Care Home: Heritage Care Centre

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What the care home does well We felt that people living at the home experienced good or excellent outcomes in all the areas we looked at. The service is well managed and there is continuous work to make sure people receive a quality service. People told us that they were happy living and working at the home. Information for people who want to move to the home is good. Records are well organised and there is a lot of information about individual people and the help and support they need. People are supported to make choices about their lives. People are supported to stay healthy. The building is nicely designed with lots of different areas for people to spend time in. The staff team are well trained and supported and are committed to caring for people. The Manager is experienced and dedicated to providing a good service. People respect her and she listens to and respects others. What has improved since the last inspection? The staff have worked with families to help create detailed records about each persons life, hopes and wishes. This work is continuing. Some new activities have been organised. Areas of the building have been decorated and furnished to create different environments and interesting features. The staff have undertaken training to help improve their skills and knowledge. The Manager asks people living at the home, visitors and staff what they think and uses their comments to help plan for future improvements. What the care home could do better: There were a number of areas we discussed with the Manager which needed to be improved. The Manager took these suggestions on board and has contacted us since our visit to tell us what action has been taken to address any areas of concern. This includes more training for some staff. We were pleased to see that the Manager had taken action to make sure people living at the home have good support. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Heritage Care Centre 30 Gearing Close Tooting London SW17 6DJ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sandy Patrick     Date: 1 0 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Heritage Care Centre 30 Gearing Close Tooting London SW17 6DJ 02086829050 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Southern Cross (LSC) Ltd care home 72 Number of places (if applicable): Under 65 Over 65 0 37 dementia old age, not falling within any other category Additional conditions: 35 0 Ancillary Staff Administrative Staff 40 hours per week Domestic Staff 2 hours per resident per week Cook/Chef 40 hours and 16 hours at weekend Kitchen Assistant(s) 105 hours per week Laundry Staff 1 hour per resident per week Activities Co-ordinator 40 hours per week Maintenance 40 hours per week The number and distribution of nurses, care staff and ancillary staff must be reviewed at regular intervals by the registered owner. If at any time, the evidence indicates that there is insufficient staff of any category available to meet the assessed needs of service users, the NCSC will require additional staffing as appropriate. Staffing levels on the First Floor AM: Two qualified nurses and five care staff PM: Two qualified nurses and five care staff Night: One qualified nurse and three care staff The above staffing levels are to be implemented once the home is fully occupied. The inspector has agreed with the organisation an incremental scale of increasing staffing levels as service users are admitted to the home. Staffing levels on the Ground Floor AM: Two qualified nurses and six care staff PM: Two qualified nurses and five care staff Night: One qualified nurse and three care staff Date of last inspection Care Homes for Older People Page 4 of 31 Brief description of the care home Heritage Care Centre is a purpose built home comprising of three storeys. The ground floor and first floor have the communal areas and bedrooms of service users. The second storey has the kitchen, laundry and staff areas. Accommodation is provided in single rooms with ensuite facilities. All rooms conform to the space requirements of the Standards. Service users are encouraged to bring in personal possessions. The home is arranged in four discreet units. Nursing care is provided for service users and there is a separate dementia unit. All service users have access to a safe level garden, where seating is provided. There is a passenger lift available. Heritage Care Centre is situated on the site of the Old Tooting Bec Hospital within a housing complex and is accessible by public transport, which is approximately ten minutes walk from the home. The home has adequate parking spaces for visitors. Fees payable at the time of the inspection range from £640 - £900, depending on care required. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection included a visit to the home on 10th February 2009 by two Regulation Inspectors. We met with people who live at the home, their visitors, staff on duty and the Manager. We looked at the things people did during the day and observed how staff supported people. We also looked at the environment and the records. We wrote to the Manager and asked her to complete a quality self assessment. We wrote to people who live at the home, staff and others and asked them to complete surveys about their experiences of the home. 21 people who live at the home and their relatives, 19 members of staff and 7 professionals who work with the home returned surveys to us. Care Homes for Older People Page 6 of 31 We looked at all the information we had received since the last inspection. This included notifications of accidents and incidents and an annual service review which we wrote about the home in 2008. People told us that they liked the home and were happy there. Some of the things people said about Heritage Care Centre were. They treat me well. Lovely atmosphere. Heritage Care has transformed a nursing home into a home away from home. A place of calmness and excellent care. I think this is the best home in England. I am consistently very impressed with the quality of care. I have complete confidence and peace of mind that my mother is well cared for. 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 Care Homes for Older People Page 8 of 31 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.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. People are given the information and support they need to help them decide if they want to move to the home. The staff at the home assess whether they can offer each person the right support and help which they need. Evidence: Some of the things people told us about moving to the home were, through a visit to the home I was given a lot of information and was shown around which gave me a good insight into life at the home, I was too ill to visit but my daughter visited and gave me information to help me before I moved here and my friend and I visited, a senior member of staff showed me around the home and talked for about 30 minutes, I also met the manager and talked to her, I knew straight away from the warmth of greeting and interest shown in my mother that this was a good choice of home for her. Care Homes for Older People Page 11 of 31 Evidence: The Manager makes an assessment of each persons needs before they move to the home. We saw copies of these assessments for some people. We saw that relatives and other important parties had been contacted and that the persons wishes, likes and needs were recorded. A more in depth assessment is undertaken by senior staff once a person moves to the home and this is used to create a plan of care and support. People who are interested in moving to the home are able to visit and are given information about the service. People are able to move in for a trial stay. At the end of this stay they have their needs reassessed to make sure their needs can be met at the home and they can say whether they want to continue living there. The organisation gives everyone a contract which outlines their terms and conditions of residency. We saw copies of some peoples contracts. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to have their individual needs met. They are supported to stay healthy and are well cared for. Evidence: One person told us, my mother is well looked after by nurses and care staff and I am very aware of their patience and kindness. Each person has their needs recorded in a care plan which tells the staff what they need to do to support them. We saw that care plans had been signed by the person they were about, or their representatives. One relative told us that they had been asked to read and agree the care plan when the person moved to the home and after 6 months when it was reviewed. The staff told us that the Manager and nurses often reminded them to read and check care plans to make sure they were supporting people appropriately. Care plans included a photograph of the person and information on their personal, Care Homes for Older People Page 13 of 31 Evidence: health, medical, social and mobility needs. Each care plan also contained assessments to show where people were at risk and what action should be taken to reduce these risks. We looked at a sample of care plans and saw that these were regularly updated and reviewed. The local GP practice provides a service to most of the people living at the home and holds a surgery there twice a week. The nursing staff work with the GP and other professionals to make sure people stay healthy. The staff monitor peoples health needs each day and record changes in health. We saw that there were appropriate records. Most people told us that they were happy with the medical care and support they received. Some of the things people told us were, I am very satisfied with the medical support my relative gets from the GP and nursing staff and the nursing staff are always monitoring my mother for any potential medical problems or sores. One person said, one of the doctors does not talk to me, he just speaks to the nurse and I want to know what he is saying. The nursing staff should make sure people get the information they need and the Manager should make sure visiting professionals speak to people. Some of the things health care professionals who visit people in the home said included, the care staff work closely with us GPs in order to ensure residents health needs are met, the staff are up to date with changes in medication, there are detailed care plans and these indicate the lengths that staff go to to ensure peoples health needs are met, residents are treated with respect and dignity, I have done numerous reviews at Heritage and can honestly say that the service provided is top quality, residents appear to be given as much say as possible regarding their care, I believe this is a high quality home and nursing care is good, people who have moved to the home have seen quick improvements to their health and as a professional I have found the staff friendly and knowledgeable. Some people told us that they would like more support to stay active and improve their mobility. One person said, the physiotherapist visited me for 6 weeks but then this stopped, I would have liked this rehabilitation to continue. Another person told us, I think the home should have some additional input to help patients mobility. Another person said, I feel that the staff could do more to encourage my relative to get out of bed. There is a suitable medication procedure. We saw that medication was well managed. The nursing staff keep accurate records, store medication safely and audit records and supplies each day. We saw evidence of this. We saw records, including risk assessments, administration charts, audits and information on each medication and possible side effects. We saw evidence that staff had been trained and assessed as Care Homes for Older People Page 14 of 31 Evidence: competent in administering medication. One professional told us, the staff aim to give people as much control over their lives as possible including administering their own medication. We saw that people who administer their own medication are given the support to do this safely. We saw staff administering medication to people. We saw that they were calm, supportive and explained why they were giving people their medicines. We saw that people were supported to make an informed choice about whether they wanted to take their medicines. Personal care needs are recorded and monitored within individual records. One person told us, my mother is kept clean and has her physical needs met. The Manager told us that the staff have been given information about a national campaign to promote dignity in caring. We saw leaflets about this and the staff we spoke to showed an understanding of how to support people to have a dignified life. In general we saw that staff were kind and respectful when offering people support. However, we observed some staff supporting people inappropriately. For example they did not tell people what they were doing, they did not offer them choices and they did not check their wellbeing when supporting them. We felt that this was particularly the case at lunchtime. We spoke to the Manager and senior staff about this. The Manager felt that the reason for this may have been because some of the staff were new or that they were anxious about the inspection. However, she agreed that this was not appropriate and the staff needed to have a better understanding of how to support people. Since our visit she has arranged for all these staff to have additional training on understanding dementia and on supporting people at mealtimes. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given opportunities to do different things, although they could be given more opportunities and better support to make sure they have full and active lives if they wish. People are supported to make informed choices about their lives. They are offered a range of nutritious and well prepared food. Evidence: People told us that they enjoyed the organised activities at the home. Some people told us that they could not get out of bed or did not leave their rooms and therefore they did not take part in organised activities. We felt that people who stay in their rooms should be offered the same opportunities to take part in activities of their choice. The staff should make sure people are supported to do things wherever they are. Some of the things people said were, I do craft activities, knitting and jigsaw puzzles, there are always activities arranged of various sorts, the activity officer is lots of fun and I enjoy the organised activities. The staff have started to work with people living at the home and their families to create a life book which shows about peoples lives before they moved to Heritage Care. These books include photographs and special memories and are used by staff Care Homes for Older People Page 16 of 31 Evidence: and others to help them understand about each person and to create opportunities for conversations and reminiscence. The home employs a full time activities coordinator. He told us about some of the activities organised at the home. The Manager told us that other staff are involved in supporting people with activities. On the day of our visit the activities coordinator was on a training course. We saw that the advertised activities did not take place and that most people were not supported with an activity by care staff. We saw one care staff singing and dancing with some people, but many people did not take part in any activity and some were seen sleeping or sitting in silence in their chairs for a long period of time. The Manager should make sure there is always something for people to do if they want to and that the care staff support people to do the things they want to. We saw that some staff spent time talking to people and making them feel relaxed, comfortable and at ease. We saw that these staff shared a joke and talked about things that interested people. However, in other areas of the home some of the staff sat in silence and did not talk to people apart from when they were performing a care task. We told senior staff and the Manager about this as we felt that all the staff should support people through conversations. One person told us, I feel that my relative would benefit from more mental stimulation and conversation. There have been some improvements to the building which have given people entertainment and stimulation. These include an indoor garden, big screen, entertainment room and reminiscence area. There is a programme of organised activities for each day. The activities coordinator told us about these and we saw some information on display in one area. We felt that information on organised activities could improve so that people can clearly see what is planned wherever they live in the home. A film is shown on a big screen once a week. We felt that people might enjoy more regular viewings on the big screen and consideration should be given to showing films more than once a week. The plan is for two main activities to take place each day. These include quizzes, games, craft and music. People told us that they enjoyed these activities. We felt that there should be additional smaller group activities organised throughout the day and evening so that people who did not want to take part in large groups could enjoy these. A hairdresser visits the home regularly. The Manager told us about special events which had taken place. These included summer and Christmas parties and trips to Kew Gardens and the Thames. There are Care Homes for Older People Page 17 of 31 Evidence: plans to celebrate St Patricks Day and there was a recent fashion show where staff and people from different countries were invited to wear their national dress. We saw photographs of special events at the home. At the time of our visit special events for Valentines day were being organised. There is a regular church service for people who wish to participate. Visitors are welcome at any time and there are facilities for visitors to make themselves hot drinks. There is a quiet room for people to meet with visitors if they wish and areas within the lounges and dining rooms where visitors can spend time. One of the staff told us, we try to provide care in a manner where everyone can be involved in the welfare of their loved one. Visitors told us that they were welcome at the home and able to be involved in their relatives care. They told us that the staff kept them well informed and consulted them. Some of the things people told us were, there is a positive input from relatives, as a relative I find all the members of staff helpful and sympathetic, as a visitor I have developed a good relationship with the staff, the home have worked very closely with families of residents to make sure people have the lifestyle they chose and the care service looks after the family of the resident taking into account their feelings. We felt that people living at the home were supported to have control over their lives. Some of the things people told us were, as far as possible residents are supported to live their lives as they would chose and are provided with opportunities to make choices from what they eat to where they would like to spend their day, emphasis is placed on individuality and personal preferences to the finest detail, clients are treated with respect and are given a choice and they appear very relaxed, the staff always seem to knock on doors and seem to respect the residents individuality and they support the residents to maintain individuality, mobility and independence. On the day of our visit the dining rooms were nicely arranged for lunch and tables were attractively presented. A selection of alcoholic beverages were available on dining tables and the Manager said that people were offered these. However, we observed that people were only offered soft drinks by staff during lunch on the day we visited. People are able to take their meals in their rooms or the lounges if they wish and we saw some people had chosen to do that on the day of our visit. People are given a choice of two main meals at lunchtime. We saw the staff showing people the different foods so that they could make an informed choice about what they wanted. A bowl of fruit was available which the Manager told us people could help themselves to. We felt that some of the fruit may be difficult for people to peel and it would be a Care Homes for Older People Page 18 of 31 Evidence: good idea for the staff to regularly offer pre cut fruit and finger foods throughout the day in addition to a bowl of whole fruits. Some people have special dietary needs. We saw that there was information on these and that the staff had a good understanding of these. The menu is chosen by the organisations head office. The chef told us that sometimes the meals were varied slightly to accommodate different tastes and choices. We felt that the menu should be chosen by people who live at the home and the chef who knows them well. Some of the things people told us about food at the home were, presentation is very good and well prepared, my wife always enjoys her meals, my relative is very fussy about what she eats and the home provide her with whatever she wants, the food is tasty and they seems to know and understand each persons likes and dislikes. Care Homes for Older People Page 19 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are appropriate procedures to help keep people safe and to give them opportunities to complain and comment on the service they receive. Evidence: People told us that they knew what to do if they had a complaint. People told us that they felt the Manager and staff were approachable. One person said, when a nurse saw me looking sad and down, I was able to talk to her and tell her what had made me upset, they are very kind and listen to me. Some people told us about concerns they had raised with the staff. They told us how these had been responded to and said that they were happy with the outcome. Everyone is given a copy of the complaints procedure and this is displayed around the home. There are appropriate procedures for protecting vulnerable people including copies of the local authority procedure. The staff have all had training in safeguarding people. The staff we spoke to had a good understanding about how to make sure people were protected and safe. People living at the home told us that they felt safe there. We saw that the Manager had followed protection procedures and had investigated Care Homes for Older People Page 20 of 31 Evidence: concerns thoroughly. We saw evidence of investigations, information for people involved and contact with the local authority. We saw that the Manager had organised for additional staff training where she felt it was necessary. Care Homes for Older People Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well maintained, attractive, clean and comfortable environment. Evidence: People told us that they liked the environment. One person told us, people are encouraged to personalise their rooms in order to create a feeling of home. A member of staff said, we have personalised some of the rooms and this brings security and warmth to people. The home is decorated to a high standard and is homely, light and airy. Some of the bathrooms had been decorated with murals. Communal rooms are nicely decorated and furnished. There is a large garden with different areas and seating. The foyer is welcoming and there are fresh flowers, gentle music and nice pictures and ornaments throughout the home. The staff have worked hard to create a varied and stimulating environment, with different areas and features for people to enjoy. Since the last inspection there have been improvements to the building. These include creating an entertainment room, where people can play games, take part in karaoke and enjoy alcoholic drinks in a pub like atmosphere. One of the lounges has been dedicated as a quiet room. This is decorated and Care Homes for Older People Page 22 of 31 Evidence: furnished as a small family lounge, with toys for visiting children. The room is often used by people who want to entertain their families. The staff have also create a reminiscence corner with old photographs, pictures and equipment. This area is quite cramped and although it is a useful new resource, it may be more beneficial to create the reminiscence theme over a larger area. There is a new large screen in one of the lounges and the Manager told us that movies are shown weekly. There is a new aromatherapy and nail care area, which has been attractively decorated and furnished so that people can relax whilst having treatment. There is also a dedicated sensory and relaxation room, which is furnished and equipped with different lights, music and other sensory equipment. We saw that bedrooms had been personalised with some people bringing their own furniture and equipment. One family had commissioned a special mural for someones bedroom wall to show her garden and the country where she grew up. There is a newly created in door garden, which has a wide selection of plants, imitation chickens and other wildlife. The Manager said that one person used to have their own chickens and she enjoys collecting the eggs in the garden. Other people enjoy caring for the plants. The home was clean and had a pleasant odour throughout on the day of our visit. Some of the things people told us were, the cleaners come in my room every day, the home is always clean like a 5 star hotel, very impressed with the cleanliness of the home and Heritage always looks well cared for with fresh flowers and welcoming smells. People told us that they were happy with the laundry service although one person said, sometimes the white are not washed separately from coloured clothes and this tends to make them very grey. 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. People are cared for by well trained, supported and suitably recruited staff. Evidence: The Manager spoke positively about the staff team and said that they were hard working, enthusiastic and used their own initiative. She said that they were dedicated and gave an example that on a recent very snowy day when public transport was limited, the staff had all managed to arrive for work and some of these staff had walked for over an hour in the snow. Some of the things people told us about the staff were, I am very impressed with the attitude of the staff, the carers are very friendly and always seem to respond to clients needs immediately, all the staff work in harmony and as one team, they are all very good and have a nice understanding, they are supportive and helpful, the staff are very attentive, care staff are well trained and experienced to support their clients, they are all very good, the care is good and the carers are friendly, the staff are conscientious, supportive and friendly and I am very impressed with the speed staff respond when my relative needs assistance. However, some people were not always happy with the staff and some of their comments were, I feel that the carers do not always have time to give people the Care Homes for Older People Page 24 of 31 Evidence: rehabilitation they need, the carers do not always seem to have enough time and I do not think as quickly as I used to and sometimes the carer has left the room before I remember to ask for help. There are a team of carers and nurses working in each area of the home. Specialist nurses work in areas where people who have dementia live. Some of the things the staff told us were, we take pride in the care we provide, we are a committed team, we thrive for the highest standards, we always aim to achieve a high standard of care, we work as a team, for me the service is excellent, they have provided me with training, paperwork, knowledge and support in order for me to become a good carer, we are a happy team and there is enthusiasm and dedication in the staff team and morale is very high indeed. The staff told us that they had regular team and individual meetings with the Manager and senior staff. One person said, a daily handover is done and we discuss care plans. The staff told us that they were given the information they needed to carry out their job. One member of staff said, our manager and nurses are always reminding us to read the care plans so we will be aware of what care and services people are entitled to. The procedures for recruiting staff include checks on their suitability and a formal interview. We saw evidence that reference and criminal record checks had been made on new staff. The Manager told us that she was planning to involve people who live at the home in recruiting new staff. All the staff have regular training and we saw evidence of training in manual handling, protection of vulnerable adults, food hygiene, fire safety and dementia. We saw that some staff are undertaking NVQ qualifications. There are records of all staff training. One member of staff told us, we have regular training with qualified nurses and the manager and another said, I had a complete induction and a chance to observe and ask questions. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is well managed. There is continuous work to make sure the service develops and improves, taking into account the wishes and feelings of people who live at, work at and visit the home. Evidence: The Manager has worked at the home since 2004. She is a registered nurse and has undertaken management qualifications. She works with other managers, organisations and the local authority to make sure she has up to date knowledge and is working to high standards. People who live at the home, their visitors, other professionals and staff all told us that the Manager was supportive, approachable and listened to ideas and suggestions. Some of the comments people said about the manager were, the Manager of the home takes great care to ensure that residents are well cared for in the best possible way, manager very approachable, listens to what I say, the Manager and the care Care Homes for Older People Page 26 of 31 Evidence: staff know all the residents well and are familiar with their specific needs, the staff and manager work closely together and are able to provide quality care, communication between the manager, all staff and stakeholders is very good, our manager is very supportive, our manager is always interacting with us, she has a sense of appreciation, I have always found the manager and her staff will take time to discuss any matter concerning my mothers welfare, the manager responds well and quickly monitoring any concerns and keeping people updated and I cannot speak highly enough of the manager her careful choice of staff, her creation of a warm and cheerful atmosphere and her approachability have made Heritage into something close to a family home. The Manager has set up systems to monitor quality and customer satisfaction. These include people being consulted weekly by the activities officer, chef and housekeeper. There are regular meetings for people who live at the home and their relatives to keep them informed and to ask for their views. There are regular recorded checks on health and safety and these identify where there are problems and what action should be taken. We saw that all safety equipment, including fire safety equipment, hoists, gas and electrical appliances had been regularly checked. The Manager has created files of evidence to show how the home is meeting and exceeding National Minimum Standards and plans for improvements for the future. Records were well organised and information was easy to find and accessible. People living at the home manage their own finances or have representatives to help them with this. However, small amounts of cash can be left with the office staff for safe keeping. This money is used for small purchases such as newspapers and hairdressing. We saw that this money was stored safely and that records for this were accurate and regularly checked. Care Homes for Older People Page 27 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 28 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 1 10 12 The Registered Person must make sure the staff always treat people with respect and give them the information they need to make informed choices. 30/04/2009 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 1 8 The staff should make sure they are supporting everyone to stay as active as they can be and are giving them the support they need to stay mobile. The staff should make sure visiting health professionals talk to their patients and explain about their health to them and not just the staff. The staff should make sure planned activities are well advertised and that these take place. The care staff should make sure they have conversations and talk to people at all times and not just when they are performing a care task. The staff should make sure people have opportunities to take part in small group activities, activities in their rooms and ad hoc activities as well as planned larger group Page 29 of 31 2 8 3 4 12 12 5 12 Care Homes for Older People activities. 6 7 8 15 15 26 The staff should make sure they regularly offer people a choice of drinks, snacks and prepared fruit. The chef, manager and people living at the home should chose and plan the menu. Staff should make sure peoples clothes are laundered and cared for so that they are not damaged. 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. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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