Care Home: Laurel Bank

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What the care home does well The manager and her management team lead the continued development of the high standard of the home, both in the environment, and in the way care is provided at the home. People living at the home are given choices, and are helped to maintain their usual daily routines as much as possible. Assessments of need and care plans provide person-centred information for staff, enabling them to know how best to look after each individual. The residents surveys returned to us told us that they always received the care and support they needed. "I`m definitely well looked after", said a resident. Staff we spoke to had a good understanding of residents` needs, and we saw good interaction between the staff and the residents living at the home. Care staff and nursing staff attend various training courses, both mandatory and specialised, and 53% of the care staff hold NVQ qualifications. Staffing levels are kept at a good level to provide more opportunity for interaction time with residents. The home holds the Investors In People award, showing a commitment to the development of staff. The home has a relaxed and friendly atmosphere, and visitors are welcome at any time. The furnishings are very homely and comfortable. Bedrooms are attractive, and the addition of many personal belongings makes them all individual. Residents told us that there are always activities organised that they could take part in if they wish, and talked about gardening and crafts sessions, restaurant meals in the dining rooms and trips out in the bus. They told us how they liked to go for short walks or sit in the garden when it was warm enough. The manager was aware of the need to always address the activities available for people in the home, and activity coordinators ensured a very varied planned programme was always in place and well advertised. Personal interests are taken into consideration, and one resident who enjoyed photography had been enabled to produce a large album recording events at the home. This was for all to view in reception, giving new residents and their families a good picture of life there. A dedicated cook plans and prepares meals, and all of the residents we spoke to told us they enjoyed the food at the home. Meetings with residents are held to discuss any problems, or take on board any suggestions for things such as meals, activities, or decor. The manager told us that the approach in the home is open, and they try to encourage staff to discuss issues, and residents and their families to chat freely and express opinions. All of the residents we spoke to were satisfied with the way they were looked after, and could not think of anything they would like done differently. The manager told us of the plans in place to further develop staff and the care provision in the home, and to continually monitor the service as a whole, in order to maintain the very high standards they aim for.She told us, "We like to promote people coming to live here as a new event - that this is something new in their lives, and a positive experience to look forward to". What has improved since the last inspection? The home`s standards are continuously monitored through comprehensive audits done by the manager and her team, the results of which give a good picture of what is going on at the home. Feedback from residents and their families is also obtained for suggestions, and the manager tries to make the way people are looked after the best they possibly can. Palliative care training has further improved, with good relationships developing with the local hospice who provide the training for all of the staff at the home. Management staff also intend to achieve the Gold Standards Framework for palliative care, aiming for the best provision through knowledge and skills that they can. Since our last visit we saw further developments in the garden of the home, with a well thought out sensory garden, and success in the national in-house `Barchester in Bloom` competition. Another national in-house competition found the chef at the home winning second place. Within the environment various seating areas have been created outside of the lounges, to give residents more of a choice of where they may like to sit in the home, outside of their rooms. The Clinical Governance System has been reviewed and further improved, being more detailed. In considering how to achieve person centred care as much as possible, individual lockable medication cabinets have been installed in the bedrooms on one floor, holding the person`s medication and their Medication Administration Record for staff to complete after administering the medication. Following discussion with residents and staff, the role of Personal Carer has been created, providing a more individual and personalised response to the requests from, and needs of, residents. In order to help develop the already varied activity programme, a second Activity Coordinator has been appointed. What the care home could do better: As mentioned above, the Barchester organisation and the manager of the home are aware that there is always room for improvements to their already high standards, and so are constantly looking for ways to improve the quality of life for people who live there. The manager told us, "It is important not to be complacent about our service provision and be aware that there is room for improvement in any organisation". We discussed the benefits of providing a short up to date overview of the comprehensive care plan for staff to use, particularly new or bank/agency staff, where a prompt on people`s needs may be useful. Key inspection report Care homes for older people Name: Address: Laurel Bank Westbourne Road Lancaster Lancashire LA1 5EF     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: Jennifer Hughes     Date: 0 7 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Laurel Bank Westbourne Road Lancaster Lancashire LA1 5EF 01524388980 0152432857 laurelbank@barchester.com www.barchester.com Barchester Healthcare Homes Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Melana Thomas Type of registration: Number of places registered: care home 67 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code 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 - Code OP Physical disability - Code PD (maximum number of places 5) The maximum number of service users who can be accommodated is: 67 Date of last inspection Brief description of the care home Laurel Bank is a purpose built care home, set in its own grounds, with attractive landscaped gardens and a large patio area with seating and tables. Parasols add to the scene in the warmer weather. It is a short distance from the centre of Lancaster, so there is easy access to transport links. The home has its own ample sized, tree lined, car park. The home provides personal and nursing care for older people, and is well Care Homes for Older People Page 4 of 30 0 5 Over 65 67 0 Brief description of the care home equipped to suit the needs of its residents. For example, there is a passenger lift, assisted baths, hoists, grab rails, and ramps. Single and double rooms are sited on two floors, all being en-suite. Toilets and bathrooms are conveniently situated. There is sufficient communal space, with lounges and dining rooms on both floors, and a large conservatory on the lower floor. Three cooked meals a day are provided, with varied choices, and snacks and any dietary needs are also catered for. Activity Coordinators make sure there is a variety of different events going on to entertain most people. Qualified nursing staff and care staff are provided over 24 hours, every day of the year. A Statement of Purpose and Service User Guide are available from the home, giving information about what it provides and the services available. As at April 2010, the fees ranged from £390 to £890 per week, but the final agreed cost depends on the individual assessment of need. Further details regarding fees are available from the home. Care Homes for Older People Page 5 of 30 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 unnannounced visit to the home, in that neither the Barchester organisation nor the manager were aware that it was to take place. The site visit was part of the key inspection of the home. A key inspection takes place over a period of time, and involves gathering and analysing written information, as well as visiting the home. The length of the visit was for 5 hours. Every year the registered persons are asked to provide us (Commission for Quality Care, CQC) with written information about the quality of the service they provide. We use this information, in part, to focus our assessment activity. This document is called the Annual Quality Assurance Assessment (AQAA). Surveys were sent and received from residents and staff of the home. Care Homes for Older People Page 6 of 30 During the site visit staff records and resident care records were viewed, alongside policies and procedures of the home. The manager and management team, residents and relatives, nursing and care staff were spoken to, and their responses are reflected in the body of this report. A tour of the home was made, viewing lounges, dining rooms, bedrooms and bathrooms. Everyone was friendly and cooperative during the visit. Care Homes for Older People Page 7 of 30 What the care home does well: The manager and her management team lead the continued development of the high standard of the home, both in the environment, and in the way care is provided at the home. People living at the home are given choices, and are helped to maintain their usual daily routines as much as possible. Assessments of need and care plans provide person-centred information for staff, enabling them to know how best to look after each individual. The residents surveys returned to us told us that they always received the care and support they needed. Im definitely well looked after, said a resident. Staff we spoke to had a good understanding of residents needs, and we saw good interaction between the staff and the residents living at the home. Care staff and nursing staff attend various training courses, both mandatory and specialised, and 53 of the care staff hold NVQ qualifications. Staffing levels are kept at a good level to provide more opportunity for interaction time with residents. The home holds the Investors In People award, showing a commitment to the development of staff. The home has a relaxed and friendly atmosphere, and visitors are welcome at any time. The furnishings are very homely and comfortable. Bedrooms are attractive, and the addition of many personal belongings makes them all individual. Residents told us that there are always activities organised that they could take part in if they wish, and talked about gardening and crafts sessions, restaurant meals in the dining rooms and trips out in the bus. They told us how they liked to go for short walks or sit in the garden when it was warm enough. The manager was aware of the need to always address the activities available for people in the home, and activity coordinators ensured a very varied planned programme was always in place and well advertised. Personal interests are taken into consideration, and one resident who enjoyed photography had been enabled to produce a large album recording events at the home. This was for all to view in reception, giving new residents and their families a good picture of life there. A dedicated cook plans and prepares meals, and all of the residents we spoke to told us they enjoyed the food at the home. Meetings with residents are held to discuss any problems, or take on board any suggestions for things such as meals, activities, or decor. The manager told us that the approach in the home is open, and they try to encourage staff to discuss issues, and residents and their families to chat freely and express opinions. All of the residents we spoke to were satisfied with the way they were looked after, and could not think of anything they would like done differently. The manager told us of the plans in place to further develop staff and the care provision in the home, and to continually monitor the service as a whole, in order to maintain the very high standards they aim for. Care Homes for Older People Page 8 of 30 She told us, We like to promote people coming to live here as a new event - that this is something new in their lives, and a positive experience to look forward to. What has improved since the last inspection? What they could do better: As mentioned above, the Barchester organisation and the manager of the home are aware that there is always room for improvements to their already high standards, and so are constantly looking for ways to improve the quality of life for people who live there. The manager told us, It is important not to be complacent about our service provision and be aware that there is room for improvement in any organisation. We discussed the benefits of providing a short up to date overview of the comprehensive care plan for staff to use, particularly new or bank/agency staff, where a prompt on peoples needs may be useful. Care Homes for Older People Page 9 of 30 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 10 of 30 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 11 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a very comprehensive assessment procedure, which is carried out for all people who live there. This means that the service provided is always tailored to an individuals needs and preferences. Evidence: The home provides very clear information about the service it provides in the form of a Statement of Purpose and Service User Guide and a brochure that contain information that clearly details who owns and manages the home, and what services the home provides. There is detail on what people who live there can expect from the day to day running of the home, and the staff who will look after them. Extensive information, including the above, is available in the reception area of the home for all to see, with contact information for other support organisations, such as Help the Aged, or advocacy services. The home produce a newsletter, which has input from residents and can be seen in reception, as well as an album of photographs of Care Homes for Older People Page 12 of 30 Evidence: the home, grounds, and events during the year, all taken by one of the residents. The home also have an internet web site that holds plenty of information about the home, and the Barchester organisation, with links to Care Quality Commission inspection reports. The manager told us that trial visits that may include lunch, or taking part in activities, are welcomed. Most of the residents we spoke to were able to tell us that they knew about the home before they moved in, with some arrangements being made by family members. One resident said he had looked at plenty of homes with his family before deciding, and said about Laurel Bank As soon as I walked through the door, I knew this was the place for me. We viewed the individual records of two residents we randomly selected. There is a set procedure for admitting someone to the home, and all of the files held preadmission assessments carried out by the manager or senior nursing staff. The preadmission assessments helped to identify that the home was able to provide the care required by the prospective resident, followed by a Total Care Assessment providing specific detail of that care. The assessments included all aspects of physical, social and psychological care, identifying the strengths and needs of individuals. They had been signed by the resident or their family, showing their agreement and participation with the assessment. Staff told us that they were always given up to date information about the care needs of people they support, and were able to view the assessments that had been made for more information. They were able to tell us about the needs of residents, and how to meet those needs. Staff told us that they felt the communication systems in the home were very good. Care Homes for Older People Page 13 of 30 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 health and personal care needs of residents are very well met in this home. Evidence: Care plans are written records that describe the care that is given to each resident. We noted that the care plan format at the home prompted comprehensive information and were very structured. A standard care plan format was used for both residential and nursing residents. The files we viewed held some good person centred information about residents and the care they required, noting the little things that are important to individuals. For example Talk her through any moves to reduce anxiety , because of dementia she requires clear instructions and time to respond, and she likes to be neat and tidy before leaving her room . The plans identified the areas of need for each person, with very clear instructions for staff on what they must do to meet that need. We saw that any task direction for staff encouraged the promotion of dignity and choice of the resident. The manager told us We are constantly looking at our care plans to make them more I centred. Due to the amount of detailed information about each person in their care plan, we Care Homes for Older People Page 14 of 30 Evidence: advised the use of a short working overview of the care plan, for staff to use as a prompt as to the care required. We saw that reviews of all areas of the care provided were carried out every month or as needed, with additional guidance for staff if there were any changes. The six monthly care plan reviews always include the resident or their family. The manager was aware of the requirements of the Mental Capacity Act 2005, and the Deprivation of Liberty Safeguards (DoLS). Information about these are available for staff. The manager told us she had made one referral under DoLS. Thorough assessments are made of any risk to the residents, with action for staff to take to reduce that risk. The care of a person with a pressure sore was very well documented, with body maps, up to date photographs, wound care chart and treatment plan, very regular reviews and good liaison with health professionals, providing the best care the home could. We saw that healthcare opportunities were offered equally to all individuals, and records of visits from healthcare professionals such as GPs, chiropodists and physiotherapists clearly note the reason for the visit and the action taken by staff in response to it. We saw clear and informative daily notes were made by staff for each resident, which gave a good picture of each persons life in the home. The manager, staff and the residents told us about the development of the personal carer role in the home. This is a planned improvement on the key worker role, to encourage staff to provide more person centred and very individual support, and having particular knowledge of a person to be able to do this. The residents we spoke to could tell us who their personal carer was, although the change of name from key worker had not yet been taken on board by them, and told us of the special things they did for them, like getting family birthday cards, reading letters, or just sitting and chatting about things. Named nursing staff in the home have special interests, such as continence, tissue viability, infection control and palliative care, and provide advice and training for staff. As a nursing home, the standard of the palliative care provided is extremely important, and the home has developed very good links with the local hospice, who provide palliative care training for all of the staff. Care Homes for Older People Page 15 of 30 Evidence: One resident told us, Were definitely well looked after, theyre very efficient. The staff cant do enough for you. We looked at a sample of medication records and stock. Residents on the first floor now have individual lockable medication cabinets in their own rooms, with their Medication Administration Record, and information about their medication. The manager told us this is still being monitored closely, but that it has caused the recording and stock keeping to be more efficient, and is also a further step towards person centred care. A designated treatment room holds medication that needs fridge storage and the secure storage of Controlled Drugs. All records seen were clear and up to date. Only trained staff administer medication. We saw that a risk assessment was carried out before any resident self medicated. We saw medication audits were carried out regularly. The manager explained that there is a Clinical Governance System in place, which is reviewed by the Clinical Team and updated by the home every month.There are clinical audits on both care and medication. Care Homes for Older People Page 16 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home experience a very good quality of life in this area. Meals were nutritious and mealtimes relaxed, encouraging people to enjoy meals and mealtimes. There were plenty of varied activities, and most people were stimulated and motivated by joining in. Evidence: The individual care plans we saw included in depth information on each persons life history, their religious needs, and what hobbies and activities they preferred. Since our last visit, a second Activities Coordinator has been appointed, and we saw that they organise a very varied programme for residents through the week. We saw that the programme was advertised throughout the home, and each resident had their own up to date copy of the daily events for the next two weeks. Each person is assessed by an Activities Coordinator as to what activities they would be able, and wish to, participate in. Each month they review what each person has felt able to join in with, to enable them to identify where people need or wish for more individual contact. We saw records of simple chats one to one between staff and Care Homes for Older People Page 17 of 30 Evidence: residents, and also observed several residents taking part in a dominoes session, which included wine and cheese tasting. The manager told us that they constantly try to introduce new things to the home, and now have a Wii games console, which is enjoyed by a few of the residents. A computer has also been installed into an area of one of the lounges that has been furnished as an office, with equipment and furnishings residents may remember from their past. The manager said she felt it was important for residents to have different environments to sit in than just a standard lounge, giving stimulation and aiding memories. She has also provided other seating areas outside of the lounges for residents to use. We saw evidence of the gardening club, with residents having their own plots to grow vegetables in, which are later sold at the Summer Fair. We saw evidence of the art and crafts club, with pictures done by residents on the walls, and home made Christmas cards. Some residents enjoy contributing to the quarterly newsletter. Some residents have helped to make a batch of shortbread, passing their pre baked items through the kitchen hatch to be placed in the oven. A few of the male residents were due to make a trip to a local pub, for a men only outing. The list of activities continues to be diverse, and surveys are regularly used to ensure all of the residents are satisfied with events, or have any suggestions. The home have a minibus, and take residents out on trips around the region. One survey suggested more trips out were needed, so the manager told us they are addressing this by providing more variety of trips for people. The pre admission assessment identifies any particular dietary need, and the catering department are kept informed and up to date. Meals are served in light, well-set dining rooms, while gentle music plays. Glasses of sherry or wine are offered with the meal. Meals are nutritious and varied, with planned menus, which are on view outside each dining room, and at the entrance to the home. The lunch on the day of the visit gave the choice of beef stew and dumplings or fish pie, followed by ginger cake or fruit and ice cream. The surveys received from residents said they always or usually liked the meals at the home. One resident told us, We are able to select what we want at the table now at breakfast and lunch time, and there are always choices at tea time as well. The organisation listen to what the residents want. For example they wanted us to have a later tea time, but we disagreed, so it stayed the same. Care Homes for Older People Page 18 of 30 Evidence: Another resident said It was stew for dinner, but I dont eat very much so I had an omelette followed by cheese and biscuits instead. The manager told us that the chef is keen to try new things, and he attends the residents meetings to get suggestions. She told us the chef, who is fairly new at the home, recently came second in a national competition within the Barchester organisation. Gourmet evenings are arranged, with the dining room being turned into a restaurant type environment. Residents are able to invite relatives and friends to enjoy a meal in pleasant and relaxing surroundings. Care Homes for Older People Page 19 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident all of their concerns will be listened to and acted upon. Staff have a good understanding of safeguarding issues, which protect people who live in the home from abuse. Evidence: There is a well developed complaints procedure in place, with a very good system of recording, monitoring and dealing with any complaints that have come to the managers attention. All concerns are recorded, including minor grumbles. Outcomes of the investigation are recorded, with review dates to check the problem has not reoccurred. The manager told us that she has an open door policy, and encourage relatives/residents to pop in and raise any issues. We saw there was a copy of the Comments and Complaints policy in reception, with one also in each bedroom. Responses from surveys showed that relatives and residents knew how to make a complaint if it were necessary. All homes are required to have written procedures in place to be followed if it is suspected that a resident has been the victim of abuse. These are generally referred to as safeguarding procedures. We saw that there was a safeguarding policy in place, and staff records showed they had all had training in safeguarding vulnerable adults. Those spoken to were clear on what to do if they had any concerns about a persons Care Homes for Older People Page 20 of 30 Evidence: welfare. People at the home said they felt safe and very well looked after. An assessment of mental capacity is made during the initial assessment of a resident, and the home have followed the guidance of the Mental Capacity Act(MCA)2005 and made one Deprivation of Liberty Safeguard (DOLS) referral to social services. Staff receive information about the MCA during safeguarding training, and the head of each of the departments in the home have attended external training. Care Homes for Older People Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment in this home is kept consistently high. It provides people with an attractive, safe and homely place to live. Evidence: The garden is landscaped and attractive, with a large patio area in front of the conservatory holding solid wooden seating and tables for use of the residents. The manager said they see the gardens as an extension of the home, and since our last visit the planned sensory garden has been created, giving another element to the home for residents, and winning the Barchester in Bloom garden competition. The local wildlife in the form of a variety of birds and squirrels enjoy the garden, and can be seen from some lounges and bedrooms. Maintenance is ongoing, with continued decoration and refurbishment where necessary. A dedicated housekeeping team ensure the home is kept very clean and fresh, and we saw domestic staff following the work schedule in place. The manager confirmed Our home is wheelchair friendly, purpose built, but retains a homely atmosphere. Daily issues are reported by staff, with the maintenance man dealing with them as soon as possible. Regular head office audits check that maintenance is carried out as it should be. All tests of lighting, fire alarms, nurse calls and water temperatures are Care Homes for Older People Page 22 of 30 Evidence: carried out very regularly, with clear records made. A tour of the home confirmed that the bedrooms, all ensuite, were nicely furnished and decorated, and were full of peoples personal belongings, such as photographs and pictures, ornaments and flowers. New admissions are welcomed to their room with the nice touch of fresh, new towels and bath products laid on their bed. The lounges are comfortable and homely, and of varying sizes. The manager has created new small seating areas outside of the lounges for people to sit if they wish, and continues to consider how the living environment can be developed for the benefit of the residents. Grab rails, assisted baths, lifting and bathing hoists, and raised toilet seats all go towards helping the mobility of people around the home. The laundry room was clean and tidy, with an organised system being used to protect against cross infection, and to make sure there is no misplaced clothing. Training and procedures are in place for staff, to make them aware of the best ways of working to keep themselves, and the people in the home, safe. Care Homes for Older People Page 23 of 30 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. The home uses a very good recruitment procedure, which ensures that only people who are suitable for this type of work are offered an appointment. Staff training is provided, and competancy measured. This means that people living at the home receive appropriate care and attention. Evidence: Three staff files we chose to view showed that the necessary recruitment checks had been carried out to ensure the protection of residents. References and Criminal Records Bureau (CRB) disclosures were available. Professional qualifications were also confirmed. The home manager, and the office manager, ensure all of the information is complete before the new staff start work. All staff receive a comprehensive induction, a staff handbook, and a copy of the General Social Care Council code of conduct for staff. We saw that the staff group are a good mix of qualified nursing staff and care staff, experienced long term staff and enthusiastic younger staff, multicultural and both male and female. The manager told us Residents needs are met by the skill mix of staff, which are dictated to by the assessments. The rotas showed appropriate numbers of nursing and care staff on duty through the Care Homes for Older People Page 24 of 30 Evidence: day and night. Domestic staff are managed by the Housekeeper, whose role is to ensure a continuous high standard of cleanliness in the home. The organisation have provided a computer for staff to use specifically as a training aid. They can use this when they are able to access information and complete training courses. We saw that there is also a Learning and Development site set up on the electronic system, holding all training records, and which is monitored by an appointed trainer to identify the training needs of all staff, and the need for refresher training. There is an ongoing programme of mandatory training, more specialised training, and in addition there are named nursing staff who have special interests in certain topics who cascade that knowledge to staff during informal training sessions. These topics cover continence, tissue viability, infection control and palliative care. Staff attend palliative care training at the local hospice, and some of the managers are working on attaining the Gold Standards Framework in Palliative Care. Trained staff have six monthly medication refresher training. All care staff are encouraged to complete National Vocational Qualification (NVQ) Level 2 in care, and at present 53 of staff hold NVQ qualifications. The manager told us that they work to always maintain over 50 of NVQ qualified staff, a figure that may fluctuate, as it is linked to the flow of staff working at the home. A staff member told us, Theres loads of training, both specialist and mandatory. You cant be complacent because people expect so much now. Training is good for staff morale, and it shows them how things should be done. Another said that they felt well supported with regular contact with the manager. Its a team of staff here and we all work together to make sure people are looked after. There are good communication systems used in the home, and the manager is very easy to talk to, said one staff member. Care Homes for Older People Page 25 of 30 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 manager leads a team of qualified and well trained staff who work to make sure people who live at the home are as safe and comfortable as possible. Their aim is to continually improve services and always maintain a good quality of life for residents. Evidence: The manager holds nursing qualifications and has many years experience of running a care home. She is assisted by a committed, experienced and long term management team. The manager returned the Annual Quality Assurance Assessment (AQAA) for the home to us when we asked for it, and it was completed well, with all of the information we needed. The manager confirmed that she has constant support from within the Barchester organisation, from the Regional Director, the Clinical Team, the training coordinator and training academy, property services, Health and Safety Officers, and the interior design department. Care Homes for Older People Page 26 of 30 Evidence: There are comprehensive systems used in the home to regularly audit and monitor standards, and to get feedback from people living at the home and their families on their level of satisfaction with the service. There is a Clinical Governance System in place at the home, and a Clinical Development nurse regularly visits the home. The manager told us that she occasionally worked a shift at the home, when she took the opportunity to spot check records, on top of the very regular audits for all aspects of the home demanded by the organisation. A summary of the regular surveys sent out to people is available in the reception area of the home for anyone to view. A letter also goes to relatives detailing the outcomes. We saw visitors calling at the home throughout the day, clearly feeling able to approach the manager and staff in this friendly environment. The manager always made time for visitors, and a visitors lounge off the large reception area gave private space for conversations. The manager said she likes to be open, and welcomes staff, residents and relatives to approach her, often walking around the home chatting to staff and individuals, and making sure her office door is always left open for people to call in and speak to her. Meetings for staff and for residents, take place regularly. All have an action plan devised following the meeting to determine how issues raised are to be addressed. Any accidents taking place in the home are recorded. A monthly overview relates the type of accident, so that reasons for any re-occurring problem can be dealt with. Records show fire training for staff, and the manager confirmed the maintenance and servicing of equipment was up to date. There was no change in the financial procedures of the home. Care Homes for Older People Page 27 of 30 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 28 of 30 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 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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