Care Home: Merryfield House Nursing Home

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What the care home does well All the feedback we received shows that people living here receive a high standard of care and support from knowledgeable and dedicated staff. The home provides a good standard of accommodation in a home that is very well maintained. The standard of cleanliness is also extremely good. People enjoy the food and variety of meals on offer. The staff team work well together and we agree with the assessor`s view in the latest Investors in People report for the home that `it has a very stable and settled workforce - a very happy staff team who are clearly totally committed to the ethos of high quality care for all the residents`. The home is well managed and the staff spoken to said the manager and Head of Care provide support and guidance about their work. The manager has an open and consistent style of management means that people feel comfortable about making suggestions and feel involved and influential in decisions made about how the home is run. What has improved since the last inspection? The home has introduced two new supervisory staff roles - a Head of Care and a Head of Hospitality - and this has improved the opportunities for residents to have `one to one` time with staff, to discuss how they like to be supported in their daily life and activities. The registered manager is better able to focus on her wider development of the service part of her role, with some of the administrative, staff supervisory and training work undertaken by others in the staff team. The range and number of activities and social events has been extended both inside and out in the local community. The home has employed a drama therapist and an occupational therapist who work together with the homes activities organiser to help people to have interesting and enjoyable things to do and explore new possibilities, for example, using computer facilities to keep in touch with family and friends. The training and development opportunities for staff have been improved and people with particular areas of interest are encouraged to share their knowledge with others on the staff team. End of life and bereavement care for residents and their families is one example where staff are developing a high level of skill and understanding. What the care home could do better: We consider that this home continues to provide an excellent service and therefore have made no requirements or recommendations following this inspection visit. The manager has identified the organisational plans for ongoing improvements and development in the homes AQAA. These plans focus on the continued development and training of staff, and the building work to create a new dining area which has been planned for some years. Key inspection report Care homes for older people Name: Address: Merryfield House Nursing Home 33 New Yatt Road Witney Oxfordshire OX28 1NX     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: Delia Styles     Date: 3 0 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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: Merryfield House Nursing Home 33 New Yatt Road Witney Oxfordshire OX28 1NX 01993775776 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): merryfieldhome@aol.com Mrs Kuldip Kaur Dhanani Name of registered manager (if applicable) Ms Tracey Anne Cahill Type of registration: Number of places registered: care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users ot be accommodated is 24 The registered person may provide the following category 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) Date of last inspection Brief description of the care home Merryfield House is a care home with nursing, providing care and accommodation for up to 24 residents. The home is situated in a residential area of Witney, close to amenities, and is surrounded by its own grounds. The building is a converted and extended older property, with a passenger lift to the first floor of the original building. The extension is at ground level, and is connected to the main house by a covered corridor that also provides a small seating area. Fourteen rooms are for single Care Homes for Older People Page 4 of 31 Over 65 24 0 Brief description of the care home accommodation and three rooms can be shared. The home has a laundry and kitchen on the premises. Care is organised by the registered manager and the Head of Care, and registered nurses, care staff, Hospitality Supervisor and housekeeping staff provide the services. Building to the side of the link corridor is expected to start in 2010, and will mean that the home can then provide a separate dining room. The weekly fees range from 552 to 815 pounds sterling. 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection of the service was an unannounced inspection during which we assessed a number of the standards considered most important by the Commission out of the 38 standards set by the government for care homes for older people. The inspection visit took place over 6 hours and was a thorough look at how well the service is doing. We took into account detailed information provided by the homes manager in the form of the Annual Quality Assurance Assessment (AQAA) - a self assessment and summary of services questionnaire that all registered homes and agencies must submit to the Commission each year. We also considered any information that we have received about Merryfield House since our last inspection in 2006. A tour of the building, and inspection of a sample of the records and documents about the care of the residents and the recruitment and training of staff, were part of the inspection. Talking with a number of residents and staff gave us information about the home and peoples opinions about what it is like to live here. Care Homes for Older People Page 6 of 31 We were not able to distribute our surveys to get feedback from relatives, their families and visiting professionals on this occasion, but were able to get a picture of the home from the kind of comments we received on the day of our visit, and from a recent Investors in People report about the home (based on talking to residents, the manager and staff). Care Homes for Older People Page 7 of 31 What the care home does well: 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. Care Homes for Older People Page 8 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service have good information about the home in order to make an informed decision about whether the home is likely to be right for them. The personalised needs assessment means that peoples diverse needs are identified and planned for before they move to the home. Evidence: The statement of purpose is available at the home, and the service user guide and the last inspection report is freely available in the entrance hall. Three individual residents files were checked to assess the homes admission procedures. From the records seen and discussion with the registered manager we consider that the pre-admission procedure is thorough and comprehensive. The managers assessment of prospective residents needs includes any information from health and social care professionals and family members where appropriate. People considering coming to live here are offered the opportunity of coming for a meal, a Care Homes for Older People Page 11 of 31 Evidence: short visit or day visit to give them an opportunity to meet staff and residents and get an insight into the life of the home. The AQAA tells us that when going to visit people in their own home or hospital the manager often takes a book of photos of the home to show the individual. The home advertises locally and most residents come from the surrounding area and are recommended by word of mouth. Printed information about the home, its facilities and services are provided, together with a questionnaire for prospective residents to use to prompt them to ask questions about Merryfield or any other service they choose to visit. All printed information can by provided in large print format if needed. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health needs of residents are well met with evidence of good multi disciplinary working taking place. The systems in place to assess peoples care and support needs in partnership with them, means that staff have the information and skills they need care for people living here in a way that promotes their dignity and wellbeing. Evidence: A sample of three residents care plans was examined and found to have comprehensive information about each persons care needs. The action that carers need to take to assist residents was also listed so that they are clear about what they have to do. The care plans are written in a way that is person-centred and reflect each individuals preferred way of being assisted and supported, and that encourages them to remain as independent as possible. The care plans are reviewed and updated each month by a registered nurse. All the care staff have a key worker role, which means looking after the personal needs of named residents, for example, keeping their toiletries stocked and talking to their families if they have new clothing requirements. Care staff also contribute to the care Care Homes for Older People Page 13 of 31 Evidence: records and their observations also contribute to any agreed changes to the care plans, after discussion with the resident and their family or representative. We noted that one of the sampled care records did not have enough detail about the aims of care and evaluation of the persons particular health care problems. This was discussed with the nurse on duty who said she would make sure the records were reviewed and updated. However, it was evident that in practice staff know and have a very good understanding of peoples individual care and support needs and their preferences about their care. The home uses a range of risk assessments to check that people are not becoming prone to health problems such as malnutrition, pressure related skin damage or falls for example. The inspector spoke individually to one resident in their room and also a number of other residents during the visit. All but one expressed a high level of satisfaction with their care. The views of the person who was less positive about the home are known to the manager, staff and their family. The manager explained that they are constantly discussing with this person how they can improve their experience of living here. The homes own most recent quality assurance surveys completed by residents in September 2009 showed a very high satisfaction rate with the care they receive personal care was rated at 5 (on a scale ranging between 1 poor and 5 excellent) and nursing care just slightly below excellent. Doctors and other health care professionals visit the home regularly to provide NHS health care as required. Medical cover to the home is provided by all the GPs from Witney practices. Residents are able to choose which local GP to register with or can stay with their own GP if that is practicable. Hospital appointments are arranged if needed and a member of the homes staff will accompany people to their appointments. There was evidence of professionals visits and the outcome of outpatient appointments and reviews in the care plans looked at. The home is well provided with equipment necessary to help people to stay as independent as possible, and to prevent problems like pressure related skin damage (pressure ulcers), for example, through having pressure relieving mattresses and seat cushions. An occupational therapist is available to advise staff about suitable disability aids and adaptations. A local large high street chemist provides medication to the home. The pharmacist visits every three months to check the homes systems for safe storage, administration Care Homes for Older People Page 14 of 31 Evidence: and disposal of prescribed medicines. The home also does its own regular medicines audit. Records seen at the inspection showed that the home has good procedures and practices in place to safeguard residents from medication errors being made. A GP carries out an annual review of all medicines in the home, with the pharmacist and home manager. The home continues to expand staff training topics and this includes the care and support of residents and their families as people are coming to the end of their lives. The home has registered with a course for staff that aims to help them achieve the highest level of care for the dying. The manager and staff work closely with GPs, a specialist End of Life care nurse and community Macmillan nurse and have introduced future wishes care plans for residents to share what they want to happen at the time of their death and final care arrangements. The home has produced its own booklet on bereavement and after death care, to help prepare families and give them information. A pastor is also working with the homes staff to provide support to families, other residents and staff following the death of a resident. Care Homes for Older People Page 15 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers a good range of activities and opportunities for people to take part in meaningful and enjoyable pastimes that suit their personal preferences and abilities. Mealtimes are relaxed and unhurried. The food is varied, nutritious and meets peoples needs and expectations. Evidence: From what the home AQAA tells us and from direct observation and conversations with people on the day of our inspection, we found that the home organises a good range of activities and entertainments. Since our last inspection the home has employed an activities organiser. Activities are offered according to individual residents needs and preferences and range from music and visiting singers, painting, bingo, visits from the PAT dog, quizzes, poetry, story telling, jive dancing lessons and memory boxes. Social events that involve family and local community visitors, such as a summer fete and an indoor summer buffet with entertainment and cream teas, and visiting owls were some of the occasions enjoyed. The home produces a newsletter to share updates and news about forthcoming plans for new and planned activities. Residents have computer access with Internet, email Care Homes for Older People Page 16 of 31 Evidence: and web cam facilities to help people keep in contact with friends and family, especially those overseas. Some areas of the home have SKY TV installed and the home has an entertainment licence that allows the showing of DVDs of residents choice. An occupational therapist visits the home weekly and has been working with some residents to write their life stories and to do quizzes. The homes AQAA tells us that they have improved over the last year by having more frequent outings, celebration lunches and entertainment. The activities organiser has attended training sessions on activities run by occupational therapists, that has enabled her to extend the range of activities on offer. Residents are involved in choices about the activities they take part in - for example, about the cookery activities and what to plant in the garden. Residents have been actively involved in planting hanging baskets and pots for all seasons and growing tomatoes and vegetables that they have enjoyed eating. The choice of menus and variety of food on offer is very good. The AQAA tells us that they have introduced protected mealtimes so that visiting professionals do not visit and interrupt people when they are eating. In response to residents different preferences, the home has changed its bread order to include different thicknesses of sliced bread for toast and uncut bread for others. The cook described the menu of the day and the different choices she was cooking to order. The food served at lunch time for residents looked and smelled very appetising. Staff members sensitively helped those unable to eat independently, and are skilled in encouraging residents to eat. Work is due to start in January 2010 to create a new conservatory room which will allow for the smaller sitting room to be used as a dining area. This will improve the ways in which residents can enjoy more sociable mealtimes, with a separate area where people can sit together at tables, rather than eating at individual tables in front of armchairs as they have to at the moment. The home obtains kitchen supplies from both local and national suppliers to provide the best nutritional value and widest choice for people living here. The homes own quality assurance survey results for meals and mealtimes (September 2009) confirmed a high level of satisfaction. All residents spiritual and faith support needs are discussed with them and Care Homes for Older People Page 17 of 31 Evidence: arrangements made to help them attend a place of worship in the community or services held in the home. Other visiting clergy and priests are available to residents for individual support. The home provides a booklet giving information about local church services. Though current residents are predominantly from a Christian faith background, the philosophy of the home and topics of training and discussion for staff indicate a good awareness and respect for diversity and the equality of all people living and working here, in terms of spirituality and religion, gender, disability, age, and sexuality. The homes philosophy of care states that Dignity, Privacy, Choice and Fulfillment are the basic rights of humanity and will be promoted and preserved at all times according to the needs and wishes of each resident. The homes own quality assurance responses about the topics of dignity and privacy and choice, that were analysed in September 2009 showed scores of 4.5 and 3.8 respectively, out of a maximum score of 5 (excellent). The home has developed a dignity policy and audit tool to check that the dignity and privacy of residents remains central to their care and life here. The home is registered as a Dignity champion and the manager and staff meet with other dignity champions from local homes and the county council to promote and share good practice. Care Homes for Older People Page 18 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. Residents feel safe and listened to. The homes policies and procedures in relation to complaints and the protection of the people living here are available, understood and consistently applied by staff. Evidence: The homes complaints procedure is displayed in the hall and complies with legislation. All the residents are given a copy of the complaints procedure and this is made available in large print if required. The registered manager, Tracey Cahill, and the home care manager are readily available to talk to residents and their families and representatives if they have any issues or problems. This open door style of management gives residents and staff confidence that any suggestions or concerns will be followed up and resolved if possible. A review report written in September 2009 by an Investors In People Assessor comments that Merryfield has created a very open and honest culture where people at all levels are prepared to voice their ideas and suggestions at any time and the feeling that these were always welcomed. Staff training records show that the homes staff are up to date in training about safeguarding and how to recognise possible abuse and report it correctly. The AQAA tells us that staff are also informed about Deprivation of Liberty and Mental Capacity issues, so that they are aware of, and support people to make informed decisions about their care and rights to come and go from the home. Care Homes for Older People Page 19 of 31 Evidence: The homes Principles of Care and Aims and Objectives are set out clearly for staff and they are encouraged to balance residents safety and risk with personal choice and independence and issues of restraint. We are aware of 2 concerns raised about the home and these were referred to the manager to investigate. One was from the relative of a potential resident and concerned the suitability of the home environment for disabled residents and the other about staffing and duty rota changes. Discussion with the homes manager and her response to us about these concerns showed that they had been carefully considered and followed up and were now resolved. Residents and relatives are invited to complete one of the homes quality assurance surveys that are distributed 6 monthly. The feedback from these is analysed and any individual concerns are followed up by the manager. The homes AQAA tells us that the home has improved in the last 12 months by developing better relationships with residents and relatives as a result of regular relative and residents meetings. Care Homes for Older People Page 20 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. The home provides people living here with a clean, comfortable, safe and attractive environment. Refurbishment and redecoration is undertaken on a planned basis. Adaptations made to the environment benefit the people living here by improving the appearance, comfort, and access to living areas and facilities as far as possible within the constraints of planning restrictions that apply to this listed building. Evidence: The home is well maintained and the standard of decor and furnishings is very good. Plans have finally been approved to start the building work to create a conservatory style sitting area that will allow the smaller ground floor lounge to be used as a dining room and residents are looking forward to this development. The roof is also to be replaced. On the day of the inspection visit the home was clean, bright and fresh smelling. The homes own survey responses (most recently completed in September 2009) showed that people are very satisfied with the standard of cleanliness and the environment. The AQAA tells us that in the last 12 months (prior to November 2009) there is an ongoing refurbishment and redecoration programme in place. Most of the bathrooms have been upgraded and are now more easily accessible to people. A new sluice disinfector machine was being installed on the first floor of the older part of the Care Homes for Older People Page 21 of 31 Evidence: building. Some of the double rooms have now been adapted to single occupancy, creating more spacious and accessible rooms. The home has a maintenance manager who has worked here for many years and knows the building well. According to the AQAA he is multi talented and keeps up to date with all the maintenance needs and safety inspections for the home. The attractive garden at the rear of the home provides an extremely pleasant and safe area of garden for residents and visitors to use. In the past year the home has employed a garden contractor to maintain the grounds. Care Homes for Older People Page 22 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 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 skilled staff who have received relevant training to meet residents care needs. The home has a good programme of staff training and development in place, and a low turnover of staff, so that residents are confident that they are cared for and supported by people who understand their individual needs and preferences. The recruitment and selection of new staff is thorough and ensures that people who come to work here have been screened and assessed as suitable to work with vulnerable people. Evidence: The homes information tells us that there are always 2 staff nurses on duty during the day with 6 care assistants. In the evenings, one staff nurse and 4 care staff and overnight there is one staff nurse and 2 care staff. This means that there is a good ratio of staff to residents. The manager said that the home is fortunate in having a low turnover of staff so that there is a stable and consistent staff team who know the residents well. They do not use agency staff, but do have a number of their own bank staff who can cover regular staff absences if necessary. Residents spoken with during the day of the inspection were very complimentary about the staff and said how caring and kind they are. We noted that staff were confident, cheerful and patient in their dealing with residents. There was a good deal of conversation and laughter between staff and residents that gives the feeling of a Care Homes for Older People Page 23 of 31 Evidence: homely and welcoming atmosphere.The homes own most recent survey results show a very high level of satisfaction with the staff - scoring 4.68 out of the of 5 (excellent) using the homes own scoring scale. The manager confirmed that there is a high proportion of care staff working at the home that have a nationally recognised qualification in care - National Vocational Qualification (NVQ) at Level 2 or above. The home therefore exceeds the minimum requirement for 50 per cent of staff to have this qualification or an equivalent. Other training and courses are available. The AQAA tells us that most care staff have completed or are undergoing NVQ level 2 or 3 training in Health and Social Care or Housekeeping or Activities or Hospitality. The most recent Investors in People review report included an assessment of the homes learning and development strategy for staff and concluded that the sharing of knowledge by experienced staff is very high on the agenda. The manager said that they use a range of courses and information to help staff find the best way of learning for them and that will benefit residents. For example, the home uses DVDs for the basis of some sessions, with additional input from the manager and senior carers. A board game - Customer Care Made Easy is used at team meetings as a good way of sharing information effectively in a fun way. The AQAA identifies a number of ways that it has improved its staffing and training in the past 12 months. These include the development of 2 new staff roles for the Heads of Personal Care and Hospitality; the development of the role of the Activities organiser with attendance at external courses specific to her work; and use of the Gold Standard Framework for end of life care training for staff. The manager is planning to further develop training by sharing resources with other home managers and helping individual staff with a specific area of interest to them to share their knowledge with others in the team. The Investors in People report comments that the needs of every resident and the willingness to provide the best care possible drive the ideas (for learning and development topics). The home makes sure that all the staff have opportunities to attend teaching sessions, including part-time and night staff and are paid to attend sessions if they were not rostered to be on duty when there is a planned event. Similarly team meetings are arranged at a time when the maximum number of staff can attend. For those who cannot get to a meeting, the agenda is circulated in advance for them to add any items for discussion, and minutes of the meetings are circulated afterwards. This ensures that all the staff feel involved and interested in the development of the home and care standards for the people living here. Care Homes for Older People Page 24 of 31 Evidence: Two staff files were selected and checked and were found to be well organised and showed evidence of a thorough and consistent vetting and recruitment process for new staff. The AQAA tells us that a newly admitted resident has agreed to sit in on interviews for new staff to help selection of people to work at the home who have a genuine interest in, and positive attitude towards older people. Care Homes for Older People Page 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements in this home are very good. People who live here are consulted about, and do influence, the way in which the home is run. There are good procedures in place to ensure the safety and well being of the people who live and work here. The management team work well together to achieve the stated aims of the home to the benefit of residents. The organisation has sound financial and business plans in place to continue to improve the performance and practice of the home. Evidence: The registered manager Tracey Cahill has been in post for almost 2 years and has been in management roles in homes in Northamptonshire and Oxfordshire since 1993. She is well qualified and experienced in her role, having obtained the level 4 NVQ in management and has a nursing qualification equivalent to the level 4 NVQ in care. She achieved a BSc in Gerontology in 2004 that incorporated studies in nursing in a residential setting, research in nursing and health care , and use of peoples life histories to improve the way in which care meets peoples individual and unique needs Care Homes for Older People Page 26 of 31 Evidence: and preferences. Since our last inspection, the former registered manager of this home has become Group Manager for Peverel Court Group, the provider company. There is good communication and coordination in the management systems for all 3 homes in the group, with an Intra net system and regular meetings of the senior staff members so that they can share good practice ideas and develop these within the homes. The home has recently had a review and has again met all the standards required to maintain its award from Investors in People. Part of the review looked at the homes leadership and management arrangements and found that people were unanimous in their praise for the nurse manager and for the knowledge she shared with them. Staff confirmed this opinion with the inspector and said they felt well supported and were involved in decision making about the way the home is run. It was evident that the manager is seen as approachable, fair and consistent in the way whe manages staff. The creation of two new staff roles at a supervisory level has given these staff more responsibility and has freed up the manager to do more work for example in staff development and increasing links with the local community and other care facilities, to share good practice and promote the work of the home. The Investors in People assessor states in their report As was the case in previous visits, I found a very happy staff team who are clearly committed to the ethos of high quality care for all the residents. They are well motivated and receive excellent leadership and development from the Nurse manager. It remains an excellent place to work and to develop new skills. There is an established business plan and the manager and all the staff are familiar with what Peverel Court Group want to achieve in the home and how it plans to do this. The home manager meets weekly with the Group Manager and the director also visits the home weekly. The manager obtains feedback informally during day-to-day conversations with residents, visitors, and staff, as well as from residents, relatives and staff meetings. The home acts upon suggestions made by residents and their families - for example, they have looked at ways of improving mealtimes, menus, choice and activities. Quality assurance surveys are carried out twice a year, involving relatives, and the results are available and given to relatives, residents and are made available to the Commission. Care Homes for Older People Page 27 of 31 Evidence: The home has an administrator and the AQAA tells us they have improved the administration procedures and systems. The office is well organised with information required by the inspector readily accessible. The home fully recognises the importance of the annual quality assurance assessment (AQAA) and the manager had completed this fully and accurately, giving us a detailed account of what the home has achieved and how it intends to develop in the future. The majority of the residents do not manage their personal finances and relatives do this on their behalf through Power of Attorney. The home keeps very small amounts of petty cash for a few residents, and keeps records appropriately. We found that there are good health and safety procedures in place to protect residents. Maintenance records are kept of safety checks, showing these are regularly carried out. The home has good systems for auditing aspects of care and the environment - these are carried out by the manager, group manager and the director. 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. 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