Care Home: Nairn House

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What the care home does well Nairn House has shown consistent improvement in the way it cares for residents. The statement of purpose identified the skills and staffing resources available to meet the needs of residents. Residents and relatives told us that they had information about the home. The home provides a statement of purpose that is specific to the home and the resident group they care for. The home carried out detailed assessments of the needs of prospective residents to make sure that it can meet their needs. A resident said, " I am happy with the care here." Admissions are not made to the home until a full needs assessment has been undertaken to ensure the best outcomes for residents. We found that there had been continued and consistent improvement in the way that the home identifies and supports residents. Care plans were detailed and identified how the needs of residents would be met. Residents told us that they felt staff understood their needs. People are involved in the planning of their care. We spoke to residents who told us that they are provided with regular activities. Residents are involved in meaningful daytime activities of their own choice and according to their individual interests and capabilities. Residents with whom we spoke confirmed that they knew how to make a complaint. A resident said, " I know how to complain if something is not right." The has an open culture that allows people to express their views, and concerns in a safe and supportive environment. The home is adapted to meet the needs of residents. The expert by experience observed that the home was, "Spotlessly clean and sparkling." We observed that residents were able to move around the home independently. Residents are provided with a safe and homely place to live. Residents and relatives told us that staff are available to meet their needs. The acting manager has continued to make sure that sufficient staff are always available. She regularly reviews the staffing level so that enough staff are available to meet the needs of residents. Staff training records showed that staff had done a range of training to equip them to meet the needs of residents. Residents told us that they felt staff understood their needs. The home makes sure that all staff receive relevant training that is focused on delivering improved outcomes for residents. What has improved since the last inspection? There were no areas of improvement identified at the last key inspection. Last year an Annual Service Review (ASR) of the service was completed. An ASR is a review of the service and how it is meeting the needs of residents. The ASR showed us that Nairn House had continued to provide improved outcomes for residents. What the care home could do better: There are no areas of improvement identified at this key inspection. Key inspection report Care homes for older people Name: Address: Nairn House 7 Garnault Road Enfield Middlesex EN1 4TR     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: Tony Brennan     Date: 0 4 1 1 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: Nairn House 7 Garnault Road Enfield Middlesex EN1 4TR 02083679513 02083679514 wadeju@bupa.com www.bupa.com BUPA Care Homes (AKW) Ltd care home 61 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: 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 who can be accommodated is: 61 The registered person may provide the following category of service only: Care Home with Nursing - Code N to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories:Old Age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Nairn House is owned by BUPA. Nairn House is a large purpose-built care home providing accommodation for 61 older people who require residential and nursing care. The service is provided on three floors and is serviced by a passenger lift. Each service user has a single bedroom with en-suite facilities. An office, nurse station, lounge and dining room are situated on each floor, in addition to toilets and bathrooms. The home is located close to shops and with access to public transport. The fees range between #535 and #750 dependent on the source of funding. This report is available through the internet. Copies may also be obtained from the provider of this service. Care Homes for Older People Page 4 of 31 Over 65 61 0 Brief description of the care home 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: The quality rating of the service is three star. This means that people who use this service experience excellent quality outcomes. This unannounced key inspection was undertaken as part of the annual inspection programme. We sought to confirm that the home has continued to improve the outcomes for residents. Prior to the inspection the home had completed its Annual Quality Assurance Assessment. The Annual Quality Assurance Assessment provided us with information about the home and how it was seeking to provide the best outcomes for people. We also looked at other information we have received about the home since the last key inspection. This included information regarding incidents that the home had told us about. The inspection took place over one day. We were assisted by Judith Wade, the acting manager, with the inspection. We spoke with three residents and five members of Care Homes for Older People Page 6 of 31 staff. We observed care practice and interaction between staff and residents. We toured the building, and examined a number of records relating to the care, health and safety, and management of the home. At the end of the inspection feedback was given to the acting manager, and areas for improvement were discussed. As part of the inspection planning it was agreed that an expert by experience would accompany us on the inspection visit. The expert by experience (Pamela Moffat) assisted us with the inspection by speaking to residents and their relatives. She also observed the care of residents. The experts by experiences observations are reflected in this report. We would like to thank the residents, relatives and staff who assisted us by answering questions about the running of the home. 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: There are no areas of improvement identified at this key inspection. Care Homes for Older People Page 8 of 31 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience 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 experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to the service. The statement of purpose is accessible to residents and their families, it provides an accurate description of the home. Peoples needs are assessed prior to admission to the home to make sure they receive the care and support they need. National minimum standard number six is not applicable to this service, as the home does not provide intermediate care. Evidence: We found that the needs of the residents case tracked were within a range of those specified in the statement of purpose. The statement of purpose identified the skills and staff resources available to meet the needs of residents. We observed that copies of the statement of purpose and service user guide were available in residents bedrooms. A resident told the expert by experience that he was happy with the care he received and, All the staff are very kind. Residents told us that they had sufficient Care Homes for Older People Page 11 of 31 Evidence: information about the home so that they could decide if it was the right place for them to live. A relative told the expert by experience that they have been able to visit the home to see what it was like. The home provides a statement of purpose that is specific to the home of the residents group that they care for. The statement of purpose confirmed that the cultural and religious needs of residents would be respected. Records show that residents were supported by the home to maintain contact with their church or other community groups. The annual quality assurance assessment identified that residents cultural and religious needs will be identified in their initial assessment and care plans. We spoke with the acting manager told us that cultural and religious needs are identified, and action taken to make sure that these needs are met. Initial assessments and care plans for residents case tracked reflected their cultural and religious needs. One person told the expert by experience, I still go to church or to the Legion. I get Dial- a- Ride to take me. Residents are supported to maintain their cultural and religious identities. Residents have varying degrees of disability. The environment has been adapted so that it is accessible. For example, there are lifts to all floors and all the facilities have been adapted to the needs of people with physical disabilities. We observed that residents were able to move about home safely. The homes environments is adapted to meet peoples diverse needs. The annual quality assurance assessment stated, A comprehensive pre-assessment document is in place to provide detailed information on the needs of prospective residents. The residents who has tracked had detailed preadmission assessment that highlighted all their needs. The home had also obtained assessments placing authorities and health professionals. These were used in the preadmission assessments to identified the individual needs of residents. Residents spoken to confirm that they received the care and support they needed. A resident said, The care here is good. You get the help you need. Admissions are not made to the home until a full needs assessment has been undertaken to ensure the best outcomes for people. Initial assessments recorded the involvement of residents and their representatives in identifying areas where they needed support. Both residents and relatives told us that they had been actively involved in the initial assessment process. We found that initial assessments reflected the individual preferences of residents and how they wished their needs to be met. For example, all the initial assessments of the residents who were case track included information about their dietary preferences, religious backgrounds and important events in their lives. A relative told the expert by Care Homes for Older People Page 12 of 31 Evidence: experience that they had been involved in the initial assessment process. Detailed initial assessments are carried out with the involvement of residents and their representatives to make sure their needs are identified. Care staff spoken to were able to explain the individual needs and preferences of the residents. They worked as key workers for a number of residents. Training records shows that staff had all the necessary training to meet the needs of residents. We observed the interaction between staff and residents found this support their continued well-being. The expert by experience observed that, Staff interaction with residents seemed to be very good. Admissions to the home only take place when staff have the necessary skills to meet the needs of prospective residents. Care Homes for Older People Page 13 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. People who use this service experience excellent outcomes in this area. This judgement has been made available evidence including a visit to the service. Peoples personal, social and medical care needs are fully planned for so that they receive individualised and holistic care. Residents are fully protected by the homes safe procedures for handling medication. Residents right to privacy is supported and promoted by the home. Evidence: The annual quality assurance assessment, and discussions with the acting manager showed us that there had been continued in the improvement in how the needs of residents are met. The annual quality assurance assessment stated, All residents have a comprehensive personal plan that is reviewed monthly and updated when necessary. The expert by experience observed that staff were meeting the needs of residents. We found that the care plans for all the residents case tracked clearly identified how their needs should be met. Care plans were based on initial assessments of the residents case tracked. For example, one resident has been identified in their initial assessment as having a history of falls. A full risk assessment Care Homes for Older People Page 14 of 31 Evidence: had been carried out. There was a care plan in place that gave clear guidance on how further falls could be prevented. There were clearly defined actions highlighted in care plans to make sure that the needs of residents were being met. Care plans provided a detailed record of residents choices and preferences regarding their care how they wish to live in the home. The acting manager explained that she had started to reflect residents capacity to make decisions in their care plans. We found that one of the residents case tracked had a capacity assessment. Staff spoken to were aware of this issue. Residents changing capacity to make decisions was reflected in their care plans. Care plans covered a range of preferences of residents. The example, food likes and dislikes, interests and hobbies, and religious and cultural needs. Residents told us that they had been asked about how they wish to be supported by staff. Staff were observed to interact respectfully and sensitively with residents. A resident told the expert by experience, I am happy here, they are really caring. Residents with whom we spoke said that they felt staff understood their needs. We saw examples where staff members related well with residents. For example, speaking to residents in a way that was appropriate given their age. One of the residents told us, Staff asked how I want things. A key worker system is in place that ensures that residents get individual attention from staff. Care plans will personalise and referred to cultural needs of residents. This included whether or not they wished to take part in religious activities. Residents are involved in the planning of their care affects their lifestyle and quality of life. Detailed nutritional, tissue viability, falls and manual handling assessments were found to be in place for all the residents case tracked. All the residents case tracked had nutritional assessments. This included a record of their weight and what action had been taken when their weight changed. All the residents case tracked had been assessed to establish if they were at risk of developing pressure sores. Where residents were found to be at risk of developing pressure sores an appropriate and detailed care plan had been put in place. One of the residents who we case tracked was highlighted in their tissue viability assessment to have a higher risk of developing pressure sores. A care plan was in place highlighting the treatment and care needed to prevent the development of pressure sores. This had been cross reference with other care plans (for example, around nutritional needs). Each care plan includes a manual handling risk assessment. we saw that equipment Care Homes for Older People Page 15 of 31 Evidence: has been provided to assist residents to mobilise safely and independently. A resident had a care plan providing clear guidance on how equipment should be used when assisting them with moving and handling. The expert by experience observed, I watched some handling and lifted. I found it was very good. We observe staff assisted in residents to walk. The member of staff did this in a way that ensured the residents safety. Management of risk makes sure that safety issues are addressed whilest at the same time improving the quality of life of residents. We were able to see from daily notes and other records that residents consistently get appropriate medical attention and advice. Residents told us that they could to see a GP when they needed to. Where the general practitioner had recommended specific medical interventions these had been followed up. Residents health promoted to maintain and enhance their continued well-being. The acting manager explained that she has continued and develop how support is provided for residents with end of life needs. Training had been provided on the Liverpool pathways and Gold Standard in palliative care. We saw that care plans have been drawn at, with the participation of residents and their families on end of life needs. One of the residents case tracked had a detailed palliative care plan that included her wishes. A pain relief assessment and guidance had also been prepared. This explained how and when pain relieving medication should be administered. We were able to confirm by looking at this residents records that the home was working closely with external professionals and specialist advice. Residents wishes about dying and terminal care are openly and sensitively discuss as part of the person centred care plan. Records of medicines received, administered and returned to the home were all complete. We were able to confirm that reisidents were getting their medication as prescribed by their general practitioners. Where the general practitioner had made changes to peoples medication this was signed to confirm the change had been made. We found that the medication for each of the residents case tracked was accurately recorded. Medication records are completed fully, contain the required entries, and are signed by the appropriate staff to make sure that residents are safe. The residents we case tracked had their consent to staff administering their medication record in their care plans. No residents are currently self administering their medication. A procedure is in place to make sure that a detailed risk assessment would be carried out if a resident wish to administer their medicines. Systems are in place to make sure that should residents choose to administer their own medicines this would be done safely. Care Homes for Older People Page 16 of 31 Evidence: Medicines were stored safely. All medicines are stored at the appropriate temperature. Separate records are maintained for controlled drugs. We checked the records of controlled medicines and found that these were correct. They contained two signatures of the staff administering medicines and an accurate record of the amount of medication still available. Regular monitoring of medication administration is carried out. The acting manager carries out an audit of medication to make sure that correct and safe procedures are followed when administering medication. Regular management checks are carried out to make sure that medication is administered safely to residents. Records show that staff are provided with training in the safe administration of medicines. Nurses spoken to were clear about their responsibilities to the safe handling of medicines. We observed staff administering medication and saw that this was done safely. Staff understands how to administer medication safely to residents. Care Homes for Older People Page 17 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. People will use this service experience excellent outcomes in this area. This judgement has been made using the available evidence including a visit to this service. People have a choice from a varied activities that reflect their cultural backgrounds and meet their needs. The home support people to maintain regular contact with their relatives and other representatives of their choice. People who live at the home are offered a balanced and varied diet. Evidence: Residents told us they have access to regular activities. We observed activities are taking place at various times throughout the day. The expert by experience observed that, There was a wide range of activities which were well advertised on the notice boards. The expert by experience observed a game of cards taking place, and residents being given a manicure. We spoke with the activities organiser who explained that she regularly consults residents about the range of activities being provided. She showed us records and notes that showed that regular daily activities were taking place. These records confirmed that the residents case tracked were participating in activities. Residents told the expert by experience that they could choose to participate in activities. Care Homes for Older People Page 18 of 31 Evidence: The residents interests are recorded as part of their care plans. We found that residents who we case tracked had their emotional and personal interests recorded in a very person centred way. A relative said that she had seen activities taking place regularly, and that residents always enjoyed them. Residents are involved in meaningful daytime activities of their own choice and according to their individual interests and capabilities. Staff will observed spending time talking with residents and listening to what they have to say. Staff spoken to understood the importance of one to one contact residents. We could see from daily notes that residents had regular contact with families and friends. We observed that residents were able to have a visit from their relatives at any time. The expert by experience spoke to a number of relatives who confirmed that they visited the home regularly. Relatives commented that there were no objections to when they visited. Residents told us that they could see visitors in private if they wished. The home supports residents to maintain and develop their family and personal relationships. The home has continued to develop ways in which it offers a varied diet to residents. The menu showed that options are offered at each meal. The acting manager explained that she regularly consults residents about the variety of meals. The Cook explained that he uses a menu planner to help plan a balanced diet of the residents. We spoke to residents who were generally pleased with the quality of the food. Residents told the expert by experience that they enjoyed the food provided by the home. One resident said to the expert by experience. The food is wonderful. Residents told us that they were offered a choice of meals. Residents are offered a variety of meals that reflect their personal preferences and meet their dietary needs. Meals were balanced and nutritious. Residents dietary needs were recorded as part of their care plans (for example, if they were diabetic or needed a puree meal). We observed that meals were well presented in a warm and friendly way. We saw that residents were supported to eat. The expert by experience commented that, I noted supported eating in the dining room it was good with a carer sitting down with the resident. Residents are able to enjoy the food they prefer and like. 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 who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to the service. People living at the home are confident that their complaints will be listened to, taken seriously and acted upon. People who live at the home are protected from abuse. Evidence: The quality assurance assessment confirmed that a clearly defined complete policy with agreed timescales for managing complaints was in place for residents to use. We found that a detailed policy was in place. Residents told us that they had received copies of the complaints policy. We observed that there were copies of the complaints policy in residents bedrooms. The complaints policy was displayed around the home. A complaints folder was available to record all concerns, allegations and complaints. There have been one complaint referred by the Commission to the home since the last inspection. A record of this complaint and how it was investigated were contained in the complaint record. This showed that a thorough investigation had taken place. The complainant had been responded to promptly and in detail about the results of the investigation. Residents with whom we spoke confirmed that they knew how make a complaint. One resident said, I know I can tell them about any problems I have. The home has an open culture that allows residents to express their views, and concerns in a safe and understanding environment. Care Homes for Older People Page 20 of 31 Evidence: There were policies by handling allegations of abuse and promoting the protection of residents. Residents said they felt confident that any concerns they raised will be handled sensitively and appropriately. The resident said, If I was worried about anything I know I can talk to the manager. There had been no adult protection issues since the last key inspection. We found that training records showed that staff had received training adult protection. Staff spoken to could recognise the signs of potential abuse, and were able to explain how they would respond to it. The expert by experience had observed that staff showed a caring attitude towards residents. Residents feel safe and well supported by the home, which has their protection and safety as a priority. 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 who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home that provides a safe and homely environment. People live in a home that is clean and hygienic. Evidence: The expert my experience observed that, Throughout the building was spotlessly clean and sparkling which was remarked upon by both residents and visitors. we walked around the home and found that it was accessible to all residents. We observed that residents were able to access all areas of the home safely. The home has the necessary adaptions to support people to move around safely. Bathrooms and toilets were fitted with appropriate adaptions to meet the needs of residents. They were accessible to residents who have mobility difficulties. The home was appropriately decorated and furnished. Records showed that there had been ongoing maintainance of the decoration, fixtures and fittings of the home. There were separate dining and sitting areas for residents to use. The expert by experience observed, the lounge/dining room is bright and airy. One in particular (the blue lounge) opens onto a beautiful garden. The acting manager explained that the residents had been involved in the design of the garden. She showed me an award that the residents had won for the design of the garden. The home environment is appropriate for the specific needs Care Homes for Older People Page 22 of 31 Evidence: of residents and promotes their independence. All that bedrooms were personalised with items of furniture and pictures belonging to residents. The expert by experience observed that one of the residents, had a big room and had obviously made it into his home, study and bedroom. It all looked very nice. A resident told us, Ive got my own things in my bedroom. The acting manager explained that she encourages and supports residents to personalise their bedrooms. Residents are encouraged and supported to personalise their bedrooms. We saw that the home was clean. The expert by experience was told by relatives and residents that the home was always clean. We found that a range of appropriate measures are in place to prevent cross infection. The home has detailed policies on cross infection. Training records showed that staff had been provided with infectioncontrol training. Staff spoken to understood how to work to minimise the possibility of cross infection. Staff confirmed that they had access to disposable gloves and aprons. We observed that these were available around the home for their use. Liquid soap and paper towels were available throughout the home. Effective infection control measures are in place to make sure that residents are safe. 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 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 experience excellent outcomes in this area. This judgement has been made is available evidence including a visit to the service. The home continuously monitors the staffing level to make sure that sufficient staff are available to meet the needs of residents. The provision of regular training make sure that staff have all the necessary skills to meet the needs of residents. Residents are protected by the homes recruitment practices. Evidence: Residents told us that they feel there was always enough staff available to meet their needs. The acting manager explained that she requires the staffing level every week to make sure that sufficient staff are available. The rota showed that a consistent staffing level was being maintained in the home. We observe that staff are available to provide individual care residents. A resident told the expert by experience that, Staff are always kind. Staff told us that the current staffing level allowed them to meet the needs of residents. The staffing level is reviewed regularly to make sure that sufficient staff are available to meet the needs residents. Residents spoken to felt that staff have the necessary skills to meet their needs. The annual quality assurance assessment highlighted that staff had been on a range of courses. A resident said, Theres someone to help when you need it. Training records showed that that staff has been on a range of courses relating to the needs of Care Homes for Older People Page 24 of 31 Evidence: residents. We observe that staff understood how to respond to residents. Staff spoken to were able to explain how they supported residents in a person centred way. A residents said, Staff understand how to help me. Staff are supported through training to meet the individual needs of residents. The acting manager was able to show that over 50 of staff have achieved a National Vocational Qualification in care. The acting manager explained that a number of staff are working towards or have completed a National Vocational Qualification in care at level III. Training records examined confirmed this. Residents and relatives spoken to by the expert by experience confirmed that staff knew how to meet their needs. Staff training records showed that staff had done training in the essential areas, such as food hygiene, health and safety, administration of medication, infection control and first aid. A training matrix had been used to plan future training to make sure staff maintain their skills. Qualified nurses had also completed their training to maintain their registration. This included training in tissue viability and palliative care. The home house received the Investors in People Award for its training and development programme. The home make sure that all staff receives relevant training that is focused on delivering improved outcomes for residents. We looked at four files of those staff who have commenced working at the home since the last key inspection. These contain all the necessary documentation to ensure that these staff were safe to work with residents. Their employment record had been checked. Two references and a POVA first/CRB check had been obtained prior to them starting work at the home. This showed that the home followed clear recruitment procedures that makes sures residents are safe. Residents said that they felt that staff could be trusted. Robust recruitment procedures are followed to ensure the safety and well-being of residents. 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. People who use this service experience good outcomes in this area will stop this judgement has been made using available evidence included a visit to this service. Appropriate management structures are in place to make sure that people receive the care they need. People living at the home are consulted about the quality of the service, and encouraged to make suggestions for improvement. People who live at the home have their financial interests protected by the homes procedures. People who live at the home and staff are protected other homes health and safety procedures. Evidence: Both residents and relatives commented positively on the Management leadership of the acting manager. The acting manager has applied to be registered with the Commission. The acting manager explained that she was to be interviewed in the week following this inspection. Since becoming manager for Nairn House the acting manager has continued to improve the care and support provided the residents. Talking to the acting manager we were able to establish that she has a clear plan for further improvement of the home. The acting manager has extensive experience of Care Homes for Older People Page 26 of 31 Evidence: managing services for older people. The acting manager is maintained and updated skills. She has a clear understanding of the key principles and focus of the service to make sure that residents receive the care they need. We observed that the acting manager spent time talking to residents and staff. The acting manager has a clear understanding of how to deliver good outcomes for people living at the home. Staff spoke highly of the acting manager. They told us they felt supported, and had received clear direction and leadership. A member of staff commented that the acting manager, Is very approachable, and she comes round to see what is happening. The acting manager works with staff to make sure that the home is run in the best interests of residents. The expert by experience observed that, The meeting with the manager was pleasant and inspired confidence. The home is managed in a way that makes sure the needs of residents are central to how the home is managed. The acting manager explained that she has started to address issues arising from the introduction of the Mental Capacity Act. We saw from residents files that their capacity was referred to in their care plans. One resident had received a full capacity assessment. Staff had received training in working within the guidelines relating to mental capacity. Staff spoken to were aware of these issues are how they might affect residents. The home responds sensitively to the changing ability of residents to make decisions. There are a number of systems in place to monitor the quality of the service provided by the home. Apart from the regular residents and relatives surveys that are carried out there are in place both internal and external quality auditing processes. These cover all areas relating to the care of residents. We saw the recent quality audit for the home. It showed the home had continued to improve in all areas. The home make sure that any areas of improvement are addressed. A survey of the views of residents, relatives and professionals had been carried out. Findings of the survey had been actioned to improve the care provided to residents. Regular residents and relatives meetings were being held to make sure that they were involved in the development of the home. Staff meetings were taking place to make sure that staff were aware of how they should support and care for residents. Residents views are sought and provide the basis for improving the quality of the service. The home does not manage residents money. The home invoices families or the relevant social service department for any expenditure made on their behalf. A system is in place to ensure receipts are obtained from any expenditure. We looked at the records relating to this expenditure. There were receipts for all items purchased. Record showed us that five residents currently manage their own finances. We saw Care Homes for Older People Page 27 of 31 Evidence: that there was a lockable space for residents to keep their money in their bedrooms. A risk assessment had been carried out to make sure that these residents were able to manage their own finances safely. Where residents needed support to manage their finances this was recorded as part of their care plan. Residents can have confidence in the homes procedures for handling their money. The home has a consistent record of meeting the relevant health and safety requirements and closely monitors its own practice. Fire drills were taking place, and the fire alarm has been tested regularly. We found that the fire risk assessment include an assessment of all potential fire hazards in the home. We questioned staff on the fire safety procedures and found that they understood fire safety issues. All health and safety policies were available and had been recently updated. Certificates of gas, legionella and electrical testing were found to be in date. COSHH guidance was in place and we saw that chemicals stored safely. We discussed health and safety issues with staff and they demonstrated their understanding. Training records showed that all relevant health and safety had been completed by staff. The home has an effective system for monitoring accidents to ensure the safety of residents and staff. The temperatures of fridges and freezers were recorded and were within safe limits. Health and safety checks, procedures and training make sure that residents are safe. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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