Care Home: Mill Brow Care Home

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What the care home does well People that use services live in a welcoming and comfortable homelike care home, which has been improved to offer brighter more comfortable living areas. Flooring on the first floor corridors and bedrooms areas have been replaced. On the first floor an additional lounge and quiet area have been created so people that use services have more choice where they spend their day and free time. The home has had new dining and lounge furniture bought as well as new curtains with the creation of accommodation that offers care to people living with dementia. People that live at the home made positive comments about living at Mill Brow and said, "This is a very nice place, just like living in a normal suburban road. You get well cared for and everyone asks you if you get enough of it. I say to them I need help not care as I can do for myself. I can have help when I need it and there`s always someone around when you need them. I get what I need and pay for it. I pay for my meals, which are enough for me. I thinks it`s worth what I pay". The home provides staff with a training programme so staff were provided with training and support to do their jobs. There is a stable staff group who have positive attitudes to the people that live there so staff treat people with dignity and respect. Appropriate staffing levels are provided so people that use services were supported around their needs. The personal care and health needs of people that use services are met to a good standard so they are supported to maintain their personal appearance and hygiene. Visitors are made welcome and visitors` comments support this A varied menu is available so people that use services can choose different meals and have a cooked breakfast if they wish. Regular health and safety checks of the building are carried out as well as continued programme of redecoration and purchasing of furniture and equipment so people that use services live in a safe and well maintained building. What has improved since the last inspection? The building work done and decoration of the building and bedrooms of people living at the home has made the home brighter so people that use services live in a more welcoming home. The purchase of new furniture and replacement of flooring has improved the comfort of the home so people that use services have a more comfortable place to live. Signs put up in the home to help people living the home recognise their bedrooms, toilets and bathrooms have improved so people can recognise their surroundings more easily. Improvements have been made in how information is gathered and recorded about the needs of people that use services and the care and support they need so staff have more information about when to provide care and support for them. The way that complaints are dealt with and people that use services are protected hasimproved so vulnerable people are prevented from being harmed. What the care home could do better: The home should should improve how decisions about daily living made by people that use services are reflected in their care plans so staff and others involved in their care understand how important peoples` daily decisions about their lives and decisions about their future are to them so the agreements about how they make or are supported to make decisions are clearly understood. People that use services should be provided with more opportunities to be involved in recreational and social activities of their choice so they can live fulfilling lives. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Mill Brow Care Home Mill Brow Care Home Mill Brow Road Widnes Cheshire WA8 6QT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Anthony Cliffe     Date: 1 2 0 8 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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: Mill Brow Care Home Mill Brow Road Mill Brow Care Home Widnes Cheshire WA8 6QT 01514204859 01514240186 millbrow@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Laudcare Ltd (a wholly owned subsidiary of Four Seasons Health Care Ltd) Name of registered manager (if applicable) Miss Lorraine Disley Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: care home with nursing - code N. To service users of the following gender: Either. Whose primary needs on admission to the home are within the following categories: Dementia - Code DE (maximum of 22 places). Old age, not falling within any other category - Code OP (maximum of 21 places). The maximum number of service users who can be accommodated is: 43. Date of last inspection Brief description of the care home Mill Brow is a purpose built two-storey care home situated in the Mill Brow area of Widnes. The home is within a mile of Widnes town centre and is close to local shops and other amenities. It is accessible by public transport and convenient for the Care Homes for Older People Page 4 of 31 care home 43 Over 65 0 21 22 0 Brief description of the care home motorway network. The home provides care for older people requiring either nursing or personal care for medical reasons associated with their age or living with dementia. On the ground floor there is a large lounge and a spacious dining room. On the first floor there is a large dining room, lounge, quiet room and a hairdressing room. There is a car park to the front of the home and a garden to the rear. Information about the home can be obtained by contacting the manager or administrator or visitng the Four Seasons web site. Fees range from Three hundred and fifty pounds to five hundred and seventy five pounds per week. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: References to we, our or us represent the Care Quality Commission This unannounced visit took place on the 11th and 12th August 2009 and lasted over thirteen hours. One inspector carried out the visit. This visit was just one part of the inspection. Other information received was also looked at. Some weeks before the visit the manager was asked to complete a questionnaire called an Annual Quality Assurance Assessment (AQAA) telling us what they thought they did well, what they needed to do better and what they had improved upon since the last visit, to provide us with up to date information about the services provided. This helps us to determine if the management of the home see the service Care Homes for Older People Page 6 of 31 they provide in the same way we do and if our judgements are consistent with home owners or managers. During the visit various records and the premises were looked at. People that use services, relatives, staff and senior managers were spoken with and gave their views about the service. We provided questionnaires to people using the service, staff and health and social care professionals involved in their care so they can tell us their views about the service the home provides. In June 2008 we did an annual service review of the home, which told us the home was still providing a good service. An annual service review is a summary of our knowledge about how a service that has not had a visit in the last year is still performing. It is also how we decide if a service is still as good as we thought it was since out last visit or annual service review. What the care home does well: What has improved since the last inspection? The building work done and decoration of the building and bedrooms of people living at the home has made the home brighter so people that use services live in a more welcoming home. The purchase of new furniture and replacement of flooring has improved the comfort of the home so people that use services have a more comfortable place to live. Signs put up in the home to help people living the home recognise their bedrooms, toilets and bathrooms have improved so people can recognise their surroundings more easily. Improvements have been made in how information is gathered and recorded about the needs of people that use services and the care and support they need so staff have more information about when to provide care and support for them. The way that complaints are dealt with and people that use services are protected has Care Homes for Older People Page 8 of 31 improved so vulnerable people are prevented from being harmed. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Important information is gathered about the needs of people that use services so they can decide if the home can provide the right care to meet their needs. Evidence: We saw that the home provides information to people that use services in an information pack. The pack contained information about the facilities and services available at the home as well as how care could be arranged so people choosing a home could decide if it could meet their needs. This information is called the service user guide. The pack also contained information about the type of needs the home could care for and how arrangements were made for people to move into the home so the home could provide the right type of care for people living there. This information was called the statement of purpose. The information pack also contained details about the organisation that owned the home as well as information about meals and activities available so people choosing a home had other useful information to help Care Homes for Older People Page 11 of 31 Evidence: them make a decision about living their. People choosing a care home are encouraged to visit the home and can have a 4 week trial period so they can decide if they want to live there and the home meets their expectations. We could see that before people moved into the home information was gathered about their needs so they could decide if the home was right for them. Gathering information before moving in included people choosing to use the service where possible, relatives and others with an interest in their care so as much information as possible could be provided on which to make decisions about their care. The information we saw gathered about people before they moved into the home was detailed and included information about the routines and lifestyles of people. We saw this covered information about their social interests and hobbies, medical information on their physical and mental health, how they communicated with people, maintaining their safety, managing finances, help with personal care, and some information about their life histories so staff had information about the people they cared for and supported. This included gathering information from health and social care professionals so staff were aware of the health and social needs of people they were asked to provide care and support for. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to be safe and well but information held about them does not support that they are directly included in the decision making process so are not always involved in everyday decisions or decisions about their care. Arrangements for administering medicines to people that use services are safe so staff follow the policies and procedures in place. Evidence: Since our last visit the home had rearranged the care it provides to people and offers care and support to people living with dementia. People living with dementia are to be accommodated on the first floor. This arrangement had only recently been finalised and the home had arranged for a number of people living at the home to have their needs reviewed to see if they needed this type of care so they could provide the right care for them. The home had employed staff with mental health qualifications so could provide guidance about the mental health care of people living at the home to staff. Since our last visit Four Seasons Health Care had introduced a new document to Care Homes for Older People Page 13 of 31 Evidence: gather information about the needs of people. We could see this was very detailed and gathered lots of useful and important information. A staff member said that the document called the CHAP stimulated his thoughts to ask more questions about peoples needs as it guided him to do this so he had more information on which to plan the care that people needed and improve their health. We saw that information was gathered about the needs of people that use services so staff had information to provide support and care. We could see some examples that the home uses a person centred approach to care but do not use person centred thinking and planning to provide care and support to people living at the home so their care is not always based around their needs and choices. Person centred planning is a really good way for people that use services to take control of their lives. Person centred thinking helps staff that care and support people that use services to listen to them and then to get what they want. A person centred plan contains information on what is positive about people that use services for example what people like and admire about them and their gifts and talents. Information should be included about what and who is important to people that use services from their viewpoint, as well as what people want for their future. A person centred plan should have information about how people that use services want to be supported, so stay healthy, safe and well. This is called a support plan but may be called a care plan. This should be detailed enough to provide a living description of how people that use services want to be supported, how they make decisions and says who will do what by when. The information the manager sent to us before the visit said that care plans were individual to people using the service and included personal routines and choices about personal care. The care plans we saw said some positive things about how people could help themselves but did not tell us how people wanted their care to be arranged and how staff would provide support or care to help them to care for themselves or if care was arranged or planned around their daily routines. So care based on their personal preferences was not always provided. For example routines around personal care and bathing. Care plans did provide staff with some guidance on supporting people to remain independent by encouraging them to attend to their personal care and saying how people helped themselves. The home had been gathering some information about the life histories of people that use services but this information was not reflected in the care plans the home had written to support and provide care for them so staff did not have information to provide individual care. Care plans were very detailed and guides staff to help and support people but did not reflect a person centred approach and only contained little information on how people could care for themselves or be involved in their personal Care Homes for Older People Page 14 of 31 Evidence: care. We could not see examples of how people that lived at the home chose their daily routines and followed their own lifestyles. Care plans were kept in offices on each floor and we could not see how they had been involved in the writing of their care plan so would not know what was written in them or if they understood some of the medical words used. We saw that staff treated people that use services with courtesy, dignity and respect and sought their views about how they wanted to be supported and saw staff help them make decisions. We saw care plans refer to staff making decisions for people that use services but did not see information about how people that use services made decisions for themselves. If people that use services did not make decisions as they lacked capacity, experience or judgement to make them. We could not confirm why, when, where and how staff supported them to make decisions so were unsure what decisions they made for them or supported them to make. Care plans made references to people not being able to make decisions due to their mental health needs and it would be up to families, their doctor or health and social care professionals involved in their care to make decisions for them. We cold not see that the mental capacity of people had been tested so could not see how these judgements had been arrived at. Care plans contained important information about the health of people that use services. An example of this was was when a person using the service had been found to have moved from hospital to the home the person had pressure sores. The home had made sure the skin care specialist nurse had been involved in giving them advice on care and treatment. We could see that the pressure sores were healing well. The home had medical cover from local doctors surgery so people that use services had their health needs looked at regularly. People that use services have information gathered about how much they eat and drink, how much they weigh, if their skin is in danger of breaking down, their ability to mobilise and walk or if they are in danger of falling as well as their ability to care for themselves so staff have information on which to provide care and support. Psychological services are provided so the home is able to provide care for people living with dementia. The home had also improved on prevention of health care acquired infections as part of a project with the local NHS Trust by working with infection control staff and the homes staff attending training so were more aware of how to reduce cross infection. At a visit to the home in June 2009 the home was praised for the improvements made in infection control. Before the visit we received a survey form a dietitian and a doctor who visit the care home. The dietitian said the home was good at requesting her advice when people Care Homes for Older People Page 15 of 31 Evidence: were having problems with their diet and weight and the doctor said the home was good at spotting social and health care problems and asking for help with these. The doctor described staff at the home as caring. Medication policies and procedures were detailed so staff understood their responsibilities and accountability for their actions when administering medicines to people that use services. Both areas of the home had similar medicine storage facilities and used the same policies and procedures. A medicine fridge was in use with the operational temperatures regularly recorded so staff knew it was operating safely. Each storage area contained the policies and procedures for medicine administration with specimen signatures of staff responsible for administering medicines. We looked at the arrangements for the ordering, receipt, administration and disposal of medicines and controlled drugs and found no errors so people that use services were receiving their medicines safely. We talked to staff who were administering medicines about the arrangements for giving out medicines during mid morning. Staff administering medicines were often disturbed by other staff asking for advice or serving people that use services with breakfast. The manager agreed to look at the medicine administration practise in the home so medicine administration was arranged around the needs of people living at the home. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use services are supported to make everyday choices but could be offered more opportunities for recreational and social contact so they have control over and lead more fulfilling lives. Evidence: An information board at the main entrance home displayed information about events taking place inside and outside of the home as well as the range of activities available in the home. There were many pictures of people being involved in activities in the home and proudly displaying pictures they had done and things they had made. This also displayed the complaints procedure as well as cards of thanks from relatives. Outside entertainment was provided by visiting entertainers. Local clergy visit the home to speak with people living there and hold regular religious services so they have opportunities to practise their faith. At the time of the visit the home employed an activities coordinator for 20 hours a week so there was some one to plan and encourage people to do activities. The activities coordinator was helped by a two staff members to do activities on her day off so there were 30 hours available for activities. The manager and regional manager Care Homes for Older People Page 17 of 31 Evidence: confirmed the home is to advertised for another activities coordinator as the budget has been increased so more opportunities will be available for people to be supported with social and recreational choices. We saw staff involved in some activities during the day so people that use services had some opportunities for social and recreational contact. We saw some people that use services reading newspapers and magazines, watching TV and listening to music. We saw staff occasionally sitting and talking with people that use services. We saw that the communal areas of the home usually had a staff member sat in them so people living at the home had contact with staff. We saw people living at the home sleeping at times so were not engaged in doing anything. Activities were mainly on the days the activities organiser worked so were limited. Activities also include exercise, arts and crafts, trips out, gardening, pampering and baking. Before the visit three people living at the home returned surveys to us that said activities were always or usually arranged that they could join in. A person said about living at Mill Brow This is a very nice place, just like living in a normal suburban road. You get well cared for and everyone asks you if you get enough of it. I say to them I need help not care as I can do for myself. I can have help when I need it and theres always someone around when you need them. I get what I need and pay for it. I pay for my meals, which are enough for me. I thinks its worth what I pay. Meals were seen to be varied and supported a balanced diet with advice sought from dietitians where necessary. The menu provided a varied diet and as the home had separate dining areas meal times were generally quiet so staff could support people to enjoy their meals without interruption. The home provided food that was freshly prepared and included home made soup to provide a varied and nutritional menu which included alternative choices of meals through the day. The menus were displayed on white dry wipe boards in the dining areas. The menu covered a four week period and was changed regularly. Breakfast was a choice of porridge, cereals, fruit, yogurt and toast. The menu included a choice of a cooked breakfast so people that use services had a variety of breakfast items from which to choose. Lunch was a choice of home made vegetable soup, sandwiches or sausages and beans. There was also a choice of two sweets. The main meal is served in evening which was a choice of corn beef hash, lamb stakes, mashed potatoes, chips and vegetables. Snacks were available throughout the day with home made cakes. The home also keeps stocks of cooked meats, cheeses, eggs, fruit, vegetables and a variety of frozen foods so people that use services have a choice of other meals. Staff were available to assist people that use services with their meals. Care Homes for Older People Page 18 of 31 Care Homes for Older People Page 19 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. People that use services are protected by the safeguarding adults procedure in place so people that use services will be confident they are protected at all times. Evidence: We saw that the complaints procedure was displayed in the entrance to the home and on notice boards around the home so people had access to it. We looked at two complaints the home had received and complaints received within the last twelve months had been dealt with satisfactorily. The complaints procedure is included in information about the home provided to people choosing to live there before they move in however we cannot yet say if people with memory related problems will be able to understand the information provided or the current complaints procedure in place. Before the visit three people living at the home returned surveys to us and said they knew who to speak to informally if they had concerns and how to use the complaints procedure in place. Policies and procedures were in place to protect vulnerable adults called the safeguarding adults procedures. The safeguarding adults procedure is how we, the local council, police and other agencies respond to and manage allegations or suspicions of abuse against vulnerale adults. The manager provided training records that recorded staff had received safeguarding Care Homes for Older People Page 20 of 31 Evidence: training. Staff had received training on how to recognise and respond to suspicions of abuse so should be able to protect vulnerable adults. We spoke to three staff and they said they had received safeguarding adults training and described what they would do if they witnessed abuse or neglect or someone reported abuse or neglect to them so could respond to suspicions or allegtaions of abuse or neglect to make sure vulnerable adults were protected. The home had a copy of the Halton Borough Council safeguarding adults procedure and had access to the local councils safeguarding adults training programme through the local training consortium. The home had made four safeguarding referrals to the local council since the last visit and had cooperated with the local council in the investigation of these. Care Homes for Older People Page 21 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. People that use services live in a comfortable and safely maintained building so their health and safety is promoted. Evidence: We looked around the building and saw improvements on the first floor. The first floor had building work completed to create a new lounge and quiet room. In addition the first floor had been redecorated and curtains and new carpets fitted throughout and new bedroom furniture purchased. The main lounge had become a dining room and a relaxation room was to be created out of the staff room. Bathrooms and toilets had been refurbished and this included the purchase of two new assisted baths which cost several thousand pounds each. Toilet and bathroom doors had been painted different colours to that of bedroom doors so people with memory related problems would be able to see they were not bedroom doors. This had been helped by improved signage to bedrooms, toilets and bathrooms which had been fitted with with large signs with pictures on showing if the room was a bedroom, bathroom or toilet. Lighting had been changed to give a much brighter look which was helped by the neutral paintwork. Corridors had been decorated with themes such as film stars of the twentieth century and world war II so people have interesting pictures and subjects to see and talk about Electronic key pads had been fitted to the front door and upstairs entrance to give Care Homes for Older People Page 22 of 31 Evidence: greater security and restrict people with memory related problems from being at risk by leaving the building and not being familiar with the local area. We could see that a lot of new equipment had been bought and this included electric beds so people could position themselves comfortably. The home plans to continue with the redecoration of the ground floor and replacement of furniture. Externally the garden areas have been landscaped and in the next 12 months aim to create an allotment with raised flowerbeds. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good employment procedures and a varied training programme are in place so people that use services are protected by a thorough recruitment process and a skilled staff team. Evidence: We saw the staff numbers in place supported the needs of people that use services so they had sufficient help with their needs. The home was not fully occupied and there were sufficient staff to provide care and support for the number of people living at the home. Additional staff were on duty to assets with domestic, laundry and catering duties. The manager works at the home five days a week and is not included in the staff on duty so is able to offer support and supervision to the staff team. The homes staff induction programme was based on Skills for Care induction standards which are nationally recognised standards for people who work in social care so staff understand their roles and responsibilities. The home employs 22 care staff and 61 of these have an NVQ level 2 qualification and three have an NVQ level 3 qualification so staff are supported to do additional training. Additional care staff are working toward the completion of the NVQ level 2 qualification. An NVQ level 2 Care Homes for Older People Page 24 of 31 Evidence: qualification is a nationally recognised qualification in social care. We examined the recruitment records of four staff employed at the home. Recruitment procedures were good and included staff having to complete an application form, full employment history and two references sought about their suitability for employment. The recruitment of staff also included a Criminal Records Bureau (CRB) disclosure which is a check of staff to see they are suitable people to provide personal care and support to vulnerable adults. Staff were provided with training which included infection control, safer food handling, safeguarding adults, moving and handling, fire safety, using caring for people with dementia, nutrition, care of the dying, preventing pressure ulcers and medicine administration so a varied training programme is provided for staff. Senior staff are trained in dementia care. The manager provided us with a record for all staff training that had been planned and completed to record as well as having individual training files so we could see they were provided with regular training to be able to do their jobs. Before the visit staff returned surveys to us that said they received regular support from the manager and training that helped them to do their jobs so were provided with the training they needed to do their jobs. Staff commented that they felt there was an improvement in the training and moral of the staff team with the staff team working together. A comment received was Overall the home is running at an exceptional standard and in my opinion has improved dramatically. The home manager has set the foundation for the home and the residents, care staff, nursing staff and visitors have all responded very well. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality assurance identifies areas for further development so the welfare of people that use services is promoted. Evidence: At the time of the visit the registered manager was working in the home. The registered manager is an experienced manager with several years of management experience. The manager was appointed as the manager in 2008 and since her appointment has made many improvements to the home. A comment received in a survey by a staff member before the visit said There has been a big change in the home since the new manager has took over, with staff, residents, families, communication skills all improved and we work more as a team. The manager completed checks on a number of things in the home to make sure the home was managed properly, important information was gathered about the home, how safety was maintained, staff were doing there jobs correctly and that people that Care Homes for Older People Page 26 of 31 Evidence: lived there were satisfied with the care they received. This was called quality assurance and was done by doing lots of checks called audits so the manager could see the home how everything was working. The managers checks were then checked again by her manager during monthly visits so Four Seasons the owners were aware of any matters in the home which needed to be improved upon and could tell the manager if she was doing a good job or needed to make improvements. Managers from Four Seasons visit the home every month to do quality assurance checks, talk to people that live at the home and staff and look at important records so they can write a report to say if the think the home is being properly managed. These visits are called Regulation 26 visits and we saw the provider did these each month. A relative said of the management of the home, This place is brilliant and the staff lovely. I cant compliment them enough. They do lots of things with mum and the activities lady does lots of one to one things with her. Mum has made cards, painted plant pots and is always doing something. I visit everyday and mum says she loves being here. They have restored my confidenece in people. Im kept informed of everything, mum has put on weight, talks a lot more and is happy. She smiles all the time and says the staff are lovely. I visit everyday and have never seen anything wrong. If I need a doctor the manager or deputy see to it. I heard good things about it from social services and the district nurse, who said the place was really good and mum would be well cared for and they were right. We looked at how the Mental Capacity Act, a law about making decisions and what to do when people cannot make some decisions for themselves, was used in the home. When people cannot make decisions for themselves, this is called lacking capacity. The Mental Capacity Act sets up safeguards that must be used when a person living in a care home, who cannot make decisions for themselves, is restricted in a way that deprives them of their liberty. This provides extra protection for them to make sure that anything being done is done in their best interests. Sometimes people may be stopped doing things they want to do, to give them extra protection. This may restrict them and might be done to keep them safe or protect them from harm. We saw that where restrictions that deprived people of their liberty had been used, permission had been given to use them by the local council and all the people who had an interest in the person who had the deprivation of liberties safeguards in place had agreed this was in the persons best interest to safeguard their welfare. The home does not act as appointees for any people that use services or manage finances on their behalf. All people that use services have an account opened for them to deposit money for personal use but they or their relatives may choose not to use this facility so manage their finances themselves. Monies held at the home were kept to pay for chiropody, newspapers, hairdressing and personal items so people using the Care Homes for Older People Page 27 of 31 Evidence: service could buy things they wanted. Balances were checked against the records held in the home and the amounts held tallied against the records on the computer so financial procedures were safe. Monies held on behalf of people living at the home were checked every month as part of the quality assurance system so there was an independent check of financial procedures. The AQAA told us that all the required maintenance checks and health and safety checks had been completed as required so people that use services lived in a safe building. We checked the records for fire safety and found all fire safety systems were checked regularly so the safety of people that lived at the home was promoted. 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 1 7 The home should should improve how decisions about daily living made by people that use services are reflected in their care plans so staff and others involved in their care understand how important peoples daily decisions about their lives and decisions about their future are to them so the agreements about how they make or are supported to make decisions are clearly understood. People that use services should be provided with more opportunities to be involved in recreational and social activities of their choice so they can live fulfilling lives. 2 12 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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