Care Home: Kent Farm

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What the care home does well Before people move to Kent Farm, the manager visits and spends time with them and others involved in their care assessing the type of support they need to ensure that the home is suitable. Assessments form the foundation for care plans that detail each person`s lifestyle that help ensure that staff understand the support they need. During the inspection, staff were able to demonstrate their understanding of people`s care needs through discussion and their actions. The standard of health care is excellent with strong links with medical and health professionals, who have praised the quality of care. For example, `the monitoring of residents so far as their medication and illnesses are concerned is first class`. Medication is well managed to help maintain peoples` well being. People were clear that their dignity is respected and that staff are skilled in their approach. The home provides an excellent range of social activities, both inside and outside of the home, and people benefit from trips out using the home`s minibus, which includes an annual holiday. Visitors are made welcome and say they have good relationships with staff. There are strong links with the local community. People generally enjoy the meals served. People are confident that they are listened to and that any problems would be resolved. Staff are clear about their duty to report internally poor practice and their role to ensure that people are safe. A person living at the home told us there is `a nice atmosphere` while a relative commented that the home `has a good, friendly atmosphere and staff are cheerful...I couldn`t wish for a better care home`. Kent Farm is clean, well maintained, and provides a homely place to live. The layout is accessible to all the people living there and is well equipped to promote people`s independence. The home is appropriately staffed, and people benefit from a core group of experienced and skilled staff, who are actively encouraged to undertake training and develop their potential. Over half the staff group have NVQ 2 in care qualifications. Mandatory training takes place, as well as additional training in specialist areas. New staff are well supported. The home is well run by an experienced manager. There is a strong sense of involvement in the way the home is run, with people living there feeling that their opinions are valued. The home has an excellent quality assurance system. Records and safety checks are well maintained. What has improved since the last inspection? The recruitment process is more robust. External activities continue to expand, which include a two night holiday in Weston-super-Mare and a planned hot air balloon. There is an on-going maintenance programme, and the manager continues to purchase new equipment to promote the independence of people living there. What the care home could do better: Requirements are made when issues must be addressed within a set timescale. We have made no requirements as a result of this inspection but we have made recommendations to have all first floor windows restricted and for all radiators to be covered to help protect the people living at the home. People living and working at the home should also be reminded how they can make a formal complaint or respond to a formal complaint, while staff should be provided with clear guidance regarding contact details for external agencies. Finally, people should be consulted about the warmth of the home to ensure that it meets their needs and medication records should be signed after medication has been administered to promote best practice. Key inspection report Care homes for older people Name: Address: Kent Farm Kent Farm Mill Street Uffculme Cullompton Devon EX15 3AR     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: Louise Delacroix     Date: 1 5 1 2 2 0 0 9 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 28 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) 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. 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 CQC 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 28 Information about the care home Name of care home: Address: Kent Farm Kent Farm Mill Street Uffculme Cullompton Devon EX15 3AR 01884840144 01884841486 kentfarm@dsl.pipex.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ms Pauleen Rachel Maitrise care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Kent Farm is a residential care home, which provides a home for fifteen older people, who may have a physical disability. It is situated in the village of Uffculme and is close to the village square. It offers fifteen single rooms, ten of which have en-suite toilets. Fourteen of these rooms are situated on the first floor, and are accessed by a shaft lift. There is a homely lounge, a visitors lounge and a dining room. The home has a car park and rooms are styled to encourage the entertainment of visitors. The home is built on three sides of a courtyard, and people are encouraged to use this in the summer. The weekly fee ranges from 280 - 410 pounds with additional charges for hairdressing, Care Homes for Older People Page 4 of 28 Over 65 15 15 0 0 Brief description of the care home chiropody, newspapers and toiletries. The homes last inspection reports are well displayed in the entrance hall. Care Homes for Older People Page 5 of 28 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 inspection was unannounced and took place over seven hours at the home, and then we spoke with the manager for one and a half hours in the evening as she had been out on a trip with people living at the home when we finished the inspection. Three people living at the home contributed in detail to the inspection, as did the manager and three staff members. We also met with other people living at the home as we looked around the home. Time was spent talking to people individually. Prior to the inspection, surveys were sent to people living, working and visiting the home, which have been incorporated into this report. We received an excellent response level with fourteen surveys from people living at the home, eleven surveys from people working at the home and three from visiting health professionals. Many of the people living at the home had been supported by their relatives to complete their surveys, so their views have also been captured in some of the comments. Care Homes for Older People Page 6 of 28 As part of the inspection, three people were case tracked, this means that where possible these people were met, and the records linked to their care and stay inspected. During the inspection, a tour of the building took place, we observed a medication round and looked at records including care plans, staff recruitment, training and medication were looked at. Prior to the inspection, the home completed an Annual Quality Assurance Assessment (AQAA), which provides the Care Quality Commission (CQC) with current information about the service, staff and people living at the home. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: Requirements are made when issues must be addressed within a set timescale. We Care Homes for Older People Page 8 of 28 have made no requirements as a result of this inspection but we have made recommendations to have all first floor windows restricted and for all radiators to be covered to help protect the people living at the home. People living and working at the home should also be reminded how they can make a formal complaint or respond to a formal complaint, while staff should be provided with clear guidance regarding contact details for external agencies. Finally, people should be consulted about the warmth of the home to ensure that it meets their needs and medication records should be signed after medication has been administered to promote best practice. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 28 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 28 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 benefit from a good admission and assessment practice, which ensures that the home is able to meet their needs. Evidence: Assessments were looked at for people who have moved to the home since the last inspection. These include a pre - admission assessment, which the manager carries out either in the prospective residents own home or other settings, such as hospital. These records showed that a full assessment had been carried out by the manager, which recognised the range of care needs that prospective residents have, including physical, mental health and social and emotional needs. Part of the assessment includes a pen picture of the persons social history and acknowledges what events in their life are important to them. Identified care needs then form the foundation for the homes care plan, which is written for each person. We met someone who told us that they had visited the home before they moved in, Care Homes for Older People Page 11 of 28 Evidence: which helped them make a decision. All of the fourteen people living at the home who completed a survey for CQC said that they had received enough information about the home to make a decision whether it was the right place for them. The home does not provide intermediate care. Care Homes for Older People Page 12 of 28 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 staff demonstrate a commitment to the health needs of people living at the home, which is documented clearly in care plans, with the health needs of people being very well met. Medication is generally well managed to help promote the well being of people living at the home. Personal support is offered in such a way as to promote peoples privacy, dignity and independence. Evidence: Three care plans were looked at and these state the care needs of each person. They are detailed and provide individual approaches for the varying needs of people, such as personalised bath plans evidencing likes and dislikes. The care plans encompass physical, mental health, social and emotional needs of people living at the home. The plans record reviews and subsequent changes to approach, which was confirmed in discussion with staff and people living at the home. Care plans had been signed by the people living at the home showing they were consulted about the content. Staff members praised the care plans. A relative said that the home was good in reviewing Care Homes for Older People Page 13 of 28 Evidence: personal needs. Another person told us that their relative was very ill and that Kent Farm is doing everything possible to look after (them). They described the care being provided as excellent. During our inspection, we saw that close attention was being paid to a persons changing needs, with care being adapted to suit them, and staff being kept up to date by the manager. Three health and social care professionals responded positively to a survey sent to them by CQC stating that the home communicated clearly and worked in partnership with them. All respondents felt that the staff demonstrated a clear understanding of the care needs of people. Eleven people who live at the home said that they always received the care and support they needed, and three people said they usually did. Two people added extra comments that they were looked after well. A relative said that the home had made good progress in getting improvements in medical care. Another relative said what else can I say, it is first class. I can speak from experience, well done. The manager told us they had made changes to the provision of medical support to the home and that they have developed strong links with these health care professionals, which a GP acknowledged in our conversation with them. In a survey they said they enjoyed their relationship with all the residents, staff and management. In April 2009, a health professional told us that the manager advocated for a person living at the home in a very caring manner so that their health needs were met. Staff members recognise these health links when they told us residents welfare is paramount and always comes first and another said that the home has excellent communication with professionals. One person we met during our visit told us how the home supported their health needs and regular visits to the hospital for treatment. We heard a staff member reassuring them and altering their meal to suit the appointment. We also saw evidence of the manager accompanying people to their medical appointments and examples of the manager advocating for their right for treatment. She spoke to us about tackling ageist attitudes towards the provision of health care. The records in the home show that peoples weights are monitored with action taken to address concerns. For frailer residents food and fluid intake is monitored and staff showed us their records, and the homes diary reminded people to complete this task. The homes AQAA states that there additional staffing now in place to meet the needs of people who need support with their meals. Care Homes for Older People Page 14 of 28 Evidence: One person did express concern that with the changes in cooks that they were not always sure that their meals suited their medical condition. A health professional said this home cares for some very dependent residents and does it exceptionally well, while care plans detail what action needs to be taken to meet the health needs of residents, such as pressure care, which we discussed with the manager. The GP for the home was described as marvellous by a person living there and we were told that they felt valued. The GP has a weekly visit to the home, plus additional visits, if needed. We saw from records that people living at the home have regular access to foot care and massages, and the homes AQAA states that the home ensures regular chiropody, eye and hearing tests. The home is proactive in trying to maintain peoples independence and well being, and we saw from records and from discussion with staff examples of this. The homes AQQA stated that there are exercise classes three times a week. Three health care professionals said that peoples medication was appropriately managed. We observed a medication round where a member of staff was seen reassuring people, checking pain relief and ensuring people had control over pain management. Care plans also recognise the need for pain control. All of these elements evidence good practice. A diary entry showed staff awareness of monitoring that people take their medication. We saw that the medication records were signed before the person took their medication, while best practice states this should be after. We discussed how the non-touch technique should always be adopted when medication is administered. Records were appropriately kept. For example, changes to the medication administration records were double signed. Drugs are correctly stored, including controlled drugs, which are accompanied by clear records, which could be easily audited during the inspection. Staff described how the medication stock is checked and the steps that have been taken to try and improve the homes current system. We looked to see how peoples dignity and privacy is respected. We saw from care plans that peoples individual wishes are recorded and when we spoke to a member of staff they talked about people in a respectful manner. In response to a CQC survey, all the respondents who live at the home said that staff either always or usually listened to them and acted on what they said. Ten people said this was always the case, and people told us this on the day, although several people felt that staff were too busy to spend much time with them and a relative said it would be nice if staff had time for a chat sometimes. A relative felt that some staff communication could be improved so that people living at the home are always responded to by staff but also told us that Care Homes for Older People Page 15 of 28 Evidence: generally we find it a well run and caring home. Other people told us that staff are caring and friendly and look after people very well. Care Homes for Older People Page 16 of 28 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. The range of social activities is excellent for the people living at Kent Farm, who are also supported and encouraged to maintain links with the local community. People make decisions about their lives. Evidence: The manager and staff with the support of people living at the home have worked hard to ensure that the activities and social opportunities within the home meet peoples range of interest and ability, and the homes quality assurance meetings help ensure this. A person living at the home explained that people had been consulted about trips that they would be interested in, and that some of these had taken place. The manager has invested in a minibus. Photographs around the home showed that a mix of people went out on the trips. Trips have included a two night holiday at Weston-super-Mare, which is a significant achievement in this area of care, and included people with complex care needs. Regular trips out include, a visit to a cafe, visits from the Donkey Sanctuary or a garden centre; the latter took place during our inspection. People also told us about a local community event that had taken place in the evening before our visit, which some people from the home chose to attend. However, one visitor to the home Care Homes for Older People Page 17 of 28 Evidence: suggested that more could be done to occupy some of the people in the lounge, and whether they could be more involved in the life of the home by setting the dining rooms table etc. During the afternoon, three people sat quietly in the lounge having chosen not to go on the trip, with occasional staff interaction. Records show that regular activities do take place for those who wish to take part. Discussions with people, staff, completed care records and the homes AQQA show that there is a range of internal activities, including craft, quizzes, and cooking sessions. Sessions are written up, which provide a good overview of the success of the event, and help monitor the general well being of people by their responses and interactions with one another and staff. From the comments made by relatives in their surveys, care records, and discussions with people living at the home and staff, we can see that the home works closely with peoples families and friends. People told us that they could see visitors in private. All the rooms seen during the inspection had room for two comfy chairs to help this happen. During the inspection, staff appeared confident and welcoming to visitors; visitors to the home said that they felt involved, and were included in social activities. For example, the home is planning a hot air balloon trip and we were told that some relatives are acting as a buddy for people living at the home who have chosen to take part in this experience. People living at the home were clear that they could exercise choice. For example, whether they joined in with activities, what they ate and where they ate meals. Some people said they preferred spending times in their rooms only coming down for meals and chosen activities; others said they enjoyed the communal life of the lounge. In the homes AQQA, there is recognition that peoples end of life choices need to be recorded and this is part of care planning development. The manager has explained to us that it has been difficult to recruit an permanent cook at the home, so agency staff have been used to supplement the current arrangements, who have been variable in standard, and consequently have been told not to return to the home. The manager has been pro-active in trying to address this problem but told us suitable candidates are difficult to find. In response to the CQC survey, four residents said they always liked the food, nine said they usually did and two said sometimes. One relative said in a survey that the food was good but another commented that the food was variable due to the difficulty of employing cooks. They told us that the food is sometimes very good! Mostly medium to good, but occasionally poor (dried up and overcooked). Always plenty though. People told us that they could have an alternative to the main meal, and gave us examples. Care Homes for Older People Page 18 of 28 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. Most people know what to do if they are unhappy about the service. Staff generally have a good knowledge and understanding of their role to ensure that people living at the home are protected from abuse. Evidence: The homes AQAA states that no complaints have been received by the home. None have been received by CQC in the last twelve months. Three health and social care professionals surveyed by CQC told us that the home always responded appropriately to concerns. Thirteen people told us in their surveys that there was someone they could speak to informally if they were not happy and nine of these people knew how to make a formal complaint. One person said there was nobody they could speak to informally if they were not happy. The manager told us how she has challenged poor practice by health care services, and is awaiting an outcome of a complaint she has made. Staff who were interviewed were clear what they needed to do if they received a complaint from a resident or visitor. Ten staff members in their CQC surveys told us they knew what to do if someone has concerns about the home but one did not. Staff were able to tell us about their role in safeguarding vulnerable adults. All were clear about their responsibilities to report poor practice to their manager but were less clear who they would contact externally. Care Homes for Older People Page 19 of 28 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 home provides people with an attractive, clean and homely place to live. There is a commitment to provide an environment that is accessible to the people living there, which is demonstrated by a broad range of equipment. Evidence: The manager continues to ensure that the home is well maintained. The courtyard is easily accessible, and last time we were at the home people told us how it was used during the summer, which photographs seen on this visit confirmed. The manager spoke about a rolling programme of maintenance and could give us examples. We saw that the kitchen has been refurbished and redecorated. A staff member commented in their survey that Kent Farm is constantly being improved... by decoration, carpeting, upgrading mattresses, beds for the needs of individual residents, hoists, commodes, chairs etc. Since the last inspection, peoples bedrooms have been redecorated and re-carpeted, which people confirmed when we spoke to them. They told us about the colours they had chosen. The communal areas of the home are homely in appearance. There is now a newly created quiet lounge so that people can meet with visitors there if they wish, which was in the process of being furnished when we visited. We also visited a room that has been decorated so that it can be used in the future for a new massage and beauty therapy room, which will be used by the weekly masseur. The manager Care Homes for Older People Page 20 of 28 Evidence: told us that lounge carpet was new, and had been chosen by people living at the home, and we discussed the replacement of carpets in the corridor and dining room. There are plans to change to the entrance of the home, which will result in an individual room for people to use the homes computer. During the afternoon, we saw that some peoples body language in the lounge showed they were cold, and staff responded by offering a blanket. Staff during the day commented that they were hot but were active throughout the day. One staff member in their survey said that some rooms could be hard to keep warm. We asked people as we went round if they were warm, one person said their room had been cold, but this had been rectified. A visitor said that the home kept their relatives room clean and warm. The home is very well equipped to meet the needs of people with a physical disability, which helps ensure that everybody has equal access and that where possible peoples independence is maintained. For example, there is a shaft lift between the two floors of the home for good accessibility. There are grab rails throughout the building, both in communal and individual peoples rooms. While in the upper bathroom, we saw that the home has bought a specialist toilet seat to increase peoples independence. There are two assisted baths, one of which includes a hoist system. Rooms have ceiling tracks hoists in place and the home is fitted with a portable call bell system. Pressure relieving equipment was seen being used around the home, and the manager evidenced through the inspection her knowledge of individual residents needs and was heard ensuring that equipment was suitable to meet these. The homes AQAA states that four new electric beds have been bought to reflect the changing needs of people living at the home, which we saw during our visit. All areas of the home are accessible to people using wheelchairs, including the courtyard. The home was clean and odour free on the day of the inspection, although there are areas of the kitchen that need further attention. In response to the CQC survey, thirteen people said the home was always fresh and clean, and one person said it usually was. Peoples rooms are fitted with paper towel dispensers. Liquid soap is provided, and staff spoke about the protective clothing available. These measures help prevent cross infection. We saw advice to staff about protection control measures to care for people, and staff were able to tell us what steps they take to reduce cross infection. Since the last inspection the AQQA states that the home have bought an upgraded commercial washer and that there are colour coded equipment in the sluice room to help promote infection control within the home . Care Homes for Older People Page 21 of 28 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. People living at the home benefit from experienced and friendly staff who have a good understanding of their needs, and who are recruited in a safe manner, and have access to training. Evidence: On the day of the inspection, there were three carers on duty in the morning, one of whom was a senior. The night carer also stays until 8.30am.The manager and the cook were also on duty. A visiting health care professional told us that a senior member of staff is always on duty to confer with and that they were provided with up to date information. In the afternoon, two staff members were on duty at the home, while other staff accompanied a group of people on a trip. The staff that remained also prepared the afternoon meal as part of their duty. The home has one waking carer and the manager provides sleep-in cover. Eleven people told us in their surveys that they always received the care and support they need and three said this was usually the case, which indicates that the home generally has an appropriate staffing level. One person told us that there was a core group that stayed but there were regular changes, and that they missed one member of staff in particular. They told us that it was difficult to recruit the right staff, which the homes AQQA also stated. Six staff said that there were always enough staff to meet the individual needs of people living at the home, Care Homes for Older People Page 22 of 28 Evidence: and five this was usually the case. On the day of the inspection, staff appeared busy throughout the day, which people living at the home commented on. This was partly due to the level of monitoring that was being provided to a person who was unwell. Staff told us in their surveys that training is promoted in the home. The homes AQQA states that over fifty percent of the staff have an NVQ 2 in care, which was confirmed in discussion with staff. We saw in a recruitment file for a new member of staff that they had commenced training for this qualification. Three staff recruitment files were looked at for staff that have been recruited since the last inspection. We also discussed the content with the manager, and were provided with further information. There has been improvements to the homes recruitment process, which address the requirement made on the last inspection. In the CQC staff survey, one respondent said training opportunities are available to all staff and another said staff are also encouraged to develop by obtaining qualifications relevant to their post, while minutes from meetings confirm this approach. All staff responding to the CQC survey said they received relevant training. A member of staff also spoke to us about their own personal development under the current manager. They were able to recognise their own areas of expertise and areas where they wished to develop further. They felt well supported by the manager. Staffing records show that training is provided, including first aid, dementia awareness and moving and handling has been provided. Induction records are in place for new staff. Six staff told us in their surveys that that their induction covered everything they needed to know to do the job when they started, a further five said this was mostly the case and one said this was partly the case. The minutes from a residents meeting show that they are asked their opinion on the work of new staff, which demonstrates that the manager values their views on care workers suitability. We also saw examples of staff members written work that showed insight into their roles and the experience of people they cared for. Care Homes for Older People Page 23 of 28 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. This home is well run by an experienced manager, with an ethos which promotes the involvement of people living at the home. Evidence: The manager has many years of experience in working in residential settings and is involved in a county wide training initiative. She recognises the importance of acting as a role model for staff, and encourages both people living at the home and staff to fulfill their individual potentials. The manager has spoken to us about promoting professionalism within the role of care workers. Feedback from staff suggested that they feel communication usually or always works well in the home, although one person felt that communication could sometimes be handled more tactfully to cause less upset. Staff told us in their surveys and from our discussions that they had the information they needed to do their jobs. Most staff felt that they received the support they needed, and that they had enough support, experience and knowledge to meet the needs of people living at the home. Care Homes for Older People Page 24 of 28 Evidence: The home is run in the best interest of the people living there. This is evidenced by discussions with people living at the home who are well informed. People confirmed that regular residents meetings took place and copies for some of meetings were seen, which showed the meetings covered a broad range of topics. People also told us about how they are involved in the recruitment of new staff and records reflect their input and their views. We have seen numerous examples of how people are asked for their opinion about the service to ensure that it is what people want, such as gathering their views on the role of the activities coordinator, the success of the holidays and the quality of entertainment. The manager explained that the home does not hold personal allowances for people living at the home instead extra costs are invoiced, for example, hairdressing. Spot checks during the tour of the building showed that window restrictors are in place, although we were told one window is due for replacement and that a suitable restrictor will be fitted. We spoke about reducing risks for the person using the room and others who may have access until this time. Most radiators are protected to help protect the safety of people but there are some that do not have this safety measure in place. The homes AQQA states that equipment services are up to date. The AQQA also states that staff have received training in infection control and food hygiene to help promote good practice in the home. Care Homes for Older People Page 25 of 28 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 26 of 28 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 Medication administration records should be signed by staff once the person has taken their medication to follow safe practice guidelines. People living and working at the home should be reminded how they can make a formal complaint or how to respond to a formal complaint. Staff should be provided with clear guidance regarding contact details for external agencies e.g. Care Direct and local Police contact details. People should be consulted about the warmth of the home, both in communal areas and in their individual rooms, and any action needed should be recorded and acted upon. All windows should be fitted with a restrictor to help keep people safe. All radiators should be fitted with protectors to help keep people safe. 2 16 3 18 4 25 5 6 38 38 Care Homes for Older People Page 27 of 28 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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