Care Home: Holmwood Nursing Home

What the care home does well Each person who lives at the home had a care plan file. To ensure their needs were identified and the staff care and support people in a consistent manner. People and their relatives told us they were involved in drawing up and reviewing the care plans and are invited to attend three and six monthly care review meetings. Nurses are responsible to update risk assessments and care plans on a monthly basis to ensure they remain relevant and appropriate to meet people`s needs. This had been done regularly. A local G.P. told us that, peoples health care needs are, "always", properly monitored, reviewed and met by the care service, they went on to say, "Holmwood staff manage very difficult behavioural issues with challenging patients very effectively with minimal need for drug intervention. The staff work well in a team and understand and know the needs of their clients". This was an excellent report, from a G.P. who visits the home on a weekly basis and who is therefore able to tell us about the consistency of their experiences. Their experience, clearly reflects our findings during our visit. Staff were aware of the contents of peoples care plans and are knowledgeable about each person`s individual needs. This protects people`s welfare. We asked two people who live at the home if they felt they were treated with respect and dignity and whether their right to privacy is upheld. This is what they told us, "Yes, the staff treat me well, they are kind and very respectful to me". Another person said, "The staff are marvellous, damn good girls, who will do anything for you". A relative told us, "My husband has had some very bad experiences in other care homes, but the manager here is second to none and the staff are, polite and respectful of people who live here". A health care professional told us, "I think this place is excellent, people are always treated with dignity and respect". People who live at the home told us, "I enjoy the singers when they visit, we can do other activities with staff, some people read to me". Another person said, "I like to see the entertainers, were having a singer to visit us this afternoon". People told us and we observed that that they receive a wholesome and appealing balanced diet, in pleasing surroundings at times convenient to them.One person told us, "The food is lovely". A relative said, "I`d love to have the meals my husband is offered they always look and smell so appetising". The manager told us that one relative is a regular visitor at meal times and is welcome to eat with their relative. People who live at the home told us, "I like it here, its nice and clean and they are always cleaning up you know". "My bedroom is lovely, I`ve got my own bedroom you know and I brought some furniture from my house". People who live in the home were protected by the recruitment and selection policy and procedures in place. Adequate numbers of staff are on duty to ensure that people`s diverse needs can be met. People are in safe hands as the staff are trained in how to keep people safe from harm. The staff team were exceptional and all ought to be congratulated on providing an excellent service to people. People live in a home which is run and managed by an exceptionally skilled and committed, registered manager. Who is a registered nurse and who holds a management certificate in health and social care. She leads the staff team in a calm and quiet manner, is fair and thorough in her approach. She is respected and liked by all of the stakeholders we spoke to. What has improved since the last inspection? We checked all of the previous requirements made at our last inspection and found that all of the previous requirements had been complied with. This was positive as it shows the home continually strives to improve their services to people. What the care home could do better: We recommend that the registered persons looks at the way care plans are devised and consider whether using person centred models and approaches to planning peoples care may better reflect the individualised care people are receiving. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Holmwood Nursing Home Warminster Road Norton Lees Sheffield South Yorkshire S8 9BN     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: Shelagh Murphy     Date: 2 8 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 30 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 30 Information about the care home Name of care home: Address: Holmwood Nursing Home Warminster Road Norton Lees Sheffield South Yorkshire S8 9BN 01142509588 01142580911 holmwood@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Southern Cross Home Properties Limited care home 41 Number of places (if applicable): Under 65 Over 65 41 dementia Additional conditions: 0 One individual named on the Registration Variation Application Form dated 12/9/03 who is in the category OP, Older People, may reside at the home. Date of last inspection Brief description of the care home Holmwood is a purpose built care home, which provides care for 41 older people who have Dementia. It is owned by Southern Cross Healthcare. The home is in a residential area of Sheffield with good access to public services and amenities. It is a two-storey building; the first floor is accessed by a lift. It is generally well decorated with good quality furniture and furnishings provided. All bedrooms are single with en-suite facilities. A private car park is provided at the front of the property. The gardens are landscaped and have a large patio area to the rear. Care Homes for Older People Page 4 of 30 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 star. This means that people who use the service experience excellent quality outcomes. Shelagh Murphy carried out this unannounced visit to the service over one day and the total time spent on site was 7 hours. In the report we make reference to us and we. When we do this we are referring to the inspector and the Care Quality Commission. We used a variety of information as well as our findings from the visit to assess the quality of service offered to people who live at this home. Care Homes for Older People Page 5 of 30 The Annual Quality Assurance Assessment or AQAA report was sent to the inspector prior to the site visit. This report detailed what the home was doing well, what had improved since the last inspection and any plans for improving the service in the next twelve months. Some information from the AQAA is included in the main body of the report. Some time was spent with the people who use the service. It was difficult to conduct conventional interviews with some people, due to their needs. However, most people were able to let us know their feelings using their specific ways of communication to let us know their thoughts about the home and the staff. We interviewed two people who lived at the home to gauge, how staff at the home supported them. It gave us some insight into how staff interacted with people, how people are supported by the staff and also an indication of peoples well being. Three staff attended interviews with us. Two relatives were also interviewed and surveys were sent to all other stakeholders including staff at the home and visiting health professionals. This ensured we had a wide range of views on which to base our judgements as to the quality of the service. Comments and feedback from these stakeholders have been included in this report. On the day of the site visit opportunity was taken to make a partial tour of the premises, to inspect a sample of care records, check records relating to the running of the home and check some of the homes policies and procedures. The inspector checked all key standards and the standards relating to the requirements outstanding from the homes last key inspection. The progress made has been reported on under the relevant standard in this report. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The scale of charges ranges from £497.30 for Local Authority fees and £699.20 for private fee payers per week. The inspector wishes to thank the people living in the home, staff, managers and relatives for their time and cooperation throughout the inspection process. What the care home does well: Each person who lives at the home had a care plan file. To ensure their needs were identified and the staff care and support people in a consistent manner. People and their relatives told us they were involved in drawing up and reviewing the care plans and are invited to attend three and six monthly care review meetings. Nurses are responsible to update risk assessments and care plans on a monthly basis to ensure they remain relevant and appropriate to meet peoples needs. This had been done regularly. A local G.P. told us that, peoples health care needs are, always, properly monitored, reviewed and met by the care service, they went on to say, Holmwood staff manage very difficult behavioural issues with challenging patients very effectively with minimal need for drug intervention. The staff work well in a team and understand and know the needs of their clients. This was an excellent report, from a G.P. who visits the home on a weekly basis and who is therefore able to tell us about the consistency of their experiences. Their experience, clearly reflects our findings during our visit. Staff were aware of the contents of peoples care plans and are knowledgeable about each persons individual needs. This protects peoples welfare. We asked two people who live at the home if they felt they were treated with respect and dignity and whether their right to privacy is upheld. This is what they told us, Yes, the staff treat me well, they are kind and very respectful to me. Another person said, The staff are marvellous, damn good girls, who will do anything for you. A relative told us, My husband has had some very bad experiences in other care homes, but the manager here is second to none and the staff are, polite and respectful of people who live here. A health care professional told us, I think this place is excellent, people are always treated with dignity and respect. People who live at the home told us, I enjoy the singers when they visit, we can do other activities with staff, some people read to me. Another person said, I like to see the entertainers, were having a singer to visit us this afternoon. People told us and we observed that that they receive a wholesome and appealing balanced diet, in pleasing surroundings at times convenient to them. Care Homes for Older People Page 7 of 30 One person told us, The food is lovely. A relative said, Id love to have the meals my husband is offered they always look and smell so appetising. The manager told us that one relative is a regular visitor at meal times and is welcome to eat with their relative. People who live at the home told us, I like it here, its nice and clean and they are always cleaning up you know. My bedroom is lovely, Ive got my own bedroom you know and I brought some furniture from my house. People who live in the home were protected by the recruitment and selection policy and procedures in place. Adequate numbers of staff are on duty to ensure that peoples diverse needs can be met. People are in safe hands as the staff are trained in how to keep people safe from harm. The staff team were exceptional and all ought to be congratulated on providing an excellent service to people. People live in a home which is run and managed by an exceptionally skilled and committed, registered manager. Who is a registered nurse and who holds a management certificate in health and social care. She leads the staff team in a calm and quiet manner, is fair and thorough in her approach. She is respected and liked by all of the stakeholders we spoke to. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. 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 Care Homes for Older People Page 8 of 30 7535. Care Homes for Older People Page 9 of 30 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 30 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 use the service have their needs assessed prior to admission to the home to try to ensure that the staff can meet their needs before they are admitted to the service. The service does not provide intermediate care. Evidence: We checked three peoples had needs assessments. One had been completed by the registered manager for a person who paid their own fees. The other two peoples needs assessments had been completed by local authority case managers or social workers. The needs assessments were all appropriately detailed to ensure the service could assess whether peoples needs could be met at the home. The registered manager confirmed that this service does not offer intermediate care. Care Homes for Older People Page 11 of 30 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. We observed and people told us that they were treated with dignity and respect. People have individual care plans, which people and their relatives are included in devising and reviewing. Health professionals were very positive in their comments and really were complimentary in their support for the service. Evidence: We checked three peoples care plans with the nurses on duty. We found that each persons health, personal and social care needs were set out in an individual plan of care. Since the last inspection it was clear that these plans had improved greatly and had been reviewed on a regular monthly basis by the nursing team. The AQAA report, which had been completed by the registered manager stated, Each client has an in depth care file, incorporating core forms with information on admission, assessment, care plans and progress. And that, Relatives are involved in drawing up and reviewing the care plans and are invited to attend three and six monthly care review meetings. This was checked with a health professional and with Care Homes for Older People Page 12 of 30 Evidence: relatives of people and found to be correct. On the day of the site visit we spoke to one relative who told us they were invited to regular meetings to review their relatives care and were, very happy and confident, that the service is able to meet the needs of their relative. We spoke to one health professional who told us that, overall the care plans contained adequate information; but that they did not always detail all of the extra support and care they knew the service offered to people and therefore did not always reflect the added value that people received from staff. A recommendation would be to make the care plans using a person centred approach, which incorporated all of the extra support staff gave to people, including their in depth knowledge of peoples likes, dislikes and preferences in each individual care plan. We checked to see if peoples health care needs are fully met. The AQAA report told us that, Staff are aware of the contents of clients care plans and are knowledgeable about clients individual health needs. The care plans we checked showed evidence that people have the opportunity to see the G.P as required as well as support from other specialist community health teams such as district nurses, opticians, dentists, psycho geriatric support etc. A local G.P. told us that, peoples health care needs are, always, properly monitored, reviewed and met by the care service, they went on to say, Holmwood staff manage very difficult behavioural issues with challenging patients very effectively with minimal need for drug intervention. The staff work well in a team and understand and know the needs of their clients. This was an excellent report on what the service does well and clearly reflects our findings during our visit. We checked to see whether people had risk assessments in place to protect their health and welfare. These were in place on each of the three care plans checked. The nursing staff told us and showed us evidence that they update risk assessments on a monthly basis to ensure they remain relevant and appropriate. The staff told us that all of the people who live at the home need the nursing team to administer their medication to them. We checked three peoples medication sheets and found them to be signed correctly. The services uses, `Boots Monitored Dosage system cartridges and stores some creams and other medicines in the drug cabinets. The nurses had recorded when people had been given medication and there was a system in place to return and reorder medication to ensure people always had a supply to meet their needs. The lead nurse told us that no controlled drugs were used at the Care Homes for Older People Page 13 of 30 Evidence: current time. Boots pharmacy staff come and inspect the homes systems on a regular basis. We asked two people who live at the home if they felt they were treated with respect, dignity and whether their right to privacy is upheld. This is what they told us, Yes, the staff treat me well, they are kind and very respectful to me. Another person said, The staff are marvellous, damn good girls, who will do anything for you. A relative told us, My husband has had some very bad experiences in other care homes, but the manager here is second to none and the staff are polite and respectful of people who live here. A health care professional told us, I think this place is excellent, people are always treated with dignity and respect. A member of staff told us they were the, `Dignity in Care Champion, for the service and continued to look for ways to promote greater opportunities to ensure peoples dignity and privacy was respected by promoting high standards of practice. Care Homes for Older People Page 14 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have lots of opportunities to meet their social, cultural and recreational needs. People received wholesome and appealing diets in surroundings, which met their needs. Evidence: Overall, we found that people found the lifestyle experienced in the home matched their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. People who live at the home told us, I enjoy the singers when they visit, we can do other activities with staff, some people read to me. Another person said, I like to see the entertainers, were having a singer to visit us this afternoon. A relative told us, My Mother isnt really interested or able to take part in some activities but she really enjoys the entertainment shows and we can attend too. Care Homes for Older People Page 15 of 30 Evidence: From the AQAA report the registered manager told us that, Music is our most popular activity and we continue to host a weekly entertainment programme, which we actively encourage family and friends to attend. Our clients enjoy monthly visits from, `Remember When, and actively participate in reminiscence activities. We have been fortunate to benefit from visits from the Salvation Army Band who are always well received. The staff told us and we saw evidence that other activities have been made available to people, in the form of visits from Zoo Lab who provide a wide variety of animals, reptiles and insects for people to hold and view. The staff told us this was a really popular activity and that people enjoyed these sessions. The manager told us, We have established a good relationship with the local primary school, Mundella and we have welcomed the school children to Holmwood on several occasions to sing. We observed that people are supported to maintain contact with their family and friends as they wish. Two relatives told us they are made to feel welcome by the staff, they can visit at any time and there is a visitors comment book for any issues or compliments to be recorded in. Two people who live at the home confirmed their relatives can and do visit them regularly. We checked to see if people are helped to exercise choice and control over their lives. We observed people to be offered everyday choices, such as choice of meals and drinks, where people wanted to go in the home and whether they wished to take part in activities. People told us and we observed that that they receive a wholesome and appealing balanced diet, in pleasing surroundings at times convenient to them. One person told us, The food is lovely. A relative said, Id love to have the meals my husband is offered they always look and smell so appetising. The manager told us that one relative is a regular visitor at meal times and is welcome to eat with their relative. The menus were varied and offered two or more choices at every meal. Snacks and fruit platters were available at all other times for people. The manager told us, We have a four week menu which has been devised to ensure that peoples nutritional needs are fully met. At the back of the menus we checked there was a graph to show the complete Care Homes for Older People Page 16 of 30 Evidence: nutritional value of the weeks menu. It identified the required level of nutrients required for people each week and the level that the menus offered. For example the energy, vitamins and minerals, fat, carbohydrate and protein values. This was excellent as this together with individual nutritional assessments ensured that peoples nutritional needs could be met. We observed lunchtime in the home, it was well organised. There were seven staff supporting people to eat, feed and drink. The meal time was relaxed. Staff were seen to prompt and coax people to eat. Some people had soft diets and other people were using aids to enable them to eat independently. It is worth noting that this service has put a lot of energy in to supporting the catering staff team to gain NVQ3 in Hospitality and supervising food awards, and will continue to support other staff to do these awards. It was clear that the catering staff took pride in their work and people really benefited from this. Care Homes for Older People Page 17 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to make complaints and their rights are safeguarded. Evidence: We checked to see if people and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. This is what we found, One person told us, I would speak to the manager if I was unhappy. A relative told us, Ive got no complaints with the home it is excellent and if it wasnt I would have no trouble in complaining. From the AQAA report the manager told us, We action all complaints as they are made. We keep a record of all complaints, which details the action taken and outcomes. These were available for inspection. No complaints had been made to the home over the last 12 months. It was clear to us from speaking to people, relatives and health professionals that the home promotes an atmosphere of open and honest communication and encourages family and friends to make them aware of any concerns or suggestions they may have as soon as they arise. For example there is a relatives comment book at the reception desk at the main entrance to the home and we saw a leaflet on the relatives notice board of managers surgeries which are held every month Care Homes for Older People Page 18 of 30 Evidence: The manager told us, We also provide family and friends with a copy of the complaints procedure, which is also on display in the reception area. This was excellent practice as it protected peoples rights and fostered good communication between all stakeholders. We checked to see how the people are protected from abuse. From training records we could see that all of the staff had completed adult safeguarding training over the last year. And all staff had been enrolled on to a new Adult safeguarding training course, which will begin in the near future. From interviews with two staff we know that they understood their responsibilities and the procedures to follow should any allegations of abuse be disclosed to them. From the AQAA report the manager has reported that, We have an adult protection policy and procedure to promote the protection of clients from harm or abuse. All our staff undertake POVA and adult abuse training, which equips them with the skills, needed to respond appropriately to any allegations. These practices help to safeguard people. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a warm, homely, safe and comfortable environment. Evidence: We took a tour of the building with the registered manager to ensure that people live in a safe, well-maintained environment. The home was clean, tidy, safe and homely. Each persons bedroom door has been made to look like their front door with door knockers and name badges and are all painted different colours. Their rooms were individually decorated and furnished to their tastes. The attention to detail was exceptional in creating a home for people with such high dependency needs and complex needs. There were no malodours in the home. Several areas of the home had been redecorated and new furnishings had been purchased, which met peoples needs. The manager said, We have purchased new soft furnishings for two lounges and we continue to purchase profile beds. We now have a large gazebo in our garden area to enable clients to be protected whilst enjoying the outdoors. These things show the lengths the home has gone to in order to meet peoples collective and individual needs. People who live at the home told us, I like it here, its nice and clean and they are always cleaning up you know. My bedroom is lovely, Ive got my own bedroom you Care Homes for Older People Page 20 of 30 Evidence: know and I brought some furniture from my house. Relatives told us, This home never smells, the staff have a lot of pride in the home and it really shows. The cleaners are excellent too, nothing is too much trouble for them. The AQAA report stated that, the, environment is now more suitable for our dementia clients. We have a variety of tactile boards, rummage boxes and sensory stimuli throughout the home, together with a themed pub, Holmwood Tavern, a themed sweet shop and a superb multi sensory room. We also have a variety of visual and auditory sensory equipment in our fully accessible garden area. These initiatives were excellent and it was clear that the manager and staff had put in a lot of extra time and effort in to providing people with a stimulating environment. The manager told us they had instigated all of these practices in the home over the last two years following completion of a course in improving dementia care services. This showed their commitment to making the home appropriate to meet peoples needs. Care Homes for Older People Page 21 of 30 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. People who live in the home were protected by the recruitment and selection policy and procedures in place. Adequate numbers of staff are on duty to ensure that peoples diverse needs can be met. People are in safe hands as the staff are trained in how to keep people safe from harm. This staff team was exceptional and all ought to be congratulated on providing an excellent service to people. Evidence: We checked to see if peoples needs were met by the numbers and skill mix of staff. On the day of our visit there were two registered nurses, seven support workers and one senior support worker on duty. They were supported by two domestic staff, a maintenance person, and administrator and a cook. The manager was overseeing the whole service. This was observed to be an adequate staffing level to meet peoples needs. Staff told us, I think we always have enough staff on, it would be nice to have more sometimes, so we can get people out more, but no the staffing levels allow us to give people good standards of care really. A relative told us, Staff are fantastic, they all listen to us, and they are all well Care Homes for Older People Page 22 of 30 Evidence: mannered and pleasant. It was clear to us that the service has a highly developed recruitment procedure that has the needs of people who use the service at its core. We checked three staff recruitment files and all had been checked to ensure they all had the appropriate records to meet the regulations in order to keep people safe. After talking to the manager and meeting numerous members of care and ancillary staff it was clear, the manager clearly sees that the recruitment of good quality nurses, carers and ancillary staff is integral to the delivery of this excellent service. From the AQAA report and other records checked we can see that the service is proactive rather than reactive in its staffing, recruitment and training. The result of this is a diverse staff team that has a balance of all the skills, knowledge and experience to meet peoples needs. There is evidence that they demonstrate a thorough understanding of the particular needs of individuals. From discussions with the manager, information from staff and the AQAA report it was clear that the manager is able to facilitate staff members to undertake external qualifications beyond basic requirements, some staff have NVQ 3 in care, hospitality etc. The home has internal developmental training, and we were shown the formal training plan. Which showed that all of the mandatory training required, had either been completed or booked for this year. And that over 80 per cent of staff had completed the other specialist training topics provided by the home. This covered topics such as challenging behaviour, care planning, pressure care, dementia care, nutrition and customer care. This shows the service is committed to ensuring they have a skilled and trained workforce. Staff told us, We get more training than anywhere else I know, its really good. From our observations it was clear that staff have the skills to communicate effectively with people who live in the home. This included both care staff and ancillary staff who come into regular contact with them. staff showed respect for people, their relationships were informal and friendly at all times. Staff told us that they have regular meetings and are encouraged to be involved in the development of the service. Agendas are developed, minutes are taken and relevant information is made available to staff and people or their representatives. Care Homes for Older People Page 23 of 30 Evidence: Staff went on to tell us that they have individual supervision sessions which take place regularly and staff say that they find them useful for their development. From our observations and from speaking to a range of stakeholders it is clear that all staff understand and are aware of the specific nature and uniqueness of the home, its aims and objectives and how care will be delivered. They all said they were happy at the home and really enjoyed their work. This shone through in their provision of an excellent service. Care Homes for Older People Page 24 of 30 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. People are living in an exceptionally well run service. They are receiving appropriate levels of care and support to meet their individual and diverse needs. People are confident in the management of the home and everyone finds the manager approachable and professional. People are safe because the home makes sure all of the proper checks are undertaken. Staff receive good levels of support and training. Evidence: People live in a home which is run and managed by an exceptionally skilled and committed, registered manager. Who is a registered nurse and who holds a management certificate in health and social care. She leads the staff team in a calm and quiet manner, is fair and thorough in her approach. She is respected and liked by all of the stakeholders we spoke to. Here are just a few of the comments people made to us, A person who lives at the home told us, Christine is second to none, shes been a God Care Homes for Older People Page 25 of 30 Evidence: send to me. A G.P told us, The manager is exceptional. A relative told us, Christine is lovely, shes been my angel since my husband has been ill. Another relative said, The manager is fantastic. A health professional told us, This is one of the best homes in Sheffield and this is down to the manager and the staff. A member of staff said, The manager is fair, down to earth and you can always go and talk to her if you have any problems. We checked to see if the home is run in the best interests of people who live there. Relatives told us, I am totally confident in the service, I can go home from here and feel happy that my Mum is safe and happy here. Another relative told us, They do everything they can for my husband, nothings too much trouble. A health professional told us, this is by far one of the best services Ive seen and they can take any criticisms on the chin and act on them, they just want the best for people who live here. We then checked three people finances, which were kept by the home. All transactions were recorded by two signatories and receipts given. The finance records maintained were clear and the manager told us she regularly audited the system with the administrator to protect peoples rights. One person told us their son managed their finances, but they managed a small amount of their own money and were quite happy with this. The AQAA report from the home detailed the way in which peoples views underpin, the reviews and self monitoring of the service. This was really positive. We were also shown evidence of a customer satisfaction survey complete in the last six months which was very positive and showed areas in which the service would like to improve. We saw evidence that the service had health and safety policies and procedures in Care Homes for Older People Page 26 of 30 Evidence: place, this ensures peoples safety and welfare. The manager said the regional operations manager visits the home to carry out regulation 26 visits, and recent records of these were available for inspection. As part of the site visit we examined some of the maintenance and servicing records. All were up to date and these included, Electrical circuit check certificate, last checked on 15 January 2008. Fire detection and fighting equipment, last checked on March 2009. Fire drills, undertaken 6 monthly, last one was on 11 May 2009. Fire alarm, weekly tests undertaken, last one was on 21 May 2009. Wheelchair checks, weekly checks done. Water temperatures, weekly checks done. Baths and hoists, last checked on 10 February 2009. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 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 7 The registered person should look at whether devising care plans using a person centred approach could better reflect the support and care people are recieving. Care Homes for Older People Page 29 of 30 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. 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