Care Home: Holbeach Hospital

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What the care home does well The people live in comfortable and clean accommodation. Each person is encouraged and supported to be independent and take part in meaningful activities. They are also offered choices about what they wish to do and to make decisions about how they spend their lives. Staff communicate well with them and respect their choices and decisions. People living in the home are cared for and supported by a caring, educated and committed team of staff. There is a programme of education and training provided for staff, which ensures that staff know how to care and support the people who live at the home. What has improved since the last inspection? As a result of very thorough safeguarding adults investigation by Lincolnshire County Council the management of the board and staff have made improvements to the home, staff training and the care approach . A new acting manager has been appointed and has addressed with her team improving the way care is delivered and how the quality of the service is monitored. Record keeping has been reviewed and improved and as a result is more individual. They have also recruited a ward clerk to relieve the administration for nurses. This has enabled them to spend more time on nursing and supporting the people living in the home. Staff training has increased and this has been aided by the recruitment of a nurse who is also the training co-ordinator. More choice has been introduced at lunch and evening meals. A programme of redecoration and refurbishment has resulted in 24 bedrooms having been redecorated with new curtains and the provision of new curtains has continued in corridors throughout the home. Bedrooms on the Anne Waltham unit have also had new curtains. In addition, new flooring has been provided in the corridor and 15 new pressure relieving mattresses have been provided and a new hoist was on order. Efforts have also been made to make bedrooms more personal and the people have been involved in choosing the colour for their bedrooms. What the care home could do better: The three requirements and 5 recommendations from the last key inspection had been adressed. There were no requirements as a result of this inspection. The management team acknowledge that the home is going through a period of change and want to further introduce more person focused care. We discussed with the deputy manager about ensuring that our new name was in their complaints procedure, the statement of purpose and service user`s guide. We have recommended that the acting manager provides training for staff about the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. We have also recommended that all care plans should containinformation about recent legislation that is designed to protect people`s rights and choices. This is so the acting manager can show that they have looked at the effects this legislation has on the lives of the people receiving care and support from the agency and plan their care accordingly. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Holbeach Hospital Boston Road Holbeach Spalding Lincs PE12 8AQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Tobias Payne     Date: 0 3 0 6 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: Holbeach Hospital Boston Road Holbeach Spalding Lincs PE12 8AQ 01406422283 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) : manager@holbeach-hospital.org.uk Holbeach & East Elloe Hospital Trust care home 46 Number of places (if applicable): Under 65 Over 65 46 0 old age, not falling within any other category physical disability Additional conditions: 0 2 The Anne Waltham Unit may care for service users requiring nursing or personal care over the age of 65 years who do not fall into any other category. In addition, this unit may care for one service user with a physical disability over the age of 61 years. The main house may care for users requiring nursing or personal care over the age of 65 years who do not fall into any other category. In addition, this unit may care for one service user with a physical disability over the age of 61 years The maximum number of service users to be accommodated in The Anne Waltham Unit is 9 The maximum number of service users to be accommodated in the main house is 37 The total number of service users to be accommodated in Holbeach Hospital is 46 Date of last inspection Care Homes for Older People Page 4 of 29 Brief description of the care home Holbeach Hospital is a care home for nursing and personal care that has been converted from a hospital and has been managed by the Holbeach and East Elloe Hospital Trust since 1989. The main building comprises an out patients department, physiotherapy, a General Practitioner 9 bedded facility (The Anne Waltham Unit) of which there are 7 beds for the use of local GPs, 2 care beds together with 37 additional care home beds. The home is a two-storey building set in its own grounds with garden and patio areas. It is one mile from the town of Holbeach where there are shops and community facilities available. Accommodation is provided on ground and first floors. The first floor is served by a shaft and stair lift. There is parking at the front of the home. The fees charged by the home for care support on the day of our inspection visit ranged from £408 to £475 each week. Extra charges are made for hairdressing, which ranged from £6.50 to £28 and chiropody, which was £6. Additional charges were for personal newspapers/magazines and personal toiletries. Information about the home including the statement of purpose, service users guide and copy of this report can be obtained from the manager. 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: 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 inspection which was unannounced took place over 7 hours. The acting manager was not present but we were assisted by the deputy manager throughout the inspection who was given feedback at the end of the inspection as well as a representative of the board of management who was present for part of the inspection. The main method of inspection used was called case tracking which involved selecting 2 people and tracking the care they receive through the checking of their records, discussion with them, the staff and observation of how the staff and people living in the home related to one another and care practices in the home. We looked at a sample of care records and walked around the home to see the quality of accommodation and visited some of the bedrooms with the permission of the people Care Homes for Older People Page 6 of 29 living in the home. We spoke with 9 people living in the home, 5 visitors as well as 6 members of staff. An (AQAA) Annual quality assurance assessment was completed by the acting manager and sent to us before our inspection. This is a self- assessment document completed by the manager of the care home. It sets out evidence from the provider to demonstrate that they are meeting the Care Home Regulations. Throughout the report the terms we and us are used and refer to the Care Quality Commission (CQC). What the care home does well: What has improved since the last inspection? What they could do better: The three requirements and 5 recommendations from the last key inspection had been adressed. There were no requirements as a result of this inspection. The management team acknowledge that the home is going through a period of change and want to further introduce more person focused care. We discussed with the deputy manager about ensuring that our new name was in their complaints procedure, the statement of purpose and service users guide. We have recommended that the acting manager provides training for staff about the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. We have also recommended that all care plans should contain Care Homes for Older People Page 8 of 29 information about recent legislation that is designed to protect peoples rights and choices. This is so the acting manager can show that they have looked at the effects this legislation has on the lives of the people receiving care and support from the agency and plan their care accordingly. 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 9 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 10 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. People coming in to the home receive information to meet their needs and support to help them make an informed choice of where to live. They are assessed before they come to the home which ensures that individual needs can be met within the home. Evidence: There were separate service users guides for the main home and one for the Anne Waltham and each person received a copy when coming into the home. There was also an up to date detailed statement of purpose and a copy of our last inspection report available on request. We noticed that our new name needed to be added to the statement of purpose, service users guide and complaints procedure. The deputy manager agreed to act on this as soon as possible. The deputy manager told us that where a referral was made either she or the acting manager would visit each person and make a thorough assessment of their needs involving the person and any other person involved in their care and support. Once this was done written confirmation Care Homes for Older People Page 11 of 29 Evidence: was sent to them that based on the assessment the home could meet their needs. Through case tracking we looked at records for a person who had recently been admitted to the home. We could see that a detailed pre admission assessment had taken place and that the person had received a letter confirming they could meet their needs. We also spoke to the wife of a person who had been admitted for short term care who told us we received a very warm and friendly welcome when we came into the home and have found it a smooth process. The service does not offer intermediate care. Care Homes for Older People Page 12 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person had a detailed care plan giving details about their care and support. This had been produced wherever possible with the involvement of the person, their family/advocate and other relevant people. This ensures that their individual needs are being met. Medication was safely given by staff who knew what they were doing. Evidence: As a result of the recent enquiry a great deal of effort had been made to improve the way care records were recorded and maintained. Each person had detailed care records giving details about their care and support. We looked at 7 care records in depth and found an improvement in the overall quality and details of information. This included a photograph of the person. Care records included details of their assessment at the time the person moved into the home, care plan, moving and handling and risk assessment. In addition, there was information about the person including life history, significant dates and life experience, brief details of activities of daily living, medication, records of GP and other professionals, monthly weight, risk and nutritional assessments including likes and dislikes. The amount of information was in more detail Care Homes for Older People Page 13 of 29 Evidence: and had clearer instructions about how staff could meet the needs of the person. The evaluations of the way care had been given were also clearer and entries were signed and dated as were the care plans which showed that the people had wherever possible been involved in their plan of care. The care plans were hand written and detailed their assessed needs and expected outcomes and how the care and support would be provided. We looked 7 care records and found only 3 had a mental capacity assessment completed. Since the last inspection the acting manager had introduced a monthly audit to monitor how care records were being recorded. The records showed that she confirmed that the way records were completed had improved. Also, since the last inspection the home has recruited a member of staff part of whose role was the relieve nurses from administration issues in order to concentrate on the delivery and monitoring of care to the people in the home. We looked at records for 2 people one of whom had complex needs. One person was cared for in bed and had a fluid balance chart and turning chart which showed the person was receiving regular fluids and their position altered to relieve pressure even though they were on an alternating pressure mattress. We also saw people confined to bed with overbed tables, bed protection rails and drinks and books within their reach. Throughout our visit we saw staff respecting the peoples wishes and choices in the way they made contact with the people living in the home and their response. We also spoke with staff who showed good knowledge about the particular needs of the people living in the home. Where required, people living in the home were referred to GPs, Community Nurse, Community Psychiatric Nurse, Tissue Viability Nurse, Continence Nurse, Physiotherapist, Opticians, Dentist, Chiropodist and other specialists. The home had also had Link Nurses who specialise in various aspects of care including tissue viability, continence and palliative care and meet up with other nurses and staff from NHS Lincolnshire to promote good practice. The home continues to work towards achieving the Gold Standard Framework for terminal care and after care which will be assessed by the Macmillan Nursing Service. Registered nurses administered medication. There was a policy and procedure for this and the acting manager or deputy assessed each person before they were considered safe to administer medication. Records we saw were clear and well maintained with a good audit trail. The manager told us that the people were encouraged by the staff team to self medicate but only one person did so, the other people needed a degree of assistance in order to ensure they took their medication safely. Since the last inspection the acting manager had introduced an audit every 2 months to monitor how records had been maintained. This again showed adequate records were being kept. In Care Homes for Older People Page 14 of 29 Evidence: addition they received a pharamcy inspection on the 19/3/2009 and the report showed no concerns. People we spoke with were satisfied with the way staff cared for them and had confidence in the staff. We saw throughout our inspection staff attended to the people in a warm, friendly and kind manner, knocking on doors before entering their bedrooms and asking whether they needed any help. The people told us, the staff are simply brilliant, they are so kind and helpful and nothing is too much for them. Care Homes for Older People Page 15 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able and supported to make their own choices about how they want to live their lives, and what they want to do. Social activities are varied and provide stimulation and interest for people living in the home. People enjoy varied and nutritious meals. Visitors are made to feel welcome and supported. Evidence: On admission to the home details were obtained about each persons interests and life history and this information was contained in their care records. There was no written activities programme but there was a notice on the notice board in the main corridor which gave details of music entertainment during June and July 2009. Since the last inspection the range of activities had been reviewed and improved and they have recruited a person who is both the ward clerk and also arranges activities. Activities included a weekly bingo session provided by the League of Friends of Holbeach Hospital. On Thursday there is movement to music provided by an outside person and visits by outside entertainers. There have also been occasional trips and visiting clothing retailers. There is a monthly interdenominational church service in the home and arrangements can be made for other religious needs to be catered for. Care Homes for Older People Page 16 of 29 Evidence: There were well-tended garden areas with accessible patio areas. Visitors were welcomed into the home at all times. All the 5 visitors we spoke with were very complimentary about the staff and home. Comments included, I come here every day and I find the staff are very good and I receive a friendly welcome. I cant fault the home and believe it is the best one around here, Whenever I come here I always find the staff are kind and helpful and they are brilliant and look after my father well. The people living in the home were offered 3 main meals a day plus snacks. Menus were on a four-week rota. There was a set menu with a choice and an alternative could be arranged to suit the needs of the person. South Holland District Council again awarded the home 3 Tulips (excellent) on the 23/3/2009 following an inspection, in recognition of the catering service provided. The report commented about the good standards. We looked at the records for food temperatures, menus and cleaning rotas and found them well maintained and up to date. Meals were served in the 3 dining rooms on the ground floors or in their bedrooms on a tray. Meals were taken from the kitchen in heated trolleys and served from them. The menus which were also displayed on notice boards showed us that there was a varied menu. The dining tables had clean table cloths and table mats. We saw staff were assisting those people who needed assistance in a dignified, unhurried and sensitive manner. All the people we spoke with were complimentary about the food. Comments included, I love the food and the food is very well cooked and well presented. Care Homes for Older People Page 17 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. People know how to make a complaint and feel that staff will listen to their views. The care team know how to respond to a complaint and how to act in order to protect people from abuse. They are protected from abuse by correct and safe recruitment procedures. People are given information and assistance to vote at elections. Evidence: Each person received a copy of the complaints procedure in the service users guide and this was also in the statement of purpose. We noticed it did not contain our new name. The deputy manager agreed to act on this. None of the people living in the home, visitors or the staff had any complaints about the home and felt they could discuss any concerns with staff or the manager. Staff also knew what to do if they received a complaint from a person living in the home. Comments we received included, If I have any concerns I feel I can discuss them with the staff or Loraine. There had been a safeguarding adults investigation by Lincolnshire County Council with the involvement of ourselves, NHS Lincolnshire and Lincolnshire Police. As a result of this the management of the home and the hospital trust board have made improvements to the home, staff training and the way care is provided and monitored. We have however been made aware of a safeguarding adults issue in May 2009 which was being investigated by Lincolnshire County Council and was not yet complete. Throughout these investigations there has been the full co-operation and assistance Care Homes for Older People Page 18 of 29 Evidence: from the management and board of the home. Staff records showed and discussion with staff confirmed that safeguarding adults training has taken place. All staff were correctly recruited including a check by the Criminal Records Bureau (CRB). During their induction each member of staff received information about abuse. We asked 4 staff what abuse was and they showed knowledge about their role and what they would do if abuse was suspected. Staff told us they received regular refresher training to ensure their knowledge was up to date. The inspection took place one day before local and European elections and we were told that information had been passed to the people in the home and they were to be supported in case they chose to exercise their rights to vote. Care Homes for Older People Page 19 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. People live in clean, comfortable, safe and well maintained accommodation. The infection control policy is followed and a safe environment is maintained. Evidence: The home was well maintained throughout. The deputy manager told us that many areas throughout the home had been redecorated with new curtains, floor coverings, pressure relieving mattresses and other improvements. During our visit we walked around the home and found all areas of the home were clean, tidy and odour free. We saw throughout our visit domestic staff cleaning all areas of the home thoroughly. People we spoke with told us they were satisfied with the decoration and cleanliness of the home. They also spoke of how they liked their bedrooms. They were encouraged to bring into the home small items of furniture, television, pictures and personal items. People told us I am very comfortable here, the home is lovely and clean and my clothes are washed well and returned the next day. There were grab rails and raised toilet seats and bathrooms and toilets were wheelchair accessible and had thermostatic valves fitted to basins and baths to prevent the people from scalding. There were a variety of pressure relieving mattresses, special profiling beds and a variety of mobile hoists with a variety of slings and other moving and handling equipment. There were clear signs throughout the Care Homes for Older People Page 20 of 29 Evidence: home which showed where toilets, bathrooms and other rooms were. The home is set around landscaped internal courtyards and garden areas, which were well maintained. All footpaths were clear from hazards and furniture was available for the people to use so they can sit outside in warmer weather. Communal areas were spacious with sufficient space for those people who use wheelchairs to move around freely. Staff had received training and knew how to use equipment properly. Separate staff were employed for domestic and laundry services. Gloves and aprons were provided and the home had clear infection control policies and alcohol hand wash dispensers were throughout the home. There is a large laundry in the grounds of the home, with sluice cycles on both of the commercial washing machines. There are two commercial tumble dryers. There are enclosed sluices on both floors. People who were sat in the 3 lounges of the home had their own belongings with them at side tables as well as in their bedrooms. The lounges each had large flat screen televisions and there were background music facilities. Those in bed had over bed tables enabling them to have access to drinks, tissues, fruit, newspapers or books or the television control. Care Homes for Older People Page 21 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 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 safely recruited, well-trained, supported staff team available who have the skills to meet the varying needs of the people living in the home. A wide range of inhouse training and National Vocational Qualification training is provided. Evidence: People we spoke with felt the home was adequately staffed with staff who were experienced and competent to care for the people living in the home. People we spoke with did not express any worries about the level or availability of staff. During our inspection visit we saw staff attended to the needs of the people promptly and in a calm and friendly manner. The home employs registered nurses, care assistants, domestic, laundry, administrator, catering staff, activities co-ordinator and a maintenance person. The people commented, the staff are always polite, courteous and respectful, the staff are simply brilliant and I cant fault them. The deputy manager told us she monitored the dependency and varying needs of the people. We examined the files for 2 new members of staff. Records were clear, detailed and showed that staff were safely recruited in accordance with the regulations. This included a check by the Criminal Records Bureau (CRB). When new staff started work Care Homes for Older People Page 22 of 29 Evidence: at the home they received a supported induction programme during which time they learnt about the policies and procedures of the home and how to provide the necessary care and support to the people living in the home. We discussed with the deputy manager the suggestion of introducing a nationally recognised more comprehensive induction in line with Skills for Care which they agreed to consider. The duty rota showed across the 24-hour period that there were 2 registered nurses working in the home. There continued to be a wide range of training provided. This included formal training in care to National Vocational Qualification standards (80 of the staff had achieved NVQ level 2 or were working towards it and one person had achieved NVQ level 3). In addition 6 staff were working towards NVQ level 2 and 3 for NVQ level 3. In addition there were 2 staff who were assessors and a further 3 who were training to become assessors. We saw records and staff confirmed that training over the last year had included, care of people with diabetes, dignity in care, dementia awareness, tissue viability, infection control, record keeping, moving and handling, fire prevention and first aid. There were 10 staff who were first aiders. Staff told us they received regular supervision and an annual appraisal. We were told that the home had recruited a nurse, part of whose role was to co-ordinate training and was keen to address staff training and was to provide safeguarding of adults refresher training in the future. We spoke with 6 members of staff who told us, I received a professional interview followed by an induction during which I was supported until I felt confident to work in the home, I received a very warm welcome when I came here and am very satisfied with the way we care for the people, the care is good, I love working here and we work very well as a team and I always receive good support. Care Homes for Older People Page 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Considerable effort has been made to ensure the people and staff benefit from the positive leadership of the management team. Management record systems have been improved to show that the peoples health, welfare, safety and choices are promoted. The management team ensures that the people living in the home have the opportunity to voice their views and opinions. The management uses feedback from questionnaires from a number of sources and improved quality assurance systems to make improvements Evidence: Since the last inspection a new acting manager had been appointed who was a registered nurse, had worked in the home for many years and had considerable experience in delivering care for older people. She had extensive knowledge of age related conditions and how they could affect people, equality and diversity issues, good interpersonal and leadership skills and had kept her learning up to date. She was in the process of applying to us to be registered as the manager. She was assisted by Care Homes for Older People Page 24 of 29 Evidence: a deputy manager who also was an experienced registered nurse with extensive knowledge. Improvements have taken place about the way the home is managed. Staff we spoke with told us they had a good relationship with the management team and felt they were open and supportive. People and visitors we spoke with echoed these views. Comments were, I feel I can discuss any concerns or worries I might have and any problems are soon sorted out. There were policies and procedures available for staff to use when providing care, which were clear and detailed and a number had been reviewed since the last inspection. There were also up to date clinical procedures. There was an equality and diversity policy and equal opportunities policy. Some people who live at the home needed additional support with their finances. Where this was the case we saw that it was well organised with clear records and receipts and signatures. Since the last inspection staff supervision had been introduced. There were staff meetings and regular staff advisory group meetings attended by the acting manager and the chairman of the Trust, regular health and safety meetings. Since the last inspection they had reviewed their quality assurance procedures. The home received monthly unannounced visits from 2 members of the Trust. We looked at the records for these visits and could see they were thorough with a review of events and obtaining the views of the people and staff. The acting manager had introduced monthly audits of care records and medication records were audited regularly with action plans where issues needed to be addressed. They also carried out an annual survey of peoples views of the service provided. The last survey was in May 2009 and 9 replies were received. All were rated good to excellent. A comment included, overall impression is extremely favourable in all aspects. I feel totally secure in the knowledge that my mother is well cared for and happy. We were also told that they hoped to introduce a newsletter in the near future. We found records throughout our visit to be well maintained, up to date and available being kept. There were also 10 staff with an up to date first aid certificate. Since the last inspection the board had arranged for an outside consultancy to review health and safety policies and as a result new up to date and comprehensive health and safety policies had been introduced as well as a staff handbook covering this subject. There were up to date risk assessments including fire risk assessments. There were regular tests of the fire system as well as regular fire drills and monthly Care Homes for Older People Page 25 of 29 Evidence: monitoring of hot water temperatures. We were told that the consultancy would make quarterly inspections throughout the year. There were also infection control policies and staff made use of alcohol hand rub bottles throughout the home to further prevent infection. The records we looked at showed that equipment was regularly checked and serviced and there were systems to monitor any maintenance issues. 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 1 8 The acting manager should ensure that all care plans include a reference to the Mental Capacity Act 2005 and the effects it has upon the peoples lives. This is to ensure that their rights and choices are protected. In addition arrangements should be made for care and nursing staff to receive appropriate training about the assessment and recording of peoples capacity as outlined in this Act. This will give them a better understanding of their role in documenting and acting on issues raised. 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. 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 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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