Care Home: High Peak Nursing Home

What the care home does well People`s need are assessed before they move to High Peak to ensure that this will be the right home for them. Each resident has a care plan that details their needs and how their needs are to be met. The care plans we looked at were lengthy and comprehensive. They had been generally very well written and kept up to date. Risk assessments for falls, nutrition, pressure damage and safe moving and handling were recorded. Daily entries were well written and detailed, and monthly evaluations were also detailed and gave a good picture of how the person has been that month. The care plans provided evidence that people`s health needs are monitored and that they are visited by healthcare professionals as needed. Equipment is provided to meet people`s needs, including adjustable beds and different types of supporting chairs to enable the more frail people to spend time out of bed and in the lounge with others if they wish. Medicines are stored safely and the records indicated that people always receive what has been prescribed by their doctor. A letter (dated 21/4/09) addressed to manager, read: `No words can ever fully express our gratitude for the care that Mum received over the past 23 months at High Peak. My personal observation was that staff did not merely care `for` the residents but they cared `about` the residents. The ethos of High Peak is such that Mum`s quality of life during her final two years of life was enhanced in a way in which we could never have anticipated.` Another letter (dated 1/3/09) read: `I cannot praise too highly the standard of care provided by you all at High Peak. Aunty could not have wished to find a `home from home` with a more skilled, loving and warm hearted environment. I am grateful for the many kindnesses that you showed her in so many ways.` The message in a `thank you` card received recently was: `It is difficult to fully express our heartfelt thanks to you all for the caring and kindness you showed to K over the past few months he was with you. It will always be a comfort to us as a family to know that he was cared for in his last few months of life by caring people like you. We are also grateful for your support and kindness to us as a family, helping us through a traumatic time.` The home employs an activities organiser in the afternoons and various trips and activities are provided for anyone who wishes to join in. A minibus is available for trips out and is used regularly. The manager told us that `all occasions are celebrated at High Peak, be it a resident`s birthday or a special day such as St George`s Day, or Easter. Any excuse for a party!` Photographs displayed on the noticeboard record these events. There is a visiting library service and church services by different denominations. There are two new 50 inch plasma television screens in each lounge with a loop system to enable people who wear hearing aids to hear them. The home has links with older people`s groups in Warrington where some residents attend dances. Visitors arewelcomed at all times of day and we saw that everyone visiting the home was given a very warm welcome. Four meals a day are provided, with snacks in between meals so that people who can only eat small amounts receive enough to eat. There is a choice at all meals. People can take their meals in their own rooms if they wish, and mealtimes are flexible. All parts of the building were clean and in good repair. The corridors and lounges have been redecorated and look very attractive, with brightly-coloured pictures and new curtains making these areas look light and bright. There are spacious well-stocked and very attractive gardens at the back of the home that are accessible for residents to enjoy. Good staffing levels are maintained to ensure that people`s needs can be met in full at all times. Well over 50% of the carers have a national vocational qualification in care. 60% of the staff have worked at High Peak for more than 12 years, which means that it is a very stable and reliable staff group. Good recruitment procedures are followed to ensure that new staff are safe and suitable to work with vulnerable people. The home has joined the Warrington Social Care Partnership and accesses training and other resources through this partnership. New staff attend the two week induction training provided by Warrington Borough Council. The home manager has been in post since November 2006. He is a registered nurse with previous experience as a home manager. Throughout the inspection he showed his enthusiasm and commitment to High Peak and to continuous improvement of the service provided. Regular staff meetings are held and all of the staff we met were friendly and welcoming, open and happy to talk about the home and their work. The manager holds `wine and cheese` evenings through the year as a way of meeting up with relatives and giving them the opportunity to speak with him in private or on more informal basis. The manager completed a health and safety course in March 2009. Records showed that all equipment is tested, serviced and maintained to ensure safety. Fire drills are held to make sure that staff know what to do should a fire occur. What has improved since the last inspection? The manager has worked to introduce a more person-centred approach to care and move away from fixed routines. Windows that were in a poor state of repair/decoration have been replaced or repaired and repainted. The exterior of the building has been redecorated. The bedrooms on the top floor of the home have been tastefully refurbished. A training matrix has been developed to show when staff have received training and to identify any staff who are due to have training updates. The provision of induction training for new staff is much improved. What the care home could do better: Although the standard of the care plans was generally good we considered that there was room for further improvement and this is detailed in the `Health and Personal Care` section of the report. The home`s complaints procedure could be improved by giving people the name of the home manager, and the name and contact details of the senior manager in the organisation for people to contact if they were not satisfied with the way the manager had dealt with their complaint, or if they wished to complain about the home manager. The patio area is uneven and needs re-laying so that it is safe for the more mobile residents to use unaccompanied. Inspecting for better lives Key inspection report Care homes for older people Name: Address: High Peak Nursing Home High Peak Nursing Home Main Lane Kenyon Warrington Cheshire WA3 4AZ     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: Wendy Smith     Date: 2 2 0 5 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 29 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: High Peak Nursing Home Main Lane High Peak Nursing Home Kenyon Warrington Cheshire WA3 4AZ 01925764081 01925768888 hpneuropeancare@aol.com 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) : European Care (UK) Limited care home 41 Number of places (if applicable): Under 65 Over 65 41 old age, not falling within any other category Additional conditions: 0 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 41 Date of last inspection Brief description of the care home High Peak is a nursing home for older people set in a rural area between the towns of Warrington and Leigh. The home is registered for 41 older people, however a maximum of 34 places are now provided, all in single rooms, most of which have ensuite facilities. The building combines an adapted three storey country house with a two storey, purpose built extension and is set in its own grounds. Bedrooms are on all three floors. The home is within easy reach of the motorway network but is not accessible by public transport. Care Homes for Older People Page 4 of 29 Care Homes for Older People Page 5 of 29 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 quality rating for this service is three stars. This means that the people who use this service experience excellent quality outcomes. Two inspectors visited High Peak unannounced on 22 May 2009 as part of this inspection. During the visit we spoke with residents, staff and visitors. We walked round the building to see all the communal areas and were able to visit some of the bedrooms. We checked some of the records kept at the home and spent time talking with the registered manager. We also looked at any information that we had received about High Peak since our last inspection there. Before the inspection the manager was asked to complete a Care Homes for Older People Page 6 of 29 questionnaire to give us up to date information about the service and survey forms were sent out for staff to give us their views. What the care home does well: Peoples need are assessed before they move to High Peak to ensure that this will be the right home for them. Each resident has a care plan that details their needs and how their needs are to be met. The care plans we looked at were lengthy and comprehensive. They had been generally very well written and kept up to date. Risk assessments for falls, nutrition, pressure damage and safe moving and handling were recorded. Daily entries were well written and detailed, and monthly evaluations were also detailed and gave a good picture of how the person has been that month. The care plans provided evidence that peoples health needs are monitored and that they are visited by healthcare professionals as needed. Equipment is provided to meet peoples needs, including adjustable beds and different types of supporting chairs to enable the more frail people to spend time out of bed and in the lounge with others if they wish. Medicines are stored safely and the records indicated that people always receive what has been prescribed by their doctor. A letter (dated 21/4/09) addressed to manager, read: No words can ever fully express our gratitude for the care that Mum received over the past 23 months at High Peak. My personal observation was that staff did not merely care for the residents but they cared about the residents. The ethos of High Peak is such that Mums quality of life during her final two years of life was enhanced in a way in which we could never have anticipated. Another letter (dated 1/3/09) read: I cannot praise too highly the standard of care provided by you all at High Peak. Aunty could not have wished to find a home from home with a more skilled, loving and warm hearted environment. I am grateful for the many kindnesses that you showed her in so many ways. The message in a thank you card received recently was: It is difficult to fully express our heartfelt thanks to you all for the caring and kindness you showed to K over the past few months he was with you. It will always be a comfort to us as a family to know that he was cared for in his last few months of life by caring people like you. We are also grateful for your support and kindness to us as a family, helping us through a traumatic time. The home employs an activities organiser in the afternoons and various trips and activities are provided for anyone who wishes to join in. A minibus is available for trips out and is used regularly. The manager told us that all occasions are celebrated at High Peak, be it a residents birthday or a special day such as St Georges Day, or Easter. Any excuse for a party! Photographs displayed on the noticeboard record these events. There is a visiting library service and church services by different denominations. There are two new 50 inch plasma television screens in each lounge with a loop system to enable people who wear hearing aids to hear them. The home has links with older peoples groups in Warrington where some residents attend dances. Visitors are Care Homes for Older People Page 8 of 29 welcomed at all times of day and we saw that everyone visiting the home was given a very warm welcome. Four meals a day are provided, with snacks in between meals so that people who can only eat small amounts receive enough to eat. There is a choice at all meals. People can take their meals in their own rooms if they wish, and mealtimes are flexible. All parts of the building were clean and in good repair. The corridors and lounges have been redecorated and look very attractive, with brightly-coloured pictures and new curtains making these areas look light and bright. There are spacious well-stocked and very attractive gardens at the back of the home that are accessible for residents to enjoy. Good staffing levels are maintained to ensure that peoples needs can be met in full at all times. Well over 50 of the carers have a national vocational qualification in care. 60 of the staff have worked at High Peak for more than 12 years, which means that it is a very stable and reliable staff group. Good recruitment procedures are followed to ensure that new staff are safe and suitable to work with vulnerable people. The home has joined the Warrington Social Care Partnership and accesses training and other resources through this partnership. New staff attend the two week induction training provided by Warrington Borough Council. The home manager has been in post since November 2006. He is a registered nurse with previous experience as a home manager. Throughout the inspection he showed his enthusiasm and commitment to High Peak and to continuous improvement of the service provided. Regular staff meetings are held and all of the staff we met were friendly and welcoming, open and happy to talk about the home and their work. The manager holds wine and cheese evenings through the year as a way of meeting up with relatives and giving them the opportunity to speak with him in private or on more informal basis. The manager completed a health and safety course in March 2009. Records showed that all equipment is tested, serviced and maintained to ensure safety. Fire drills are held to make sure that staff know what to do should a fire occur. What has improved since the last inspection? What they could do better: Care Homes for Older People Page 9 of 29 Although the standard of the care plans was generally good we considered that there was room for further improvement and this is detailed in the Health and Personal Care section of the report. The homes complaints procedure could be improved by giving people the name of the home manager, and the name and contact details of the senior manager in the organisation for people to contact if they were not satisfied with the way the manager had dealt with their complaint, or if they wished to complain about the home manager. The patio area is uneven and needs re-laying so that it is safe for the more mobile residents to use unaccompanied. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. 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 10 of 29 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 11 of 29 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. Peoples need are assessed before they move to High Peak to ensure that this will be the right home for them. Evidence: When we visited there were 28 people living at High Peak; all were older people. The home offers short stays as well as permanent places but does not provide intermediate care. The manager goes out to meet and assess any people interested in going to stay at High Peak and details of the assessments were contained in the care plans. The care plans also contained pre-admission assessments that had been provided by social workers and health professionals. The home provides end of life care for people who are referred to them by the local primary care trust. They are working towards the National Gold Standard in Palliative Care and a course of training for staff is booked for September 2009. Information Care Homes for Older People Page 12 of 29 Evidence: provided by the manager in a pre-inspection questionnaire indicated that eleven of the people living at the home have dementia, however it was evident that these people also have needs due to physical frailty and there appeared to be no difficulty for staff in providing the care they need. Information about the home is provided in a folder in each bedroom. These could be improved to give people the information they need in an easy to read format. Care Homes for Older People Page 13 of 29 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. The health and personal care needs of the people living at High Peak are met to a very high standard to make sure they receive the care they need in the way they prefer. Evidence: Each resident has a care plan that details their needs and how their needs are to be met. We looked at the care plans of four people living at the home and found them to be lengthy and comprehensive. They had been generally very well written and kept up to date. Risk assessments for falls, nutrition, pressure damage and safe moving and handling were recorded. Daily entries were well written and detailed, and monthly evaluations were also detailed and gave a good picture of how the person has been that month. We found that some of the plans for a resident had been written in 2007. Although changes had been recorded, it would be better to rewrite the plan when there have been significant changes to a persons needs. Also we thought that there could have been more information in some of the plans, for example two of the care plans for Care Homes for Older People Page 14 of 29 Evidence: nutrition had no information about what the person likes/dislikes. One contained the instruction find out likes and dislikes, but no record that this had been done. Also care plans for continence gave no information about what kind of aids the person used. At the time of our visit no residents were very ill and one person was cared for in bed. Different types of supporting chairs are available so that most people who are frail can spend time out of bed and in the lounge with others if they wish. A small number of people choose to remain in their own room throughout the day. The care plans provided evidence that peoples health needs are monitored and that they are visited by healthcare professionals as needed. One person had been admitted with extensive skin damage and this was well documented. People admitted for end of life care are monitored by district nurses and a community matron and the deputy home manager said they provide good support for the homes staff. There is adequate storage for medicines in the staff area that is divided by a codelocked door from rest of the home. Medicines are handled only by registered nurses. Items with a short life had been dated on opening. There were no missed signatures on the medicine administration records and the records indicated that residents receive their prescribed medication at the correct time. Each drug is counted daily. Storage and recording of controlled drugs was satisfactory. Anticipatory medicines had been prescribed for a person admitted to the home for end of life care so that symptoms could be controlled as they occurred. The manager told us that at present no residents look after their own medicines, but a risk assessment is available if someone did want to self-medicate to assess whether this would be safe. We spoke with a relative whose mother has lived at High Peak for four years. She told us that her mother has a lovely bedroom, the care is excellent, and she is always informed of any changes to her mothers care. Her mother doesnt choose to join in activities but will go on trips out with some persuasion. The staff are lovely and the food is always good, with plenty of choice. Another relative told us that she has no problems at all; it is a lovely home and staff are pleasant and professional. We observed that the staff had an excellent rapport with residents and their families. We were shown a letter (dated 21/4/09) addressed to manager, which read No words can ever fully express our gratitude for the care that Mum received over the past 23 months at High Peak. My personal observation was that staff did not merely care for the residents but they cared about the residents. The ethos of High Peak is such that Mums quality of life during her final two years of life was enhanced in a way in which we could never have anticipated. Care Homes for Older People Page 15 of 29 Evidence: Another letter (dated 1/3/09) read I cannot praise too highly the standard of care provided by you all at High Peak. Aunty could not have wished to find a home from home with a more skilled, loving and warm hearted environment. I am grateful for the many kindnesses that you showed her in so many ways. The message in a thank you card received recently was It is difficult to fully express our heartfelt thanks to you all for the caring and kindness you showed to K over the past few months he was with you. It will always be a comfort to us as a family to know that he was cared for in his last few months of life by caring people like you. We are also grateful for your support and kindness to us as a family, helping us through a traumatic time. Care Homes for Older People Page 16 of 29 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. A good range of activities and trips out are provided to meet the social and recreational needs of the people living at the home. Evidence: The home employs an activities organiser in the afternoons and various trips and activities are provided for anyone who wishes to join in. A minibus is available for trips out and is used regularly. An area of the lounge is set aside for activities. The manager told us that All occasions are celebrated at High Peak, be it a residents birthday or a special day such as St Georges Day, or Easter. Any excuse for a party! Photographs displayed on the noticeboard record these events. There is a visiting library service and church services by different denominations. There are two new 50 inch plasma television screens in each lounge with a loop system to enable people who wear hearing aids to hear them. The home has links with older peoples groups in Warrington where some the residents attend dances. On the day we visited there were entertainers performing in the afternoon. The staff told us that they are good and vary their programme. The manager has worked to introduce a more person-centred approach to care and Care Homes for Older People Page 17 of 29 Evidence: move away from fixed routines. Visitors are welcomed at all times of day and we saw that everyone visiting the home was given a very warm welcome. Four meals a day are provided, with snacks in between meals so that people who can only eat small amounts receive enough to eat. There is a choice at all meals. People can take their meals in their own rooms if they wish, and mealtimes are flexible. Care Homes for Older People Page 18 of 29 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 procedures in place to ensure that people are protected from abuse and that any complaints are addressed. Evidence: The home has a complaints procedure that advises people how any complaint they make will be dealt with. This is displayed in the main entrance area of the home. We considered that the complaints procedure could be improved by giving people the name of the home manager, and the name and contact details of the senior manager in the organisation for people to contact if they were not satisfied with the way the manager had dealt with their complaint, or if they wished to complain about the home manager. No complaints had been recorded at the home since our last visit and the Commission has received no complaints about the service. The manager told us that any concerns expressed by residents or their families are dealt with immediately. The manager told us that all staff have received recent training about protecting vulnerable people from abuse and some have attended safeguarding interactive workshops provided by Warrington Social Care Partnership. This is to make sure that they know what to do to protect the people who live in the home from possible harm. Care Homes for Older People Page 19 of 29 Care Homes for Older People Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. High Peak provides a spacious, comfortable and clean environment for people to live in. Evidence: We walked around the home and found all parts of the building were clean and in good repair. The corridors and lounges have been redecorated and look very attractive, with brightly-coloured pictures and new curtains making these areas look light and bright. Windows that were in a poor state of repair/decoration have been replaced or repaired and repainted. The exterior of the building has been redecorated. There are spacious well-stocked and very attractive gardens at the back of the home that are accessible for residents to enjoy. However the patio area is uneven and needs re-laying so that it is safe for the more mobile residents to use unaccompanied. The manager told us that there are plans for an extension in this area. A full time maintenance person is employed and the gardens are looked after by contractors. The bedrooms on the top floor of the home have been tastefully refurbished. All except two bedrooms have an en-suite toilet. Most bedrooms have an adjustable bed, including two extra long beds. We saw that people could bring in their own belongings, including furniture, to make their room more homely. Care Homes for Older People Page 21 of 29 Care Homes for Older People Page 22 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Enough competent and experienced staff are provided to ensure that peoples needs can be met in full throughout the 24 hour period. Evidence: The home employs six nurses, 22 care staff and 13 ancillary staff. Well over 50 of the carers have a national vocational qualification in care. In a morning there are two nurses on duty with six carers. In the afternoon and evening there is one nurse and four or five carers, and at night one nurse and three carers. These levels should be more than adequate to ensure that peoples needs can be met. 60 of the staff have worked at High Peak for more than 12 years, which means that it is a very stable and reliable staff group. The manager told us that staff are always willing to cover shifts at short notice, so that there is very little use of agency staff. On weekdays there are either two or three housekeepers on duty with one at the weekend, and there is a laundry assistant each day. Recruitment records for the four most recently employed staff were looked at. These showed that good procedures had been followed and included Criminal Records Bureau disclosures and at least two references for each person. The manager said that he has spent a long time sorting through staff training and Care Homes for Older People Page 23 of 29 Evidence: supervision records and trying to get them in order. He has recently developed a matrix which shows training booked for each member of staff. They have joined the Warrington Social Care Partnership and access training and other resources through this partnership. The staff have commenced e-learning with the Common Induction Standard tool. The programme generates a learning analysis so manager is aware of strengths and weaknesses for each person and this can be discussed with them in individual supervision meetings. A member of staff we spoke with said it is a good place to work. She has completed NVQ level 2 and is working towards level 3. She has regular supervision meetings to check how she is working. We also spoke with the two nurses on duty. They both felt supported to give good nursing care and were looking forward to future development of the palliative care service. New staff attend the two week induction training provided by Warrington Borough Council. At the time we visited, five members of staff were either doing this training or were booked on it. Care Homes for Older People Page 24 of 29 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 home is very well managed to ensure that people are kept safe and they are given opportunities to express their views of the service. Evidence: The home manager has been in post since November 2006. He is a registered nurse with previous experience as a home manager. He has completed a national vocational qualification level 4 in management and is registered with the Commission. There is also a deputy manager who has worked at the home for several years. Monthly monitoring visits to the home (required by regulation 26 of the Care Homes Regulations) are carried out by the programme manager and a report follows each visit. Care plans are audited to make sure they are kept up to date. There is a weekly falls analysis and a monthly accident audit. The manager has recently completed the companys lengthy self-audit which covers all of the National Minimum Standards for care homes and generates an action plan for any areas that need improvement. Care Homes for Older People Page 25 of 29 Evidence: We saw evidence that regular staff meetings are held and the minutes were available to read. All of the staff we met were friendly and welcoming, open and happy to talk about the home and their work. The manager holds wine and cheese evenings through the year as a way of meeting up with relatives and giving them the opportunity to speak with him in private or on more informal basis. The manager also told us that he has an open door policy; he knows all the families and considers that they would all feel happy to come and see him. One of the visitors we spoke with said she finds the manager to be open and approachable. A customer satisfaction survey is done twice a year, but the format used could be improved so that the manager gets better feedback. An administrator is employed to deal with day to day financial procedures in the home. Residents are able to keep small amounts of personal spending money in safekeeping and the administrator keeps satisfactory records of this. Hairdressing is provided free of charge and until recently the home was able to access a free chiropody service. The manager has written to families to ask what they would like to do about getting a private chiropodist to provide a service. The manager completed a health and safety course in March 2009. In the AQAA he gave us details of testing, servicing and maintenance of plant and equipment. A fulltime maintenance person is employed. The fire officer visited on 12 November 2008 and made five requirements. The manager told us that four of these are now completed and work to replace intumescent door strips is due to be completed by the end of June. New fire points and additional fire detection equipment has been provided. We looked at the fire records which showed that regular weekly checks are carried out including emergency lighting and fire alarm systems. Fire drills had been held in February and March 2009 and these included night staff. A number of doors are fitted with automatic closers linked to the fire alarm systems. The homes kitchen was awarded a five star rating by the environmental health officer. Care Homes for Older People Page 26 of 29 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 27 of 29 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 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) 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. 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