Care Home: John Wills House

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What the care home does well People will be provided with clear information about the home, and their care needs are assessed prior to admission. This means they can be assured that the home will meet their needs. Intermediate care is provided in The Beeches - this may be a short stay to enable carers to have a break or to assist people to regain their independence and to return home. The care planning processes ensure that each person receives the individual care and support that they need, and that they will be well cared for in respects of their health, personal and social care needs. Medications are well managed. People will have the opportunity to participate in a range of different activities but can choose to spend their time as they wish. They are supported to maintain contact with family, friends and the outside community, and are provided with an excellent standard of catering. People can be assured that any complaints or concerns they have will be listened to and acted upon. The staff ensure that those who live in the home are safeguarded from harm. John Wills House is a comfortable and safe home, that is fully equipped to meet the needs of the people who live there. It is beautifully furnished and maintained to the highest of standard. People who live in this home will be cared for by staff who are skilled and competent to do their jobs, so they can be assured that their specific care needs will be met. Robust recruitment procedures ensure that the right staff are employed at the home. John Wills House is well managed, has clear and effective leadership, and is run in their best interests of the people who live there. Their opinions and comments are valued and there is a real committment to providing the best possible service. What has improved since the last inspection? No requirements were made after the last inspection and all expected standards were either met or exceeded. What the care home could do better: It has not been necessary to issue any requirements following this inspection. Key inspection report Care homes for older people Name: Address: John Wills House Jessop Crescent Westbury Fields Westbury on Trym Bristol BS10 6TU     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: Vanessa Carter     Date: 1 5 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 31 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 31 Information about the care home Name of care home: Address: John Wills House Jessop Crescent Westbury Fields Westbury on Trym Bristol BS10 6TU 01173773700 01173773725 angela.healey@stmonicatrust.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): St. Monica Trust Name of registered manager (if applicable) Mrs Angela Rosalind Healey Type of registration: Number of places registered: care home 80 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 80. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) - maximum of 15 places Physical disability aged 50 years of over (Code PD) - maximum of 3 places Date of last inspection Brief description of the care home John Wills House is a purpose built care home, built and owned by St Monicas Trust. It is registered with the Care Quality Commission (CQC). The home is situated in the Care Homes for Older People Page 4 of 31 Over 65 0 80 0 15 0 3 Brief description of the care home Westbury Fields Retirement Village. In addition to the home there is a complex of sheltered housing, retirement apartments and bungalows, these do not fall under the remit of CQC regulated services. The home is well appointed and shares its building with a purpose built pub, the Cricketers. John Wills House is registered to provide different levels of care in each of the four units: The Willows provides placement for 50 people, both male and female who require nursing care, in two separate 25 bedded units. All rooms are for single occupancy, with ensuite facilities and ceiling fitted hoist mechanisms. The Orchards provides placement for 15 people, both male and female with personal care and dementia care needs. The Beeches, is again for 15 male or female persons, but only on a short term or respite basis. A number of the beds are block booked by South Gloucestershire PCT and Bristol City Council. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection of this service was undertaken in April 2007 and our overall judgement about the quality of the service provided for the people who live in John Wills House Nursing Home was that people received an excellent service. After that inspection we planned to visit again within three years. In the meantime, we have completed annual service reviews in 2008 and 2009 and have been assured that the service was still providing excellent quality outcomes. Since the last inspection St. Monicas Trust have made a major variation application and 20 new beds are now provided. Prior to this inspection the registered manager completed the annual quality assurance assessment (AQAA). This is a self assessment document that focuses on how well outcomes are being met. The assessment had been completed in detail and told us about the improvements that have made over the last 12 months and identified those Care Homes for Older People Page 6 of 31 areas where they felt they could do better. It also provided us with some data information about the service. We sent surveys to the home manager for dispersal to people who live in the home and staff who are employed. We received 21 completed forms back. This gave us useful information about what it was like to live and work in John Wills House. During the inspection we looked at records kept by the home, including care records and those that are kept in respect of the running of the home. We spoke to the manager and those registered nurses and care staff on duty. We observed the interactions between individual staff and the people who live in the home, and we spoke to a number of people who live in the home and asked them what it was like to there. At the time of writing this report the fees for placement in the home range between 623 and 959 pounds per week - there are different fee rates for the different types of service provision that the home provides. The home manager will be able to provide further information about this. Additonal charges may be made for other services (hairdressing and newpapers for example) and these are detailed in the homes brochure. Care Homes for Older People Page 7 of 31 What the care home does well: 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 8 of 31 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 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will be provided with clear information about the home, and their care needs are assessed prior to admission. This means they can be assured that the home will meet their needs. Intermediate care is provided in The Beeches - this may be a short stay to enable carers to have a break or to assist people to regain their independence and to return home. Evidence: The homes Statement of Purpose and Service Users Guide has been kept up to date and reflects the services and facilities available at John Wills House. It contains all the necessary information to enable a prospective person who wants to live in the home, and/or their representative, to make an informed choice about what the home has to offer. The 16 people who completed our survey forms each said they had been provided with enough information about the home and had decided it was the right place for them - I had a respite stay here and then decided to move here, my daughter decided on this home and made a good choice and I used to live in the Care Homes for Older People Page 10 of 31 Evidence: village therefore it was natural to come here. Each person is provided with a statement of terms and conditions of residency upon admission. Some people are privately funded whilst others are partly funded by the local authority or the primary care trust. In these instances the home will have contracts drawn up with whichever relevant party. An assessment of care needs will be undertaken following an enquiry for a room, prior to any placement being offered. A comprehensive EasyCare document is used to record the assessment - it covers all aspects of a persons personal care needs, daily living, health needs and social care needs. The assessment will identify whether there are any specific equipment needs. These measures will ensure that the home is able to meet the persons specific care needs and any equipment would be in place on admission. One person commented during the inspection I was visited on the ward by the manager, as I couldnt return to my flat. We talked about John Wills and how they could look after me. As the people who live in The Orchards have varying degrees of mental frailty and dementia, new admissions will only be arranged after a series of assessment visits which take place in the unit. Placement will only be offered after a full assessment of the suitability and compatibility with the others who already live there. The Beeches is an Intermediate Care Unit and has 15 beds and its own separate communal facilities. South Gloucestershire PCT Intermediate Care Team (ICT) have block purchased three of the beds, and people will be admittted from their own homes when they have an illness and hospital admission can be avoided, when a community package of care breaks down, or for rehabilitation. The care staff on the unit will provide care for these people, working in conjunction with the ICT staff to enable the people to return to their own homes. Two beds are funded by Bristol City Council who use them for planned respite and often people will return on many occasions. People can also make their own private respite arrangements directly with the home. The usual maximum length of stay is six weeks. Care Homes for Older People Page 11 of 31 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 care planning processes ensure that each person receives the individual care and support that they need, and that they will be well cared for in respects of their health, personal and social care needs. Medications are well managed. Evidence: We looked at four care files during the inspection to determine the arrangements that are followed to work out how people are cared for. The plans were each personcentred, had been written in the first person, and evidenced that they had been written in conjunction with the person and/or their representative. The plans were comphrensive and covered all areas of personal care, health care. emotional, social and mental health, and took account of each persons diverse needs. It is very evident that each person is treated as an individual, and is cared for in the way that they want to be. Identified care needs were set out in the various plans of care, with detailed instructions for the care staff in how these needs should be met. The plans are reviewed on a monthly basis and amended and updated as necessary. Where equipment has been identified as being essential to maintaining the persons Care Homes for Older People Page 12 of 31 Evidence: comfort, this is referred to in the plan of care. The plans are supported by a number of risk assessments and we saw those that had been completed in respect of likelihood of developing pressure sores, nutrition, falls and moving and handling tasks. A manual handling profile and risk reduction strategy is prepared for each person and a copy is kept outside each bedroom, so that staff have readily available information and always know how to move someone safely. Senior care staff have received additional training in moving and handling and are Key Movers - they will reinforce training for new staff and can provide advice on solutions if new moving and handling problems present. The following comments were made by people spoken with during the inspection or who completed our survey forms - the staff are wonderful. I have only got to press by bell and somebody comes to help, it is lovely here, I come back on a regular basis to recharge my batteries, I am very lucky to live here, the care is excellent, the staff always help me when I am having a bad day and the staff make residents feel valued, special, comfortable and at home. We are assured by what we have seen and heard that people who live in John Wills House will all be very well cared for and will receive an excellent standard of care. Daily communication sheets record the care given and are completed by the nursing care assistants and registered nurses. Those entries that we looked at were detailed, provided a clear insight into what care had been given and were written in a respectful manner. Each entry was signed in line with good record keeping guidelines. A record is maintained for each person showing their contact with their GP or other health care professionals. We were told that the majority of people are registered with one practice and there are currently negotiations in place to set up a contact with the PCT for this GP to provide a local enhanced service. This GP already visits the home on a twice weekly basis and at other times when needed Examples of other healthcare professionals who visit the home include opticians, dentists, and a psycho-geriatrician and memory nurse visits the people in The Orchards. All the people who completed our survey forms said they received the medical care that they needed. People have access to physiotherapy and chiropody services provided by the home. The medication procedures were looked on one of the nursing units and The Beeches - the short term stay unit. The home has robust procedures in place for the ordering, receipt, administration and disposal of medications. We saw that hazard warning signage was displayed when oxygen therapy was in use and where cylinders were being temporarily stored - cylinders will generally be stored in an outside secure storage area. A Self Medication policy and procedure has been instigated in the short term care unit. This is to ensure that when people return to their own homes they still have the necessary skills to manage their medications independently. A risk assessment will Care Homes for Older People Page 13 of 31 Evidence: always be undertaken and the level of support determined (this will range from being unable to self-medicate up to full responsibility for their own medications). people are provided with a leaflet about these arragements and staff have attanded a clinical workshop regarding the scheme. We looked at the storage arrangments and the medications administration records (MAR charts) - it would be good practice that any handwritten entries made on these MAR charts are countersigned by another member of staff to double check that they are correct. This is particularly important in the short term stay unit where people come in with their own supply of medications. However, people can be assured that they will receive their medications correctly. It is evident that people are cared for with respect to their dignity and their privacy. Those people who completed our survey forms said the staff are always very kind and helpful, I am treated very well and the nursing and general care is 100 . Personal care is provided in private and staff were observed to be polite and courteous in their dealings with the people they were looking after. The home always ensures it knows how people want to be cared for if they have a sudden illness or a gradual deterioration in their health. Peoples wishes regarding their end of life care and death is recorded in their plan of care. The staff are skilled in consulting with people at the appropriate time and will involve the GP and any relevant family or representatives. Any significant conversations will be recorded in the persons care notes. People can be assured that the staff will look after them in the manner in which they wish, when it comes to end-of-life care. Care Homes for Older People Page 14 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will have the opportunity to participate in a range of different activities but can choose to spend their time as they wish. They are supported to maintain contact with family, friends and the outside community, and are provided with an excellent standard of catering. Evidence: The home has a programme of activities each day that people can choose whether or not to participate in. The weekly plan of activities is displayed throughout the home and a copy posted in each bedroom. We looked at the programmes for a two week period. Those people who can are supported to attend functions held in the sheltered housing complex, on the same Westbury Fields site. Exercise classes, current affairs group, music sessions, arts class, bingo, and a Willows Walk. There are weekly Singing for the Brain sessions - particularly beneficial for people with a dementia or mental impairment. A pastoral co-ordinator holds a worship meeting each week plus there is a prayer meeting, led by one of the people who lives in John Wills House. The home ensures that it can meet any cultural and religious needs. The pastoral coordinator will visit each person after admission, and will find out what the persons expectations are. The home has a computer room, with internet access and computer lessons and guidance is provided - people can be helped to maintain email contact Care Homes for Older People Page 15 of 31 Evidence: with family and friends. A minimbus is available on a shared basis with other St Monica trust care services, and trips to the shops are arranged. We received the following comments from people we spoke with during the inspection and in our survey forms - my friend is a long standing christian and therefore the pastoral visits are very important to them, the weekly singing for the brain sessions are fabulous, various outings and activities are arranged and I have been ill recently and missed all the goings on. But the staff have popped in regularly and kept me in touch with things. Attached to the home there is The Cricketers Pub - this is well used by people who live in John Wills House and the Westbury Fields Village. Visitors can have a meal there with their relative or friends. Some people have partners and friends who live in the village, and therefore this facility enables them to still be able to go out for lunch. The home has an open visiting policy and visitors are viewed as essential to maintaining a persons well being. One relative who completed our survey form said the home is also very supportive of the relatives as well. The manager provided an example of how they had cared for a relative whilst they were unwell, to ensure that the person who lived in John Wills did not get distressed. During the inspection we observed positive and friendly interaction between staff and visitors. We were told that visitors are always offered coffee/tea and biscuits/cake when they visit their relatives. People will be encouraged to make decisions about all aspects of their daily life. This may include choosing where to take a meal, where to spend their time, or what time to get up in the morning and what time to retire to bed at night. A choice of menu is offered at each mealtime and people are asked what they would like to eat at the next meal when teas and coffees are served out mid-morning or mid-afternoon. There is a also a list provided for each person in their bedroom of alternatives meals can can be provided - this list included foods such as omelettes, jacket potatoes, salads and other snack options. We were told by the home manager and one of the regisetered nurses that high-energy nutritious drinks or supplements will be offered to those who are reluctant to eat. A roast meal is served twice a week, and was served on the day of inspection - I have just had the roast meal, the meat just melted in your mouth was a comment made by one person. The menus consist of a range of chicken, fish and red meat meals and each day there is a vegetarian option. The home will cater for other diets as and when necessary - the catering manager will visit people to discuss specific dietary requirements. The same meals served in the home will be served in The Cricketers Pub. People will be encouraged to take their meals in the dining room however can have a tray service in their own Care Homes for Older People Page 16 of 31 Evidence: rooms if they wish. Each of the units has their own dining room, and catering staff will serve out meals supported by care staff. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that any complaints or concerns they have will be listened to and acted upon. The staff ensure that those who live in the home are safeguarded from harm. Evidence: The homes complaints procedure is contained within their Statement of Purpose and the Welcome Pack placed in each persons bedroom. We received 11 of our survey forms back from people who live in the home or from relatives. Those people spoken with during the inspection said that they were aware that the home had a complaints procedure - there is nothing to grumble about here, If I have a problem I tell them about it, they always act on it and nothing is too much trouble. The home manager has handled four formal complaints in the last 12 months. A record of any complaint and the outcome is kept in the complaints log. We have been contacted on one occasion in the last year and we visited and met with the home manager,to discuss the information we had been provided with. We were assured by this visit that the situation had been handled appropriately. The manager looks upon complaints positively and sees them as a means of reflecting on working practices that are brought into question, and looking for ways to prevent a reoccurence of the issue. This positive approach will ensure that the service remains appropriate for the needs of the people living in the home. Care Homes for Older People Page 18 of 31 Evidence: Staff who were spoken with during the inspection demonstrated a very clear awareness of safeguarding adult issues, and of their responsibilities to take any appropriate action. They told us what they would do if something unacceptable were observed or told to them in conversation, and who they would report concerns to. Concerns would be reported to the home manager or the most senior member of staff on duty. Information regarding safeguarding reporting procedures were displayed throughout the home. We made a suggestion that the contact telephone number for the local authority duty desk (Care Direct) be added to this document. This was actioned straight away. All staff are expected to undertake safeguarding of vulnerable adult (SOVA) training at the organisations training department. People we spoke with during the inspection said that they were well cared for and were safe - everyone is so kind and polite, my relative is happy and settled and I am confident that her well being is paramount and I feel safe in the hands of the care staff. Care Homes for Older People Page 19 of 31 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. John Wills House is a comfortable and safe home, that is fully equipped to meet the needs of the people who live there. It is beautifully furnished and maintained to the highest of standard. Evidence: The home was first opened in 2003, but was extended in 2008 to provide an additional 20 bedrooms. Both inside and out the building is well maintained and the gardens surrounding the home are well tended. There is a planned programme of redecoration and the corridors and some of the dining rooms are due to be revamped this year. The home is built within the Westbury Fields Village, in addition to retirement apartments and sheltered flats. The building surrounds a central courtyard that has nice landscaped garden, with plenty of seating provided. Those people who live in The Orchards, are able to access a safe and secure garden area - this has been landscaped bearing in mind the needs and people with dementia. Westbury Fields is entered via electronically operated gates. The home is a two- storey building, entered via a large and pleasant reception area. The reception area is staffed during office hours. The Willows, the nursing beds, is split in to two units, 25 beds on the ground floor and 25 on the first floor. The Orchards unit for up to 15 people who have dementia care is on the ground floor and the Beeches (the respite care/intermediate care unit) is on the first floor. In order to Care Homes for Older People Page 20 of 31 Evidence: prevent the people in The Orchards from wandering off, the door into the unit is key padded and all other exits from the unit are linked into the alarm call system. Each of the bedrooms in The Orchards has a sensor system installed. This can be set differently for each person, or switched off, dependent upon their specific needs. Sensor pads placed under the mattress will switch on lights when a person gets up during the night and will alert staff if they do not return to bed within a specified time. This equipment enables people to retain their independence in safety. The first floor can be accessed by one of two lifts, or a stairway, thereby it is fully accessible for older and disabled people. The four separate units each have their own lounge area and dining rooms. The furniture and soft furnishings are of a superior quality, making the rooms a very pleasant space in which to relax and take a meal. In addition, there is a large lounge area leading off from the reception area that is also used by people who live in the Westbury Fields accommodation. Attached to the home is The Cricketers Pub and this is used by some people, particularly when entertaining their visitors and family. Each of the 80 bedrooms is for single occupancy, spacious and with ensuite bathroom facilities. All bedrooms in The Willows and The Beeches are fitted with tracked ceiling hoists, thereby reducing the need for bulky manual hoists to be used - these tracks continue into the shower rooms. The home has an electric hoist for use in those areas where tracked ceiling hoists are not sited. In addition to the ensuite facilities, there are specialist bathrooms and toilets located throughout the home. People are encouraged to bring in their own possessions and small items of furniture. However, each room is furnished with quality furniture and fittings. All beds in the nursing units and the intermediate care unit are specialist profiling beds. In The Orchards, memory boxes are placed outside of each bedroom doors, and contain family photographs or other memorabilia. Each bedroom door is marked with the persons name and a very large brass number. This aids people in locating their own bedrooms independently. The home is centrally heated and well lit, and each room is well ventilated. The radiators are all of low surface temperature type. Fans are made available during the hot weather but air conditioning units are available in the lounge areas during the warmer weather. All parts of the home are tastefully decorated and furnished throughout. In general the bedrooms are decorated when they become vacant. The home is kept spotlessly clean, tidy and odour free. Air freshener units are installed in the corridors and perfume the air without being overpowering. Comments received on our survey forms Care Homes for Older People Page 21 of 31 Evidence: completed by people who live in the home and relatives included the following - they maintain high standards of cleanliness and hygiene, the home is kept clean and confortable and everyone works hard to keep things looking nice. The laundry service for all St Monica Trust homes is provided off-site from the Cote Lane facilities. The manager told us in the AQAA that there are still some problems with the laundry service but a new labelling system is in the process of being introduced. One person who completed our survey form made reference to the difficulties with lost laundry, or receiving that of another person. The manager is fully aware of the problems and is taking action. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home will be cared for by staff who are skilled and competent to do their jobs, so they can be assured that their specific care needs will be met. Robust recruitment procedures ensure that the right staff are employed at the home. Evidence: The home currently has two empty beds in the nursing units but they are already earmarked for new admissions. There is one empty bed in the short stay unit. Any vancancies are generally filled quickly and therefore the home runs at near full occupancy at all times with a waiting list of people who want to live at John Wills House. Staffing levels are arranged based upon the collective dependency levels of the people in each of the units. The appropriate numbers of staff were on duty to meet peoples needs. The manager maintains an overview of dependency levels on each of the four units, and amends staffing levels accordingly. There is a unit managers for each of units, and they each have day to day responsibility and report to the home manager. There are 20 registered nurses and 69 nursing care assistants, and each worker is allocated to work in a specific unit. There are also a team of catering, housekeeping, administrative and portering staff, who provides services to meet peoples daily living needs. St Monica Trust has a team of bank staff who can be called upon to cover any shifts, Care Homes for Older People Page 23 of 31 Evidence: as and when needed - staff will also cover in-house if they are able to. Agency staff are not used and this means that people will be cared for by staff who are familiar with their care needs. This ensures consistency of care for the people who live in the home. Of the 69 nursing care assistants, 47 have already obtained at least, a National Vocational Qualification (NVQ) in Care, Level 2 (68 ), but a further six members of staff are working towards the award (76 ). All staff are encouraged to apply to do NVQ2 and NVQ3. There continues to be a commendable commitment to providing trained members of care staff. The following comments were made on our survey forms - The girls are all lovely. They are very good and friendly, the staff are always so kind and cheerful and the continuity of staff provides familiar faces and consistency for the residents. We received six of our survey forms back form staff who work at the home. All six said that they received enough information about people to be able to care for them properly, they had training relevant to their role,they were well supported by the manager and they were able to meet the different needs of people who live in the home. We provide high standards of care, this is a great place to work and we can be highly adaptable to peoples differing needs. We looked at a sample of staff files to check the processes that they follow when recruiting new staff. A robust recruitment procedure is followed that ensures that only suitable workers are employed. Applicants for a job will complete an application form and attend for a face to face interview. Two written references, CRB and ISAfirst clearance are obtained for all new recruits before an offer of employment can be taken up. New recruits will complete an induction training programme that meets the key requiremenrs of the common induction standards. They will receive training in the following - principles of care, safeguarding, fire, health and safety, moving and handling, and food safety. St Monica Trust has its own training department and have an annual training and development plan. We looked at the plan for 2010. In the first six months of the year the following courses were scheduled - assertiveness to improve communication, dementia awareness, nutrition for good health, emergency first aid, infection control, food hygiene, fire awareness, moving anf handling, and safeguarding adults. There are also clinical skills training and updates arranged. Each staff member has a Continuing Professional development training file that evidences the training they have undertaken - we saw these on one of the units. In each of the units there is a lead Care Homes for Older People Page 24 of 31 Evidence: nurse who is responsible for co-ordinating the training for the staff team. Care Homes for Older People Page 25 of 31 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. John Wills House is well managed, has clear and effective leadership, and is run in their best interests of the people who live there. Their opinions and comments are valued and there is a real committment to providing the best possible service. Evidence: The registered manager Mrs Angela Healey is a registered nurse and has completed her Registered Managers Award. She has been the Care Home Manager since the home opened in 2003. She is well qualified and has the necessary skills and experience for this position. She is supported in the the management of the home by a deputy manager, a clinical manager, night manager and unit manager. The deputy manager is currently undertaking an NVQ Level 4 in Leadership and Management in Care Services, and in the absence of the home manager, takes responsibility for the running of the home. Residents meetings, registered nurses meetings and care staff meetings are held on a regular basis and ensure that the home is run in the best interests of those who live Care Homes for Older People Page 26 of 31 Evidence: there. It is evident that there is full and open communication with all teams in the care home. People we spoke with and comments made on our survey forms include the following - We are always being asked if everything is okay and we are happy with things, nothing is too much trouble and we get first class service here. St Monicas Trust undertake an annual residents survey. People are asked about the accommodation, the care and support they receive, staff and communications, the catering housekeeping and laundry services, the gardens estates and portering, and the activities arranged and community involvement. We looked at the last survey results and these showed that customer satisfaction was between 91-96 in four areas and between 81-87 in the other three areas. The Trust deveolps a plan of action in response to the survey results in order to improve standards. In addition, people who have a short stay in The Beeches will be offered a Short Term Care Questionnaire, where they are asked about their stay and what was the best and worst experience they had. Regulation 26 visits are made by one of the Trustees and the Operations Manager on a monthly basis, to monitor the quality of service. The home manager will complete a number of audits throughout the month - these include care plan audits and medication audits and a review of any events that have happened in the home. These measures evidence that the home looks seriously at how they provide their service and want to ensure it remains appropriate and meets peoples needs. The home looks after personal monies for some people who want this facility. The procedures in place for managing each individual account have been changed since the last inspection and we looked closely at the process with the administrator. There are good administrative procedures and computer records in place, backed up with paper records and evidence of transactions in and out of each fund. There is a planned programme of staff supervision for all staff members. The manager supervises the registered nurses who will each have responsibility for the supervision of a group of staff. Those staff spoken with during the inspection confirmed that they have regular supervision with a senior member of staff, and are well supported in their role on a day to day basis. Those home records that were examined were all in order. We have been notified (regulation 37 notification process) throughout the year of all events that have occurred in the home, and we have been assured that all events have been managed well. St Monicas Trust have a Fire Officer, who will check all fire safety arrangements in the home, and also a Health, Safety and Sustainability Officer. Risk assessments are Care Homes for Older People Page 27 of 31 Evidence: carried out for all safe-working practices and records are maintained when any restrictive measures (use of bed rails) need to be taken to secure a persons safety. Manual handling risk assessments are completed for each person and a moving and handling profile is devised - these are kept in a tray outside of each bedroom. This means that they are readily available for the staff to refer to. The home has robust health and safety procedures to ensure that the home remains a safe place in which to live and to work. No health and safety concerns were raised as a result of this inspection. Care Homes for Older People Page 28 of 31 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 29 of 31 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 9 All handwritten entries on medication administration charts should be countersigned to double check that the information is correct. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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