hygienic and free from unpleasant odours. Evidence: Access to the home was by a driveway and parking was provided for residents, visitors and staff at the front of the building. The home was an elegant and imposing Victorian country house, which had been adapted for use as a care home, whist retaining many of its attractive original features. The carpeted entrance hall was warm and welcoming and led to a Victorian staircase with framed pictures displayed. Fresh flowers were arranged, there were comfortable leather chairs to sit in and a notice board displayed photographs of all the staff and information about the home, including the most recent report and the collated results of the most recent quality assurance questionnaires to inform residents, visitors and prospective residents. A tour of the premises was undertaken and all the communal rooms and some of the residents bedrooms were viewed. The large, carpeted sitting room was comfortably furnished with large sofas, supportive chairs and occasional tables for the comfort and enjoyment of the residents. A cat was relaxing on a sofa and there was a large fish Care Homes for Older People Page 21 of 31 Evidence: tank containing a goldfish. The manager stated that all the residents took an interest in the cat and that one resident in particular enjoyed looking after the goldfish. There were pleasant views of the mature gardens to the front of the house through the large windows, which made the room feel light and airy. The original fireplace was decorated with a display of dried flowers and the high ceilings retained the original ornate moulding. Lighting was by wall lights and a candelabra style central light, which were in keeping with the style of the home. There was a piano for visiting entertainers to use and an activity cupboard contained arts and craft materials, games, puzzles and DVDs for the entertainment of the residents. The manager stated that a previous resident of the home, who had been brought up there as a child, when it was privately owned by their family, had visited recently to give the residents a talk about the history of the house, which they had enjoyed. The smaller lounge was nicely furnished, contained a television and DVD player and overlooked the gardens to the side of the property. French windows led to an enclosed terraced area with outdoor seating, trees and shrubs, which the residents could access in clement weather conditions. A new wheelchair ramp had been recently provided to enable wheelchair users to access the patio area situated to the rear of the building and safely enclosed for the protection of the residents. Outdoor seating, tables and brollies had been supplied for use in the summer months and there were bird tables to encourage the wild birds into the garden in the winter. A third communal area was an attractive garden room, which linked the home to another home. This room had been adapted to provide space for the visiting hairdresser, who had just completed a residents wash and blow dry. The resident stated she was pleased with the results. There was a library area containing large print books for those with visual impairment and the manager stated that the mobile library visited and the books were changed regularly. There was also seating and tables for the comfort and convenience of the residents and the room was pleasantly decorated for Christmas. Bedrooms viewed, had been personalised with individuals photographs, ornaments and other personal belongings, and were furnished with good quality domestic furniture. The manager stated that prospective residents had the opportunity to bring small items of their own furniture with them to make their bedrooms more familiar when they moved in and that most of the residents took this opportunity. The laundry was suitably equipped with industrial washing machines fitted with sluicing facilities. A staff member, who had worked in the laundry for many years, stated they enjoyed the challenge of dealing with the laundry for the three homes on the site, and explained how the washing was organised to ensure a prompt and efficient service, Care Homes for Older People Page 22 of 31 Evidence: which usually worked. The staff training matrix recorded that all the staff had received infection control training and good hand washing facilities were in place, supplemented by alcohol hand gels and protective clothing and gloves for protection of the staff and residents. Six of the eight residents, who completed surveys, confirmed the home was always clean and fresh, and two thought that it usually was. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient staff, who had been safely recruited, well-inducted and adequately trained, provided nursing and caring support to meet the needs of the residents. Evidence: The AQAA recorded that there was a total of thirty-one care staff and registered nurses working at the home, some of which were part-time and worked as bank staff. The AQAA also recorded that the registered nurses had specific areas of responsibility such as tissue viability, infection control, moving and handling, and the promotion of continence. There were eight other staff providing support in the kitchen, the laundry, the office, the maintenance department and as an activities coordinator. Three of the four staff, who completed surveys, thought there were always enough staff to meet the individual needs of the resident and one thought there usually were and commented, this is a three story building and we can have residents with high dependency needs. Staffing levels could be improved depending on the occupancy and the residents needs, and the activities co-ordinator is too often asked to help in areas other than activities. The manager explained that the activities co-ordinator also did some bank care duties, which were completed in addition to her permanent duties. The occupancy levels had also decreased due to most of the double rooms providing single occupancy and seven of the twenty-one residents did not have nursing needs but were living at the home on a purely residential basis. Care Homes for Older People Page 24 of 31 Evidence: Three of the eight residents, who completed surveys, confirmed the staff were always available when they needed them and five recorded that they usually were. Residents comments included, Sometimes the seem to take quite a long time to answer my bell and the staff always seem to be busy and dont have time to spare. Its always nice to have a few minutes to chat and pass the time of day. All the residents confirmed that the staff listen to them and act on what they say, and one qualified this by writing, mostly, but theyre in too much of a hurry to listen to me. One of the residents spoken with on the day of the site visit stated, the staff are very nice, they are kind and sweet natured. 65 of the staff had completed a National Vocational Qualification at level 2 or above, the manager stated and, over the previous twelve months, an induction based on the Skills for Care Common Induction Standards, had been introduced, which new staff had completed over the first three months of employment. This induction emphasises the residents rights to be treated as an individuals and with dignity and respect. Three of the four staff, who completed surveys, recorded that their induction covered everything they needed to know to do the job when they started, very well, and the other staff member, who had worked at the home for several years commented, the induction process is much improved since I started working here. Staff personnel files sampled, contained evidence that recruitment checks, including Criminal Record Bureau (CRB) and references, had been carried out prior to the offer of a post, to ensure that only those suitable to work with vulnerable adults had been employed. Four staff, who completed surveys, confirmed that their employer carried out checks, such as CRB and references, before they started work. Full employment histories had been obtained and the application form required the applicant to explain any gaps in employment and the reasons for leaving employment, which involved the care of vulnerable adults or children. Equal opportunities monitoring forms had been completed to confirm the process was fair and interview checklists had been completed. The four staff, who completed surveys, all confirmed they were being given training which, is relevant to their role, helps them to understand the individual needs of the residents with respect to equality and diversity issues, and keeps them up to date with new ways of working. The staff training matrix recorded that all the staff had received updated training in fire safety, fire drills, food hygiene, moving and handling, the control of substances hazardous to health, health and safety, the protection of vulnerable adults and infection control. Relevant staff had accessed training in nutrition and the registered nurses had received training in the safe handling of medication to support this aspect of their role. Care Homes for Older People Page 25 of 31 Care Homes for Older People Page 26 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit form living in a well managed home, in which their opinions and those of their representatives are sought, for the improvement of the service. The home has effective systems in place to promote the residents health, safety and welfare. Evidence: The current manager is a Registered General Nurse with twenty-three years of experience in a wide range of specialities and clinical areas, including general nursing, care of adults with learning and physical disabilities and elderly care. She had eight years of management experience prior to taking up this post, had been in post for sixteen months and had been the registered manager since January 2008. She had achieved the Registered Managers Award and completed the National Vocational Awards Assessor training and Mentoring course. The AQAA recorded that, over the previous twelve months, the managers updated training included, medication management, the Mental Capacity Act Managers brief, the Mental Capacity Act Train Care Homes for Older People Page 27 of 31 Evidence: the Trainer, the local authority Safeguarding Training and a Managers Development day arranged by the provider organisation. The results of the most recent quality assurance questionnaires were posted on the notice board in the entrance hall along with minutes of meetings, which included residents and their representatives. Minutes of the meetings showed that the home took positive action to alleviate problems as they were identified. This included providing a food trolley to ensure the food would remain hot when delivered to the rooms more distant from the servery and the planning of a new laundry for the home on the site, which produced the most laundry, to prevent clothes being returned to the wrong home. Residents monies, held in safe keeping, were kept securely and accurate records, including receipts were maintained. The AQAA recorded that these records were audited monthly by the manager, and validated bi-monthly by the operations manager. The health, safety and welfare of the residents were promoted by regular staff training in moving and handling, fire safety, first aid, food hygiene and infection control. The staff training matrix and certificates on staff training and development files sampled confirmed this. The AQAA recorded that policies with respect to health and safety were in place and that equipment had been serviced or tested as recommended by the manufacturer or other regulatory body in a timely way to protect the residents and the staff. A sample of certificates seen on the day of the site visit confirmed this. Accidents had been recorded appropriately with records kept of actions to reduce risks. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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