Care Home: Marsh House

Similar services:

• Chirnside House
• Keer Sands Residential Home
• Ruskin Lodge
• Bushell House
• Langrigg House
• Parkside
• Dystlegh Grange
• Thornton Lodge

What the care home does well The home provides people with appropriate information about the services they provide and complete a detailed assessment of people`s needs to make sure the home is suitable for them. This involves the manager and supervisory staff working closely with the person, their family or Representative and other professionals involved to record their needs and preferences about how they like to live their life and their personal care and healthcare needs. People we met during this visit including people who live in the home and visitors talked about having the opportunity to visit the home or being able to stay in the home for respite care, before making a decision to move in. One person described how they had looked at other homes first but "as soon as I walked in I liked this one and I am happy with my choice, it is lovely". All the files we examined contained a contract of terms and conditions explaining the rules about living in the home and people`s rights and responsibilities. It also contains information about the care and services provided, fees payable and additional services available. The care plans we examined were based on the needs assessments providing staff with detailed information about a person`s personal and healthcare needs. The home is in the process of developing more person centred care plans. We examined a completed plan, which was very informative and gave staff a real insight to the person`s life experiences and important relationships in their lives. This detailed information gives staff a better understanding of individual needs and personal preferences about all aspects of their lives. Visitors to the home including family members and visiting professionals were very complimentary about the management of the home and the "friendly and professional attitude of staff". They also talked about a "homely atmosphere" and a "consistently high standard of care and cleanliness". They said staff were "very aware of people`s individual needs and were quick to report any changes or concerns about a person`s health or wellbeing". One person described the palliative care as "fantastic". The home provide a good range of both sedentary and non sedentary activities both in the home and in the local community. People we spoke to said how they enjoy joining in the group activities such as bingo, cards, craft classes, musical afternoons or exercise sessions, whilst others said they looked forward to the regular bus trips to local points of interest, a walk in the local park or going in to town. Staff were aware of people`s interests and hobbies, which are recorded in care plans. There were examples throughout the day of people`s choices being respected with staff taking on an enabling role to support and encourage an independent lifestyle. All areas of the home are clean and hygienic and well maintained making sure it is safe and comfortable with no obvious hazards noted. The home has a competent and well motivated staff team who have developed good relationships with the people they support. They provide a consistent service providing care and support to help people achieve their aims and enjoy a fulfilling lifestyle of their choice. 95% of care staff have completed their National Vocational Qualifications (NVQ) and complete regular training in both core subject areas and more specialist areas of care giving them the skills and knowledge for their role. A recent health and safety audit by the organisations health and safety department complimented the home on the "consistently high standards the home has maintained" in relation to record keeping and management of health and safety in the home. Based on comments made in survey responses and on our own observations and discussions with people living in the home, care staff and visitors the home is being well managed and their views and opinions are valued, listened to and acted upon. There was evidence that regular formal consultation is taking place in addition to staff liaising with people through their key work responsibilities and on a day to day basis. Regular meetings are also held with people living in the home and staff, enabling information to be shared and giving people another opportunity to make their views known. What has improved since the last inspection? New person centred style care plans provide valuable information for staff enabling them to provide a personalised service to people. The use of photographs `brings the plan to life` and helps to tell the story giving staff a real insight to the important events and relationships in people`s lives. What the care home could do better: Although staff have completed some safeguarding training for some staff it was a number of years ago, prior to recent legislative changes and reviews of the organisations and local authority policy and procedure. Refresher training should now be planned to make sure all staff receive up to date training in line with new legislation and current good practice. A review of daily care notes should take place to make sure they reflect how people spend their day, personal and healthcare support they receive and the activities they have undertaken. Key inspection report Care homes for older people Name: Address: Marsh House Victoria Road Ulverston Cumbria LA12 0ER     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: Ray Mowat     Date: 1 0 0 3 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 28 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 28 Information about the care home Name of care home: Address: Marsh House Victoria Road Ulverston Cumbria LA12 0ER 01229894114 01229894112 david.tyson@cumbriacc.gov.uk www.cumbriacare.org.uk Cumbria Care Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr David Tyson Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 30. Two service users may share a bedroom of at least 16 sqm usable flloor space only if they have made a positive choice to do so, and when one of the shared spaces becomes vacant the remaining service user has the opportunity to choose not to share, by moving to a different room if necessary. When single rooms of less than 12 sqm usable floor space become available they must not be used to accommodate wheelchair users, and where existing wheelchair users are in bedrooms of less than 12 sqm they must be given the opportunity to move to a larger room when one becomes available. Date of last inspection Care Homes for Older People Page 4 of 28 Over 65 30 0 Brief description of the care home Marsh House is a care home registered to provide residential accommodation for 30 people over 65 years of age. It is situated in a residential area of the town of Ulverston, Cumbria, within walking distance of the amenities of the town centre. The home is on two floors, the top floor being accessed by one of two passenger lifts or staircases. The ground floor is divided into three distinct living areas: Richmond, Springfield and Victoria that each comprises a lounge and kitchen/dining area. Residents move freely between the three living areas. There are also a number of bedrooms on the ground floor. The remainder of the bedrooms are on the first floor in addition to communal bathing and toilet facilities. The home has a well kept garden and off road parking facilities to the front and a private, enclosed garden and patio area to the rear. The scale of charges are based on individual needs assessments , with additional charges for personal sundry expenses such as hairdressing and toiletries. Information about the home is provided in an informative service user guide, which includes the terms and conditions of residence. This information and the previous inspection report are displayed in the entrance hall. Care Homes for Older People Page 5 of 28 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 assessed all the information we have relating to the home. This included: The annual quality assurance assessment (AQAA) was completed and returned to us by the manager Mr David Tyson. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the home and the people who live and work there. We visited the service and spent time talking to people who live in the home. We met with the manager and supervisory staff and spent time in the office examining records required by legislation. We also met with family visitors and other professionals who were visiting the home and spent time with care staff as they went about their duties, as well as meeting some of them individually. We also sent out surveys to gain feedback from people living in the home, the staff Care Homes for Older People Page 6 of 28 who work there and other people with an interest in the home, such as social workers and health professionals. We looked at information we have about how the home has managed any concerns, complaints or adult protection referrals. We also considered information supplied to us in Regulation 37 notifications. These are a legal requirement and provide us with information about significant events in the home that affect the people living and working there. We also look at the previous key inspection report and the results of any other visits that we have made to the home in the last 12 months. Relevant information from other organisations and what other people have told us about the service is also taken into account when making our judgements. Care Homes for Older People Page 7 of 28 What the care home does well: The home provides people with appropriate information about the services they provide and complete a detailed assessment of peoples needs to make sure the home is suitable for them. This involves the manager and supervisory staff working closely with the person, their family or Representative and other professionals involved to record their needs and preferences about how they like to live their life and their personal care and healthcare needs. People we met during this visit including people who live in the home and visitors talked about having the opportunity to visit the home or being able to stay in the home for respite care, before making a decision to move in. One person described how they had looked at other homes first but as soon as I walked in I liked this one and I am happy with my choice, it is lovely. All the files we examined contained a contract of terms and conditions explaining the rules about living in the home and peoples rights and responsibilities. It also contains information about the care and services provided, fees payable and additional services available. The care plans we examined were based on the needs assessments providing staff with detailed information about a persons personal and healthcare needs. The home is in the process of developing more person centred care plans. We examined a completed plan, which was very informative and gave staff a real insight to the persons life experiences and important relationships in their lives. This detailed information gives staff a better understanding of individual needs and personal preferences about all aspects of their lives. Visitors to the home including family members and visiting professionals were very complimentary about the management of the home and the friendly and professional attitude of staff. They also talked about a homely atmosphere and a consistently high standard of care and cleanliness. They said staff were very aware of peoples individual needs and were quick to report any changes or concerns about a persons health or wellbeing. One person described the palliative care as fantastic. The home provide a good range of both sedentary and non sedentary activities both in the home and in the local community. People we spoke to said how they enjoy joining in the group activities such as bingo, cards, craft classes, musical afternoons or exercise sessions, whilst others said they looked forward to the regular bus trips to local points of interest, a walk in the local park or going in to town. Staff were aware of peoples interests and hobbies, which are recorded in care plans. There were examples throughout the day of peoples choices being respected with staff taking on an enabling role to support and encourage an independent lifestyle. All areas of the home are clean and hygienic and well maintained making sure it is safe and comfortable with no obvious hazards noted. The home has a competent and well motivated staff team who have developed good relationships with the people they support. They provide a consistent service providing care and support to help people achieve their aims and enjoy a fulfilling lifestyle of their choice. 95 of care staff have completed their National Vocational Qualifications (NVQ) and complete regular training in both core subject areas and more specialist Care Homes for Older People Page 8 of 28 areas of care giving them the skills and knowledge for their role. A recent health and safety audit by the organisations health and safety department complimented the home on the consistently high standards the home has maintained in relation to record keeping and management of health and safety in the home. Based on comments made in survey responses and on our own observations and discussions with people living in the home, care staff and visitors the home is being well managed and their views and opinions are valued, listened to and acted upon. There was evidence that regular formal consultation is taking place in addition to staff liaising with people through their key work responsibilities and on a day to day basis. Regular meetings are also held with people living in the home and staff, enabling information to be shared and giving people another opportunity to make their views known. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 28 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 28 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. There are good systems in place to make sure the home is suitable for people and they can make an informed decision about living there. Evidence: We examined the homes statement of purpose and service user guide there was evidence these had been kept under review, with changes made to information they contained to make sure they were up to date and accurate. They also contained a copy of the latest CQC inspection report. The documents were clearly displayed in the foyer of the home and also made available to people on request. We examined in detail the care plan files of three people living in the home. Two of these people had recently moved in to the home, which gave us an insight to the homes admission procedures. We also spoke to people and some relatives about their experiences of the move in to the home. All the files we examined contained a signed contract of terms and conditions making sure people were aware of the rules about Care Homes for Older People Page 11 of 28 Evidence: living in the home and their responsibilities. All the files we examined included either a social work needs assessment, the homes pre admission assessment or both. This gave staff sufficient information to make sure the home had the skills and resources to meet their individual needs.The home identifies a link member of staff who will take a lead role with the manager or supervisor to liaise with people and their families to make sure they are given all the relevant information and make sure the home is suitable to meet their individual needs. This may also involve liaising with other professionals or agencies if specialist needs are identified. People who talked to us about their experiences were very positive, they confirmed they had visited the home and were supported to make an informed decision. As one person said, it is a lovely home I am very happy with my choice. A relative we met also confirmed that they had visited the home with their relative before making a decision and that the manager and staff had been very helpful and friendly and gave them all the information they needed. The needs assessments were detailed providing staff with sufficient information in key areas of peoples care and support to enable them to produce a person centred care plan. These included all aspects of personal and healthcare needs and social interests and included specific assessments and risk assessments for diet and nutrition, falls including a manual handling risk assessment and pressure care. A record of all medication was held separately including the level of support each person required with the administration of their medication. The home has two beds used for providing respite care in addition to providing a day care service, this gives people the opportunity to experience life in the home before making a decision about moving in to the home on a permanent basis. We also met people who moved in to the home at quite short notice due to a change in their circumstances. However they said the experience had been made easier to cope with because of the kind and caring attitude of staff and they were now very happy living in the home. The home does not provide intermediate care. Care Homes for Older People Page 12 of 28 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. Staff have developed a good understanding of peoples individual needs treating them with respect and dignity and providing personalised and valued care and support. Evidence: Person centred style care plans are being introduced for all the people living in the home. Where these have been completed they provide staff with a valuable insight about a persons significant life events, relationships and what is important to them. In one of the completed ones we examined, photographs had also been used, which really brought the document to life and made it even more personal. Staff described how useful the information is in making conversation with people and just getting a better understanding about them. The care plans we examined were based on the completed needs assessments with the link workers taking a lead role in developing the plans with the person, their family and any other professionals involved to make sure it was sufficiently detailed and accurate. There was evidence the care plans are reviewed by staff on a monthly basis with a record of any changes or significant events and reflecting peoples views and preferences. Care Homes for Older People Page 13 of 28 Evidence: All health interventions and routine appointments are recorded making sure people receive appropriate services and support when the need arises. Nutritional and dietary assessments are completed on admission to the home and kept under review with peoples weight and food intake monitored and recorded on a regular basis. People we met confirmed they are able to see their GP or other professionals when required. During the inspection we met with visiting professionals who spoke highly of the quality of the care provided in the home. They confirmed communication is good and they have a good working relationship. They also said staff were very aware of peoples individual needs and were quick to notify them of changes or concerns. They said Palliative care in the home was particularly good. If people express specific wishes upon illness and death they are recorded within the care plan with care staff working closely with the person, their family and the other professionals to make sure their wishes are respected. We examined the contents of the medication cabinet checking a selection of peoples medication against the records held. We found these to be in order with all records appropriately completed and a clear audit trail of all medication entering or leaving the home and being administered. Good records were in place for all PRN (as and when required) medication including protocols to guide staff how, when and why to administer relevant medication. Staff receive relevant training before taking responsibility for administering medication. During medication rounds one staff will administer the medication with a second staff supporting them as a quality checker making sure good practice is followed. Care Homes for Older People Page 14 of 28 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. People living in Marsh house are enjoying a fulfilling lifestyle of their choice. Evidence: Within peoples care plans their needs and preferences are recorded in relation to their social and cultural needs and social interests including their daily living routines. This helps staff to make sure people receive the appropriate levels of care and support to lead a fulfilling lifestyle of their choice. A notice board is used to advertise daily and weekly events and activities. There was also information available about local advocacy services and the role of CQC. People we met talked to us about the activities they enjoyed which included a good range of both sedentary and non sedentary activities. We also met with the activity coordinator for the home who confirmed the range of activities provided. These included both small group activities such as bingo or card games and 1-1 activities such as a manicure or hand massage. Regular bus trips are planned each week going to the lake district or to other local points of interest, which normally involve a stop for a cup of tea or an ice cream. People are also supported to access the local community either with staff support or independently. This could involve a trip to the local shops, a walk in the park or a visit to a pub or cafe. On special occasions entertainers are Care Homes for Older People Page 15 of 28 Evidence: booked to appear which always proves a popular activity. There were photographs displayed in different areas of the home recording recent trips out and activities people had taken part in. Peoples religious and cultural needs are recorded with church services being held in the home as well as people attending a church of their choice. People we spoke to during the visit talked enthusiastically about the activities they had enjoyed. Some days I keep myself busy watching television or reading. Other times I will join in the exercises, play cards or go out on trips, we are never bored. Another said it is like living in your own home you please yourself what you do. We examined the activity record but this was not completed each day and did not record which people had taken part in activities. It is recommended activities people take part in are recorded in daily care records to enable staff to monitor how people are spending their time and making sure people needs are being met. During the day we met with visiting relatives who were also complementary about the support provided by staff, making sure people were able to pursue their hobbies and interests. They also said they were always made welcome and that staff were attentive and knew what their relatives liked. There was a relaxed atmosphere in the home with staff enjoying a friendly banter with the people they were supporting and caring for. All the people we met during the day also commented on the friendly atmosphere in the home. We joined a group of people for lunch which was served in the dining area on each unit from hot trolleys. There was a choice of two freshly cooked hot meals with alternatives provided if requested and special diets were also catered for. People told us the food was good quality and plenty of it, other people said I like my food and this food is good and we are well fed and get plenty of drinks. The meal time was relaxed with staff conversing with people as they served their meals making sure they were offered alternatives and extra portions if they wanted them. The food provided was well presented freshly cooked and nutritious. The cooks have developed a four week rolling menu based on feedback from people, which is then kept under review with seasonal food included. The menu for the day is displayed on a notice board as well as staff supporting people to make their choices. Nutritional needs and food intake and weight are monitored regularly and adjustments made if peoples diets or tastes change. Care Homes for Older People Page 16 of 28 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 living in the home feel safe and their views and concerns are listened to and acted upon. Evidence: The home has a suitable complaints procedure which is clear and easy to follow. It is included in the service user guide and statement of purpose and made available to people living in or visiting the home. It is also displayed around the home. People living in the home and staff were consistent in their response about raising concerns or complaints. They talked about the manager being easy to talk to and always available. They also said whenever issues are raised they are listened to and they are sorted out. People felt confident to raise any concerns and said the managers door is always open. Through the person centred approach peoples views and rights are respected with staff supporting them to lead independent lives. People are supported and encouraged to make choices from what time to get up and what to wear to more major decisions about their lives. Local advocacy services are advertised within the home and staff also work closely with families and other professionals to make sure people are appropriately represented. Although all the staff have completed safeguarding training some completed it a number of years ago and have not had this refreshed in line with changes in Care Homes for Older People Page 17 of 28 Evidence: legislation and local procedures. It is recommended refresher training is now planned for staff to make sure their knowledge and practice are up to date. There have been two safeguarding referrals made in the last twelve months. These were reported in a timely manner to the appropriate agencies and people were safeguarded throughout the investigation process and actions taken to prevent a re occurrence. As a County Council home the councils policies and procedures have been adopted. Care Homes for Older People Page 18 of 28 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. Marsh house provides a safe and comfortable home that is well maintained, clean and hygienic. Evidence: The home is decorated, furnished and maintained to a good standard although some areas of the home the decoration is now looking dated. An annual condition survey is completed by the manager and the organisations accommodation manager that identifies planned repairs and renewals that will maintain a safe and comfortable environment. The manager and staff take pride in the home which is reflected in its appearance, with each area having a homely feel. There are suitable bathing and toilet facilities throughout the home which are accessible and are fitted with range of aids and adaptations to promote peoples independence. These include bath hoists, grab rails, toilet seat raisers and a fully accessible walk in shower. There were examples of the home working closely with other specialist services and agencies for assessment to ensure the environment is safe and accessible and peoples independence is promoted. All the bedrooms we examined were suitably decorated and furnished with people bringing in to the home some of their own furniture and belongings, which gives the rooms a personal feel. It is recorded in peoples care plans if they chose not to have Care Homes for Older People Page 19 of 28 Evidence: the amount of furniture recommended in the National Minimum Standards (NMS). The home has dedicated domestic staff to maintain a clean and hygienic living environment. All areas of the home were found to be clean, hygienic and free from any offensive odours. Laundry facilities are suitable for the size of the home with suitable procedures in place to ensure foul laundry is handled and laundered safely to control the risk of infection. The layout of the home provides suitable space where people can relax and enjoy each others company or take part in an activity. The rooms are all fully accessible with people able to move freely around each area. The manager described plans to improve and extend the rear patio, the condition of which is starting to deteriorate, which will make it safe and accessible to more people. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient numbers of appropriately trained staff who understand peoples needs and provide a personalised service. Evidence: The home benefits from having a stable and well trained staff team who have relevant experience and training to guide their practice. There were suitable numbers of staff on shift to meet the needs of the people currently living in the home. There was a relaxed atmosphere as staff went about their duties in a calm and efficient manner sharing a conversation or joke with people. It was evident from our observations and discussions with people living in the home that they have developed good relationships with staff. They have a good understanding of each persons needs and preferences and were attentive when supporting them with various tasks. 95 of care staff have completed or are working toward their National Vocational Qualification (NVQ). Supervisory staff have completed both NVQ level 2 and level 3, which is more appropriate for their role, which is good practice. The manager monitors staff training keeping a matrix of the names of staff and the courses they have attended, to identify training shortfalls and make sure suitable training is provided. The organisations training department produce a training plan based on the needs of staff with the manager also organising local training when needs are identified. Visiting professionals confirmed they work closely with the manager to deliver Care Homes for Older People Page 21 of 28 Evidence: appropriate specialist training when needs are identified in areas such as palliative care, stoma care and catheter care. The organisation has robust recruitment procedures in place that make sure staff are both safe and suitable for the role. Checks and references are completed prior to appointment and suitable induction training is provided in addition to an induction to the routines of the home and policies and procedures of the organisation. Job descriptions and job profiles are issued to people along with a contract of terms and conditions which is agreed and signed. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being managed effectively in the best interests of the people living there. Evidence: The manger Mr David Tyson is suitably qualified and experienced. He provides clear leadership and is respected by the people living in the home and the staff working there. People told us he is approachable and his door is always open. The friendly atmosphere in the home was commented upon consistently by people living there, staff, visitors and other professionals. The home has good systems in place to support the effective and efficient management of the home. All the records we examined were up to date and accurate. There are clear lines of accountability between the manager and staff, with the manager works closely with the supervisory team to provide support and guidance for the care and support staff. An annual customer satisfaction survey is used to get feedback from the people who Care Homes for Older People Page 23 of 28 Evidence: live in the home. The organisation also complete staff surveys to get their views. Based on this feedback from the surveys an action plan is developed to make sure issues are responded to and resolved and this information is used to develop the homes business plan. People we met during this visit were very complimentary about life in the home as the following quotes reflect. I am happy here I like living here. It is like living in your own home you please yourself what you do. All the staff are lovely very kind and caring. Its a nice home the staff look after you. The organisation complete various audits and quality monitoring procedures to support the management of the home. We examined recent reports completed by the health and safety department and a quality audit. These both recorded very positive results commenting on consistently high standards being maintained. The manager also completed a night audit to make sure good policy and practice was being followed by night staff and that they were receiving appropriate support and guidance, which is good practice. The manager also completes management reports for senior management, which is a quality monitoring system that relates to the organisations business plan and enables the manager to measure progress against key targets. The manager is responsible for the homes budget and liaises with senior management regarding budget plans. Monthly monitoring takes place to ensure operational budgets are being met. The home keeps small amounts of personal finances for people, which are securely stored with staff keeping clear records of all transactions. Receipts are retained and referenced to the records to make sure a clear audit trail is in place. We examined supervision records and spoke to staff who confirmed they got good support and guidance from the manager and supervisory team and felt comfortable raising any issues or concerns. Regular team meetings are also taking place every eight weeks which provides another opportunity for two way communication with staff. All the records we examined were up to date and accurate making sure the home is operating safely and effectively. All routine safety checks and servicing of equipment were up to date. The manager confirmed the home received five stars from the Environmental Health Department (scores on the doors) in relation to the kitchen environment and food safety good practice. Different staff take a lead role in key Care Homes for Older People Page 24 of 28 Evidence: areas with the manager monitoring practice and making sure the organisations policies and procedures are followed. We examined a selection of COSHH risk assessments (substances hazardous to health), equipment service records, cooking and fridge temperatures and the fire log and found these to be up to date and in order. Care Homes for Older People Page 25 of 28 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 26 of 28 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 12 Activities people take part in should be recorded consistently in daily care records to enable staff to monitor how people are spending their time and making sure peoples needs are being met. Refresher training in relation to safeguarding vulnerable adults should be provided for staff to make sure their knowledge and practice are up to date and in line with current legislation and good practice. 2 18 Care Homes for Older People Page 27 of 28 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. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!