Care Home: Lashbrook House

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What the care home does well In regard to the care provided one relative stated; "We are very happy with the care given to my father." Additional comments made by visiting health and social care professionals were in regard to what they do well; "Care for individual patients, each one matters." And "Deals with people with dementia well, in a step by step way." As to working professionally together one social care practitioner put; "They liaise with us about clients needs and work in partnership with social and community services to meet those needs." From information obtained through this inspection the people who use the service can be confident that they will obtain an excellent standard of care and support. They will also be provided with the opportunity to continue to with their daily lives as they wish. A comment made by a relative was; "There are frequent social activities which include family and friends. They are always well organised and well attended." They can be certain that their concerns will be listened to and that they will be protected from possible abuse or harm by the systems in place. The service provides a homely comfortable environment that is able to accommodate their needs and has the necessary equipment to do so. Staff are friendly welcoming and supportive and have been provided with the training and knowledge to care and support them well. The service is run in the best interests of the people who live in the home. Information from the whole inspection process shows that the service is managed well and effectively. What has improved since the last inspection? They have continued to look at improving how they assess individual`s needs and provide the nursing and care support that they may require. This is through obtaining holistic information about each person and developing the planned care to reflect this. What the care home could do better: They should ensure that the redecoration and refurbish programme is carried out a little more effectively to ensure that the quality of the environment meets the excellent quality of the nursing and care provided. Key inspection report Care homes for older people Name: Address: Lashbrook House Mill Road Shiplake Henley-on-Thames Oxfordshire RG9 3LS     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: Ruth Lough     Date: 2 5 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 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 32 Information about the care home Name of care home: Address: Lashbrook House Mill Road Shiplake Henley-on-Thames Oxfordshire RG9 3LS 01189401770 01189404342 lashbrookhouse@majesticare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Majestic Number One Ltd care home 46 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 46. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE) Date of last inspection Brief description of the care home Lashbrook House is situated in an attractive part of Oxfordshire near the river Thames and there is a railway station in the nearby village of Shiplake, as well as a post office and shop. The home is set in extensive grounds with views across open countryside. The home is registered to provide residential and nursing care for up to 46 residents aged 60 years and over. Registered nurses are on duty 24 hours a day. There are 30 single bedrooms and one double room on the ground floor, as well as two lounges, a Care Homes for Older People Page 4 of 32 46 0 Over 65 0 46 Brief description of the care home dining room and a reception area. The first floor has 12 single bedrooms, one double room and also a lounge/diner. Most bedrooms have en-suite facilities of a toilet and washbasin. The five bedrooms without these facilities are provided with a washbasin situated within the room. Recreational and social activities are provided. The fees range between £700 and £950 per week. Care Homes for Older People Page 5 of 32 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: This was an unannounced key inspection process generated from the Excellent findings identified at the last assessment of the quality of the service by the commission in December 2006. This inspection process included reviewing information provided by the service in the Annual Quality Assurance Assessment and any returned surveys to the commission before a one-day visit to the home. An annual quality assurance assessment (AQAA) is a self assessment and a dataset that is filled in once a year by all providers whatever their quality rating. It is one of the main ways that we will get information from providers about how they are meeting outcomes for people using their service. The Annual Quality Assurance Assessment from this service was returned within the Care Homes for Older People Page 6 of 32 required timescales and had been completed satisfactorily. The registered manager was present when we visited the service on 25th November, between 11:00 and 20:20. During the day the records for care planning, recruitment, and administration of the service were assessed. At least 10 of people using the service were involved with the inspection process. We met with staff, and 2 relatives who were present in the home. The people who use the service and the staff who provide the support were also consulted about their opinion of what is provided, through surveys. Of the10 people who are in receipt of support that we contacted, we received 8 responses at the time of writing this report. Six staff were also contacted through surveys, of which 4 were returned. Three professionals who has been involved with purchasing or visiting the service regularly provided their opinion in surveys. From this visit it was found that they continue to provide an excellent service to people and assist them to have an active busy life that meets their needs and expectations. A small number of good practice recommendations were given at the time of the inspection and can be found in the body of this report. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: They should ensure that the redecoration and refurbish programme is carried out a little more effectively to ensure that the quality of the environment meets the excellent quality of the nursing and care provided. Care Homes for Older People Page 8 of 32 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 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 32 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. The people who use the service have their needs assessed thoroughly before they are offered a place in the home. Evidence: All the nine people who use the service or their representatives who returned surveys to the commission, confirmed that they had received enough information to decide if the home was the right place for them before they moved in. The manager provided information in the Annual Quality Assurance Assessment that there is formal process of pre-admission assessment carried out before individuals are offered a place in the home. This includes inviting prospective residents to visit and where possible offering a day trial before a final decision is made to stay permanently. A relative we spoke to during the day of the inspection confirmed that they were provided with the opportunity to visit the home prior to a decision being made to use the service. Care Homes for Older People Page 11 of 32 Evidence: We looked at the processes for the assessment of individuals needs that is carried out before they are offered a place in the home. This was to establish if the processes is sufficiently in depth and incorporates seeking information both from the individual concerned and any relevant health or social care professionals involved in their care. The two records sampled showed that there is a very comprehensive assessment carried out including covering general topics such as medical, mobility, dietary and continence needs to detailed assessments for memory or dementia and how these effect the persons daily life. In addition they assess with reference to the Mental Capacity Act 2005 as to establish if they need to make further steps on the individuals behalf. Throughout the documents that were reviewed it was very evident that personal choices and wishes are obtained from the individual concerned, where they are able to provide the necessary information. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service can be very confident that their health and personal care needs will be thoroughly assessed, planned for and provided to them by the staff in the home. Evidence: Of the nine people who responded to the surveys all but one indicated that they thought they received the care and support that they needed. One noted sometimes to this question but this may have been in reference to a further comment about what the response was by the visiting GP made to requests for medical attention. In regard to the care provided one relative added, We are very happy with the care given to my father. Additional comments made by visiting health and social care professionals were in regard to what they do well, Care for individual patients, each one matters. And Deals with people with dementia well, in a step by step way. Care Homes for Older People Page 13 of 32 Evidence: As to working professionally together, one social care practitioner put, They liaise with us about clients needs and work in partnership with social and community services to meet those needs. We looked at the care records for three people living in the home including those identified earlier and for one person who has complex care needs. From what could be seen they have developed further the care planning and assessment tools that they use than those reviewed during the last inspection process in 2006. The assessment of need records are used effectively as to plan an initial care summary of the specific support each person before they are admitted to the home. On arrival nursing staff use this information to develop the key areas of the planned care including personal care, meeting health and medical needs, support with medication, and general and specific risk assessments about the environment or safety concerns for the person concerned. Accompanying these are those assessments relevant to providing nursing and care support such as Waterlow(dependency needs), nutrition, risks of falls, oral healthcare and for those with dementia or poor verbal communication a ways of expressing your needs, which all aid staff to provide support holistically. The detail recorded by the lead nurses or the key workers in the care planning was very comprehensive and gave all staff very good instruction to support the person concerned. This included both the daytime and that specific to the night time pattern of support the person may need. Equally, staff could be seen to recording well the daily outcomes each person was experiencing which supports that they are obtaining the care that they need. As previously identified all respondents to the surveys, with the exception of one, thought that residents obtained the healthcare treatment and support that they needed. Records in the care documents show that each person is enabled to see routinely their GP, and dental, opticians and podiatry practitioners are sought for routine healthcare and consultations. What was good was the recorded running history that each practitioner completes following a visit or consultation which gives a good picture of the outcomes for them, enabling the nursing staff to monitor collectively the individuals changing needs. We looked at the record keeping, administration and storage practices for medication managed in the home. From looking at the individual care plans it was clear that staff are given as much information as possible about the particular medications or treatments the individual is prescribed. Including what each drug is used for and what risks are involved for the person concerned. There is a completed care plan for this which includes where relevant under professional instruction Covert medication Care Homes for Older People Page 14 of 32 Evidence: administration can occur. The sampled MAR(Medication Administration Record) records confirmed that staff are recording appropriately any administration carried out and are provided with an up to date photograph of individuals as to aid ensuring that the right medicine is given to the right person. The home obtains all its medications through a local pharmacy who also visit and carry out periodical audits. From information given by the registered manager, none of the current residents can manage their own medications and all are dependent on the nursing staff to support them with them. However, there are the processes, assessment and accompanying recording tools should this be required in the future. Residents also have secure lockable spaces in their bedrooms to safe keep medications should they wish and are able to do so. Within the assessment of need process that the staff undertake with all new prospective residents they do try to seek personal choices and wishes for the preferred support that individuals want at the end of their lives. Each person is given the opportunity to provide pertinent information about the care that they wish for and the responsible next of kin to be contacted if they become seriously unwell. This discussion is taken forward by the nurse or key worker leading their care and is included as part of the planned support. From looking at the samples of records available the topic is handled sensitively and detailed information is recorded about personal preferences, and anticipated support that people wish for at the time when they may be too unwell to speak out for themselves. The training records that were provided show that a small number of nursing and care staff have attended either palliative care or care of the dying course to assist them with being able to give the necessary nursing and emotional care individuals and their families may need, at this particular point in their lives. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service enjoy the opportunities for a busy social and be part of the friendly community in the home. They are given the support to exercise choice over their lives and be able to maintain their interests as much as they are able. Meals and menu planning meet their health needs and personal choices and support is given by staff, when required. Evidence: We looked at what the service provides to residents in regard to maintaining their choices and wishes for how they like to conduct their daily lives. From information given by the residents and relatives involved in the inspection visit, individuals are supported with their usual patterns of their day but are also encouraged to participate and join in with social and communal activities. Comments included in the returned surveys were: There are frequent social activities which include family and friends. They are always well organised and well attended. Care Homes for Older People Page 16 of 32 Evidence: An additional comment from a health professional in regard to what they could do better was, Improve activity programme. All the residents who responded to the surveys indicated that there were activities included in the regular programme that they could join in with. The care planning records that were reviewed showed that recent improvements in how the gather information about the personal life history and interests has ensured that for some residents a comprehensive picture of the person concerned has been obtained. A very good example was seen in one persons record where a member of the individuals family had spent some considerable time in recording information about various time periods in their relatives life. They had used the new document tools to note life history from childhood, adolescence, through to present day. Each resident has a social care plan included as part of their overall plan which highlights personal interests and hobbies and how staff can enable them to continue with them where possible. The records we reviewed did not have a recorded chosen daily or night time routine showing individuals usual pattern of living, although some of this could be seen included in the various care planning topics mentioned previously. Providing staff with a documented usual routine would ensure that there is a consistent approach to providing support that all staff could follow which is particularly relevant to those with diminishing mental health who are unable to comment or request assistance themselves. The home has a member of staff specifically employed for 30 hours per week to provide activities in the home. From information given she is in the home Monday to Friday each week and enables a programme of regular activities that range from practical craft making, mental stimulation to encouraging physical activity. When not in the home the activities organiser has developed a large portfolio of activities plans which other staff can access and provide to residents. However, it was difficult to establish what staff do with individuals on a one to one basis when they do not wish to or are unable to participate in the communal activities. Records in the individual care plans did show the participation and enjoyment that they experienced that staff observed them to have during events or activities provided. In the dedicated unit for dementia, the environment and activities programme was slightly different for individuals living there. Staff ensured that there were plenty of tactile objects left in prominent places in the communal areas including the corridors Care Homes for Older People Page 17 of 32 Evidence: for people to engage with and enjoy. Hats, bags and scarves are left for people to pick up and wear if they wish in preparation for their day. Books, magazines are left for them to read or soft toys to cuddle or gain comfort from. Staff were seen to engage residents in conversation and participate in short periods of activities such as ball throwing, large jigsaw puzzles and talking about the activities going on in the home. From information given by staff residents living in this area of the home are always included in the planned programme of events scheduled in the calendar although with extra support. The residents, families and staff have enjoyed summer events in the home including a summer fete and a champagne barbecue utilising the moderately sized secure gardens to the side of the home. There was also a celebration for Halloween and Fire Works night. The minibus, which is shared between the organisations other two homes in the area, is used well and has enabled some of the residents to enjoy visiting local gardens, Henley Regatta and other trips out. Regular activities brought into the home include a Pat a Dog, musical and other entertainers. Pastoral visits from the local denominations also visit the home regularly and Holy Communion is provided monthly. We observed a main meal time, met with residents and sampled a selection of the food provided. This was to see if the meals and menu planning met their expectations, were enjoyable and were appropriate their dietary needs and requirements. From the responses given in the returned surveys most participants were positive about the food provided. From what we observed and the comments from the residents we met during the day the meals appear to be enjoyed very much, with staff making an effort for them to be presented well in a pleasant environment. The main dining room is situated on the ground floor and provides views across the garden. Residents sit in small groups and are encouraged to maximise the opportunity to chat and enjoy a meal together. Staff ensure that the tables are presented well with the days menu left on display for residents to read. Not all residents are able to use the dining room at one time and to aid those who need extra support the main meals are provided in two sittings. Additional comments made by relatives as to what the home does well, Always provide a tray of tea to visitors and are willing to put lunch or supper to be taken in own room if there is a guest or visitor. From information provided in the Statement of Purpose and Service User Guide residents are supported with notice given to be able to have guests at mealtimes to enjoy them together. Residents we spoke to confirmed that they were consulted about their choices for the next days main meals of the day, although if required, Care Homes for Older People Page 18 of 32 Evidence: alternatives are on offer should they change their minds. Full cooked breakfast is available everyday if they would like them. The staff responsible for the residents living in the 1st floor unit confirmed that they were able to provide snacks and finger foods at any time of the day for those people who are unable to linger long enough to enjoy a full meal in one sitting. Care Homes for Older People Page 19 of 32 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. The people who use the service can be confident that their concerns or complaints will be listened to and acted upon. The service has effective systems in place to protect the people living in the home from possible abuse or harm. Evidence: The people involved in the inspection process were very complimentary about the staff and the way that they responded quickly and rectified minor concerns that they expressed. All returned surveys confirmed that the participants felt they could speak informally if they were not happy and they knew how to make a formal complaint. The information provided to them in regard to the formal complaints process was reviewed as to see if the detail is sufficient and gives them clear contacts to refer a complaint to and the expected timescale that the service should manage and respond to them. Each person is given a copy of this in the Statement of Purpose and Service User Guide home guide that is kept in their rooms for easy reference. The formal complaints process is also on display in the main reception area for all to see. Information was given in the AQAA stated that they have had 2 complaints made to them during the last 12 months, none of which were upheld. The commission has been in receipt of a concern since the last inspection process which was in regard to the response to questions about the raising of the fees, which was referred back to the home for them to answer. From information given by the manager there is no formal Care Homes for Older People Page 20 of 32 Evidence: process of recording, for quality assurance processes, the minor concerns or Niggles that residents or visitors express. Some of these could be seen to be recorded in the individuals daily outcome records in their care plans and relatives are given the opportunity to comment through the regular Residents and Relatives Meetings. They were advised to look at how they can achieve this as to assist with effective monitoring of the overall delivery of the service. Any compliments made to the service are placed in a file in the front area of the home for visitors and others to view. The records that were reviewed showed that all staff are provided with the necessary training in regard to safeguarding and protection of the people they support. The care records also show that individuals mental capacity, level of risk and vulnerability are also assessed and actions put in place to support them safely. During the last 12 months they have informed the commission that there have been 2 safeguarding referrals and 2 investigations and with one staff member dismissed and put on the POVA list. From additional information given at the time and following the investigations the staff and service manager acted appropriately and swiftly, and put suitable actions in place. Care Homes for Older People Page 21 of 32 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. That the home is generally maintained well and meets the needs of the people who live there. The home is comfortable and provides a homely environment in the communal living spaces and residents are able to personalise their private bedrooms. Some of the required redecoration and refurbishment is slowly occurring. Evidence: A comment made in a returned survey in regard to what the respondent thought what the home could do better, was about the environment. They referred in particular to the redecoration of the bedrooms and en suites, although the person making the comment put that they appreciated that this was difficult with residents present in the rooms. Another comment received was that the home always appears clean and did not smell. We were informed in the AQAA that during the last 12 months some of the communal areas and corridors have been redecorated and there has been a replacement of furniture in the reception area, lounges and dining room. Also new baths and a shower room have been installed. We were informed that the call bell system in parts of the home were in the process of being updated as some of the en suites are not currently connected. Care Homes for Older People Page 22 of 32 Evidence: The home has been converted from an original family residence that was built before 1900. The most recent addition was made in 1996 which has aided the majority of residents to have picturesque views over the countryside from their own bedrooms and provided secure garden facilities for residents to enjoy. The layout of the ground floor of the home has varying irregular level of floors, with slopes and ramps that follow the external landscape around the building. Some of the rooms shapes and sizes reflect the semi circular design of the extensions with triangular bedrooms and communal bathrooms. These unique shaped rooms limit the placement of furniture and fittings. The majority of residents enjoy comfortable rooms with en suite facilities only 5, including the 2 double rooms have only a hand wash basin. Bathrooms and toilets are placed in close proximity to the bedrooms and communal rooms although on closer review some are poorly designed, have limited access for hoists and staff to support residents when using them. A small number of the bathrooms do not provide toilet facilities with the baths which could be inconvenient if people wish to use these before assisted into the baths. There was limited storage or shelving in some of the bath and shower rooms for residents to put personal toiletries etc., when in use. Likewise many of the en suite toilets did not have sufficient bathroom cabinets or shelving. We were informed that a number of the bathrooms were in the process of being updated with new facilities. The manager was strongly advised to seek professional help from an Occupational Therapist before they continue with this programme as to assist with ensuring that the new facilities meet the needs of the people they support and provide the most appropriate space for safe working practices for staff to enable them to use them. Throughout the building it could be seen that there is a rolling programme of redecoration, refurbishment and maintenance. However, it was evident that the redecoration programme was falling behind in some parts of the home with damaged paintwork in main corridor and particularly one bedroom on the ground floor of the home. The manager was also advised to look at the screening in the 2 shared bedrooms as the current mobile screening is minimal and does not offer full privacy and quite clinical in appearance. It was very evident that staff support residents to personalise their bedrooms with their own furniture, ornaments and bed linen. Care is taken by domestic staff to ensure that they maintain individuals choices of how they wish their rooms to be kept but still maintain a good standard of cleanliness. Effort is also put in to ensure that the communal spaces remain homely and comfortable for residents to use. Care Homes for Older People Page 23 of 32 Evidence: Throughout the home residents and staff are generally provided with appropriate hand washing facilities with liquid soap and paper towels. However, in some of the communal bathrooms there are no facilities at all, which means staff need to leave the bathroom to do so, which could compromise the safety of the person they are supporting or the management of infection control. Care Homes for Older People Page 24 of 32 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 number of staffing and skill mix within the home meet the needs of the people who require nursing and care support. The staff have had the necessary training they may require and been supported to obtain relevant qualifications for the roles they are employed for. The recruitment process is carried out appropriately and evidence shows that employees are fit for the roles they do. Evidence: Comments from residents about the staff included; The staff and the chefs are brilliant. With reference to the question in the survey as to the staff being available when residents needed them, there were positive responses and one added, Staff do an excellent job. Further comments made were The staff are always very friendly and, I believe, treat my father with dignity. They do a super job under very difficult circumstances. In regard to what the home does well a relative stated in a returned survey, The staff are excellent, friendly, smiling and helpful. Couldnt ask for more. They also added, The staff are what has the most impact for Mum, as she is now bedridden. Care Homes for Older People Page 25 of 32 Evidence: Observing staff during the day of the inspection it was very apparent throughout the whole team that the focus was on the experiences and well being of the people living in the home. Communication between staff and residents was good irrespective of the role the staff were carrying out. We looked at the duty rota, recruitment and training records for staff to see if there were sufficient staff on duty at all times, that they had been recruited and trained appropriately to work in a nursing and care environment. The duty rota showed that the core nursing and care staff are not required to provide domestic, catering or laundry duties in the home and can concentrate on providing direct support to the residents. Staff are specifically employed for these roles plus in addition there are full time maintenance staff who undertake driving the shared transport when required. The majority of the nursing and care staff appear to undertake 12 hour shifts and does not employ staff from agency to supplement the regular staff team. The 2 samples of the staff recruitment and employment records that were reviewed showed that the necessary details are obtained, including references, health status, work history and Criminal Records Bureau and Protection of Vulnerable Adults list checks. The recruitment records like those for individuals care planning are organised, hold the relevant information and include a check list to assist with ensuring that the recruitment practice is carried out effectively. Comments from the 4 staff who returned surveys to the commission were complimentary about the support they receive from management and about the training and development programme provided to them. The home provided information that there were over 76 of care staff who had obtained an NVQ 2 or above. They also provided information that they were in the process of recommencing a NVQ training programme to ensure that all recently recruited staff have the opportunity to obtain a qualification. Additional information provided during the day of the inspection visit shows that the registered nurses are supported to maintain their clinical skills and during the last 12 months the topics have included vena puncture, male catheterisation, wound care management and care planning. The records also supported that there is a rigorous training programme for the core topics of safe working practices and protection that all staff are provided with, including catering, domestic and maintenance staff. Training for caring for people with dementia has been provided to some staff. One senior nurse has attained a diploma in dementia care to support her role. However, there are a number of staff who havent, and the proposed training programme to rectify this was discussed with the registered manager. Care Homes for Older People Page 26 of 32 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 service is run in the best interests of the people living there, and is managed effectively by a knowledgeable manager and provider. Evidence: Residents comments about what the home do well were: Everything. I am very satisfied. This home does well in providing information. An additional comment about the home made by a health professional was: Very caring home, well run and delightful staff. Care Homes for Older People Page 27 of 32 Evidence: Another put, Sue Gogna is an excellent manager. The service is managed by Sue Gogna, a registered nurse who has obtained an RMA and is an NVQ Assessor. She was able to provide information of the professional development that she has undertaken to support her role during the last 12 months. This has included training and updates to maintain her nursing and care knowledge, such as wound care management, mental capacity act and medication. In addition she attends company training and conferences relevant to her management role. We were informed that although they had recently employed a deputy manager to support the management of the home this post was now vacant and they were again seeking someone to provide this role. The manager is supported well by a consistent and experienced group of staff including the House Manager who leads in the administration of the home and senior registered nurses who enable the nursing and care practices to be maintained to a good standard. It was very clear through observing the registered manager going about her role in the home and through discussions with residents, relatives and staff that she is very approachable, and friendly and respected by them. There is a very broad programme of quality assurance carried out in the home. The focus is on encouraging residents and relatives to comment and contribute their opinion of how the service is run. This is through informal discussions and formally in regular surveys, resident and relative meetings. In addition to this there is a regular programme of staff and heads of department meetings plus supervision and appraisal of staff. Residents and relatives are also kept up to date with changes and news through the newsletter which gives information about planned events, changes in the staff team and the findings from any recent survey consultations carried out. The home holds some monies on behalf of a small number of residents as for them to pay, where required, for hairdressing, chiropody or toiletries if an advocate is unable to do this for them. A sample of records were reviewed which show that all transactions are audited and receipts kept to support any actions carried out on their behalf. We looked at samples of the safe working practices carried out in the home. Examples of maintenance and safety checks for water temperatures, wheelchairs and emergency lighting support that staff carry these out routinely. Information was provided in the AQAA show that equipment safety checks are carried out for hoists, the lift and fire safety. Care Homes for Older People Page 28 of 32 Evidence: We were informed that automatic fire closures were in the process of being fitted to some of the bedroom doors as a small number of residents prefer to keep their doors open. One resident put about what the home does well was, If I go out I am happy to come back. Care Homes for Older People Page 29 of 32 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 30 of 32 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 31 of 32 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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