Care Home: Leominster Residential & Nursing Home

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What the care home does well People are provided with information about the home and encouraged to visit and trial the service. Their needs are carefully assessed before a place is offered to ensure these can be met. People`s care and health needs are met and their medicines are safely managed. The home is purpose built and is being well maintained to provide a safe, comfortable and smart home for the people who live there. People have access to the grounds and there is a lounge that can be used by visitors. People told us the staff are friendly and helpful and they encourage people to remain as independent as possible. People felt they are supported to live the way they wish and feel safe and relaxed. One person said, `They make me feel like an individual not a number`. Another said, `They help me to be independent`. There are regular opportunities for people to enjoy social activities if they wish. There is low staff turnover which means people get to know the staff well. Staff are carefully checked before they start work, then they are given a full induction and time to learn the job. They feel well supported and trained. The management ethos is one of constantly striving to improve the service. Mrs Hartley (Matron) is highly thought of by the people in the home and their relatives. One person`s relative said, `The level of care is excellent and a reflection of the excellent management which ensures good care. We are most fortunate to have Mrs Hartley as a manager. It has taken such a weight of my mind and I feel confident all is done for my wife`. What has improved since the last inspection? The way people`s care needs are recorded and reviewed has improved with the introduction of the new Company system. Medication management systems are more robust and staff are better trained in the safe management of medicines. Improvements continue to be made to the building and equipment, such as new lounge curtains and new nursing beds. What the care home could do better: The role of Keyworker could be further developed to ensure each person`s service is personalised. A Keyworker is an identified worker who spends time with a person getting to know their preferred lifestyle. The assessment of moving and handling need should ensure the safest and most comfortable arrangements are in place for each person. More staff could be provided at certain times to increase the amount of personal attention each person receives. All staff should be trained about dementia. At least half of the care staff should hold a National Vocational Qualification in Care. Key inspection report Care homes for older people Name: Address: Leominster Residential & Nursing Home 44 Bargates Leominster Herefordshire HR6 8EY     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: Jean Littler     Date: 2 9 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 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 29 Information about the care home Name of care home: Address: Leominster Residential & Nursing Home 44 Bargates Leominster Herefordshire HR6 8EY 01568611800 01568611855 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.bupa.co.uk BUPA Care Homes (CFC Homes) Ltd care home 51 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 51 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 (OP) 51 Dementia (DE) 51 Physical Disability (PD) 51 Date of last inspection Brief description of the care home Leominster Residential and Nursing Home is owned and managed by BUPA Care Homes (CFCHomes) Ltd. The Home was opened in 1996 and consists of a two-storey purpose built Home with a Georgian style facade. The service is for a maximum of 51 older people of both sexes, who need support because of a physical disability, dementia, or frailty due to old age. The Home is located in the town of Leominster, a short distance Care Homes for Older People Page 4 of 29 Over 65 0 51 0 51 0 51 Brief description of the care home from the shops and other amenities. The Home has 45 single en-suite bedrooms and 3 double en-suite bedrooms. A designated single bedroom is available as a respite care facility. The Home has a passenger lift. There is parking and accessible gardens. There is a pack of information that describes the service offered at the home. All enquirers receive one of these packs and each bedroom at the home is supplied with one. The Provider does offer to produce the information in a way that will be accessible to people who have difficulty reading the standard version e.g. large print. From 2010 the fees range from £520 plus a £75 a week top up (for people funded by the Local Authority) to £733 for privately funded nursing care. Respite care is £840 a week. Additional charges are made for hairdressing, chiropody, private physiotherapy, private alternative treatments, toiletries, newspapers and magazines. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We, the Commission, carried out this unannounced inspection over one full day. The service was already rated as providing excellent outcomes for people, therefore an inspection was not carried out for three years. Annual Service Reviews were in the interim years. The information received from the manager, Mrs Hartley, and from surveys indicated that positive outcomes were still being achieved. Mrs Hartley provided us with the annual quality assurance assessment (AQAA) that registered people are asked to complete each year. A sample of survey forms were sent out to obtain feedback on the service from people living in the home, their friends and relatives, staff and external professionals. Thirteen were returned from people living in the home and nine from relatives. During the visits to the home the building was toured, records such as medication, care plans, training and staff recruitment were sampled. People living in the home and staff Care Homes for Older People Page 6 of 29 were spoken with. The support arrangements for two people with nursing needs were looked at in more detail, their views were gained and they agreed to us seeing their bedrooms. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: The role of Keyworker could be further developed to ensure each persons service is personalised. A Keyworker is an identified worker who spends time with a person getting to know their preferred lifestyle. The assessment of moving and handling need should ensure the safest and most comfortable arrangements are in place for each person. Care Homes for Older People Page 8 of 29 More staff could be provided at certain times to increase the amount of personal attention each person receives. All staff should be trained about dementia. At least half of the care staff should hold a National Vocational Qualification in Care. 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 29 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 29 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. Admissions to the home are carefully planned so that the person and their relatives know what to expect of the service, and the staff have the information they need to meet the new persons needs and expectations. Evidence: There is a pack of information that describes the service offered at the home. Mrs Hartley said in the AQAA that everyone has a copy of this information before they move in and this includes information about the fees. The information can be produced in different formats if needed e.g. large print. All but one person who returned a survey said they had received enough information about the home. The care records for one new person were seen. These showed that information about the persons needs and expectations had been gathered before a place had been offered. Mrs Hartley said she always carries out the assessments and then she has confidence that staff have the right information to start providing a service to a new person. The assessment then forms the basis for the care plan, with the original assessment being Care Homes for Older People Page 11 of 29 Evidence: rewritten after six reviews have been carried out. The information seen was clear and covered all appropriate areas. People are all offered the opportunity to visit the home before moving in. If this is not possible because the person is in hospital then their family are encouraged to visit to assess the service. Mrs Hartley said she likes to get to know each new person and their family so they feel they can come to her with any problems in the future. All admissions are agreed on a trial period and a meeting is held before the placement is confirmed as permanent. Every person receives a contract of residence to confirm the arrangements and the fees. When charges are altered a letter is sent out to inform the resident or their relative. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People feel their needs are met with dignity and respect. Each person has their needs recorded in a plan that is kept under review. They and their relatives are consulted as part of this work. People are having their health needs met and their medicines safely managed. Evidence: Each person has a written plan describing their support needs and preferences. A Company format is used and senior staff review the content every month. The plans seen were clear and they reflected the current situation for the people in terms of their personal and health needs. Staff gave feedback that they are kept well informed about changes in peoples needs and conditions. A carer told us that she had found the plans very helpful when she started in her job. People told us that they are consulted about their care. One man said he is involved in decisions about his health care such as why his doctor had changed his tablets recently. Since new nurses have been recruited there is now usually two on duty. Staff said this has made it much more practical for them to carry out all their duties well, such as supervising carers, writing records and giving medication. Care Homes for Older People Page 13 of 29 Evidence: Arrangements are in place for routine health services such as the dental and chiropody. One visiting professional was seen to treat a person in the lounge rather than arranging for them to go somewhere private. Mrs Hartley said this does not normally happen and privacy is taken seriously. She confirmed that the nurses are trained in the nursing techniques needed in the home, such as catheterisation. The care plans showed that risk areas are assessed and action identified, such as pressure area care, the use of bedrails, the need to monitor peoples weight, food and fluid intake. Two people currently in the home had developed pressure areas. Appropriate equipment was in place and both sores were healing. If people on the residential floor have a specific nursing need, this treatment this is provided by the local district nursing team. A GP said, This is an excellent service with high standards on both the nursing and residential side. I have no concerns about the quality of care. A McMillan nurse said, The staff are always polite, helpful and courteous. They always greet you at the reception, they are interested in the residents welfare and best interest. Staffing levels sometimes seem difficult. All but one relatives and friends indicated that the care service meets the needs of people in the home. One said, The service ensures that my wife is always cared for in a peaceful and friendly environment. Her every need is catered for. The staff in all roles and the manager are caring and ensure I am informed of any problems. The home is always immaculate. Accidents and incidents are monitored. The home has a low incidence of people falling or developing pressure sores. A First Aider is on every shift and the policy is for this person to take charge of administering first aid even if there is a nurse on duty, unless the nurse is a first aider. The medication arrangements on the nursing floor were checked. The systems were clear and were being correctly implemented by the nurses. Hand written entries on the administration records had been signed by two staff to confirm information is accurate. Controlled drugs were being appropriately stored and actual balances of stock matched the balance recorded in the controlled drugs register. Staff who administer medication have all received the Company training on safe handling of medications. Mrs Hartley said all nurses and both residential team leaders have recently started an advanced level medication course. Appropriate arrangements are in place to support people with diabetes. Mrs Hartley told us that people are supported, when possible, to die at the home if that is their wish. She described how family and staff sang carols around a persons Care Homes for Older People Page 14 of 29 Evidence: bed as they died at Christmas time. People are being consulted about their wishes in the event of them dying at the home. In some cases the details in the care plan were very brief and could be expanded. Resuscitation wishes are recorded by their GP after consultation with the person and their representatives. Now people are legally enabled to make living wills, that cover their wishes should they loose mental capacity, Mrs Hartley could promote the completion of these. Care Homes for Older People Page 15 of 29 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 like the staff that support them and they are encouraged to remain as independent as possible. People experience a good quality of life in the home and enjoy the range of activities available. There is some scope for the service to be more personalised. People enjoy their meals and they are offered a choice each day. Evidence: All staff spoken with seemed to have a positive attitude and were seen to treat people with respect and kindness. Relatives said they found the staff helpful and the atmosphere welcoming. The activities co-ordinator is also the lead housekeeper. She has a duel role working 25 hours in each capacity. She arranges a regular programme of organised activities such as flower arranging and art. Some sessions are held by external people, such as armchair exercises and Holy Communion. A hairdresser comes three times a week. She has been coming for six years so knows the styles people want. Feedback indicated that people enjoyed some of the things on offer. One lady liked the Friday cinema film show and the flower arranging. She was being supported to attend her church and enjoyed regular visits from her family. She spoke about her recent birthday party where the chef had catered well for all her guests. One man said he Care Homes for Older People Page 16 of 29 Evidence: liked the card games, art and exercise classes. He also still goes into town independently on his electric wheelchair. Both felt that they were enabled to spend time doing pastimes of their own choice. Both people were interested in garden birds. The man was trying a window bird feeder and the lady goes into the garden to put food out. Mrs Hartley had recently brought in some articles to read on the subject. The man said he can get up when he chooses to but he now goes to bed a lot earlier than he used to at home. He said he agrees to get into bed at 7.30pm as staff come and ask if he is alright. He feels this is their prompt to get ready for bed as they go off duty soon afterwards. He said he does not mind too much, so he has not raised the issue, as he continues to read or watch television in bed. Discussions like this indicated that the care arrangements could be more personalised by keyworkers spending time talking to people about how they experience their daily routines. Mrs Hartley reported in the AQAA that more individual activity sessions are now being provided and that activities are now also being arranged for the weekends. Special events are also organised. For four weeks over the summer a cruise theme programme of entertainment was followed with food, music and costumes for each of the international cities featured over the four weeks. Speakers were also arranged and members of the community joined in. A photo display showed people enjoying themselves. Feedback showed that people are happy with the quality of the meals. The four weekly menu is on display in the main lounge area. These are audited by the Company to ensure they are nutritionally well balanced and varied. People are consulted on their meal choices for the following day. The chef confirmed that there was a sufficient budget so good quality provisions could be ordered. A system is in place to ensure kitchen staff are aware of peoples special dietary needs. Surveys gave mixed views on the food, most were positive but four people said they only sometimes enjoy their meals. The lunchtime main meal was observed to be served in a calm and congenial atmosphere. The tables are set nicely with china and glassware. Wine and Sherry are offered each day. Mrs Hartley said staff are aware of where people sit as some do not like to see fellow residents receiving assistance with their meals. The man spoken with in depth said he does not always get a hot drink when he first wakes and he may be up for two hours before he has his breakfast and a drink. There was a list of drink preference but his preferences were not included. Care Homes for Older People Page 17 of 29 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. People in the home and their relatives know how to raise concerns and are confident they will be taken seriously. Suitable systems are in place to help safeguard vulnerable people. Evidence: The home has a complaints procedure. This is included in the information given to everyone when they move in. Mrs Hartley said she spends time getting to know people and their families so they feel able to come to her with any concerns. All feedback received indicated that people feel able to raise issues. Mrs Hartley said there have only been two formal complaints received in the last year. One was about a fee increase and the other was about care matters. A record is being kept of any complaints. This showed that complaints are taken seriously and are responded to promptly. We have not received any complaints about the service in the last year. The staff have received training in adult protection. There is company training on this that is covered during the induction period. Staff have also attended safeguarding adults training provided by Hereford County Council and Mrs Hartley has attended the managers course. The staff spoken with were clear about their responsibilities in this area and said they would report any issues to help protect people. There have not been any concerns or incidents in the last year that Mrs Hartley has needed to report under the local multi-agency safeguarding procedures. Cases in the past have been appropriately reported and steps taken promptly to maintain the safety and wellbeing Care Homes for Older People Page 18 of 29 Evidence: of people in the home. Recruitment records showed robust checks are carried out on potential employees to help ensure they are suitable to work with vulnerable adults. Care Homes for Older People Page 19 of 29 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. People benefit from accommodation especially designed to suit their needs and a high quality of furnishings and facilities. The home is kept well maintained, safe and clean. Evidence: The home was purpose built and it has been well maintained. Improvements have been added over time, for example, a sensory garden. Decor, furnishings and fittings are high quality and periodically replaced. The kitchen is now showing its age, but Mrs Hartley said repairs to tiles and the floor have been agreed. The chef said the original extraction fans are difficult to deep clean because they are aluminium rather than the modern preferred design in stainless steel. Consideration should be given to refitting the kitchen equipment. Upstairs there are 31 bedrooms and on the ground floor there are 17. The three double bedrooms continue to be used as single rooms so each person has full privacy. One bedroom upstairs is kept so respite care can be planned ahead for local people to enable their carers to have planned breaks. Mrs Hartley said bedrooms are redecorated before someone new moved in. People are encouraged to personalise their bedrooms and can bring items of furniture and pictures with them etc. One man spoken with said he had his own chair and his TV and other items arranged as he wished. One person had needed to move upstairs to the nursing floor when her support needs increased. She appreciated that Mrs Hartley had arranged for her to Care Homes for Older People Page 20 of 29 Evidence: move to a room with the same layout as her ground floor room so her personal items could be put in the same place. There are communal toilets around the home and close to communal rooms for convenience. Each bedroom has an ensuite toilet and sink and thirteen rooms also have a shower with a wall seat. On the nursing floor there are three assisted bathrooms and a large shower room. There is also an assisted bathroom on the ground floor. There was also another bathroom on the ground floor but Mrs Hartley said this was not used so it is being turned into a much needed office for her. There is a large communal dining/lounge on the ground floor with access to seating areas in the garden. There is a second lounge that has a library section and an organ. This can be used for visitors and can be booked for meals with families and for private celebrations such as birthday parties. All bedrooms have television aerials fitted. On the first floor there is no dining area so people are assisted to come downstairs for meals or they eat in their bedrooms. There is a small lounge on this floor which is used for serving meals to those eating in their bedrooms, activity clubs and communion and relatives room. There is a hairdressing salon that can also be used for consultations with health professionals. There is a passenger lift between the two floors that is serviced regularly. Each room has a call bell and the system gives an alert sound when a call is not answered within three minutes. Mrs Hartley said she is hoping to upgrade the system. When this is done a system should be considered that can give a printout of response times to aid monitoring and can be linked to mobile hand sets for when people wish to sit away from a call bell socket e.g. in the garden. Staff confirmed that they have the appropriate equipment to meet peoples special needs, such as pressure relieving mattresses and hoists. In the last year ten new electric profiling beds have been provided on the nursing floor. Each room on this floor has a bed with adjustable height controls. Discussions with one man indicated that as his wall seat in his ensuite shower is too low he is standing holding a rail while staff shower him. He is a wheelchair user, so this indicated that the initial assessment of his moving and handling needs had not been thorough enough. Fire exits are alarmed and the front door is locked at 5pm when the reception and office staff leave. Mrs Hartley said that although the home is registered for people with dementia she only admits people with mild confusion or at the later stages of the condition when their primary nursing needs are physical. Mrs Hartleys line manager carries out monthly visits to the home, on behalf of the Company. During these the Care Homes for Older People Page 21 of 29 Evidence: premises is toured and records such as those for fire systems are checked. Mrs Hartley said the monitoring systems are robust and her manager will pick up on even minor issues, which helps keep standards high. The laundry is suitably equipped and ventilation has been improved in the last year to improve working conditions for the laundry assistants. Systems help ensure people have the correct clothes returned to them. Arrangements are in place to manage clinical waste and soiled laundry items correctly and reduce the risk of cross infection. Staff have protective clothing and hand washing facilities. Mrs Hartley said one person who left hospital with an infection was barrier nursed and the infection did not spread. There is a team of housekeeping staff and bedrooms are cleaned daily. Care Homes for Older People Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive a service from a competent team of staff who have a clear understanding of their role and who are suitably trained. New staff are carefully selected and introduced to be sure they will work safely. Evidence: On arrival the details and photograph of the nurse in charge were on display at reception. Office staff were welcoming and assisted until Mrs Hartley arrived. The home seemed calm and well organised. A new rota pattern had been introduced that day, where staff are going to work mainly long days, rather than a morning or evening shift. Mrs Hartley said this will be monitored to see if it meets the needs of the service users without staff becoming too tired. Staff spoken with felt positive about the change and had been consulted. The shifts are managed by a lead nurse on the first floor and a team leader on the ground floor, where people do not usually have nursing needs. The team also includes catering, administration, maintenance and housekeeping staff. Feedback from discussions and surveys showed that people in the home and their relatives feel there is enough staff to meet peoples care and health needs. Some people commented that staff should have more time to spend with them rather than just complete care tasks. Comments included, Carers could spend more time talking with us and listening to us; Carers are always polite, the keep the home very clean and deal well with Care Homes for Older People Page 23 of 29 Evidence: emergencies. I do feel it is very expensive for the amount of attention I receive. There is a ratio of one carer to five people on the nursing floor, however on the ground floor there is only the team leader and one carer to support 18 people. Consideration should be given to providing three staff on this floor. A new kitchen assistant is starting next week. Mrs Hartley has arranged this to help relieve carers of having to carry out some catering tasks, for example at tea time. Some staff commented that there have been staff shortages over the last year. Mrs Hartley said it has been difficult to recruit nurses, which has caused difficulties over the last year. The Companys agreement to increase salaries recently has enabled current vacancies to be filled. Feedback indicated that people found the staff to be helpful, kind and suitably trained. There are no male carers currently. This has been acknowledged and a mens group is being set up. The new maintenance man is also getting to know residents and has taken a role in social occasions, for example he wore a kilt on Robbie Burns day. Only three staff have left in the last year, which is a low turnover rate. Recruitment files sampled showed that robust procedures are being followed to help ensure the right people work in the home. One worker said she had a good induction with a mentor and was enabled to just watch for a least the first three days. Staff told us that they feel well supported in their roles and have had opportunities to attend relevant training. They found the staff meetings and handovers helpful. A training co-ordinator is employed and a training plan is in place for the coming year. Core training is provided as well as specific courses such as dementia. Two staff spoken with including a team leader had not attended dementia training. Staff are being informed about new issues such as the Mental Capacity Act and some were due to attend a course. Two areas could be developed. Currently only six of the thirty care staff hold a national vocational qualification (NVQ). The National Minimum Standard is for at least half of the carers to be qualified. Mrs Hartley said there is no financial incentive for staff and she has difficulty motivating staff to enrol. She said there are three cohorts a year and three more staff are due to start the programme. Care Homes for Older People Page 24 of 29 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 being run in the best interests of the people living there. There is a positive ethos in the home and staff are given good leadership. There are effective quality assurance systems in place. Evidence: The Care Manager has been in post since the home opened. She is suitably qualified and very experienced. The Provider offers her regular opportunities to update her professional knowledge and awareness of changing legislation and good practices. People in the home, their relatives and staff express considerable confidence in her abilities and many said she is very approachable. Mrs Hartley encourages links with the local community. For example the Osteoporosis Support group and Care in the Community group hold their meetings at the home. Mrs Hartley submitted the AQAA on time. This was quite brief in parts but it showed that she is aware of the strengths of the service. Current staff supervision practices are in a nursing model, where the term refers to Care Homes for Older People Page 25 of 29 Evidence: guidance being given from a senior during a shift. The Company has a policy for staff to receive formal supervision, at least six times a year, in private with a line manager. They provide a model agenda and guidance. Mrs Hartley should consider arranging for senior staff to be trained in this model. It can have great benefits to staff and help protect vulnerable people, as it gives workers a safe space to discuss care practice issues and any concerns. The Company are a national provider and have corporate support structures such as a clinical governance team to help ensure policies are updated to reflect developments in the sector. As mentioned under the Environment section, a Company representative visits at least once a month. During these visits all aspects of the service are audited to ensure standards are being maintained and Company policies adhered to. These arrangements and other quality assurance systems seem to be effective and the outcomes for people using the service remain positive without routine inspections from us. As mentioned earlier Keyworking could further improve outcomes. The standard of record keeping sampled across the service is very high. Mrs Hartley reports incidents appropriately to us and operates the service in an open and transparent way. People are encouraged to make their own arrangements for support with their financial affairs. They do not take on appointee responsibilities. If people have to rely on the Company to support them a dedicated bank account (with interest) is used for holding savings. Records of transactions into and out of this account were inspected and provided clear accountability for each person. Items in the homes safe that are the property of people in the home are recorded in a log book. There was no build up of items that had not been reclaimed by families of past residents. The Company arranged for the finance systems to be audited twice a year. Health and safety of the premises is maintained through a regular programme of servicing and internal audits, such as daily fire checks. Each person is assessed as to their ability to evacuate in the event of a fire. A colour coded system is used to inform staff who they need to assist first in the zone were the fire is located. No unmanaged hazards were observed during the inspection. Care Homes for Older People Page 26 of 29 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 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 11 12 Promote the completion of a Living Will rather than just resuscitation arrangements. Develop the role of keyworker to help ensure care delivery and lifestyle is provided in line with each persons true wishes. Review the way early morning drinks are managed to ensure everyones preferences are planned for. Refit the kitchen with modern equipment, as well as replacing damaged tiles and flooring. Ensure the assessment of each persons moving and handling needs is thorough and kept under close review. Keep the amount of person time given to people by staff under review. Consider providing a third carer on the ground floor. Provide all support staff with dementia awareness training. Increase the number of qualified carers to over 50 . Introduce a formal system of staff supervision in line with current good practice in the sector. 3 4 5 6 15 19 22 27 7 8 30 36 Care Homes for Older People Page 28 of 29 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. 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. 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