Care Home: James Page House

What the care home does well Before anyone moves into the James Page, they and their relatives are invited to visit, look around and meet some of the people living and working there. Staff also visit the person and carry out an assessment of their needs and choices as well as providing information on the service the home offers. The level of information provided to and obtained about people helps everyone to decide if the James Page is the right place for the person to live. The people living there told us that they get support with their personal care and that they are able to have a bath or a shower whenever they want. This is backed up by a weekly hairdresser service, all of which supports people to maintain their appearance in accordance with their choices. Staff liaise well with health care professionals and support people to make and attend health care appointments. The home has good systems in place for managing and auditing people,s medication. This all helps to ensure people receive the health care that they need. Visitors are welcomed at all reasonable times and people can choose whether to see them in private or in communal areas as they prefer. A choice of meals is provided at all mealtimes and people told us that they can have a drink whenever they wish. At mealtimes staff make an effort to minimise interruptions and ensure dining rooms are nicely laid out. This all helps to make mealtimes a social relaxed occasion for the people living there. The people living at the James Page told us that they like the staff team. Staff have a good understanding of people`s support needs as well as of the things they like to spend their time doing. This is backed up with training for staff which helps to ensure they are up to date with current good practice in how to support people safely and well. The building is well maintained and warm. Everyone living there is provided with their own en-suite bedroom which they can personalise as they choose. In addition there are sufficient communal rooms and gardens to provide everyone with a choice of places to sit, as well as see their visitors, if they wish. The people living at the James Page know how to raise any concerns that they may have and are confident that staff will listen to them and act upon them. This helps the people living there to feel safe. Clear management structures are in place, which help to ensure the smooth running of the home. Staff and the people living there expressed confidence in the manager and said that they find her approachable and helpful. This is backed up with clear quality assurance systems that enable the manager to check the quality of the service being provided, quickly note and deal with any issues that may arise and plan for future improvements. What has improved since the last inspection? The introduction of tea bars throughout the home has provided the people living there and their visitors with way to make a drink or get a small snack. This helps to increase people`s independence within the home and to provide a more homely atmosphere for those living there and their visitors. The people living at the James Page told us that they really like the yoga classes that have been arranged twice a week and look forward to attending these. The home now has a vehicle and driver available once a fortnight so that the people living there can go on outings. Good systems have been put into place to audit the way in which people`s medication is managed. This helps to lessen the risk of errors occurring and also helps to quickly identify any issues so that they can be dealt with in a timely manner. What the care home could do better: The people living at the James Page had different opinions of the quality of the meals provided. Some people thought they were excellent whilst others felt they were not as good as they used to be. People told us they enjoyed the activities that were arranged. However some people felt that there was not enough for them to do and that they would like more or different activities. The home should discuss these matters with the individual people living there to obtain information on where people would like to see future improvements and whether these can be provided. Call bells are not always answered as quickly as people would like them to be, with some people feeling that at busy times they have to wait too long. Although the manager has monitored this in the past, continuing monitoring will help to identity any issues with call bell response times. They can then ensure that they are able to respond and meet people`s needs within a reasonable time. The information recorded in people`s care plans is variable. Some plans do not contain sufficient information to guide unfamiliar staff in how to support the person safely and well. Some records in care plans are not reviewed as regularly as they should be, which could lead to changes to the person`s support needs not being noted and acted upon as quickly as possible. A system should be implemented to ensure all care plans are reviewed regularly and that the information recorded is sufficient to guide staff in how to support the person safely and well. Inspecting for better lives Key inspection report Care homes for older people Name: Address: James Page House Deyes Lane Maghull Liverpool Merseyside L31 6DJ     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: Lorraine Farrar     Date: 1 9 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: James Page House Deyes Lane Maghull Liverpool Merseyside L31 6DJ 01515316067 01515263506 ann.keogan@parkhaven.org.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) : Parkhaven Trust care home 36 Number of places (if applicable): Under 65 Over 65 36 old age, not falling within any other category Additional conditions: 0 The registered person may provide the following categories of service only. Care home with Nursing code N, to people of the following gender:- Either. Whose primary care needs on admission to the home are within the following categories: - Old age not falling within any other category - Code OP. The maximum number of people who can be accommodated is: 36 Date of last inspection Brief description of the care home James Page House is owned and run by Parkhaven Trust, a local organisation who have several care homes in the Maghull area of Liverpool. The home is on a large site on Deyes Lane in Maghull and is shared with another registered home belonging to the organisation. The grounds are large and there is plenty of room for people to sit out or go for a walk. Although in its own grounds the home is in the middle of a residential area and there is a public transport service nearby, car parking is provided and local shops and facilities are not far away. Care Homes for Older People Page 4 of 29 Brief description of the care home The building is single story and has been adapted to a high standard. There are 35 single bedrooms each of which has an en-suite with shower, toilet and sink. The home has three wings and a main dining / sitting area. Each wing has bedrooms, sitting and dining areas and bathrooms. In addition there is a main laundry, kitchen, offices and a reception area. Recently building work has provided four extra bedrooms, each with en-suite facilities, three of which have patio doors to access a courtyard area. The home is registered to provide care with nursing for 35 people. Registered Nurses and carers are available at all times; in addition there are domestic and kitchen staff during the day. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We gathered information for this inspection in a number of different ways. Before we visited we sent comment cards to some of the people who live and work at the James Page. This was so they could let us have their views about the home. In total eight of the people living there and four of the staff team replied. We also sent a self assessment form to the manager which she completed and returned to us. This provided information about how the home operates, staff, the support they provide to the people living there and any future plans. We also reviewed any information we have received about the James Page since our last big inspection in October 2007. All of this information helped us to plan our site visit and was taken into account in writing this report. Care Homes for Older People Page 6 of 29 We carried out an unannounced site visit to the James Page on 19 November 2008. This took place for over eight hours and included reading records and looking at the building. We spent time looking at the support the people living at the James Page receive. This included looking at the support they get with their personal and health care, daily lives, care plans, medication, money, activities and environment. We talked with nine of the people who live at the James Page and with four of their relatives. We also talked with seven members of staff. This helped us to find out what it is like to live at the James Page and whether people receive the support they need and choose. It currently costs five hundred and twelve pounds ninety pence each week to live at the James Page. What the care home does well: What has improved since the last inspection? Care Homes for Older People Page 8 of 29 The introduction of tea bars throughout the home has provided the people living there and their visitors with way to make a drink or get a small snack. This helps to increase peoples independence within the home and to provide a more homely atmosphere for those living there and their visitors. The people living at the James Page told us that they really like the yoga classes that have been arranged twice a week and look forward to attending these. The home now has a vehicle and driver available once a fortnight so that the people living there can go on outings. Good systems have been put into place to audit the way in which peoples medication is managed. This helps to lessen the risk of errors occurring and also helps to quickly identify any issues so that they can be dealt with in a timely manner. 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 7535. Care Homes for Older People Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient information is provided to and obtained about people considering moving into the James Page. This helps everyone to decide if it is the right place for the person to live. Evidence: The people living at the James Page told us that they like living there. Comments we received from them included, I would recommend it to anyone and Its lovely, the best I have seen. A relative of a person who lives at the James Page told us that before their relative moved into the home the family were able to visit and look around. They also confirmed that staff from the James Page visited their relative and carried out an assessment of her needs and choices. Care Homes for Older People Page 11 of 29 Evidence: We looked at records for two people who had moved into the home not long before our visit. These showed that before the person was offered a place to live staff from the James Page visited them. They completed a written assessment of the persons health, personal care, social and cultural needs. The people who live at the James Page told us in their comment cards that before they decided to move in they received enough information about the home to help them make their decision. Documents are also available in the hallway of the James Page, which provide information about the service they offer. This information is written in an easy to understand manner and includes information on how to make a complaint, fees and terms and conditions as well as other aspects of the service offered. The information provided to people and obtained about their needs and choices helps to ensure that everyone has enough information to decide if the James Page is the right place for the person to live. It also provides enough information for staff to plan how they will support the person effectively. The James Page does not provide an intermediate care service. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at the James Page receive appropriate support to make sure their health and personal care needs are met in the way they prefer. Evidence: The people living at the James Page told us in their comment cards that there are usually enough staff to support them with their personal care. They also told us that staff listen and act on what they say and they usually get the health care they need. Relatives of some of the people living at the James Page told us that they are satisfied with the support their relative receives. During our last main inspection of the James Page in October 2007 we noted that some of the people living there felt that they waited too long to have their call buzzers answered. The manager monitored this afterwards and could not identity any problems with call answering times. During this visit we saw that call bells were answered quickly. However, some of the people living there told us that sometimes they have to wait for an answer, with one person telling us it can be between two and twenty Care Homes for Older People Page 13 of 29 Evidence: minutes before they get a response. A member of staff explained that they do not have pagers to go with the call bell system, therefore if they are in a bedroom they may not always hear a call bell sounding. Staff we spoke with estimated that it can take ten to twenty minutes for them to answer a bell at busy times. They also explained that there is an emergency bell that can be used if a quick response is needed, although they were not sure if the people living there were aware of this. We did note that people had easy access to their call bells, with one person having hers attached to her chair to ensure it was within reach. However a slow response to call bells may mean that the people living at the James Page do not always get the support they need within a reasonable time. Individual care plans are in place for all of the people living at the James Page and we looked at a sample of three of these. We found that plans contained information about how to support the person with their personal care. However the quality of this information varied. One plan contained good, personal care information about the person, stating that they liked to pick their own clothes and look presentable at all times. Other plans contained less guidance. For example one stated that the person requires, full assistance with all areas of personal cleansing. Maintain privacy and dignity. This may not provide sufficient information for staff who are unfamiliar with the person to support them in the way they need and prefer. One plan noted that the person used continence pads and advised, use the correct size pad but did not guide staff as to what this was. In meeting the people living at the James Page it was clear that they had received support to meet their personal care needs and to dress in accordance with their choices. A weekly hairdresser service helps people to maintain their chosen hairstyle. One of the people living there told us that they can have a daily shower if they wish and a member of staff confirmed that everyone is supported with a daily bath or shower if this is what they choose. During our visit we heard one person comment that their leg was sore and observed the nurse stop and discuss this with her before providing treatment quickly. Staff we spoke with had a clear understanding of peoples different heath and personal care needs and were clear in explaining how they meet these. The contents of care plans we looked at varied as to the guidance they gave with regards to the persons health care needs. One plan we looked at contained good information about all of the persons health care needs along with clear guidance for staff in how to meet these. However it had not been reviewed for nearly eight weeks. Another plan contained an assessment of the persons health care needs, but did not provide a plan for supporting the person with all of these. These things could lead to Care Homes for Older People Page 14 of 29 Evidence: the person not getting all of the support they need with their health care. Records showed that staff at the James Page support people to access health care professionals. This includes support to see the GP routinely and if a health issue arises, as well as support to have health tests, hospital visits and see specialist nurses, such as the Parkinson nurse and continence adviser. Clear records showed that assessments are regularly carried out to identity the risk of the person developing pressure wounds. Where a person has a wound, records confirmed that staff deal with this appropriately, seek advice and ensure the person has the correct equipment, such as specialist mattresses, in place. In April 2008 a problem arose with medication in the home. This was throughly investigated by the organisation that runs the home and appropriate action taken to lessen the risk of similar issues arising in the future. An audit system is in place which helps to quickly identity any potential issues with medication that may arise. This is thorough and includes random observations of medication rounds as well as actual audits of medication held in the home and records of administration. We looked at a sample of medication records and storage and found that these had all been managed appropriately. Care Homes for Older People Page 15 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at the James Page are supported so they can take part in activities and live a lifestyle of their choice. Evidence: In the comment cards they sent back to us, three of the people living at the James Page told us that there are usually activities arranged by the home that they can take part in. However five people felt that there were only sometimes activities arranged that they could take part in. This was confirmed during our visit to the James Page when some people said they enjoyed the activities arranged by the home and felt there were enough of them. Others said they enjoyed the activities that were available but would like more. Recently yoga classes have been run for the people living at the home and people told us they enjoy these very much. A list of activities displayed in the lounge includes weekly hairdresser, weekly Catholic service and monthly Church of England service, knitting, quizzes and games. In addition there is a stock of board games, DVDs and books which people can use. One lady we spoke with also confirmed that the staff at the home have arranged for a daily newspaper to be delivered for her. A couple of times a month an entertainer visits the James Page. One of the people Care Homes for Older People Page 16 of 29 Evidence: living there told us that at a recent residents meetings they discussed day trips out for the summer. A member of staff explained that the home has access to an adapted vehicle and driver through Parkhaven Trust. Recent outings had included Christmas shopping and a trip to the Albert Dock. We looked at records for some of the people living at the James Page and found that they had been supported to take part in a number of activities including, music, TV, planting flowers and yoga. The activities that are arranged as well as the availability of things like daily papers and religious services helps people to maintain their interests and try new things. The regular residents meetings provides a way for people to suggest new activities they would like to try and places they would like to go. As not everyone attends these, informal discussions with people regarding their choice of activities in the home may offer opportunities for everyone to express their views. During our visit we observed that a number of people had visitors throughout the day and were able to see them either in the communal areas or their bedrooms as they preferred. People we spoke with confirmed that they are able to have visitors whenever they want and they are always made welcome. In addition the homes communication book showed that staff will support people to get ready if they are going out with family or friends. People are able to personalise their bedrooms however they wish and are encouraged to manage their own finances, with family support if possible. The regular residents meetings provide a way for people to express their views about how the home operates. This all helps people to retain as much control over their own lives as possible. Most people told us in their comment cards that they always or usually like the meals provided at the James Page. During our visit the menu displayed showed that there is always a choice of meals offered for people and we observed the cook asking people what they wanted for their evening meal. In addition to the tea bars provided on each wing people confirmed that they can have a drink on request, with one person explaining, you can have a cup of tea day or night. The opinions of people living at the James Page varied with regards to the meals provided. These ranged from, cant fault it. Excellent to not bad lately and not as good as it was. People confirmed that they have a choice of meals and a relative explained that they are able to visit and support their relative at mealtimes whenever they wish. Care Homes for Older People Page 17 of 29 Evidence: The James Page operates a system called, protected mealtimes. This involves staff ensuring there are no distractions at mealtimes. We observed that all dining tables were nicely laid with cloths, condiments and flowers, helping to provide a relaxed sociable environment for mealtimes. Care Homes for Older People Page 18 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are thorough procedures for dealing with complaints and concerns and staff receive training so they know how to protect the people living at the home from possible abuse. This means that the people living at the James Page can be confident that any concerns or complaints they have will be listened to and acted upon. This helps people to feel safe whilst living there. Evidence: The people living at the James Page told us in their comment cards that they know how to raise any concerns they have about the home and who they can talk to. They confirmed this when we talked with some of them during out visit to the home. One person explained they would talk to the manager, she always listens and tries to sort it. Another told us that they had, no complaints but if they did they would discuss them with the nurse as, she would help. Information about how to raise any concerns or complaints is made freely available to the people living there and their friends and relatives via a notice board in the foyer. Relatives of a person who lives at the James Page explained that they raise concerns with senior staff and get a reasonable reasons to them. We could see this from the homes complaints record. These recorded minor concerns raised and showed that appropriate action had been taken to deal with them. Care Homes for Older People Page 19 of 29 Evidence: This all helps the people living at the James Page to feel safe, that they are listened to and any concerns they have will be acted upon. Staff told us in their comment cards that they know what actions to take if someone does raise concerns with them. Those we talked with during our visit were able to explain safeguarding procedures and the actions they would take if any issues arose. Staff records we looked at confirmed that staff receive training on safeguarding of vulnerable adults. Copies of the homes safeguarding procedures and local authority procedures are freely available to staff. This all helps to ensure that staff are equipped with the skills and knowledge to deal well with any issues that arise. Care Homes for Older People Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The James Page is well maintained so it provides people with a warm, comfortable and safe home to live in that is well adapted to meet their individual needs. Evidence: The people living at the James Page told us in their comment cards that their home is always fresh and clean. This was confirmed during our visit when all areas of the home appeared very clean, warm, well decorated and comfortable. People who live at the home who we spoke with during our visit told us that they liked the environment. Comments we received includedit doesnt smell, its warm enough and they have got every facility. All areas of the home are at ground level with a ramp available to the front of the home to provide easier access for people with mobility difficulties. There is parking available at the home with nearby access to public transport. Everyone living at the Jame Page has their own bedroom with large en-suite shower and toilet facilities. Bedrooms to the side of the home also have doors leading to a small patio area. People told us that their rooms are always warm enough and they can adjust the temperature if they wish. One person told us that she was able to choose the decor for her room. We also spoke to relatives of another person who felt Care Homes for Older People Page 21 of 29 Evidence: that she did not like the decor in her room as it was fairly dark. We discussed this with a senior manager during our visit who responded positively. The home shares extensive grounds with another care home on the site. In addition they have their own garden and patio areas that provide places for people to sit in warmer weather. There are four separate bedroom areas at the James Page. The three wings provide bedrooms and have dining and lounge facilities. In addition a main lounge and dining area provides additional seating and place for people to meet up if they wish. A senor manager explained during our visit that they plan to refurbish lounge areas in the forthcoming months. During our visit we observed the people living there choosing where to spend their time. Some people chose to see visitors in one of the lounge areas or in their bedrooms; others spent time socialising in the lounges or engaged in hobbies in their bedrooms. The manager explained in her self assessment form that recent additions to the environment have included tea bars in each wing. We saw these were up and running during our visit, providing facilities for visitors and the people living there to make a drink and obtain a small snack. A variety of equipment is provided to support people with their personal care and mobility. This includes call bells, adapted baths and showers, toilet seats, grab rails and specialist beds and mattresses. A laundry room provides sluice, washing and drying facilities. Disposable gloves, aprons and bags are available for staff to use. This helps to prevent or contain any outbreak of infection. Care Homes for Older People Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at the James Page are supported by an experienced staff team so they can be confident that their needs will be met well and safely in the way they prefer. Evidence: The people living at the James Page told us that they like the staff team and get the support they need from them. Their comments included, very good, helpful, polite and staff are so nice, cant ask for nicer. They also told us that there are usually enough staff available to support them when they need it. We looked at a sample of staff records. These showed that before anyone starts work at the James Page a series of checks are carried out on them. These include obtaining written references, checking the protection of vulnerable adults register and obtaining a Criminal Records Bureau (CRB) disclosure about the person. These checks help to ensure that staff are suitable to work with people who may be vulnerable. Staff told us in their comment cards that they get the training they need to help them support the people living there. This was further evidenced in discussions with staff during our visit to the home. One member of staff told us, I feel I learn all the time and described the training they receive as, fantastic. Records we looked at showed Care Homes for Older People Page 23 of 29 Evidence: that as well as receiving training in basic areas of care practice such as moving and handling people and safeguarding vulnerable adults, staff also receive training specific to the needs of the people living there. This training is as diverse as supporting people with epilepsy, supporting people with swallowing difficulties and supporting people to manage their behaviour. The self assessment form completed by the manager showed that ten of the care staff have obtained a national qualification in care, (NVQ) with other staff working towards obtaining this. The variety of training available helps to ensure that staff are up to date in how to support people safely and well. The staff we spoke with during our visit showed a good awareness of how to support the people living there. They were knowledgeable about not only the health and personal care needs of people but also about their preferred lifestyles and how they liked to spend their time. Throughout our visit we observed staff speaking politely and respectfully to people and responding positively to requests for support. Care Homes for Older People Page 24 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The James Page has an experienced management team who ensure that the service is operated effectively for the benefit of the people living there. Evidence: Mrs Ann Keoghan is the registered manager of the James Page. She is a registered nurse who is experienced in management within a nursing home environment and has obtained a qualification in managing care services. Staff and the people living at the James Page displayed confidence in the manager. One of the people living there told us that she listens to them and tries to sort any concerns out that they may have. Staff told us that they find her, very supportive and fair and approachable. This open approach helps to ensure that people feel they can contribute to how the home operates. There are several systems in place at the James Page for checking the quality of the Care Homes for Older People Page 25 of 29 Evidence: service they provide. Regular visits are carried out by the Trustees of Parkhaven Trust that runs the home. In addition regular audits of care plans and medication provide a way to quickly identity any potential issues and act upon them. Parkhaven Trust arranges for an external quality assurance of the home to be carried out each year. This includes the external company talking with the people living there, their relatives and with staff. In 2008 the company again awarded the James Page a five star rating, which they describe as being in the exceptional bracket. In addition the organisation hold the investors in people award. This is a national award that recognises orgainsations who invest in their staff and helps to ensure staff are equipped with the skills and knowledge to support people successfully. These different systems for checking the quality of the service provided at the James Page provide a clear way for the organisation to identify any areas where the service could improve and plan how to do so. They also provide opportunities for the people living there and staff to contribute their views. Wherever possible the organisation encourages the people living there to manage their own money or receive support with this from a relative. If this is not possible then Parkhaven Trust will act as appointee for the persons benefit money, for which they have an account separate from their business account. This helps to ensure that peoples money is managed as safely as possible. During our visit to the home we looked at a sample of records of money held by the James Page for the people living there. We found that the records tallied with the actual amounts held. The self assessment form completed by the manager recorded that health and safety checks are carried out on the building and equipment regularly. We looked at a sample of these during our visit and found that they are kept up to date. This includes regular contractor checks on the electrics, gas and aids for mobility as well as in house checks in areas such as fire and water temperatures. These checks help to ensure that the James Page is a safe place for people to live, work and visit. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Care plan reviews should take place every four weeks. These should also include checking that plans contain sufficient information to guide staff who may be unfamiliar with the persons health and personal care needs and choices. Discussions should take place with the people living at the James Page and staff working there with regards to response times to call bells. If any issues are raised these should be monitored and action taken to rectify them. Individual discussions should be held with the people living at the James Page with regards to their opinions of activities and meals arranged by the home. This will help to ensure everyone has the opportunity to express their view and help the home plan future changes to benefit the people living there. 2 8 3 12 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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