Care Home: Ince Blundell Hall

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What the care home does well One relative interviewed stated, "It`s unique, it`s a benchmark for how every care home should be done. My dad is so lucky being here. It`s very, very special". The pre admission process ensures that prospective residents are well informed of what the service has to offer them and that their needs will be met. A senior member of staff is appointed to prospective residents and their families. This ensures that during the pre admission process they arrange to visit and are given time to look around and benefit from the staff member to provide any additional information they may need. Some of the residents have been admitted to the service for periods of respite and this has given them an insight into how the service is run. A relative interviewed stated, "We came and visited and met Sister Gemma and Sister Laura. My father came for a couple of weeks respite and got to know the Sisters and staff. I`m more than happy that dad is looked after". A resident interviewed stated, "Sister came to see me, I came here after being very ill, my Dr recommended it". The service ensures that residents have been consulted with regard to their individual needs and are provided with the best possible care. Care documentation evidences that all the identified needs during the assessment process have been addressed in care plans. Residents interviewed told us that they were consulted regularly with regard to their individual needs. One resident interviewed stated, "I am so happy here, I have no worries whatsoever. I realise how lucky I am". Relatives canvassed for their views commented, "My father arrived over 6 months ago with severe medical problems. The very fact that he is still with us is testament to the care and attention he receives" and "This is an exceptional nursing home, which provides all the care and support we could have hoped for, we want for nothing". Residents individual preferences are promoted during their time living here. Care documentation evidences that residents are consulted with regard to their particular routines and how they wish to be cared for. Relatives canvassed for their views commented, "My mum requires increasing care because of her illness and she always receives it" and "The high standards should be seen as the criteria that all other homes should strive for". Residents are being protected by the service policies and procedures. Residents spoken with knew who to speak with if they had any concerns. Residents live in beautiful surroundings that are well maintained. One relative canvassed for their views commented, "The home provides excellent accommodation in a beautiful setting. There is always a calm and relaxing atmosphere conducive to the needs of the elderly patients. First class standards of hygiene. Excellent well balanced menus". The service provides a caring and well trained workforce to support and care for the residents. A resident canvassed for their views commented, "I would just like to add that the atmosphere of the home is very warm and welcoming. Any visitors I have, receive the same impression. My family are especially pleased that I am here in such a beautiful place". Staff interviewed told us they enjoyed working here. One staff stated, "It really is fantastic, you couldn`t find another place like this". Ince Blundell Hall provides a well managed service that is run for the benefit of the residents. All of the residents, relatives and staff canvassed for their views gave positive opinions about the service. Visitors are made very welcome and one relative interviewed stated, "What is so special about it is even the younger girls are so polite, so well trained. As soon as you arrive you are offered a tray of tea or coffee". What has improved since the last inspection? The service continue to refurbish Ince Blundell Hall following planned upgrades. This is ongoing and requires particular specialist input as it is a listed building. Ince Blundell Hall is very well maintained and includes beautiful gardens and grounds. Further equipment has been provided including remote control adjustable beds for residents, new armchairs in some of the bedrooms, a new ramp in the conservatory, new kitchen equipment, upgrade of the music room, upgraded one of the bathrooms, replaced the shale around the grounds and painted the exterior of Ince Blundell Hall. What the care home could do better: The service need to ensure that new references are sought for any staff that return to work at Ince Blundell Hall following a break of service. References need to show the date of receipt to ensure they were checked prior to employment commencing. They also need to have a further police check before re commencing work. The service need to ensure that all new staff induction should be recorded and documented in staff files. Key inspection report Care homes for older people Name: Address: Ince Blundell Hall Ince Blundell Liverpool Merseyside L38 6JL     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Margaret VanSchaick     Date: 2 1 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Ince Blundell Hall Ince Blundell Liverpool Merseyside L38 6JL 01519292596 01519292188 enquiries@ibhnursinghome.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Augustinian Nursing Sisters Name of registered manager (if applicable) Sister Gemma Maria Hughes Type of registration: Number of places registered: care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Four beds registered for Younger Adults over 50 years of age Service Users to Include up to 22 (OP) Date of last inspection Brief description of the care home Ince Blundell Hall is registered to provide 24 -hour accommodation, support and nursing care for up to 22 older people. The service is owned and managed by the Augustinian Nursing Sisters, several of whom have lived and worked within the service for many years. The service admits residents for long term care, supports residents and families with short term, post operative or respite care needs. The service has strong catholic links and provides support to many members of the catholic clergy and faith, however the service also offers a service to people with differing religious beliefs. Care Homes for Older People Page 4 of 30 Over 65 22 0 Brief description of the care home The manager of the service is Sr. Gemma Hughes who has managed the service for the last 17 years. Ince Blundell Hall is set in extensive well maintained private grounds. The majority of residents accommodation in the service is provided in single rooms, with one double room available. Bedrooms are located on the first and second floor and a lift is also available. The service offers residents the benefit of living in quiet surroundings with picturesque views of the surrounding countryside As a listed building, the home are obliged to provide tours on request to people who express an interest, however, these are limited to the grounds and lower communal rooms and pantheon. The village church for Ince Blundell is internally accessible from the service and residents can attend. This does not form part of the registered premises. Fees are £656 weekly. Care Homes for Older People Page 5 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: A site visit took place as part of the unannounced inspection. It was conducted over two days for the duration of 10 hours. Twenty residents were accommodated at this time. As part of the inspection process many areas of the service were viewed including residents bedrooms. Care records and other service records were viewed. Discussion took place with some of the residents, staff and one relative. The inspection was conducted with Sister Gemma (registered manager) and Helen Lunt (administrator). During the inspection process two residents were case tracked (their files were examined). All of the key standards were assessed. Satisfaction forms Have your say about ..... were distributed to a number of residents, relatives and staff prior to the inspection. A number of comments included in this Care Homes for Older People Page 6 of 30 report have been taken from surveys and interviews. An AQAA (Annual Quality Assurance Assessment) was completed by the manager prior to the visit. The AQAA consists of two self assessment questionnaires that focus on the outcomes for people. The self assessment provides information as to how the manager and staff are meeting the needs of the current residents and a data set that gives basic facts and figures about the service including staff numbers and training. Care Homes for Older People Page 7 of 30 What the care home does well: One relative interviewed stated, Its unique, its a benchmark for how every care home should be done. My dad is so lucky being here. Its very, very special. The pre admission process ensures that prospective residents are well informed of what the service has to offer them and that their needs will be met. A senior member of staff is appointed to prospective residents and their families. This ensures that during the pre admission process they arrange to visit and are given time to look around and benefit from the staff member to provide any additional information they may need. Some of the residents have been admitted to the service for periods of respite and this has given them an insight into how the service is run. A relative interviewed stated, We came and visited and met Sister Gemma and Sister Laura. My father came for a couple of weeks respite and got to know the Sisters and staff. Im more than happy that dad is looked after. A resident interviewed stated, Sister came to see me, I came here after being very ill, my Dr recommended it. The service ensures that residents have been consulted with regard to their individual needs and are provided with the best possible care. Care documentation evidences that all the identified needs during the assessment process have been addressed in care plans. Residents interviewed told us that they were consulted regularly with regard to their individual needs. One resident interviewed stated, I am so happy here, I have no worries whatsoever. I realise how lucky I am. Relatives canvassed for their views commented, My father arrived over 6 months ago with severe medical problems. The very fact that he is still with us is testament to the care and attention he receives and This is an exceptional nursing home, which provides all the care and support we could have hoped for, we want for nothing. Residents individual preferences are promoted during their time living here. Care documentation evidences that residents are consulted with regard to their particular routines and how they wish to be cared for. Relatives canvassed for their views commented, My mum requires increasing care because of her illness and she always receives it and The high standards should be seen as the criteria that all other homes should strive for. Residents are being protected by the service policies and procedures. Residents spoken with knew who to speak with if they had any concerns. Residents live in beautiful surroundings that are well maintained. One relative canvassed for their views commented, The home provides excellent accommodation in a beautiful setting. There is always a calm and relaxing atmosphere conducive to the needs of the elderly patients. First class standards of hygiene. Excellent well balanced menus. The service provides a caring and well trained workforce to support and care for the residents. A resident canvassed for their views commented, I would just like to add that the atmosphere of the home is very warm and welcoming. Any visitors I have, receive the same impression. My family are especially pleased that I am here in such a Care Homes for Older People Page 8 of 30 beautiful place. Staff interviewed told us they enjoyed working here. One staff stated, It really is fantastic, you couldnt find another place like this. Ince Blundell Hall provides a well managed service that is run for the benefit of the residents. All of the residents, relatives and staff canvassed for their views gave positive opinions about the service. Visitors are made very welcome and one relative interviewed stated, What is so special about it is even the younger girls are so polite, so well trained. As soon as you arrive you are offered a tray of tea or coffee. 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 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 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The pre admission process ensures that prospective residents are well informed of what the service has to offer them and that their needs will be met. Evidence: The statement of purpose continues to be updated so that prospective residents and their families are kept informed of what the service has to offer. This can also be made available in an alternative format. The website also offers an alternative way of accessing information about the service. A senior member of staff is allocated to the prospective resident and family to ensure they are given quality time to view Ince Blundell Hall and what the service has to offer. Further information is provided during the visit including the resident guide, contract, homes brochure and recent inspection report. The registered manager carries out pre admission assessments of residents to Care Homes for Older People Page 11 of 30 Evidence: ascertain their individual needs. Residents care documentation evidenced that pre admission assessments have been carried out. The date and signature of the person assessing prospective residents has been included. Residents confirmed they had been assessed prior to admission. One resident interviewed stated, Sister came to see me, I came here after being very ill, my Dr recommended it. The service offers regular respite for residents who visit for short periods of time and also for those who wish to stay on a permanent basis. The pre admission assessments were detailed and provided comprehensive information about the prospective residents. All aspects of care had been addressed. The information collated at this stage is used to set up an individual and person centred care plan, which shows how the service will meet the prospective residents needs. The pre admission process evidences that many areas are assessed including communication, personal care, medical and nursing input, continence, pain, mental health, mobility, foot care, eye and oral care, likes and dislikes and religious needs. Residents interviewed confirmed their needs were being met. One relative interviewed about their decision to choose Ince Blundell Hall stated, My father came for a couple of weeks respite and got to know the Sisters and staff. We came and visited and met Sister Gemma and Sister Laura. Im more than happy that dad is looked after. Care Homes for Older People Page 12 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. The service ensure that residents have been consulted with regard to their individual needs and are committed to provide the best possible care. Evidence: The two residents that were case tracked each had a care plan in place. Comparing the assessment details with the care plans evidenced that both residents identified needs had been addressed. Both care plans were up to date and where changes had occured in the residents condition since admission the care plan had been updated. There is evidence of regular reviews of care needs with staff evidencing they have been carried out by entering their signature and dates. The care plans show that the details entered are specific to the individual therefore ensuring they are person centred and all needs addressed however minor. One resident interviewed stated, Im very happy, I couldnt complain about anything. Im very comfortable, its like a home from home, I wouldnt move from here. I get help in the bathroom, staff are very good indeed. The care plans were easy to follow and very detailed in how each resident is supported Care Homes for Older People Page 13 of 30 Evidence: with their individual care needs. Areas addressed include mobility, heart problems, pain, nutrition, kidney failure, sleep pattern, personal hygiene, continence, communication, wound care, hypertension, breathing problems, emotional wellbeing, sight, hearing and skin care. Residents have agreed their care with relatives agreement where needed. One family member that was interviewed told us that they were very happy that their relative was here. Relatives canvassed for their views commented, The love and care provided by Ince Blundell Hall Nursing Home is excellent. This is an exceptional nursing home, which provides all the care and support we could have hoped for. We want for nothing and My father arrived over 6 months ago with severe medical problems. The very fact that he is still with us is testament to the care and attention he receives. Residents independence is promoted and where needed staff support is provided. Risk assessments were in place and evaluated regularly. These looked at many areas including medication, mobility, pressure area risk, nutrition and falls. Specialist equipment was noted in some areas of the service and additional aids are made available to provide further support for the residents. Residents care documentation evidences other health professional support has been sought for residents who need it. This includes, specialist nurses, Gps opticians, chiropodists, audiologists, dermatologists, practice nurses and other health care professional support where needed. Medication documentation was viewed and this showed clear and easy to follow records were kept. All medication administered to residents was signed by the registered nurse. There is good stock control and audits are carried out regularly on a monthly basis. The pharmacist who supplies the service carries out an annual audit also. Any new medication is logged in and any unused stock is carried over as evidenced on medication documentation. Medication cupboards were locked and when opened showed tidy, organised stocks. A medication trolley is used on the 2nd floor. Residents who self medicate have a lockable facility in their bedrooms. A medication returns book was in place. A waste box for unused medication was in place and records evidence any destruction. Privacy and dignity is promoted within the service. It is paramount. The atmosphere is the service offers a quiet, relaxed and comforting place to be. Staff were observed to interact with residents in a respectful and friendly manner. They were also noted to be patient, kind and caring towards residents. 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. Residents individual preferences are promoted during their time living here. Evidence: Care documentation evidences that residents wishes and preferences with regard to their individual needs and routines has been recorded. Equality and diversity is promoted in this service. All residents are supported to be involved in daily life activities and assisted in whichever way is needed by staff. Residents interviewed confirmed that staff were aware of their needs and provided a friendly and supportive environment. Individual routines have been discussed and where possible residents preferences have been supported. One staff interviewed stated, Residents decide when they want to get up and retire. The notice board for residents and their visitors displays the various activities including concerts. Some of the activities that residents participate in include visits to Martin Mere, Southport, local garden centre, musical events, passive exercise classes, alternative therapies, visits by local wildlife experts, who brought some owls for the residents benefit and local historians also visit to give talks. Residents are also able to go for walks around the grounds with family or staff support, there are many suitable sitting out areas. Residents who want to, can join in with the activities if they wish. Care Homes for Older People Page 15 of 30 Evidence: Those who dont wish to, have their privacy respected. Residents were seen to spend their time as they wished within their ability and with staff support where agreed. The service also have an excellent relationship with the local community and residents friends and visitors are encouraged to visit regularly. One resident interviewed stated, I have two girls who visit when they can and I have friends. All are made to feel welcome. We observed some of the residents had visitors during our visit. Staff made the visitors feel welcome. Relatives and residents interviewed confirmed that visitors are always made welcome. There are no restrictions. One relative interviewed stated, Dad is looked after if I am here, or not. Its unique, its a benchmark for how every care home should be done. My dad is lucky being here. Its very, very special. Residents interviewed stated, Its home, they are so kind, anything I need its there, they do everything for me. I am so happy here, I have no worries whatsoever. One relative canvassed for their views commented, In every respect the elderly are treated with the utmost care and dignity. The high standards should be seen as the criteria that other homes should strive for. Residents from the local community have been able to continue to worship in their own church, which is in the grounds of Ince Blundell Hall. The service also has a church, which provides residents with Mass each day. Ministers from other religions visit to provide Communion for non Catholic residents. The service has their own chaplain who is available for everyone should they wish it. Ince Blundell Hall promotes the rights of the individual and where possible encourages people of all denominations. The menu offered to residents covers a 4 weekly rota. The menu evidences a nourishing and varied diet. There are plenty of fresh fruit and vegetables also. Residents have a 3 course lunch and 2 course tea. Some of the herbs and vegetables used are grown in the service garden. Various dietary needs are catered for and residents preferences are known. The chef meets with new residents to discuss their individual needs. Families are encouraged to join their relatives at mealtimes and visitors spoken with during the inspection confirmed they had some of their meals at Ince Blundell Hall. Residents have choices with regard to what they would like to eat and when they are unable to eat at the usual time, they are offered a meal when they are ready. Meals are served in the dining rooms. This is an important social occasion as many of the residents meet up at this time. For those who do not wish to, their privacy is respected. Some of the residents choose to eat in their own rooms and this is accommodated. One staff interviewed stated, Meal choices are offered, we know their Care Homes for Older People Page 16 of 30 Evidence: diets well and who likes crusts on their bread or not, the kitchen are given a list of likes and dislikes and special diets. One resident interviewed stated, The food is excellent, I go down for meals and have breakfast in my room. If I wanted a drink in the night staff would bring me one. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are being protected by the service policies and procedures. Evidence: Policies and procedures have been updated since the last inspection. The service complaints procedure has been updated and a complaints form has been made available for those who wish to raise any concerns. The complaints process looks easy to follow and a named complaints manager will deal with any that are raised. Each resident has a complaints log attached to their care documentation. These were viewed during our visit and only one resident has raised minor concerns that have been dealt with immediately to the residents satisfaction. The individual log for the resident shows the concern raised, the investigation and the outcome for the resident. The complaints log shows no serious concerns have been raised. There have been no complaints or adult protection concerns raised with the Commission. The service has an up to date copy of the adult protection procedure, with copies in both Nurse stations and staff have attended training provided by Sefton Council. In house training also takes place regularly with regard to abuse to ensure staff keep up to date and are alert to it. Staff interviewed had a good understanding of the adult protection procedures. Staff told us they were able to spend time with residents individually so that they have Care Homes for Older People Page 18 of 30 Evidence: the opportunity to discuss any concerns or worries they may have. Residents interviewed confirmed that they were able to talk to staff had they any worries. One resident stated, I have no complaints. Id just talk and request can I have this Sister Gemma, Sister Teresa and they would deal with it. Local advocacy details are available for residents. A whistle blowing policy is in place. 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. Residents live in beautiful surroundings that are very well maintained. Evidence: A tour of the service took place and this showed that residents live in a clean, comfortable and beautiful environment. Ince Blundell Hall is listed. The service is spacious and provides good size bedrooms and plentiful bathroom facilities for residents use. Adaptations and equipment have been fitted unobtrusively to promote the independence and safety of residents. Residents have a remote control facility to adapt their beds. Residents bedrooms have been personalised to ensure they are comfortable in their surroundings. Residents interviewed stated, We have lovely furniture, and we could do what we wanted, my bookcase with books and own personal items. I have lovely views from my room, its very nice. I have a new bed and chair, both are comfortable and I have everything I need, my bed is very comfortable, its adjustable and an up to date telly. Public rooms are spacious and provide many areas for residents to use including a library, quiet sitting room, conservatory, 2 dining rooms, lounge and drawing room. The public rooms are beautifully furnished with elegant and comfortable furniture, which provides a wonderful environment for the residents to live in. Despite its grandeur, Ince Blundell Hall provides a comfortable home that is suitable for the residents. A relative canvassed for their views commented, The home provides excellent Care Homes for Older People Page 20 of 30 Evidence: accommodation in a beautiful setting. There is always a calm, relaxing atmosphere conducive to the needs of the elderly patients. A resident canvassed for their views commented, My family are especially pleased that I am here in such a beautiful place. Another advantage is the beautiful grounds surrounding the home. The service has an ongoing plan of refurbishment and maintenance. A maintenance person is employed to ensure that the building is well maintained. Since the last inspection visit many areas of the service have been upgraded including, the painting of the front and rear of the service, music room, bathroom, some residents bedrooms and new shale for the grounds. Following discussion with the residents a new ramp has been fitted to the conservatory to ensure easier access for residents. New equipment has also been purchased including kitchen equipment. The service also provides overnight accommodation for residents families. This facility comprises of 6 bedrooms, bathroom and shower facilities and a kitchen for their use. It is used for families who travel from long distances or when their relative is ill. The grounds surrounding Ince Blundell Hall are spacious and beautifully maintained by two gardeners. There are many sitting out areas suitable for residents and their visitors and two summer houses. Residents have easy access to the grounds. There is also a small chapel for residents, a village church, temple for visitors and a Pantheon for concerts. Residents have the use of two dining rooms with wonderful views of the gardens. Both dining rooms provide a spacious, comfortable environment for residents to enjoy their meals. Tables were laid with care, providing floral arrangements and clean table linen. Mealtimes are promoted as a social occasion and residents were observed to enjoy their food served by staff. Interaction took place between the residents and it became apparent that it was an enjoyable experience for them. Staff provided assistance discretely. The kitchen was spacious and very clean. Staff wore clean uniforms and it was obvious that the cleaning schedule on display was carried out to a high standard. Fridges and freezers were clean and all storage well organised. The food safety diary was completed daily and showed what food was served, temperatures of hot food and fridge/freezers. Staff told us they had attended various courses and were up to date with all mandatory training. Staff told us they had a good budget for residents meals. There was evidence of fresh fruit, vegetables and home baking for residents. There is a laundry facility separate to the kitchen and a large ironing room. Staff have Care Homes for Older People Page 21 of 30 Evidence: policies and procedures to follow and have attended infection control training. A relative interviewed stated, The ladies clean every day, Sister Gemma is very particular about the standards. As a listed building, Ince Blundell Hall is visited by people who show an interest. These visits do not intrude on any of the residents privacy as they are restricted to certain areas. Care Homes for Older People Page 22 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. Ince Blundell Hall provide a caring and well trained workforce to support and care for the residents. Evidence: The staffing rota evidenced that sufficient nursing and care staff were on duty on both floors. There was also sufficient staff on duty in the kitchen and other domestic areas to manage the service efficiently. The service try to ensure that care staff enrol on the NVQ training programme. At present 12 of the care staff have this qualification. Four staff files were viewed including their training records. Most of the staff files viewed held completed application forms with details of their work experience, checklist of qualifications seen by the service, commencement of employment date, references, PIN numbers from registered nurses, health questionnaire, signed contracts, passport copies, police checks, induction records, appraisals, personal development reviews, training attended and job descriptions. Not all of the staff files included evidence of an induction on commencement of employment but the manager told us that an induction had taken place over 3 months and the staff member confirmed this to us during the visit. The staff member interviewed stated, I did have an induction when I started and been advised of the training schedule. The service also has a DVD to support the induction training for Care Homes for Older People Page 23 of 30 Evidence: staff. One of the staff files evidences references originally taken some years ago when they had previously worked in the service. Some years later they had returned to work but without new references therefore this needs to be addressed. The police check for this staff is also from some years ago therefore the manager was advised that a new one must be sought for them. One of the references on another staff file is not dated. The service need to ensure that a date is recorded on receipt of the reference to ensure authenticity. One of the staff files shows that the references given by a recruitment agency go back many years therefore this needs addressing. Most of the staff who are employed in the service have worked there for many years. All have regular appraisals and are supervised on a continuous basis. Residents are able to give their views about whether staff employed on a probationary period should be employed permanently. One relative interviewed stated, What is special about it? even younger staff are so polite and so well trained, as soon as you arrive, you are offered a tray of tea/coffee. One of the residents interviewed stated, I realise how lucky I am, definitely a pleasant place to stay. Sister Gemma and any other staff I can talk to. Staff comforted me when I had a nightmare once. Staff are so nice. The training records were viewed for all four staff and they evidenced health and safety, risk assessments, fire, protective equipment, first aid, bereavement, beauty therapy, reflexology, palliative care, supervision, nutrition, cpr, infection control, nurse documentation, mental health act and deprivation of liberty, manual handling, adult safety, public health, basic food hygiene, equality and diversity, language skills, advance care planning, time management, restraint and intervention and COSH. The service access external training providers to provide up to date training including mandatory and also use internal trainers to provide updated training in manual handling, abuse as well as some of the other skills that senior staff are able to cascade to staff. Staff employed at Ince Blundell Hall were very happy working there and told us they had a very good training programme. Staff interviewed stated, It really is fantastic, you couldnt find another place like this, I love it, I do like it here, we can be with the residents and spend a bit of time with them, it has a nice atmosphere, a nice positive place and good training, Its is a very caring and lovely place to be, residents are happy, Patients come first here at all time and the care is excellent. Care Homes for Older People Page 24 of 30 Evidence: Staff canvassed for their views commented, The home provides a caring and spiritual environment for the residents, The patients are well cared for and the nursing home is spotlessly clean and free form smells. Patients are made to feel at home. They are happy with the wonderful tender loving care. Respite patients come back regularly and Our standards are high and we treat all patients with the respect they deserve. One relative canvassed for their views commented, All of the staff support my mum with loving care. They also support the family. Their hospitality to all my mums visitors could not be better. My mum requires increasing care because of her illness and she always receives it. Care Homes for Older People Page 25 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. Ince Blundell Hall provides a well managed service that is run for the benefit of the residents. Evidence: The registered manager, Sister Gemma, has been in this post for many years and leads a team of staff who have worked together for some years. This provides continuity for the residents. The manager continues to keep up to date and training records evidence training attended over the past year. Staff, residents and families spoken with find the manager and senior staff very approachable. Residents are able to have one to one conversations with staff, which enables them to give their views on how the service is run. Their views have been acted on as observed regarding the ramp being fitted to the conservatory. Staff interviewed stated, Sister Gemma is very professional, caring and helpful. A relative interviewed stated, Sister Gemma is always available and I can always speak to staff. Care Homes for Older People Page 26 of 30 Evidence: The service have commenced management team meetings from January this year and the minutes of these were viewed to show they have been held regularly since. Items under discussion include management, staff, organisational issues, teaching, learning and any other business. Residents are spoken with each day and are able to communicate with staff easily and if needed they can raise any issues they may have with senior staff. The service has received many letters and cards from families telling them how pleased they were with the care and support provided to their relatives during there stay at Ince Blundell Hall. Comments were very positive and people wrote many complimentary phrases. These were viewed by us during the visit. Many of these were from families whose relative came on a regular basis for respite. One of the residents financial records were looked at during the visit. One of the senior staff helps this resident with their personal finances and there were clear, detailed records of all the financial transactions taken place. The Power of Attorney also monitors the finances. This is good practice. Policies and procedures continue to be updated as seen. Safe working practices were in place and staff are updated throughout the year with regular mandatory and other training relevant to their role as evidenced in training records and through discussion with staff. Maintenance records show that all health and safety checks are carried out regularly and were up to date. Regular servicing of boilers, electrical systems, gas appliances, fire and other equipment were up to date with certificates evidencing this. Risk assessments were in place. Accidents records have been completed correctly. 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 29 The registered person should ensure that new police checks have been carried out for staff returning to work in the service following a break in service. The registered person should ensure that all references received regarding new staff are dated and current. This ensures they have been received just prior to employment. The registered person should ensure that all staff induction is recorded and documented on staff files. 2 29 3 30 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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