Care Home: Manor Place Nursing Home

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What the care home does well The home provides a safe, well maintained homely environment for the service users. Service users and relatives voiced satisfaction with the environment, which is maintained well and has an ongoing improvement plan. Care plans are very well constructed and detailed with a person centred focus and inform the practices of the home on how to meet the needs of the individual service users. Staff report that they could easily care for a service user from the information recorded in care plans. Service users` healthcare needs are provided for by a variety of visiting professionals. Service users felt safe and secure and happy that staff could look after them properly and treated them with respect. The home`s routines are flexible and it promotes the right of service users to make choices for themselves and exercise personal autonomy within their activities of their daily living. A well-balanced and varied diet is offered to service users. This can be adjusted to meet their own needs and preferences. Service users` and relatives` comments on the food were generally positive. The surveys received from the service user, staff and relatives and talking to staff, relatives and service users at the time of this visit, provided us with positive comments about living and working at the home. `The service does well and supports staff. The service is innovative and proactive`. `The staff monitor all aspects of care relevant to each individual. They review care needs appropriately`. `Our nursing home is very good and we care about the residents` individual needs. We like to do activities with them to make them happy and relaxed`. `The food is good and the care is good`. `All staff are always kind, caring, cheerful and helpful to me`. `It is a really happy atmosphere and I feel privileged to live here`. `The home keeps familiar faces on the staff and have good communications with the family`. `At the moment the service could not do better. The care and support my wife receives is the best you can find`. `All staff are welcoming to visitors and appear caring to the residents`. `The home is well managed and the staff are kind and compassionate`. What has improved since the last inspection? The home now has a more robust recruitment process and all the information required to be sought and recorded in personnel files is now in place. The environment has improved with new flooring in some areas and new furniture. An activities co-ordinator has been employed to arrange a programme of activities around service users` individual social needs. A new sensory corner has been created in the lounge which the home will use to help service users relax. The staff training programme has been widened and a variety of training is now available for all staff. A new induction programme has been introduced and all newly recruited staff have undertaken this. New staff lockers have been installed. The company has employed a mental health manager who attends the home regularly during the week to give training and advice on caring for people with dementia and mental health problems. The home has also employed a registered mental health nurse to widen the expertise of the trained nurses. What the care home could do better: A more in depth social history should be recorded and a programme of activities designed around service users past recreational preferences. Care plans should be written to identify the social needs of the service users. Records should be maintained of what activities the service users participate in and the level of their involvement and enjoyment. Menus could be produced in a picture format to aid service users with dementia of mental health problems to choose their food. Key inspection report Care homes for older people Name: Address: Manor Place Nursing Home 116 Church Lane East Aldershot Hampshire GU11 3HN     The quality rating for this care home is:   two star good 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: Janette Everitt     Date: 2 8 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 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Manor Place Nursing Home 116 Church Lane East Aldershot Hampshire GU11 3HN 01252319738 01252327899 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dr Zyrieda Denning Name of registered manager (if applicable) Ms Janice Margaret Horsnell Type of registration: Number of places registered: care home 52 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 52 The registered person may provide the following category/ies of service only: Care home with nursing - N to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Dementia - DE Date of last inspection Brief description of the care home Manor Place is a care home with registered to provide accommodation, nursing care and support for up to fifty two older persons some of whom may have dementia The home is located in a 19th Century Victorian mansion on to which a 17-bedded extension was built and later in February 2006 a further extension was completed to increase the number of beds available to 52. The home, which is sited close to Care Homes for Older People Page 4 of 31 Over 65 0 52 52 0 Brief description of the care home Aldershot town centre, shops and other local amenities, is divided into three wings. Victoria wing is in the older part of the home and has four shared rooms and ten single rooms and accommodates eighteen people. Nightingale wing has seventeen single bedrooms all with en suite facilities. The latest extension is Churchill wing and has sixteen single rooms and one double room all of which offer en suite accommodation. The home also has a secure landscaped rear garden, which is easily accessible from all of the accommodation wings. Parking is available in the front of the property with spaces for 8 vehicles. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The site inspection visit to Manor Place Nursing Home, which was unannounced took place on the 28th January 2010 and was attended by one inspector. The registered manager, Ms J Horsnell assisted us throughout the inspection. The responsible individual, Dr Denning, was also in the home throughout the visit. For the purpose of this report and being a representative of CQC, the inspector will be referred to as we and us throughout. The visit to the home formed part of the process of the inspection of the service to measure the service against the key national minimum standards. The manager had returned the Annual Quality Assurance Assessment (AQAA) which gave us information we asked for. The focus of this visit to the home was to support the information stated in the AQAA and other information received by the CQC since the last fieldwork visit, which was a key inspection on the 31st March 2008. Documents and care records were examined and staff working practices were observed where this was possible. We looked around the home and spoke to a number of service Care Homes for Older People Page 6 of 31 users, staff and visiting relatives in order to obtain their perceptions of the service the home provides. Those spoken to were very happy and complimentary about the care and the services that are provided. Surveys had been distributed to service users, relatives, staff, GP and other visiting professionals. Two (2) service users, four (4) relatives and three (3) staff surveys were returned to CQC. There was no response from other surveys distributed. The outcome of the surveys and talking to service users indicated that there was generally a high level of satisfaction with the service and that service users and relatives are pleased with the care the home provides. At the time of the visit the home was accommodating 50 residents of mixed gender and cultural backgrounds. A number of residents were unwell and unable to communicate effectively with us. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? The home now has a more robust recruitment process and all the information required to be sought and recorded in personnel files is now in place. The environment has improved with new flooring in some areas and new furniture. An activities co-ordinator has been employed to arrange a programme of activities around service users individual social needs. A new sensory corner has been created in the lounge which the home will use to help service users relax. The staff training programme has been widened and a variety of training is now available for all staff. A new induction programme has been introduced and all newly recruited staff have undertaken this. New staff lockers have been installed. The company has employed a mental health manager who attends the home regularly during the week to give training and advice on caring for people with dementia and Care Homes for Older People Page 8 of 31 mental health problems. The home has also employed a registered mental health nurse to widen the expertise of the trained nurses. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 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 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a system of assessing and identifying service users needs which ensures that their assessed needs can be met. Evidence: The AQAA stated that all potential service users is fully assessed prior to admission by a qualified nurse and a full risk assessment is also carried out. This is aimed at fulfilling a person centred approach to care. The registered manager told us that a registered general nurse or a registered mental health nurse will undertake the assessments prior to a person going to the home to live. A sample of four care plans was viewed. These evidenced a comprehensive preadmission of assessments of the persons physical, emotional and cultural needs. The home had recently admitted a service user who was from a different cultural background. His pre-assessment had been undertaken with family involvement and Care Homes for Older People Page 11 of 31 Evidence: his special dietary needs and cultural needs were documented and care plans had been written to ensure these special needs were respected. As part of the admission process the home also liaise with external health and care professionals regarding any care needs, risks, equipment and aids, that need to be taken into consideration when developing a plan of care. The AQAA states the manager has produced a new coloured brochure with photographs of the home and staff with more information about the home and these are given to all prospective residents and their relatives. Surveys returned to CQC from service users and relatives indicate that they consider they received sufficient information and were able to look around the home before any decisions were made about going to the home to live. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has developed a system of care planning that is person centred and reflects service users wishes and aspirations of how those needs are to be met. Service users health care needs are met and staff respect their privacy and dignity Evidence: The AQAA stated that the service users health, personal care and social care needs and wishes are clearly set out in individual care plans. The sample of 4 service users care plans viewed evidenced that care plans are person centred and with service users or relative having signed the care plans as evidence of their involvement and agreement with the plan. The care plans are compiled following an admission assessment that covers all aspects of that persons health, emotional and social care needs. Risk assessments are also undertaken for bed rail use, moving and handling, nutrition, mobility, tissue viability, behaviours and isolation. For one person who was from a different cultural background and who had reverted Care Homes for Older People Page 13 of 31 Evidence: back to their native tongue following a stroke, care plans had been written to meet their specific needs, one being that for communication. The care plan stated that if possible this service user should be cared for and communicated with by one of the nurses who could speak their native language and documented other methods of communicating with this person. For another service user who had swallowing difficulties and had been assessed by the speech and language therapist, the care plan detailed what the consistency of their food and drink should be as part of the strategy to manage the risk of their choking. Care plans have also been written that identify service users preferences about their daily routines. Times of morning routines, times for going to bed and food preferences are documented in the care plans. Daily records evidenced detailed information about how each service user has spent their day. Handover meetings are held at the beginning of the afternoon shift at which time information is shared with staff coming on duty about any significant events and how service users have spent their day. This is to ensure staff have all the information they need to deliver person centred continuity of care. Care plans were seen to be reviewed monthly or whenever the service users needs change. Care plans identified both physical and mental health care needs. The home employs two nurses who are mental health trained as well as general nurses. Care plans contained records of all visiting health professionals and the outcomes from their visits. Residents spoken with also confirmed they were able to see the doctor if they wished to or any other health professional when they needed to. The records viewed indicated that apart from doctors, who visit the home weekly, speech and language therapist, continence adviser and other specialists are consulted when required. Appointments with the dentist, optician, chiropodist and any other external health professionals are recorded and include details of any advice and treatment given. The home uses a monitored dosage system for the administration of medication which is delivered by the local pharmacist. A registered nurses co-ordinates the ordering, receiving, storage and returns of unwanted medication. The nurse spoken to told us that the medication order is checked for accuracy before it is sent to the pharmacist to ensure that only the Care Homes for Older People Page 14 of 31 Evidence: medication needed, is delivered. It was observed in a storage cupboard a large stock of an as needed PRN medication for a service user. It was discussed with the nurse that the stock should be sent back in case it became out of date and attention should be paid to stock rotation when ordering these drugs. Protocols are documented in care plans for as needed PRN medication to ensure the reasons for administration are consistent and appropriate. The home has medication trolleys for the various wings of the building, so are stored in different areas of the home. Those not stored in the medication room were observed to be attached to a wall for security. The trolley looked at by us was clean and well organised. The controlled drug cupboard was observed to be fixed appropriately to the wall of the medication room. The controlled drugs (CD) register was checked with the stock of CDs being stored in the cupboard and were correct. The register was observed to being signed by two people following administration. A registered nurse was observed administering medication and was seen to be following policy and procedures and demonstrating safe practice. The medication records and storage were viewed. We looked at the medication administration record (MAR) charts and these demonstrated that they are signed each time medication is administered or reasons recorded why medication has not been given. Records were checked of unwanted drugs which are disposed of in an appropriate manner by a waste disposal contractor. Procedures are in place if a service user wishes to manage and keep their own medication. This choice is respected but is done within a risk assessment framework to ensure the safety of the service user. At the time of this visit there were no service users choosing to manage their own medication. From observations throughout the day and the interaction between service users and staff indicated that there are good relationships and that staff are very familiar with the care needs of the service users, some of whom, have complex needs both physical and mental. Staff were observed to knock on doors before entering a room and service users who needed help with their eating were being given assistance in a courteous manner. Care Homes for Older People Page 15 of 31 Evidence: Service users and relatives surveys returned to CQC told us that: The staff are kind and compassionate. The care and support my wife receives is the best you can find. At the moment the service could not get any better. The nurses, carers are hardworking and the home is clean and friendly. Excellent nursing staff who listen and act on information. Good communication with family. The staff are always kind, caring, cheerful, happy and so helpful to me. The care is good. The nursing home is very good home and we do care about the residents. A relative spoken to at the time of this visit told us that they were very pleased with how their relatives general health was, considering that when she was in hospital they thought she would not live much longer and since being at the home she has recovered well and although confused, is happy and integrates and responds to the care she is given. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities do take place in the home but a person centred approach is not used around the planned programme. Service users are encouraged to maintain contact with their families and the community. The home provides a varied and nutritious diet and care plans reflect preferences and choice. Evidence: The AQAA states that the home has employed an activities organiser and a number of staff were booked to go on activities training the week after the visit. The manager told us that the aim is to put in place more personalised activities around a persons abilities taking into account their past social and recreational life. The activities organiser was not in the home at the time of this visit. The social histories that are recorded in the initial assessment do not give detailed information. The manager has written to all relatives requesting that they provide the home with a social history of the service user and any photographs that may assist the activities person to arrange activities around the persons previous past times and help stimulate their memories. Care Homes for Older People Page 17 of 31 Evidence: The home has recently had installed a sensory corner in the lounge which works around lamps, music and movement and is said to have a calming effect on those who are agitated. The unit was not in use at the time of this visit and there was no evidence of records of who had used it, but the manager told us it had only just been installed and had not been used extensively. Activities do take place in the home most days. A relative spoken to told us he visits regularly and the staff do activities with the service users most days. Outside entertainers also visit the home. Birthday parties are held, BBQs and parties at the festive times of the year. Relatives are invited to these occasions and the visitor spoken to confirmed that they are always invited to attend any functions and find them very enjoyable. Surveys from relatives and service users said: The home provides entertainment weekly and at significant times of the year. There appears to be no programs for dementia people. There are always activities to take part in but I am unable to participate. There is always activities arranged that I can participate in if I choose. The home does not record clearly what activities have taken place each day and who has participated and to what degree that person has been involved. This was discussed with the provider who showed us a record book of what activities had taken place. The care plans also have a chart where a code indicates what activity the service user has taken part in and although it is recorded each day it does not document the level of involvement and participation. Information like this would evidence that the focus for a person centred approach to activities was taking place. The manager and provider told us that in future they would ensure that the activities organiser recorded more detail in the activities journal. There were photographs around the home to evidence the social events that have taken place in recent months and the manager told us these are regular occurrences and many of the relatives contribute and attend. A more in depth social history should be recorded and a programme of activities designed around service users past recreational preferences. Care plans should be written to identify the social needs of the service users. Service users religious beliefs are respected and the home is visited regularly by the local clergy and Roman Catholic priest who will give communion if requested. Three service users are taken to church across the road on a week day morning and Care Homes for Older People Page 18 of 31 Evidence: escorted by staff. The visitors book demonstrated that the home has a number of visitors each day. A visitor spoken to said she visits every day and is always made most welcome and offered tea. A survey siad that all staff are welcoming to visitors. The AQAA told us that where possible the service users are taken to outside venues like the park and garden centres and relatives are encouraged to assist with this in the better weather. A date board was observed to display the day, date and weather conditions to help encourage the service users awareness of the day. Service users were observed to be wandering around the home freely. Choices and preferences about daily routines are documented in the care plans. We visited a service user in her room who chooses to stay in bed until late morning and she told us that she likes breakfast in bed and is in no hurry to get up. The kitchen was visited and the cook spoken with. The kitchen was clean and well organised. The cook told us that menus are seasonal and that the service users enjoy the old fashion food which she makes for them. There is an alternative menu for the main meal at lunch time, as were meals in a different format such as pureed for those residents that required it. Tea time there is a choice of sandwiches and soup and desert. Drinks, snacks and sandwiches are available throughout the whole day. The previous report highlighted that some residents may not fully understand menus produced in a written format. An alternative to a written menu is of importance for those with dementia, who may find the addition of pictures of benefit to them to help them make a more meaningful choice. The manager told us that the menus are currently being put together in a picture format to enable service users with communication problems to make choices and know what is on the menu each mealtime. The cook makes home made soup every day and this is offered to start lunch. The cook said she gets a variable response from this but some service users enjoy this. The cook told us she also makes cakes most days for the residents tea. Care Homes for Older People Page 19 of 31 Evidence: The lunchtime meal was partly observed and service users appeared to be enjoying the food. Those spoken with said they enjoyed the food and had enjoyed their lunch. Comments on surveys returned to CQC said: Excellent food. The food is of good quality. I usually like the meals The food is good. Nutritional assessments are undertaken and if a risk is identified the service user is referred to the GP for further advice. Weights are recorded monthly and these were seen in care plans. Care Homes for Older People Page 20 of 31 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. Service users are protected by the policies and procedures for safguarding vulnerable adults and staff are aware of the procedures. Service users are confident that their complaints will be listened to and acted upon. Evidence: The service has a complaints procedure displayed on the notice board in the reception area. The complaints procedure is also stated in the Statement of Purpose which is distributed to all service users and their representatives. A suggestion book is kept in the reception area and the manager looks at it daily and anything recorded is acted upon. The complaints log was viewed and demonstrated that no complaints have been received by the service since the last inspection. Surveys returned to CQC by relatives and service users indicated that they would know who to go to if they wished to complain. Comments said: The home has good communication with the family and staff who listen and act on information. Staff are always approachable and always act immediately on any concerns raised. I know how to make a formal complaint. Care Homes for Older People Page 21 of 31 Evidence: The home has a Safeguarding policy and procedure that operates in tandem with the policy and procedure produced by Hampshire County Council. The Hampshire procedure is based on National Guidelines and the document No Secrets that is designed to safeguard residents from abuse. Staff are required to sign off to say they have read the policies and procedures around safeguarding. Staff have receiving training in safeguarding vulnerable adults and the training matrix evidenced this and staff spoken to told us they had received training and that they understood the procedures to take if they needed to report any form of abuse. Staff have also received training on the mental health act and the deprivation of liberty safeguards. Bed rails are used in the home and there was evidence that risk assessments are undertaken before a decision is made about their use. Care Homes for Older People Page 22 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a safe, well maintained, clean and suitably furnished home, which meets their needs Evidence: The AQAA stated that the service continues to improve the external and internal environment for the benefit of service users, visitors and staff. The original part of the home is a large old house with many retaining features. Two wings have been added in later years enablling the home to accommodate 52 service users. The home has a garden that is secure and is accessible to the service users. This is maintained by a landscape gardener the home has employed recently. The home is configured into three wings that lead from one to the other. There is a lounge area and dining area for each wing. We visited areas of each wing. Bedrooms were seen to be decorated pleasantly and had been personalised by the service user with family photographs and their own belongings. For rooms that were shared, privacy screens were seen to being used. A service user spoken to who was in a shared room told us that she was happy with her room and that she enjoyed sharing with the other service user. Care Homes for Older People Page 23 of 31 Evidence: There have been a number of environmental improvements over the last year and this has included some areas being decorated with new furniture and flooring purchased for these areas. The manager told us that it is ongoing work as one part of the home is improved the maintenance people start again. The home is awaiting to have a new kitchen fitted and at the time of this visit one of the lounges was being redecorated. There are plans for the dining areas to be refurbished. It was observed that there was little or no signage on bedroom or toilet doors for service users to recognise the rooms. The manager told us that there are plans to decorate one of the wings corridors. Each door will be painted in a specific colour and have appropriate signage on the doors which will help the service users to recognise and associate with that sign and therefore be able to find their room. The home has a dedicated housekeeping staff and all areas of the home that were seen were clean and free from unpleasant odours. Surveys returned to CQC said: The home is clean and safe. The home is clean and friendly. The home has a infection control policy and procedures in place and the training matrix and AQAA confirm that all staff have received this training. Gloves and aprons were evidenced around the home for staff to use appropriately. Hand washing facilities were also observed in all bathrooms and toilets. The home has a laundry and has dedicated laundry staff. The home has individual laundry bags and trolleys to help maintain a personalised laundry service. The manager told us that the plans for the coming year are to extend the laundry. Care Homes for Older People Page 24 of 31 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. Service users needs are met by sufficient numbers of well trained and supported staff who are recruited and selected using a procedure designed to protect all residents. Evidence: The home was accommodating 50 residents at the time of this visit. The staff rotas were viewed by us and demonstrated that the morning shifts had 2-3 trained nurses with 10 care staff. The afternoon shift there were 2 trained nurses and 8 care staff. The night shift have one trained nurse and 5 care staff on duty with a trained nurse staying on from afternoon shift until 10:00pm to assist the nurse with medication. The manager is also in the home five days a week in her management role and the activities co-ordinator also supports the staff. The home has a separate housekeeping staff and three cleaners are in the home weekdays with two at the week-end. There is a laundry assistant on duty seven days a week and there is a cook and kitchen assistant on duty every day. The home has a separate administration team and the reception is manned six days a week. From observations of the day and speaking to service users and relatives there Care Homes for Older People Page 25 of 31 Evidence: appears to be sufficient staff on duty to meet the needs of the service users. One comment from a service user said: sometimes there is a delay in answering the bell which worries me but I am very happy in the home. On the day of this visit call bells were alarming quite frequently and this turned out to be happening in an empty room and proved to be a fault. The engineer was called immediately to rectify the fault as it was confusing for staff. The manager told us that the organisation has employed a mental health trained nurse as the mental health manager for the group and she visits the home approximately three times a week. The AQAA stated that 31 of the 42 care staff have achieved the national vocational qualification NVQ at level 2 and above. This represents over 70 per cent of the care staff. The training records evidence that staff have undertaken various training courses in the last year and the manager told us that there has been increased levels of external and internal training provided and as a consequence some staff have been promoted to a higher level of responsibility. The home has an induction programme in place that is based on the Skills for Care induction standards and the AQAA stated that this has been undertaken by all care staff as they have commenced employment. The home employs a mixed gender and culture staff group. A sample of recruitment files were viewed by us. The records evidenced that the home now has robust recruitment procedures. Criminal Records Bureau (CRB) and the Protection of Vulnerable Adults (POVA) checks had been taken us and received. An application form and references were in place. Care Homes for Older People Page 26 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home ensures that the health, safety and welfare of service users and staff are promoted and the home is run in the best interests of the service users, whose views about living in the home are formally sought. Evidence: The registered manager has been registered with CQC since August 2009. Although not a trained nurse she has many years management experience in various management roles, the last being in a domiciliary care agency and therefore she has insight into the care industry. Since becoming the manager she has undertaken various training courses and has achieved the Leadership and Management qualification, dementia care course, safeguarding vulnerable adults and deprivation of liberty training. She told us that she has a particular interest in dementia care and is willing to undertake further training to increase her knowledge base. The manager told us that she has a senior registered nurse who assists her with the recruiting of registered nurses but she feels she has the right skills to manage the Care Homes for Older People Page 27 of 31 Evidence: staff group and the home. Staff spoken to said that they are well supported by the manager and from observations during this visit, respectful relationships exist between the staff and the manager and staff responded to her leadership. The home has a quality assurance system in place. The manager has distributed questionnaires to service users, relatives and staff and as a result issues have been highlighted in the analyses, one being that the door bell was not being answered quickly enough and as a result the manager has extended the staffing of the reception area to 19:00 every evening and every Saturday until 15:00. Staff lockers have now been installed as a result of this questionnaire and discussion has taken place around choice of food and menus, which were being reviewed at the time of this visit. The manager has introduced monthly staff meetings, for which minutes are kept, and any issues are discussed at this time. The manager told us she also monitors the cleanliness of the home, recruitment files to ensure all the information required is there. Care plans are audited monthly and medication administration record charts also. The accident book is audited monthly and an accident report was audit trailed to the service users care plans and evidenced that the reporting procedures are robust. The Regulation 26 visit reports are undertaken every month and the reports left in the home as part of the quality assurance. It was noted that the homes equipment, plant and systems were checked and serviced at appropriate intervals i.e. passenger lift and hoists, fire safety equipment, portable electrical equipment, hot water and gas systems. A contract for the management of waste was also seen. A fire risk assessment had been produced in July 2009. All staff had undertaken the mandatory health and safety training appropriately and this was evidenced on the training matrix that the manager told us she checks regularly to identify training needs. It was observed that all cleaning materials were kept in a locked environment when not in use and were not left unsupervised whilst being used. Care Homes for Older People Page 28 of 31 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 29 of 31 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 30 of 31 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. 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