Care Home: Kerr House

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What the care home does well Residents live in a home that is really well run. The philosophy of care in the home is to try and ensure that people can stay at the home for as long as they wish to. A number of the staff team are now well trained in extended nursing care roles. This means residents do not automatically have to move to a nursing home if they become frailer. There is a really useful amount of information made available for people to find out about the home and the service provided. Residents needs are being really well met by the staff who look after them. Care plans explain really well what sort of help and support that people require. Residents can do a variety of social and therapeutic activities. Residents are provided with a well cooked well balanced diet. Complaints when they are made are properly addressed and investigated. The environment is a suitable, safe and relaxing place for residents to live in. Staff do a really good level of training to make sure they can do their job effectively. What has improved since the last inspection? There were no requirements set at the last inspection. The overall rating for the home has remained at excellent. What the care home could do better: See above comments. Key inspection report Care homes for older people Name: Address: Kerr House 50 Morley Road Staple Hill Sth Gloucestershire BS16 4QS     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: Melanie Edwards     Date: 0 3 0 1 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 33 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 33 Information about the care home Name of care home: Address: Kerr House 50 Morley Road Staple Hill Sth Gloucestershire BS16 4QS 01454866295 01454866297 Linda.Dicks@southglos.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: South Gloucestershire Council care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Kerr House is a purpose built Local Authority residential care home that is registered to provide personal care and accommodation for up to thirty one service users aged 65 or over. One room is designated for service users to receive respite care on a regular basis. The home is located on the KingswoodStaple Hill borders approximately a quarter of a mile from local amenitiesshops including banks, a post office and various shops. The home is well served by bus services that stop within easy walking distance from the home. Accommodation is provided on one level and is sited around a courtyard and garden area. All rooms are single occupancy. Rooms do not have en suite facilities. Each room has a wash hand basin set into a vanity unit. Communal rooms are situated on two floors and comprise of five lounges, two separate sitting areas, a large dining room, activities rooms, a small kitchen, a hairdressing room, library area and a designated smoking room. There is a choice of lift or stairs to the first floor. The grounds and gardens are well maintained and are fully accessible to Care Homes for Older People Page 4 of 33 Over 65 31 0 Brief description of the care home service users from lounges and corridors. All exits have ramps and handrails. Fees range from GBP497 minimum to GBP497 maximum. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We met twenty three of the residents living at the home. We spoke to the duty manager, Mrs Linda Dicks who is the registered manager, two care staff and a cook. We saw staff help residents with their needs. We saw lunch being served and we ate a meal. We looked at a range of records to do with the running and management of the home. The records we inspected included the service users guide, the statement of purpose, information about social activities, menus, the complaints procedure, the record of complaints, training information, the staff duty record, finance information, quality assurance information, accident records and health and safety information. Care Homes for Older People Page 6 of 33 Care Homes for Older People Page 7 of 33 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 33 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 33 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 are confident that their needs can be well met. This is because there is a proper assessment of their needs carried out when they move to the home. There is good information to tell people all about the home and the support they will get there. The home does not offer intermediate care. Evidence: We inspected the different information that there is available for prospective residents and other interested people to find out about the home. We looked at a copy of the statement of purpose and the service users guide. Everyone who moves in to the home has their own copy of the service users guide so they can find out about day to day life in the home. We read in the service users guide information about the service Care Homes for Older People Page 10 of 33 Evidence: provided, qualifications of the staff and the accommodation that residents can expect. The statement of purpose includes the aims and objectives of the home and how the service aim to meet residents needs. The complaints procedure is in the service users guide so that people know how to complain if they need to. A copy of the last inspection report that we wrote about the home, is kept in the entrance hall of the home, so that people can read about how we rated the home on our last inspection. We read three residents assessment records to find out more about how well needs are identified and the care that people need planned with them. The assessment records are used to help plan what sort of care and support people will need. We found the assessment records that we read were informative and they set out the residents different physical, mental and social, nursing and personal care needs. We read some very clear and easy to follow information about what to do to support each person in the assessment records. The assessment records we read were being regularly reviewed and updated. This helps show that the information in them is still current and that residents are getting the correct sort of care and support in the home. The staff talked to us about how residents needs are assessed. They explained the system for allocating care each day. They explained to us that one of the managers nurse and a small group of care staff will be allocated to take specific responsibility for building up a really good relationships with the residents while caring for them. The home does not provide intermediate care for residents. In the aqaa document is some really useful information about how people are helped to make a choice as to whether to move to the home . We have quoted this extract: All admissions to Kerr House are referred via the Adult Care orMental Health Older People Team. Every service user prior to admission to Kerr House, will have an assessment and a care plan undertaken by social workercare manager. They are provided with an Information bulletin updated 13 July 2009, relating to the Consultation and ending at the end of October, 2009. For service users referred to Kerr House, the manager receives the assessment and care plan in order to determine if the persons needs can be met at Kerr House. The person will be offered a trial period. During this period the service user and staff will complete a Service Delivery Plan. This plan takes into account the persons lifestyle, the support they require with daily living tasks, their skills and their wishes. This plan is outcome based. Twenty four hour care is then provided in conjunction with Individual Provider Support Plans. There is a choice menu and alternatives can be provided. Kerr House achieved five Care Homes for Older People Page 11 of 33 Evidence: star award for Food Hygiene from Environmental Health and Trading Standards. All service users have an individual bedroom, which they can personalise with furniture and belongings. The home is a single storey premises with several different types of assisted bathing facilities to meet individual needs. Through skilfull assessment by the care team and good support from primary care services, the home is able to meet peoples individual needs fully. The rate of discharges to alternative care are very small, as we aim to make Kerr House a Home for Life for each individual service user. The home calculates its staffing levels using a Department of Health tool. This ensures that peoples changing needs are fully met. Care Homes for Older People Page 12 of 33 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. Residents health, personal and social care needs are really well met. Each resident has a plan of care that shows really well how to meet their needs. Residents medicines are managed safely. Residents privacy is respected and they are supported in a way that maintains their dignity. Evidence: All of the residents that we met explained to us that staff are really helpful when they assist them with their needs. One person said, I love it here the staff are very friendly, another person said, the staff are doing a perfect job. We read three residents care plans to find out more about what is done to ensure residents are properly supported by staff to meet their nursing and personal care needs. The information we read in the care plans was helpful and explained clearly to Care Homes for Older People Page 13 of 33 Evidence: us how to meet the care needs of each resident. The care plans set out what actions staff need to do to help the resident to meet their needs and live their daily life to the full. We saw instructions in the care plans for residents who benefit from the extended role of staff. By this we mean that some residents are receiving some nursing care given to them in the home. The district nurses oversee the care that is given by certain staff in the home. The staff concerned have done extensive training, run by the district nurses to enable them to provide additional support to residents with more dependant needs. The care plans we read were really user friendly and they had been written in a person centered style. This style of writing a care plan helps staff to ensure that the person concerned is always at the centre of the decisions about the care that is planned for them. We saw detailed information in residents care plans that showed us staff support residents very well to maintain their independence in daily living activities in and out of the home. This shows a real importance is placed on residents being very well supported to make decisions and keep independence in their lives. The home have designated dignity champions, whose additional role is to guide and advise staff in developing and improving the way that residents are cared for. This is a National Health Service led scheme, to ensure that people in care homes are treated with dignity and respect at all times. We noticed staff assisting residents in a polite and friendly manner. We saw the staff knock on bedroom doors before they went into them to maintain privacy. We checked how residents medication is given to them, stored and disposed of, to see if the systems are safe. We looked at seven medication administration records charts in close detail. We saw a photo of each resident kept with his or her administration chart to help staff give out medication safely. We saw information used to guide staff about how each resident prefers to take their medication written down, next to the medication charts. This helps residents to be given their medication in the way that they prefer. We found that medication stock was satisfactorily organised and administration charts were being kept up to date. We checked and saw that there is a safe system for ordering and receiving medication and the records were up to date. We saw that medication stock is stored in a metal cupboard which is kept in a locked room. We saw the locked movable metal trolley used to take around the home to give out medications to residents at their convenience. Care Homes for Older People Page 14 of 33 Evidence: In the aqaa document is some really useful information about how people are helped with their health and their personal care in the home. We have quoted this extract: We have clear aims to respect the rights of our service users to make personal choices, to enjoy privacy and to have their own personal space. We ensure that we offer a caring, supportive and stimulating environment in which service users and relatives are encouraged to participate in reaching decisions affecting their care. We aim to assist our service users to become and remain, as self reliant and independent as possible. We involve both service users and their relatives in preparing the Service Provider Plan for each service user. An open visiting policy is actively encouraged at all homes, enabling the local community to be drawn into the life of the home. Ongoing care will be underpinned by national care standards and a systematic approach of person centred individualised care. We have key staff members who meet with the service user and their family.members and record all of the service users needs and aspirations. This enables us to care for the service user to the highest possible standards. A Service Provider Plan is then devised which details how, the specific needs of the service user will be met. This includes a great deal of detail and will specify the likes and dislikes of the service user, tailored to the individual and person centred. A moving and handling profile is undertaken as are appropriate risk assessments. All of these actions are discussed with the service user, relatives and carers to ensure their understanding and agreement. The home operates the key worker System. Each key worker will be responsible for ensuring that the service users in their group will receive care in accordance with these principles. All staff attend a training programme, organised by North Bristol Trust, South Glos. PCT and Community Care & Housing Department. This training ensures that staff fully understand South Glos. medication policy and Standard 9 of the Care Standards Regulations. This includes the storage and administration and handling of prescribed medication. The homes manager has good knowledge and skills which ensure that regulations and standards set by the Department of Health Care Homes for older people National Minimum Standards are met. As far as possible, self-advocacy will be promoted and, where necessary, an advocate will be appointed to offer advice on the individuals welfare, rights, and choice. The care will be provided directly by staff working in the Home in partnership with other professional or multi-disciplinary agencies. The Care Home will facilitate individuality, personal dignity, selfdetermination and freedom of choice for every Service User. Service users rooms will be treated as strictly private and respect given to their personal space and belongings. Intervention and support will aim to maintain and promote independence and life skills. Staff receive training in palliative care, Loss and bereavement. Information is collected from service users and family regarding their wishes around their death. This information is Care Homes for Older People Page 15 of 33 Evidence: held with their care plan to ensure their wishes are respected. Information is communicated sensitively and consistently between all parties previously identified by the service user. Hospitality is offered to family and friends . Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to feel part of their local community. Residents can follow their interests and take part in a variety of activities. People are able to keep in touch with family, friends and representatives. Residents are well supported to maintain independence in their daily lives. Residents are provided with nutritious and attractive meals and snacks. Evidence: Residents benefit from the input from a member of the care staff who has extra role of ensuring daily social and therapeutic activities are put on for residents to take part in. We saw notices on display to tell residents about future social events taking place in the home. We saw care staff putting on different social events with the residents, including a quiz. The residents looked as if they were really enjoying this activity. We saw a timetable of social activities on display in the home to help people to know about Care Homes for Older People Page 17 of 33 Evidence: social events that are planned to take place. We saw some photos taken at recent social events. The residents looked as if they had had a really good time at these events. There is a mobile shop in the home and we saw residents buying small every day items from there. This is a very helpful facility for people who can not get to the shops. We were told by staff and by residents that the home encourages contact with family and friends. Some residents see their relatives regularly. We saw residents having visitors see them at the home. The staff and some of the residents told us that there is a relaxed and flexible visiting policy. We also noticed that staff received visitors in a warm and welcoming way. The residents who we met told us that, within reason they can do what they like in the home. We saw people getting up at different times during the morning. We noticed at lunchtime that residents were offered a choice of meals. These are all really good examples of how resident can have some autonomy and make choices in the home. We ate a portion of the lunchtime meal. The lunch was roast lamb roast, boiled potatoes, with two cooked vegetables or fresh cooked salmon. We saw there was a homemade rice pudding for dessert. The meal was tasty and well presented. We saw staff serving meals to residents and assisting some people. The staff were polite and friendly in the way that they helped residents with their meals. We noticed that residents who did not want either main meal choices were offered other meal options. This is a very good example of offering residents choices in a really important part of their daily lives. We saw the daily menu on display on a notice board in the dining room, to help residents to know what meals are on offer that day. We saw the cook asking the residents what meal choices they would like for the following day. The residents menu choices that we saw looked really well balanced and traditional. Residents can choose what meals they would like to have. The residents who we met were very positive about the meals that they have at the home. In the aqaa document is some really useful information about how people are helped with to enjoy daily life in the home. We have quoted this extract :Daily activities are provided at the home and service users can choose to participate if they wish. We have an activities co-ordinator who regulary meets with the service users to seek their feedback and to plan future events. All events attended are recorded in the activities Care Homes for Older People Page 18 of 33 Evidence: file and individual diaries. These activities provide service users with the opportunity to socialise and form friendships. These include group or individual activities and social gatherings, to accommodate individual choice and preferences. Suggestions and feedback are noted and discussed, which promotes service users excercising their choice. Planned internal and external events are displayed on the Service Users notice board and staff will inform them on the day as well. A range of activities will be made available to the Service User but it is accepted that each Service User may make No a positive choice. We strive to encourage service users to retain links within the local community. This includes the attendance at a local church. The Older Peoples Forum. Service users are enabled and enjoy frequenting the local amenities as they often meet old friends. Extra hours have been provided to ensure a service user can return to her home and friends on a regular basis. We issue a quarterly newlsletter for the service users to provide additional information of forthcoming events and provide reviews of past events. This will provide a meaningful opportunity to fully action a programme of activities following consultation. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents concerns with their care are looked into and action taken to put things right. Residents are safeguarded from abuse and neglect and action is taken to follow up any allegations. Evidence: We saw a copy of the complaints procedure in the reception area, each resident is also given their own copy. The procedure includes our details for anyone who needs to contact us. The contact details of a senior manager from South Gloustershire who run the home are in the complaints procedure if people wish to contact them directly to make a complaint. The residents we met told us they would make a complaint to Mrs Dicks or the duty managers. We saw the duty manager spend time talking to residents who had a concern. We saw that duty manager listened to the residents and spent time with them. This helps to show that residents views are welcomed and responded to positively. We saw a procedure in place relating to the issue of protection of vulnerable adults from abuse. The procedure includes up to date information about the need to contact and be guided by the Adult Protection team in the event of an allegation of abuse. The staff team have done training on understanding the Deprivation of Liberty legislation. This helps staff have a good understanding of residents legal rights are Care Homes for Older People Page 20 of 33 Evidence: protected. This should help ensure residents, as much as is possible are kept safe and risks from abuse are minimized. The staff team have also done training courses in understanding the principle of protecting the residents and keeping them safe from abuse. We saw a copy of the homes safeguarding policy for staff to respond in the event of an allegation of abuse. We saw information that confirmed that the staff team do regular training on the subject of how to keep residents safe from abuse. In the aqaa document is some really useful information about how people are helped to make complaints and how they are kept safe in the home. We have quoted this extract: Kerr House accesses the departments procedure for complaints, compliments, suggestions and freedom of information. This is discussed and information provided on admission to the home and during reviews. Families and carers are also provided with this information. We have an open door policy and take time to listen to and resolve any concerns raised by the service user or family orcarers. Internal complaints book available to record any informal issues that can be dealt with immediately to ensure the complaint does not have to become more formal unless stated by the service User. The department adheres to Safeguarding Adults Policy and provides statutory training to all staff. NVQ level 2, 3 and 4 also includes work based competence for Safeguarding Adults. Care Homes for Older People Page 21 of 33 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. Residents live in a homely and safe environment. Evidence: Kerr House is a purpose built home that is near to private houses in Staple Hill in South Gloucestershire. The home is near to bus stops into the city centre of Bristol. There are local shops, pubs, churches and coffee shops all nearby. This helps residents to be a part of the community. We found the home looked really clean and tidy in all areas that we viewed. The building is wheelchair accessible for people who may have restricted mobility. We saw that there is a really spacious dining area and four homely looking lounges. We saw residents sitting in communal areas looking really relaxed and comfortable in the home. There has been a real effort to make the lounges look very welcome and home like and this is a real benefit for the residents. We found the home was well ventilated and warm with plenty of natural light. We saw a range of special adaptations and useful equipment in place in bathrooms, toilets and lounges to help assist residents and visitors with disabilities throughout the building. Care Homes for Older People Page 22 of 33 Evidence: We saw that the bathrooms have specially adapted baths to assist residents who may have reduced mobility. Toilets are close to communal areas and bedrooms. The bathrooms and toilets were very clean and were well stocked with hand towels and soap to help minimize risk from cross infection. We saw that there are bathrooms and toilets near to bedrooms that do not have these facilities. We saw a washbasin in each bedroom. The home is set in its own grounds. The gardens are satisfactorily maintained and there are patio seats where residents can sit. In the aqaa document is some really useful information about how the environment is suitable and safe for the people who live there. We have quoted this extract :The home is purpose built single storey building that provides individual bedrooms for all service users. There is a door entry system which enhances the the security for the service users. In addition, external security lighting is installed outside the home and in the car park. There are sturdy wooden, lockable gates which section the outer gardens and perimeter of the building to enhance security. Service users are issued with a key to access their bedroom and each bedroom has a lockable cabinet for personal possessions. Services users are provided with the opportunity to furnish their own bedrooms and bring small electrical appliances Portable Applicance Tested by a qualified electrician. Kerr House has four communal lounge areas for use by the Service Users and their visitors. In addition to this we have two further sitting areas and a tea room for the service service users convienence. Kerr House benefits from three communal dining rooms, one of these dining rooms caters for four service users, affording a measure of privacy and independence and another which accomodates a married couple who enjoy privacy dining together. The central garden consists of a patio area, with grassed area and floral arragements. Two out of the three garden areas are enclosed. Garden seating and a water feature ehances the presenatation of the garden. All grounds are maintained to a high standard. An annual refurbishment plan is agreed, utilising both capital and revenue expenditure to maintain the environment of the home to a high standard. Service Users are involved in the choice of the soft furnishi ngs and decoration. All communal facilites and individual bedrooms have a nurse-call bell for service users to summon support when required.The Environmental Health department has awarded Kerr House a 5 star rating for food hygiene and catering arrangements. Infection control procedures are followed at all times and we have access to the Infection control manual to refer to when required. Our guidance for the prevention and control of infection Hygiene and Care Homes for Older People Page 23 of 33 Evidence: Control of Infection, is based on published professional guidance and addresses the risk elements of hand hygiene and use of personal protective equipment as specified in the DoH Essential Steps to Safe, Clean Care Guide. Our Guidance also covers other issues such as dealing with spillages and environmental hygiene. Staff undertake training, delivered by North Bristol Primary Care Trust, in infection control. Care Homes for Older People Page 24 of 33 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. Residents needs are well met by the numbers of staff who work at the home. The procedures for recruiting new staff are safe and help to protect residents. The additional extended role training that some staff have done has a really positive impact on the quality of life for the residents. Evidence: Some of the staff team have gone on extensive training run by the district nurses to enable them to provide additional support to residents with more dependant needs. Residents who need it can now receive some extra nursing care given to them in the home. The district nurses oversee the care that is given by certain staff in the home. This is a real benefit for the residents, as it means if people get frailer and their health declines they do not automatically have to go to a Nursing home, but they can stay in Kerr house longer. This is also one of the key aims of the service and this objective is met really well. We saw the staff helping residents with their care needs in a warm and kind way. This helps to demonstrate that staff are skilled at caring for the residents. The residents who we met spoke really positively about how kind and helpful the staff are to them. Care Homes for Older People Page 25 of 33 Evidence: We saw in the training records of staff that they are keeping up to date in their knowledge of the needs of residents. We saw that staff had attended training sessions and updating over the last twelve months. There is a training programme for all staff that includes mandatory training. The majority of staff have done National Vocational Qualification in care award training. We did check recruitment records to see if the home carries out employment safety checks on staff before they start work. We saw written confirmation that all new staff have a criminal records bureau check undertaken to confirm that they are suitable to work with vulnerable people. We checked the number of staff on duty for each shift over twenty four hours, to find out if there is enough staff to meet residents needs. There is a minimum of one duty manager and four or five care assistants in the morning. There is a duty manager and at least three care assistants in the afternoon. At night there is two care staff on duty. There are two or three domestic staff on duty most days, a cook, a kitchen assistant and a maintenance person. We saw that residents needs are being well met by the number of staff on duty each day. Mrs Dicks works full time hours over a seven day week. Mrs Dicks is also assisted in her role by a deputy manager. In the aqaa document is some really useful information about the staff team and how residents benefit from the training that the team do. We have quoted this extract: The manager ensures that the care home is staffed at all times in accordance with the requirements of the Care Home Regulations to meet the needs of the service users. The manager uses the Department of Health tool for calculating staffing levels. In addition to the manager, there are four duty managers to support the Councils requirements for the management of the home. The staffing structure includes care staff and ancillary staff. The keyworker system is implimented to ensure person centred care for all Service Users. There are two waking night staff on duty to meet agreed Service User needs in the nightime hours. The Home has a robust recruitment and retention policy. The staff employed at the home have many years of experience. The Home compiles and accesses the South Glos. staff training and development programme, which enhances the knowledge and skill mix of all staff. All managers have the opportunity to undertake the National Vocational Qualification NVQAssessor course. All permanent care staff have achieved an NVQ award, many at level three. All domestic staff have achieved the NVQ award one. All new employees undertake the Skills for Care Induction programme. Each staff member has been issued with a Continuous Professional Development folder with instructions on its use, and it is reviewed at each supervision session.The home has a robust recruitment and retention policy which includes meeting the requirements as set out by the Care Home Care Homes for Older People Page 26 of 33 Evidence: Regulations. All staff are subject to enhanced Criminal records bureau checks. Several staff are Care Ambassadors. This involves visiting local schools and colleges promoting the care industry. As a result of this we frequently take appropiate student placements and have formed effective working relations with the placement officers. Care Homes for Older People Page 27 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is really well run and is run in the best interests of the residents. Residents finances are properly looked after in the home. The health and safety of residents, staff and visitors is well maintained. Evidence: Mrs Linda Dicks is the registered manger of the home and she has been in charge of the home for a significant number of years. Mrs Dicks has many years of working in care homes at a senior level. She is registered with us as the manager of the home. This demonstrates she is fit and competent to be the manager. One resident said to us that Linda is a very kind lady, another resident said she is very approachable and a good friend . This helps to show us that the residents feel really well supported by her. The residents also told us that they see Mrs Dicks often and they can go to her with any concerns at anytime. Care Homes for Older People Page 28 of 33 Evidence: There are regular residents meetings held in the home. Residents can make their views known at these meetings about any aspect of life in the home. This is a really good example of the open management style in the home. We saw the system for monitoring the quality of the care and the service that residents receive. We saw the information that had been obtained from a recent quality monitoring exercise. We saw that residents are really well consulted about a varied range of matters to do with the running of the home service .We saw that Mrs Dicks has written a very detailed action plan to show what she will do to address the matters that had arisen from this consultation exercise. We found that the environment looked safe and satisfactorily maintained in the areas we saw. We saw information in the staff training records that confirmed the staff do regular training food safety. This is a really good way for staff to help residents to prepare and cook food in a safe way. The staff also do training in health and safety matters including first aid, infection control and fire safety. This should help protect residents if staff are knowledgeable and well trained in health and safety principles and practices. We looked at three residents finance records, we found that the records are being properly maintained and in satisfactory order. The records to do with the management of the home were also satisfactorily maintained up to date and in order. Individual records and the homes records were kept secure in the home and are available to staff when needed. We have referred to other records elsewhere in the report. We checked the fire logbook record, and we saw that the required weekly and monthly tests of the fire alarms and the fire fighting equipment are being carried out and are up to date. These checks are done to make sure fire fighting equipment works in the event of an emergency. We saw records that confirmed catering staff check the temperatures of all high risk cooked food before it is served to people to make sure it is hot enough and safe to eat. In the aqaa document is some really useful information about way that the home is run The Registered Manager meets the qualification and experience requirements of the Care Home Regulations. The Duty Managers have appropriate Nationa Vocational Qualifications for their role. One Duty Manager is trained and responsible for the management of Moving and Handling, and four Managers are qualified NVQ Assessors. Care Homes for Older People Page 29 of 33 Evidence: The Department has a strong comittment to staff development by arranging this training following individual reviews.The home has a Management and Quality Assurance programme that is administered by an independent consultant, and the management and staff team. The home is issued with audited results and an action plan compiled. This is an ongoing process which reflects the comments of service users, relatives and staff, The information is then discussed with the team and used to improve the service. An action plan is produced which is outcome focused. South Glos. Council has an Investors in People Profile. Aims are made to improve organisational performance and encourages continous improvement by recognising good practice. We are working towards focusing on outcomes rather than processes. The management team actively support individual team members to develop and improve care services and performance. The care home has implemented the use of management competency framework linked to the annual appraisal system for all staff. The results are used to give more focus to learning and enable outcomed to be more quantifiable. The department has a forum that meets three monthly to rewiew policies and procedures, along with good practice. This is shared with staff and Service Users at planned meetings.Service users financial records are maintained. The home is audited by Internal Audit to ensure all financial procedures are followed. there is a financial management systems manual in place. Advice and guidance can be sought from South Glos. finance and Audit department. All systems are transparent. South Glos. has a Health and Safety policy, staff receive training in all aspects of health and safety such as:Yearly Health and Safety training, which incorporates COSHH, Risk Assessment, Fire, First Aid, Moving and Handling, infection control, Safeguarding Adults, Basic First Aid and Food Hygiene and medication. All new staff complete an induction workbook which covers the main six common induction standards.There are systems in place for monitoring the servicing of all equipment, electric appliances, fire equipment, wheelchairs, hoists, lifts, bathing equipment and moving and handling equipment.We have an asbestos management system and a watersafe management system that is regualrly maintained in house and by external contractors. All incidents and accidents are reported and recorded where applicable a regulation 37 is completed and sent to the Care Quality Commission. There are generic risk assessments and individual risk assessments that pertain to the individual service users. Care Homes for Older People Page 30 of 33 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 31 of 33 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 32 of 33 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). 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