Care Home: Kernow House

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What the care home does well Kernow House provides nursing, personal care and support for a maximum of 98 people. On the day of the inspection people looked well cared for and those spoken to (or their relatives) said they were happy living in the home. Staff were observed working with people in a positive manner resulting in individualised care and support. People reported that they appreciated the `hotel style services` such as the comfortable reception, relatives being invited to have a hot drink with their family when visiting and the welcoming environment. They added that the meals are very good. Residents and relatives spoken to said that the staff are very kind, supportive and approachable at any time and appreciated being kept up to date about their ongoing progress. Comprehensive pre admission assessments are always carried out to ensure that the home can manage the needs of the person concerned. Access to Barchester`s training programme (tailored to meet the needs of current residents) and the in house trainer means that staff are regularly updated and have the skills to look after the residents. Documentation and records seen were well organised, up to date and stored appropriately. People are given choices about how they spend their time and activity organisers dedicated to each unit work with people to ensure the activities are tailored to meet their needs. Entertainers are bought into the home regularly and the variety of communal space means that people can spend time where and with whom they like. The home has two mini buses so people can go out on trips and shopping locally. We were told that the meals are nicely presented and the hotel style service in appreciated. Two mealtimes were observed and staff were available throughout to provide help and support as required. The robust recruitment system means that people are selected and checked appropriately before starting work meaning residents welfare is protected. The complaints management and ongoing quality assurance means that the home is always taking feedback and using it constructively to continually improve the service, this is noted as good practice. The environment is updated regularly to reflect current trends and ongoing redecoration and refurbishment mean people always have a comfortable and safe environment in which to live. What has improved since the last inspection? There were no requirements or recommendations made following the last key inspection in July 2007. The requirements made following a random unannounced inspection in November 2007regarding medicines management have all been met and as a result regular audits take place and medicines management remains consistent throughout the home. What the care home could do better: There were no requirements or recommendations made following this key inspection. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Kernow House Landlake Road Launceston Cornwall PL15 9HP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mandy Norton     Date: 1 7 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Kernow House Landlake Road Launceston Cornwall PL15 9HP 01566777841 01566777843 kernow@barchester.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Barchester Healthcare Homes Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 98 Number of places (if applicable): Under 65 Over 65 43 43 28 28 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: 0 0 0 27 Overall total number of service users not to exceed 98.. Service users to include up to 27 adults with physical disability (PD) in Millaton Court. Service users to include up to 28 adults of old age (OP) accommodated in Caradon Unit. Service users to include up to 28 adults with a physical disability (PD)(E) accommodated in Caradon Unit. Service users to include up to 43 adults aged over 65 years with Dementia DE(E) accommodated at Pethewin Unit, of which 5 may be between the age of 55 and 65. Service users to include up to 43 adults aged over 65 years with a mental illness MD(E) Care Homes for Older People Page 4 of 27 accommodated at Petherwin Unit, of which 5 may be between the ages of 55 and 65. Total number of service users accommodated in Petherwin Unit not to exceed 43. Total number of service users to be accommodated in Caradon Unit not to exceed 28. Date of last inspection Brief description of the care home Kernow House is part of the Barchester Healthcare group of homes. It is purpose built to provide nursing care and accommodation for up to 98 people. The accommodation is divided into three units Caradon unit can accommodate up to 28 elderly frail people, Petherwin unit up to 43 elderly people with dementia (five maybe between 55 and 65 years of age) and Millaton Court unit 27 people with a physical disability (presently all of whom have Huntington?s Disease). The home is situated on the outskirts of Launceston near the Health Centre & hospital. The home is built on two floors, which are connected by shaft lifts (for passengers & goods) and stairs. Caradon unit is on the ground floor, Petherwin unit is upstairs and Millaton Court is a separate single storey wing. Accommodation is mainly in single en suite rooms although there are a number of doubles within permitted limits. There are a variety of lounge and dining facilities on each unit. Exit & entrance doors are protected by keypads to ensure the safety of people in the building. There is a small patio accessible to residents outside the Caradon dining room, a sensory garden between Caradon and Millaton Court and separate garden area at Millaton Court. There is sufficient car parking available for staff and visitors at the front of the house. Qualified Nurses and Care Assistants provide care within a friendly but professional atmosphere. Activities take place each day organised by a number of activities coordinators. Information about the home is available in the form of a Residents Guide, kept at reception along with a copy of most recent inspection report, some thank you cards and letters and other useful information about local services. Fees across the whole home range from £637 to £2,026 per week (correct July 2009). Toiletries, chiropody and newspapers for example are not included in the fees. Care Homes for Older People Page 5 of 27 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: two star good 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: This unannounced Key Inspection took place from 10.05 am until 4.30pm on 15th July 2009 and from 9.50 am until 2.50 pm on 17th July 2009. It was conducted with the general manager, the deputy manager and the unit managers from Petherwin and Millaton Court. A tour of the home was carried out and residents, relatives and staff were observed and spoken to informally during this time. A variety of documents and records were seen during the course of the inspection. Other evidence gathered since the previous inspection such as notifications received from the home (e.g. regarding any incidents which occurred), the annual quality assurance assessment (AQAA) (a self assessment document that the home completes annually and submits to the Commission) and completed surveys from both care staff Care Homes for Older People Page 6 of 27 and residents was also used to help form the judgements made in the report. What the care home does well: What has improved since the last inspection? There were no requirements or recommendations made following the last key inspection in July 2007. The requirements made following a random unannounced inspection in November 2007 Care Homes for Older People Page 8 of 27 regarding medicines management have all been met and as a result regular audits take place and medicines management remains consistent throughout the home. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 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 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service have information about the home in order to make an informed decision about whether the service is right for them. The personalised needs assessment means that peoples diverse needs are identified and planned for before they move to the home. Evidence: The manager said that people are always assessed prior to moving into the home to ensure their needs can be met. If people are to be admitted they and their representatives are given as much up to date information about the service as possible, invited to look around and spend some time at the home and ask any questions they may have. During the inspection a number of completed pre assessment forms were seen, they asked for relevant details and form the basis of the care plan when a person is admitted. The manager, deputy manager and heads of unit Care Homes for Older People Page 11 of 27 Evidence: carry out the pre admission assessments as they have the relevant skills to decide if the home can meet a persons needs. Emergency admissions are sometimes necessary. Immediate information is recorded so that staff can meet initial care needs, a more detailed care plan is then completed over the next few days. People admitted to Millaton Court have often been on the unit for respite care prior to being admitted permanently or have been seen by the local outreach service whilst they were still at home. A comprehensive assessment of their needs is ongoing and the care adapted as required. An up to date Service Users Guide, available in the reception area, was seen and included up to date information about the services the home offers and a complaints procedure. The current fee level ranges from £637 to £2,026 per week (correct July 2009). Newspapers, hairdressing, chiropody and toiletries remain the responsibility of the resident. If people decide to stay at Kernow House the contract describes their rights and responsibilities, what the fees are and what is included in the fee. The AQAA told us that we have a comprehensive statement of purpose outlining our philosophies and beliefs. Advice and information is given regarding our terms and conditions and we ensure we are transparent in all our information. We offer any information we may have regarding funding and advise of advocacy services available. All five completed Service User surveys indicated that they had enough information prior to moving into the home to help them decide if it was the right place for them and that they were given written information about the homes terms and conditions. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The practice regarding the planning and delivery of care means that people can be sure that their health and personal care needs will always be met. Evidence: The care plans are updated at least daily and reviewed monthly. The nursing and care staff complete daily records about a persons welfare and detail what care and support has been provided. The care plans examined set out peoples needs and contained information about visits made by health care professionals such as physiotherapists, dieticians, GPs, opticians and dentists. There was also information about social history and hobbies and interests that the activity organisers use to tailor the activities to suit peoples group and individual needs. Individual risk assessments seen were up to date and relevant. A tour of the home showed that specialist equipment to help skin stay in a good condition and for prevention of pressure sores is available and meets peoples current needs. Staff spoken to said that they feel there is enough specialist equipment. Care Homes for Older People Page 13 of 27 Evidence: Caradon and Petherwin Units use a blister pack system for administering medication and Millaton Court dispenses medicines from their original boxes. This is because the residents on this unit may need their medications at different times than a blister pack allows and they often have their medication adjusted. The 2 drugs fridges seen had their temperature taken and recorded daily. The records of administration were clear and a photograph of each resident is kept with the record to aid identification. The procedure for receipt, storage and disposal of unwanted medicines was explained and is in accordance with laid down legislation. All of the requirements made following the random inspection carried out by the Commissions pharmacist in November 2007 have been met and regular in house audits carried out by the deputy manager and unit head and by the regional manager when they carry out their monthly visits ensures that good practice is ongoing. A number of completed audits were seen during the inspection. Staff in all units (including nursing, care, domestic and hostesses) were heard and observed interacting with people appropriately and providing care and support in a discreet manner. Staff were knocking on doors before entering and doors remained closed whilst personal care was taking place. One comment on a completed Service User survey was that it (the home) treats us with dignity. Relatives spoken to during the inspection said that peoples dignity is maintained and they are treated as individuals. Care Homes for Older People Page 14 of 27 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. A range of activities within the home mean that people have opportunities to participate in stimulating and motivating activities. Meals and mealtimes are not rushed and staff are available to help make them an enjoyable and social occasion for people. Evidence: There are a number of activities organisers working in the home (who all wear yellow polo shirts to identify them) and they are unit based allowing for continuity. Activities are recorded as are one to one companion sessions. The AQAA states that we have a full and varied programme of activities which are devised in conjunction with our residents who meet regularly to discuss what activities they wish to take part in. Activities include regular outings (planned and not planned) in the 2 minibuses they have, a fortnightly art group, shopping trips and outside entertainers. Religious needs are met and a hairdresser visits 3 times a week, who can also do hand massage and manicures. The AQAA says that people can choose to keep their own hairdresser or chiropodist if they wish. Relatives who were spoken to during the inspection had high praise for the ongoing activities and the time spent engaging people. One of the Care Homes for Older People Page 15 of 27 Evidence: completed service users surveys completed by relatives indicated that the home always arranges activities they can take part in and two indicated they usually do. Visitors are welcomed at anytime and people were seen coming an going freely during the inspection. Relatives spoken to when visiting appreciated that they are always offered a drink and for a small charge can join their relative for a meal. There are garden areas around the home that are accessible to the residents. There is seating for people to use and plants and vegetables are being grown, with input from some residents. There is a covered outdoor smoking area for residents to use. There is a digital photograph frame at reception with a number of photographs of the residents (only put on with their permission) enjoying their days out. Each unit has its own dining room although people can eat in their rooms if they wish. There is a 4 weekly menu rota and the daily menu is displayed in reception and on the dining tables (in Caradon Unit). People are asked what they would like for their meal and there is always a choice. Drinks and snacks are available 24 hours a day. Specialist diets are catered for and the home work closely with the local dieticians and Speech and Language therapists (especially in Millaton Court). Records are kept of what people eat to ensure they are receiving a balanced diet. The AQAA states that Barchester have enlisted the support of Paul Rankin to promote our Cooking With Care initiative which at Kernow House, has seen a much improved service. The food is prepared in the kitchen and taken to the units in heated trolleys. The two mealtimes observed showed that staff are available throughout to give people any help or support they may need. Care Homes for Older People Page 16 of 27 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. Formal complaints and safeguarding policies and procedures are in place and are available to staff at all times. Some staff undertake safeguarding training. This means that people who live at the home are adequately safeguarded. Evidence: The complaints procedure was seen displayed in the home and is included in the Service Users Guide and Statement of Purpose available in reception and given to people on request . It is comprehensive and gives options about who to contact and timescales for responses to be made. There have been no complaints made to the Commission in the last 12 months and the AQAA states that the home received 1 written complaint which was not upheld. The manager said that people are seen by senior staff daily and hopes that any issues or concerns would be bought up at then she added that they have regular contact with a number of relatives and feels they would be able to approach the appropriate staff with any concerns that would then be dealt with quickly. All five completed resident surveys indicted they knew how to make a formal complaint and that there was somebody they could speak to informally if they were not happy. The two completed staff surveys indicated that they knew what to do if somebody has concerns about the home. The AQAA states that we consider every concern raised as a serious issue as it is affecting the enjoyment of life with us for that individual. We therefore investigate Care Homes for Older People Page 17 of 27 Evidence: all issues raised in a robust fashion as quickly as possible and endeavour to work closely with the family concerned for a resolution. Relatives spoken to during the inspection said that could easily approach staff to discuss ongoing care and any worries or concerns they may have. Records show that a number of staff have attended safeguarding training, they also have information about safeguarding when doing National Vocational Qualification (NVQ) training and during induction training. The manager has made safeguarding referrals appropriately and works well with the Commission and the local Department of Adult Care and Support (social services) during safeguarding investigations. Senior staff know the local reporting procedures. The registered manager and the unit managers know about the deprivation of liberty safeguards (DOLS) bought in with the Mental Capacity Act 2005 (see www.cqc.org.uk for more information on the Act) and work with the local lead in assessing people as required. The AQAA states that should a need arise to restrict a residents freedom of movement etc,eg the need for safety rails, a full risk assessment is completed and consent obtained from the resident/relative. Care Homes for Older People Page 18 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Ongoing refurbishment, redecoration and maintenance means that people have a comfortable, homely and safe environment in which to live. Evidence: Kernow House is part of the Barchester Healthcare group of homes. It is purpose built to provide nursing care, support and accommodation for up to 98 people. The entrance to the home is hotel in style and has seating, fresh flowers, suitable music and access to the homes bar, that can be used by residents and their relatives if they want to see each other away from their room or other larger communal areas. The accommodation is divided into three units Caradon unit can accommodate up to 28 elderly frail people, Petherwin unit up to 43 elderly people with dementia (five maybe between 55 and 65 years of age) and Millaton Court unit 27 people with a physical disability (presently all of whom have Huntington?s Disease). The home is situated on the outskirts of Launceston near the Health Centre & hospital. The home is built on two floors, which are connected by shaft lifts (for passengers & goods) and stairs. Caradon unit is on the ground floor, Petherwin unit is upstairs and Millaton Court is a separate single storey wing. Accommodation is mainly in single en suite rooms although there are a number of Care Homes for Older People Page 19 of 27 Evidence: doubles within permitted limits. There are comfortable and spacious lounge facilities and dining areas on each unit. Meals are cooked in the ground floor kitchen and taken in heated trolleys to the units to be served (there are satellite kitchens on Petherwin Unit and on Millaton Court). Exit & entrance doors are protected by keypads to ensure the safety of people in the building. There is a small patio area accessible to residents outside the Caradon dining room, a sensory garden between Caradon and Millaton Court and separate garden area at Millaton Court. The AQAA states that we are limited to outside garden space but our gardener is passionate about providing areas that appeal to all tastes as she believes that these gardens belong to our residents. She works in conjunction with residents projects to maintain a year round display of shrubs and plants that are on view all around the home for everyones pleasure. She has entered into this years Barchester in Bloom competition in several categories to include best sensory garden and best hanging baskets. There is sufficient car parking available for staff and visitors. A tour of the home showed that peoples rooms are personalised with furniture and momentos they bought in with them. People spoken to said they were happy with their current accommodation.Barchester have an ongoing programme of routine maintenance and redecoration. The interior design team were in the home during the inspection discussing some planned decorating and improvements, the bar area was also being decorated and a number of other refurbishments were ongoing. There is a maintenance manager and an assistant employed by the home supported by Barchesters estates team. The home complies with the local fire service and environmental health department requirements. There are enough assisted bathrooms, shower rooms and toilets for the people who currently live at the home and many rooms have en-suite facilities. On the days of the inspection all areas of the home were clean, tidy and hygienic. There are a team of domestic staff and laundry staff all of whom know the importance of infection control. Four of the five completed residents surveys indicated that the home is always fresh and clean and one that it usually is. One comment was that it really doesnt appear to be like a residential home, more like a hotel - fresh flowers and a pleasant smell. Policies and procedures around infection control are up to date and available to staff at all times. In house training on the importance of infection control is routinely offered to staff. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing levels and skill mix are satisfactory meaning peoples needs are being met at all times. The recruitment procedure means that people who live at the home are being looked after by appropriate staff and their welfare is not at risk. Evidence: On the day of the inspection there were appropriate staff numbers and skills mix available to provide the required nursing care and support for people at all times. The manager and nursing staff are supported by carers, activity organisers, administrative, domestic, catering, hostess and maintenance staff. There are at least 2 trained nurses on duty 24 hours a day. One of the two completed staff surveys indicated that there are sometimes enough staff to meet he individual needs of the residents and one that there was usually enough. Each unit has its own staff team and rota. This ensures that staff working on each unit are trained specifically to look after the people on their unit. Millaton Court also uses the services of extra physiotherapy, dietician and speech and language therapists to assist the people with Huntingtons Disease. The AQAA states that 30 of the 71 care staff have completed at least an NVQ level 2 in care. Upcoming training dates were seen displayed on staff notice boards. The home has an in house trainer who offers statutory training and training specific for the needs of the Care Homes for Older People Page 21 of 27 Evidence: current residents. The AQAA states that Kernow House has a very motivated full time Home Trainer who is fully supported by the services of The Barchester Learning and Development Academy.Here our Home Trainer has access to the learning and development resource file. She attends regular meetings with the academy and other home trainers to share ideas and learn of new developments. The academy provides training strategies for a number of areas such as induction of all staff, challenging behavior, H&S, First Aid etc.It also incorporates the NVQ academy which offers support and help to those undertaking NVQ training. In addition we have a training computer and staff can complete courses covering food hygiene for all food handlers, H&S and customer care for all staff and induction for care staff. Outside training is also accessed as required. The unit manager for Millaton Court has worked closely with the Huntingtons Disease Society and is able to pass on up to date training and good practice recommendations to her staff group. Staff spoken to said that training is always on offer and they have the time to attend. Staff files we looked at all had completed application forms, 2 written references, CRB/POVA clearances, statements of terms and conditions of employment and job descriptions, they were all stored securely. The manager said that nobody is allowed to start work unless they have a CRB check carried out and the two completed staff surveys indicated that Barchester carried out appropriate checks before they started work. The AQAA says that following an initial induction period the length of which is determined buy a persons previous experience and in which department they are going to work they are then allocated a mentor and review dates are set. The two completed staff surveys indicated that their induction covered everything they needed to know to do the job when they started very well. The home had two student nurses assigned to them at the time of the inspection. One was spoken to and said that she was really enjoying working on the dementia unit, felt well supported and had learnt a lot. The unit manager was supporting her in completing an initial care plan and she was going with him to carry out a pre admission assessment within the next few days. Care Homes for Older People Page 22 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems and procedures in place are designed to meet the needs of the service as they strive to continually improve the service the home offers to the people that live there. The attitude to health and safety shown by the providers, nursing,care and ancillary staff means that people live in a safe and well maintained environment Evidence: The registered manager is a trained nurse and has worked at Kernow House for over three years. She has the appropriate skills and experience to run the home. She has support from her Regional Director who visits the home at least once a month to see the manager and carry out a detailed inspection of the home to ensure compliance. The manager said that she also has support from the two monthly meetings the South West General Managers have. The general manager and unit managers were were able to demonstrate that they have appropriate checks in place for various health and Care Homes for Older People Page 23 of 27 Evidence: safety procedures including portable appliance tests, insurances, environmental health and the maintenance of fire safety. Three monthly internal audits based on the views of people who use the service (and their representatives) and a wider ranging annual Barchester audit, taking views from other people such as GPs and social workers are carried out to ensure the ongoing quality of the service. Thank you cards and compliment letters are included in the file with the Service Users Guide kept at the reception to show ongoing satisfaction. The results of these surveys are analysed and evidence that action is taken to improve the service is available. The manager said that regular resident and relatives meetings take place where any issues can be discussed. Relatives spoken to said that the staff try hard to ensure the service meets their relatives individual needs. One comment on a completed residents survey was that day to day running of the home always seems well organised. The homes policies and procedures are up to date and available to staff at all times. We saw the written records kept of all financial transactions on behalf of the residents, they included income and outgoings and receipts, the administrator said they avoid dealing directly with peoples money and prefer to invoice the person paying the fees. Secure facilities are used for storage of money and any valuables. The AQAA states that we treat the health and safety (H&S) of our residents with the greatest of respect and are very proactive in this area. We are ably assisted by Barchesters own H&S advisor who is available at all times to offer assistance and advice and who is part of Barchesters H&S committee keeping us informed of any new developments in this field. We have clear guidelines with regard to the daily attention of H&S. In addition we have a Home Incident plan to guide us in the event of a more serious issue so as to further protect our residents. Numerous records were seen during the inspection to demonstrate ongoing H&S and maintenance of equipment. The maintenance manager and assistant carry out the ongoing routine maintenance required in the home. There appeared to be a good rapport between management, all grades of staff and the residents. Records of some supervision sessions were seen in staff files examined. Care Homes for Older People Page 24 of 27 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 25 of 27 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 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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