Care Home: High Meadow Nursing Home

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What the care home does well There is a homely atmosphere. The Manager consults with people before they move in so that they are confident that their needs can be met. One care worker says, `we try to find out about someone before they move in so that we can make them feel welcome. Over time of course we get to know people really well like family and so we just know how they like things done. They`re not patients or residents to us, they`re individuals and everyone`s different`. People say that they receive the assistance they need in ways that are right for them. One person says, `although (nurses and care workers) are busy of course, they`re never too busy to have a little chat and to ask how you are. That makes a difference to me because it feels like being at home and normal. You don`t feel that you`re a number. No, I`ve no complaints at all about the place`. There is a good range of special equipment such as hoists to help people who have reduced mobility. People can receive visitors whenever they wish and they can meet with them in private. The Manager keeps in touch with relatives so that they know how things are going. There are interesting and engaging social things that people can do. The Expert by Experience says, `there is a good programme of activities each day`. People enjoy their meals. One person says, `I enjoy most of the meals here and we get a good choice. The Chef comes and speaks to us and asks what we like`. There are reliable arrangements for the ordering and administration of medication. People are helped to stay in good health. This includes keeping an eye on how everyone is and then calling doctors as soon as they are needed. The kitchen meets the requirements of the local Department of Environmental Health. The laundry is well equipped and well organised. Security checks are completed on new nurses and care workers. Nurses and care workers have training opportunities so that they can further develop their skills and knowledge. What has improved since the last inspection? A number of improvements have been made since our last Key Inspection.The brochure and the complaints procedure have been strengthened so that they are more informative. The range of social activities that people can do has been extended. Parts of the medication administration system have been strengthened. This has been done to help nurses double check that they are dispensing correctly. Four bedrooms have been redecorated. New locks have been fitted to all bathroom and toilet doors. Various repairs have been made to particular windows to return them to a serviceable condition. New carpets have been laid in the main hallway and in the stair wells. Repairs have been completed in the laundry so that it can operate more efficiently. Plans have been developed to improve the water pressure on the top floor. All of these things contribute to the Service being better able to care for people in ways that are right for them. What the care home could do better: Until very recently there has not been an established Manager in post to supervise the day to day operation of the Service. The current Manager is not registered in his post. It is a legal requirement that the Registered Provider ensures that the Service is overseen by someone who is registered with us. Limited parts of the accommodation are not presented to a normal domestic standard. The quality assurance system does not fully involve all of the people who live in the Service. This means that some people might not have the opportunity to contribute ideas about the improvement of the Service. Some members of staff are not receiving fire safety training in the way considered necessary by the Registered Provider. This might reduce the level of fire safety protection provided in the Service. Key inspection report Care homes for older people Name: Address: High Meadow Nursing Home 126 - 128 Old Dover Road Canterbury Kent CT1 3PF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Mark Hemmings     Date: 2 4 0 5 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: High Meadow Nursing Home 126 - 128 Old Dover Road Canterbury Kent CT1 3PF 01227760213 01227762412 avidan@highmeadow.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Avidan Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 34 The registered person may provide the following category of service: 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 category : old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Up to 34 older people who need nursing care or personal care can make their home in High Meadow Nursing Home (the Service). The main property is a three storey detached building that has been adapted for its present use. At the back there is a large purpose built ground floor extension. In the main building the accommodation is on all three floors. There is a passenger lift that Care Homes for Older People Page 4 of 28 Over 65 34 0 2 3 0 9 2 0 0 9 Brief description of the care home gives step-free access around the accommodation. When full, six of the bedrooms can be shared by two people. All of the other bedrooms are for single occupancy. All of the bedrooms have a private wash hand basin. One of them also has a private shower and toilet and a further four have their own toilet. The bedrooms are laid out as bed sitting areas. There is a bed, a comfortable chair, bed side table and a wardrobe. Each bedroom has a television point and people can pay to have a telephone point put in if they want to. There are an adequate number of toilets and bathrooms. There is a main lounge, a conservatory and the dining room on the ground floor. All of the bedrooms, the bathrooms and the toilets are connected to a call bell system. This means that people can summon a member of staff if they need assistance. At the back of the building, there is a small enclosed garden. There is a seating area. To get to it there is quite a steep path. The garden has both lawns and flower beds. The Service is set back a little from a busy main road. Canterbury town centre is about half a mile away. There is a bus stop nearby and there is some off street car parking. The nearest mainline railway is about one mile away. The Service does not have its own vehicle. The weekly fee for living in High Meadow Nursing Home runs from £329.65 to £800.00. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this Service is 2 Star. This means that the people who use this Service experience good quality outcomes. We arrived unannounced at the Service at about eight oclock in the morning and we were there for about six and a half hours. It was a thorough look at how well things are going. We took into account information provided by the Registered Provider in its self assessment. This is called the Annual Quality Assurance Assessment (the Assessment). We received this on time. Some parts of it are only completed in very brief detail. Further, we considered any other information that we have received about the Service since we did our last Key Inspection on 23 September 2009. During the present inspection, we spoke with 10 of the people who currently live in the Service. We spent time in the company of another seven people while they were in the lounges or resting in their bedrooms. We also met with four relatives. We spoke with Care Homes for Older People Page 6 of 28 the Operations Manager. She is a senior manager who oversees the operation of the Service. We also spoke with the Manager, two nurses, three care workers, the activities coordinator, the chef, the laundry manager and the administrator. We looked around parts of the accommodation and the grounds. Also, we looked at a selection of key records and documents. These included things like the individual written plans of care, medication records, the activities plan, the menu, complaints documents, the staff roster, staff training records, financial records and various health and safety certificates. Before we visited the Service, we asked some of the people who live there and some nurses and care workers to fill out a questionnaire for us. We wanted them to tell us what they think of High Meadow Nursing Home. The Registered Provider has also asked people who live in the Service to complete questionnaires about their home. Later on in our Report, we will tell you the main things that are being said in both sets of these questionnaires. We were joined by an Expert by Experience. She has a thorough knowledge of the special needs of older people. She spent about three hours in the Service. During this time, she observed what was going on in the lounges. She also talked with people who live in the Service and with members of staff. She had a look around the main parts of the accommodation. This included going into some of the bedrooms by invitation. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? A number of improvements have been made since our last Key Inspection. Care Homes for Older People Page 8 of 28 The brochure and the complaints procedure have been strengthened so that they are more informative. The range of social activities that people can do has been extended. Parts of the medication administration system have been strengthened. This has been done to help nurses double check that they are dispensing correctly. Four bedrooms have been redecorated. New locks have been fitted to all bathroom and toilet doors. Various repairs have been made to particular windows to return them to a serviceable condition. New carpets have been laid in the main hallway and in the stair wells. Repairs have been completed in the laundry so that it can operate more efficiently. Plans have been developed to improve the water pressure on the top floor. All of these things contribute to the Service being better able to care for people in ways that are right for them. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are thinking of moving in are asked about what nursing and personal care they need and how they want this to be done. They are encouraged to visit the Service to get a first hand feeling of what it is like. People who want to stay for only a short time are supported to go home again. Evidence: The records show that the people who are thinking of moving in are asked about what nursing and personal care they need and want. They and their relatives are also invited to visit the Service. This is done so that they can be confident that moving in to High Meadow Nursing Home is the right thing for them. The Manager also talks with people such as doctors and care managers (social workers). All of this helps him to build up a really good picture of how the person can best be supported. There is a Service Users Guide. This is a brochure that gives lots of useful information about the facilities and the services that people can expect to have when they move Care Homes for Older People Page 11 of 28 Evidence: in. Recently, it has been updated so that it is more detailed and accurate. Nurses and care workers say that the Manager shares with them the information he has obtained about someone who is due to move in. This is done so that they know what care they need to provide. One care worker says, we try to find out about someone before they move in so that we can make them feel welcome. Over time of course we get to know people really well like family and so we just know how they like things done. Theyre not patients or residents to us, theyre individuals and everyones different. One person says said, I cant remember much (about moving in) but Im sure I was told about the place before I moved in here. Either way Ive no concerns because the staff are all so kind and friendly. I wouldnt move anywhere else now that Im here. Most of the people who move in do so with the intention of making High Meadow Nursing Home their longer term home. However, someone might only need to stay for a shorter time. This might be so that they can recuperate before going back to their own home. The Manager says that he liaises carefully with relatives and health and social care professionals in order to help the person achieve their goal of moving on. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are written individual plans of care that describe the nursing and personal care to be delivered. People are reliably receiving all of the support they need. They are treated with courtesy and respect. People have access to the medical and health care services they need. There are reliable arrangements for handling medication. Evidence: Each person has an individual written plan of care. These describe the nursing and personal care they are to receive. The plans are detailed and are kept up to date with regular reviews. When people use the call bell to ask for assistance it is answered promptly. The records show that people are receiving the medical care they need. This includes seeing professionals such as their doctor as and when they are needed. As necesary, they also see specialist nurses who give advice to the Service about how best to respond to people who have complicated nursing care needs. Care Homes for Older People Page 13 of 28 Evidence: In their replies to the Registered Providers questionnaire, people say that the care they receive is very good or excellent. One person says, the staff are kindness itself really and nothing is too much trouble for them. Ive never ever had a reason to complain and I see them like family really because you get to know them so well. Another person says, although (nurses and care workers) are busy of course, theyre never too busy to have a little chat and to ask how you are. That makes a difference to me because it feels like being at home and normal. You dont feel that youre a number. No, Ive no complaints at all about the place. One relative says, I am glad I found this Home for my Mother. I couldnt have found anything better. The Expert by Experience says, the (nurses and care workers) treat the residents with kindness, care and dignity and give gentle encouragement when needed. During the time they were serving morning coffee they were talking to the residents and helping if necessary. Both residents and their visitors confirmed that the staff are excellent. The nurses manage medication for people. There is a system to check that the correct medicines are received from the chemist. Once in the Service, medicines are stored in a locked facility. There is a procedure for administering medicines to ensure that it is done in a reliable way. One part of the system has recently been strengthened to help nurses to double check that they are dispensing correctly. There is a record that is completed on each occasion that a medicine is given. These are being completed correctly. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can take part in social activities if they want. People are free to receive visitors and to spend the day as they wish. Good quality meals are served. Evidence: In their replies to our questionnaire, people say that they are satisfied with the social activities on offer. On most days there is an activities coordinator. The records show that she supports people to do things such as artwork, board games and tabletop gardening. She says, each person is very different and I try to find out what sorts of things they like to do. People also vary according to the day. They need to have the chance to do interesting things without feeling that they have to join in. Recently, the range of things that people can do has been extended. The activities coordinator says that more opportunities will be added in the future. There are also people who come into the Service to lead gentle exercise sessions or to play music. There is a visiting hairdresser. There have not been any organised trips out in the past six months. Care Homes for Older People Page 15 of 28 Evidence: The Expert by Experience says that, there is a good programme of activities each day. On the day of my visit the activities coordinator was doing gardening outside with the residents. They were potting up baskets and pots with plants and really enjoyed this experience. Those residents not involved in the gardening had simple picture crosswords puzzles to do where they were sitting in the lounge. The activities coordinator also went around talking to the residents and helping with morning coffee. She takes residents out either singly or in twos into town to the shops, travelling by taxi. People are free to receive visitors whenever they want. They can speak with them in the privacy of their bedroom if they wish. The Manager says that he keeps in touch with relatives so that they know how things are going. The Manager says that people are encouraged to make their bedrooms their own private space. They are helped to arrange them as they want them to be. The three bedrooms we were invited to see are comfortable and welcoming spaces. People can use their bedrooms whenever they want. They can choose to have private time on their own or to be in company. The Expert by Experience says that the bedrooms, are spacious and well furnished and residents are able to bring their own furniture and other items with them if they wish. The decor is pleasing and light. The Registered Provider does not get involved in helping people to manage peoples financial affairs. Most people are helped by their families or by the local authority. The records show that there is a varied menu. The main meal is lunch and the sorts of dishes served are things like chicken and leek pie and savoury mince. There is a cooked option for tea. There are drinks and biscuits served mid morning, mid afternoon and later in the evening. People can dine in their bedroom if they wish. In their replies to the Registered Providers questionnaire, people say that the meals are either very good or excellent. One person says, we have good meals here and I always have enough. Ive no complaints at all about the food. Someone else says, I enjoy most of the meals here and we get a good choice. The Chef comes and speaks to us and asks what we like. The Expert by Experience joined people for lunch. She says, the meal was pleasant and plentiful. Help was given (to people) where needed. Some residents ate in the dining room and others at tables in the lounge. Each resident had a jug of water or juice at their table in the lounge during the day and there was also a supply of fresh fruit available. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a complaints procedure. There are systems in place that are designed to keep people safe. This includes people being protected from prejudice and discrimination. Evidence: There is a complaints procedure that explains how someone can raise concerns in relation to the Service. Recently, the procedure has been revised so that it gives a more comprehensive account. The Assessment says that, all complaints are taken seriously and are dealt with appropriately by the Manager and any actions needed are dealt with and followed up. In the procedure the Registered Provider commits itself to fully investigate complaints and to resolve them as soon as possible. Since our last Key Inspection, the Registered Provider has received three complaints about aspects of the nursing and personal care provided and about the quality of the catering. The records show that each complaint was promptly investigated and resolved. People who live in the Service are confident that they are safe and that their wellbeing will be promoted. In their replies to our questionnaire everyone says that members of staff always treat them well. Nurses and care workers are confident that people are being kept safe. One nurse says, all of the patients get treated well here and we are careful to make sure that all health care needs are met. People deserve kindness and attention. The Operations Manager says, we are committed to making sure that Care Homes for Older People Page 17 of 28 Evidence: people are safe and are well cared for. Since our last Key Inspection, Kent County Council has investigated separate concerns that two peoples wellbeing may have become compromised. We understand that the Registered Provider cooperated fully with the investigations. The enquiries concluded that the people concerned had received appropriate nursing and personal care when in the Service. Suitable arrangements are in place for exceptional circumstances when someone may need to have parts of their liberty limited in order to promote their best interests. The Assessment commits the Registered Provider to promoting diversity in the Service. This means respecting each person who lives there as an individual. It also means making sure that no one experiences any form of prejudice or discrimination. The records show that nurses and care workers receive training about this subject. This is done both when they start their employment and then on an ongoing basis. The Manager says that this commitment to promoting diversity is also expressed in practical terms. For example, in the way that each person receives individualised care in ways that respect their preferences and wishes. Some people are assisted to manage paying for things such as seeing the hairdresser. This involves the Registered Provider settling the bill and then invoicing people later. A few people are also helped to manage small amounts of cash. This is retained for them by the Service and given to them on request. Aspects of this latter system were not well recorded. However, since the inspection visit the Manager has said that the system has been strengthened to resolve any problems. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some parts of the accommodation are not adequately presented. There is a modern fire safety system. The kitchen is adequately equipped. There is enough equipment to help people who have difficulties with their mobility. There is a suitable laundry. Evidence: The building provides a suitable range of facilities for the people who live there. These are in line with what the Registered Provider has committed itself to deliver in its Statement of Purpose. This is a legal document that describes in some detail the facilities and services that are available in High Meadow Nursing Home. The building is well maintained on the outside and the garden is well kept. On the inside, most of the accommodation is adequately decorated and furnished. The lounges are quite comfortable spaces. All of the bathrooms and toilets are rather bare. In various places in hallways, landings and stairwells wall and woodwork finishes have become scuffed and marked with age. In the course of the past year various improvements have been made. New carpet has been laid in the main hallway and in the stairwells. Four bedrooms and some of the hallways have been redecorated. Some of the stairwells are in the process of being redecorated. New locks have been fitted to all bathroom and toilet doors. Various Care Homes for Older People Page 19 of 28 Evidence: minor maintenance jobs have been completed to repair things such as window frames and defects in the laundry. There is a range of equipment to help people who have reduced mobility. This includes special rise and fall baths that are easier to access. There are three mobile hoists that can be used in the lounges and in the bedrooms. There are other things such as special sheets to help people change position in bed. There is a modern automatic fire detection system. This has been assessed to make sure that it continues to meet the national standard. People say that the accommodation is always comfortably warm. The radiators are fitted with guards. This means that their surface does not become hot enough to burn someone. The hot water system is temperature controlled. This has been done so that it does not get hot enough to scald someone. The water pressure on the second floor is quite low. The Manager says that there are plans to address this problem. The kitchen is clean and well equipped. The local Department of Environmental Health says that the kitchen meets its requirements. It has given it four stars out of a possible five stars. Its report says that there is a, good standard of food management. The laundry has a commercial grade washing machine. This is fitted with a special cycle for items that need a particularly hot wash. There is a commercial dryer. The area is well organised and clean. People have their clothes marked so that there is less chance of them being misdirected. There are sluices that are used for cleaning items such as commodes. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough nurses and care workers on duty to provide people with the care they need. Nurses and care workers know what they are doing and they receive regular training. Security checks are completed on new nurses and care workers. Evidence: The records show that there is always a qualified nurse on duty. They are supported by four care workers in the morning and three care workers in the afternoon and evening. At night time there is a nurse and two care workers on waking duty. During the day there are other people who do the housekeeping, the laundry and who work in the kitchen. One care worker says, we seem to have enough staff on duty to make sure that people get the help they need. We dont rush people, we dont need to. Theres plenty to do but we can get through it okay. The records show that the necessary security checks are being completed for new nurses and care workers. These include things such as confirming their identity, taking up references and doing a police check. This is done to make sure that they are trustworthy people to work in the Service. Care Homes for Older People Page 21 of 28 Evidence: The records show that nurses and care workers do introductory training before they join the roster. One care worker says, I got lots and lots of training when I came here and was given a good introduction to care work and all that it entails. The training was about residents rights and practical things such as how to help people move around safely. After their introduction, there is ongoing training in key subjects such as first aid, health and safety and how to promote good hygiene. The records show that this training is being completed in an organised way. One care worker says, Ive done quite a few courses since I came here. Things like fire safety, food safety and infection control. Theres plenty of training and if we need help we can always ask the nurses. More than half of the care workers have completed a relevant National Vocational Qualification (NVQ). This Award is designed to further develop their ability to provide people with the assistance they need. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Manager is not registered with us. The quality assurance system does not fully involve everyone who lives in the Service. Some aspects of how peoples personal monies are handled need to be strengthened. There are some limited shortfalls in the health and safety arrangements. Evidence: The Manager is a Registered General Nurse and a Registered Mental Nurse. Also, he has a recognised management qualification. He has been in post for about two months. Before he arrived, there have been a number of changes of manager and no one has been registered in the post for several years. The Operations Manager says that the Registered Provider intends to ask us to register the current Manager as soon as possible. Nurses and care workers say that there is good team work in the Service. One care worker says, the team work is okay actually and in general this is quite a happy place to work. We know our jobs and we all get on and work together. Care Homes for Older People Page 23 of 28 Evidence: There are handover meetings at the beginning and end of each shift. These are when nurses discuss how things are going so that they can plan what needs to be done. They then pass this information on to the care workers. There are also regular staff meetings. The Manager says that nurses and care workers will receive regular professional support. This will enable him to appraise the quality of each persons work so that he can offer any advice that may be necessary. There are quarterly residents meetings when people and their relatives can comment on the Service. There are also the annual questionnaires to which we have already referred. Only a very small number of people complete them. There is no organised system to inform people about what has been said and about what improvements are going to be made. The Operations Manager regularly calls to the Service to check how things are going. The records show that she completes an organised review of how things are going. There is a health and safety policy. This commits the Registered Provider to maintaining a safe environment in the Service. As part of this the chef regularly checks that the refrigerators and freezers are cold enough to store food safely. He also checks that hot foods are cooked through. There is a system to date mark food so that it does not go beyond its use by date. Several members of staff are overdue the periodic fire safety training that the Registered Provider considers to be necessary. The Manager says that this oversight will be addressed by 1 June 2010. Unannounced fire drills are being held regularly. The records show that items of equipment such as gas appliances, the passenger lift and the various hoists remain in good working order. The records also show that there have not been many significant accidents in the Service since our last Key Inspection. The Manager monitors the occurrence of accidents. This is so that he can see if anything needs to be done to help prevent them from happening again. He says that nothing particular needs to be done at the moment. There is a monthly health and safety audit. This is done to help make sure that there are no hazards that might result in someone having an accident. The Manager says Care Homes for Older People Page 24 of 28 Evidence: that there are no particular hazards that need to be dealt with. We did not notice any either. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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