Care Home: Old Rectory Nursing Home - Warrington

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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 in the kitchen has been replaced. The main lounge and dining area has been redecorated and is bright and comfortable. Corridor lighting in the main ground floor corridor has been improved so people can recognise the door which leads to the additional ground floor dining area and bedrooms. People that live at the home made positive comments about living at The Old Rectory and said, "I can`t say I know everything about this place. This is a hotel and I`m only here temporarily. The food is very nice and the young girls or staff are very nice and helpful, always asking me am I alright, always smiling and bringing me a drink when I need one". 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 high 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. The home provides a high standard of food and comments from people living in the home and relatives were that the food was excellent. 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 decoration of the building and change of lighting has made the home brighter so people that use services live in a more welcoming home. 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 manager had introduced a lot of checks on how satisfied people living in the home were with the standard of food, personal care, cleanliness, activities and communication in the home so they could make positive contributions to how the home is managed. What the care home could do better: The home should should improve how decisions about daily life made by people living there 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 any agreements about how they make or are supported to make decisions are clearly understood. People living at the home should be provided with more opportunities to be involved in more individual recreational and social activities of their choice so they can live fulfilling lives. Staff should receive training on The Mental Capacity Act so they are clear that decisions to restrict people to ensure they remain safe and well do not restrict their liberty. Staff should receive training in how to provide care and support for people living with dementia so they can recognise how this affects their physical and mental health, lifestyle choices and how their capacity to make decisions are reduced so staff can appreciate and understand more clearly the personal difficulties that people have and support them in these areas. Key inspection report Care homes for older people Name: Address: Old Rectory Nursing Home - Warrington Old Rectory Nursing Home Church Lane Grappenhall Warrington Cheshire WA4 3EP     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: Anthony Cliffe     Date: 1 7 0 9 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 33 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 33 Information about the care home Name of care home: Address: Old Rectory Nursing Home - Warrington Old Rectory Nursing Home Church Lane Grappenhall Warrington Cheshire WA4 3EP 01925604611 01925269000 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Valerie Anne Eyes care home 39 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 39. Date of last inspection Brief description of the care home The Old Rectory is a 39 bedded care home registered to provide nursing care to adults aged over 65 years of age. It has been converted and extended from the 15th century building, which was the original rectory for the adjoining church. Communal areas comprise a large dining room, spacious lounge and conservatory. Facilities are available in the home for hairdressing. The home provides nine twin bedded rooms and twenty-one single rooms, some with en suite facilities. There is wheelchair access to the home and a passenger lift to the upstairs accommodation. It has extensive rear Care Homes for Older People Page 4 of 33 Over 65 39 0 Brief description of the care home gardens, a veranda to the front of the building and the Bridgewater Canal passes by the grounds. The home is situated in Grappenhall village, which is within easy travelling distance from Warrington, Stockton Heath and Lymm. Information about the home including the range of fees can be obtained by contacting the manager or owner. Care Homes for Older People Page 5 of 33 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: References to we, our or us represent the Care Quality Commission This unannounced visit took place on the 17th September 2009 and lasted over nine 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 they provide in the same way we do and if our judgements are consistent with home owners or managers. Care Homes for Older People Page 6 of 33 During the visit various records and the premises were looked at. People that use services, relatives, staff and manager 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 August 2008 we did an annual service review of the home, which told us the home was still providing an excellent 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. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 33 The home should should improve how decisions about daily life made by people living there 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 any agreements about how they make or are supported to make decisions are clearly understood. People living at the home should be provided with more opportunities to be involved in more individual recreational and social activities of their choice so they can live fulfilling lives. Staff should receive training on The Mental Capacity Act so they are clear that decisions to restrict people to ensure they remain safe and well do not restrict their liberty. Staff should receive training in how to provide care and support for people living with dementia so they can recognise how this affects their physical and mental health, lifestyle choices and how their capacity to make decisions are reduced so staff can appreciate and understand more clearly the personal difficulties that people have and support them in these areas. 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 33 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 33 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. 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 may choose to live there with a variety of information. A brochure had been produced containing pictures of the home and activities people were involved in as well as information about the facilities and services available at the home and 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 different 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 also included information about what facilities and services the fees people Care Homes for Older People Page 11 of 33 Evidence: that chose to live there pay for as well as examples of meals and activities people had taken part in so people choosing a home had other useful information to help them make a decision about living their. The information provided to people is supplemented with information about the activities taking place in the home and pictures of people being involved in them so people choosing a care home have an idea of what it is like to live there. The information describes how activities are used to help people remain healthy so their mobility and ability to care for themselves does not deteriorate as well as having opportunities for recreation so people can see that activities are arranged to promote healthy living. 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, 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 33 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. Evidence: 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 Care Homes for Older People Page 13 of 33 Evidence: 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 unique to people living at the home and included information about their personal routines and choices about personal care. The care plans we looked at were called core care plans, which are plans that are written to include information about the needs of people and contain guidance for staff on the things they need to do when providing care and support. These plans did not describe in detail the individual care or support provided to people living at the home or include information about how they chose their care to be arranged or how they chose to live their lives. For example if they were able to manage their own care so did not reflect their choices and decisions about how they received care and support. The core care plans had some additional information writen on them about the routines and choices that people made 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 a core care plan about bathing said that people should have a twice weekly bath but did not say if this was the choice of the person or if they were able to bath themselves or attend to their own person care such as washing or dressing 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. The core care plans were detailed and guide 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. We could not see written examples of how people that lived at the home chose their daily routines and followed their own lifestyles. Care plans were kept at the nurses station 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. Daily records were kept to record the care and support that people that lived at the home received. Daily records recorded information on the different needs of people Care Homes for Older People Page 14 of 33 Evidence: and contained information about their medical history, visits from health and social care professionals. Each month the home does a monthly summary of the information kept in daily records so they can see how the health and social care needs of people have progressed. For example a person living at the home had been seen by a dietitian and a doctor and food supplements prescribed. The summaries described how the persons weight had increased along with his mobility as he joined in with chair based exercises. In 2009 as part of asking people what they thought about the services provided and quality of living at the care home the manager had sought the views of people living in the home to see what they thought about the personal care they received. Twelve people responded and eight said the person care they received was excellent and two satisfactory. All ten people said that staff did their best so were happy with the support and care they received. People were particularly happy with the hairdressing and nail care they received. 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 did not see care plans about helping people to making decisions for themselves or 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 see written guidance for staff that confirmed how people made decisions or how staff supported them to make decisions so were unsure what decisions they made for them or supported them to make. 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 with pressure ulcers. 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 ulcers were healing well. The home also has its own skin care specialist who talks to the district nurses about what treatments to use so people living at the home benefit from staff that are up to date with current practise on skin care. 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 Care Homes for Older People Page 15 of 33 Evidence: to provide care and support. Before the visit we received a survey from a a social care professional and doctors who visit the care home. The social care professional said that the family of the person they had placed at the home were very complimentary about the care their relative received. A comment received from a doctor was Very high standard of fixtures and fittings. Very caring staff who know their patients very well. Maintains peoples dignity and independence. The home employs the services of a physiotherapist and aromatherapist. At the time of the visit both theses people were at the home. We saw a large group pf people and staff involved in chair based exercise. The home provides information to people that choose to live there with information about the health benefits of the activities that the home provides so they can remain fit and active. Medication policies and procedures were detailed so staff understood their responsibilities and accountability for their actions when administering medicines to people that use services. The home has one medicine storage facility with policies and procedures on medicine management. The storage area contained the policies and procedures for medicine administration with specimen signatures of staff responsible for administering medicines. A medicine fridge was in use with the operational temperatures regularly recorded so staff knew it was operating safely. 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 said they took time to administer medicines and could be disturbed by other staff asking for advice or sharing information with them. 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 33 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 that use services are supported to make everyday choices but could be offered more individual 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 a leisure coordinator who is one of the full time registered nurses so there was someone to plan and encourage people to do activities. The leisure coordinator was helped by a the staff team and people from outside of the home to do activities so there was always someone available for activities. We saw staff involved in chair based exercise and joined in with enthusiasm. Care Homes for Older People Page 17 of 33 Evidence: We saw staff organising games of floor skittles as well as noughts and crosses and were involved in 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 regularly 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 organised throughout the week so was something arranged everyday. The activities we saw were mainly group activities so were limited for individuals. The records of the people we looked at recorded that they had occasional one to one time with staff as they needed this level of support, but again this was infrequent so could not pursue individual leisure interests. For example one person had been out to the local walking day. We could not see regular individual activities arranged based on the individual needs and choices of people living at the home.At the last visit we recommended that people living at the home had individual support plans which reflected their lifestyle and leisure interests so individual activities could be arranged around their preferences. The home had introduced individual activity support plans for people as well as their life histories. Gathering information such as this would benefit staff having more information about people that live at the home so they can arrange activities to support them. An example of this was the home had done a detailed life history of a gentleman from Warrington and encouraged him to watch rugby league but the person had memory problems and became anxious and the home were not using the very good information they had gathered about him to reduce his anxiety or points of interest they could use in conversation or as reference points to talk about his life. We received surveys from people living at the home that said activities they could participate in were always arranged. Comments describe the home as friendly and homely. One person said the were lucky to be living there. Comments from staff said they wanted more or separate facilities to be able to do activities as well as a greater variety of activities and reminiscence room would be useful. Comments received from people living at the home were Effort is put into making occasions special. i.e Christmas day, fathers day, St. Patricks day and each residents birthday. They make the effort to take residents out on trips. Another person living at the home said they would like more activities in the afternoon. The variety of regularly arranged activities included skittles, discussion groups, chairobics, gentle mobilisation, board games, crosswords and a piano morning. In addition there was hairdressing twice a week and aromatherapy for people that wanted this so there were some Care Homes for Older People Page 18 of 33 Evidence: alternative activities available. In 2009 as part of asking people what they thought about the services provided and quality of living at the care home the manager had sought the views of people living in the home to see what they thought about the activities provided so we could see the home was asking people for their thoughts and ideas. Twelve people participated and they were asked questions about the ten activities available. People were asked to provide their answers to four questions ranging form enjoying the activities very much, a little bit, not at all and not taken part.The most popular group activities were skittles, crosswords, aromatherapy piano and singsongs and discussion groups. Comments recorded that people living at the home did not like board games but no changes to the activities available were made as the overall result was good. 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 the home had two 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 made 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 black boards near the dining areas. The menu covered a four week period and was changed seasonally. 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 mashed potatoes, broccoli and sausages with a list of alternative meal choices available. There was also a choice of two sweets which was home made egg custard or poached pears and ground rice. The main meal as the chef works later so the evening meal is freshly prepared and meals not left for staff to serve . Snacks were available throughout the day with home made cakes. The home also keeps stocks of fresh cooked meats, cheeses, eggs, fruit and vegetables so people that use services have a choice of other meals. Staff were available to assist people that use services with their meals. The home has fresh meat, fruit and vegetables delivered three times a week as well as milk and bread. The home does not keep large supplies of frozen food and only kept frozen peas and ice cream. The chef demonstrated the home had received a five star award for food safety and management from the local council. The home buys all its produce from local suppliers that have supplied the home for many years. The chef said she orders all the food and the owner never questions how much is spent on food. She said examples of this were buying fish from a fishmonger and bettering this at the home as well as buying freshly made pies from a local butcher. The chef said The choice of cereals is endless we even have coco pops for someone that likes them. At breakfast we cook whatever Care Homes for Older People Page 19 of 33 Evidence: people want and there is always a cooked breakfast. We cook all our food from fresh and even batter our own fish, we get from a fishmonger. There are never any comments about the food budget. I am responsible for ordering and the owner has never ever said anything about what we spend on food. She buys only the best. For example we buy home made pies from our butcher. We pride ourselves on the food we serve. Resident are always complimentary. The owner even provides meals for relatives free of charge so residents can eat with their family. In 2009 as part of asking people what they thought about the services provided and quality of living at the care home the manager had sought the views of people living in the home to see what they thought about the quality and variety of meals served at breakfast time. Fourteen people gave a response. All said the choice of breakfast and way it was served was excellent. Comments received were that people were aware they could request alternative meals and had been provided with cheese on toast, fried bread, grilled tomatoes on toast and mushrooms on toast. The information had been given to the kitchen staff so they could act on the choices of people living at the home. Before the visit we received surveys from people that live at the home who commented about the standard of food they received. people said the always or usually enjoyed the meals served. Comments received were,They come to talk to me about the meals and what I like, The food is very, very nice. Care Homes for Older People Page 20 of 33 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 so people had access to it. The information the manager sent to us before the visit said the home had not received any complaints in the last 12 months. The complaints procedure is included in information about the home provided to people choosing to live there before they move in. Before the visit seven people living at the home returned surveys to us and sit they knew who to speak to informally if they had concerns and how to use the complaints procedure in place. Comments received were Can speak to any staff and matron always seems to be here. I am happy though to tell matron or the owner and they sort things out and The owner is totally committed to running the home and spends a great majority of her time here. 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 and supervision records that recorded staff had received a refresher course at the home on safeguarding adults so should be able to Care Homes for Older People Page 21 of 33 Evidence: protect vulnerable adults. We spoke to two 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 Warrington Borough Council safeguarding adults procedure and had access to the local councils safeguarding adults training programme through the local training consortium.The home had arranged for staff to attend the local councils safeguarding adults training in February 2010 with a total of 18 places booked. The home had a safeguarding allegation made against it since the last visit and had cooperated with the local council in the investigation of this. The outcome of this was that the home had acted to protect someone from falling by the use of a restriction. The home had not had any training on The Mental Capacity Act so were not aware the actions to protect the person were a restriction of liberty. Care Homes for Older People Page 22 of 33 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: The home is set in a picturesque village and the building is well maintained by constant redecoration and upgrading. People can bring their own furniture to personalise their bedrooms so are able to make themselves at home. The cleanliness of the home was very good with an odour free environment. The home has a large conservatory overlooking the Bridgewater canal. Information sent to us before the visit confirmed that the home meets fire regulations as well as having a very positive environmental health visit report. The owner aims to create a hydrotherapy room with hydrotherapy bath and shower so people living there have modern bathing facilities which benefits their health. We could see that since the last visit the main lounge had bee decorated, emergency lighting replaced and as recommended at out last visit corridor lighting changed. The owner had fitted brighter lights in the downstairs corridor so people using this area can recognise the door to the downstairs extension where further dining facilities and bedrooms are located. The gardens had been improved with trees cut back and borders well tended. The removal of trees had provided more light into the building. New equipment had been purchased with 12 electrical profiling beds purchased so Care Homes for Older People Page 23 of 33 Evidence: people could adjust there position in bed and help themselves to remain independent. A large flat screen TV had been bought and mounted on the wall of the lounge so people could see the TV without interruption. We received surveys back from people living at the home and staff before the visit that said the home is always fresh and clean and the environment homely and comfortable. Comments received were I am very happy here. It is the most wonderful place and I have a beautiful bedroom. My daughter found me the best place to come to, Cleanliness of the home is very good as there are never any unpleasant odours and Always smells nice and others comment on this. Care Homes for Older People Page 24 of 33 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. 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 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 assist 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 26 care staff and 17 of these have an NVQ level 2 qualification and 5 staff have an NVQ level 3 qualification so staff are supported to do additional training. An NVQ level 2 qualification is a nationally recognised qualification in social care. We examined the recruitment records of two staff employed at the home. Recruitment Care Homes for Older People Page 25 of 33 Evidence: 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, nutrition, care of the dying, preventing pressure ulcers, equality and diversity and medicine administration so a varied training programme is provided for staff. The manager provided us with staff training files so we could see they were provided with regular training to be able to do their jobs. Some people living at the home are living with dementia and the manager confirmed that staff do not have training in caring for people with dementia. 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. Comments received were ,I feel the Old Rectory staff do everything relating to care to the best of their ability. I am very happy to be part of such a good team. I also feel valued and given lots of support and encouragement. The home cares extremely well for all aspects of care to the residents and works closely with the family of residents. No staff have left the home in the last 12 months so the home has a low staff turnover with a stable workforce which provide stability for people living at the home. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Continual asking people who live at the home about improvements 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 many years of management experience. The manager is supported by the owner who works at the home on a daily basis. In surveys returned before the visit the owner was described as committed. The manager is supported by a team of experienced registered nurses who take individual responsibility for supervision and wound care. There are usually two registered nurses on duty as well as the manager. Comments from relatives we spoke with during the visit and from surveys received from people living at the home, their relatives and visiting professionals was that the home has a dedicated staff team with minimal staff turnover so the home is consistently well managed. People that live at the home and relatives said they could not praise enough how well the home was managed and how high the standards of care at the home were. Two relatives spoken Care Homes for Older People Page 27 of 33 Evidence: with said their relatives had been ill and with patience and dedication from staff they had made a full recovery as they would not have received the individual level of attention in an NHS facility. A visitor was moved to tears when describing how the home had handled the care of his relative and described how staff helped to rebuild his relatives dignity. He said, He had lost his sense of dignity as he couldnt help himself but told me he felt respected and dignified in the way he was cared for by staff. In a nutshell its safe, comfortable, respectful, and dignified thats why we chose it. Another visitor said, I have spent much time in NHF facilities. The care here is excellent and I feel I am in a very strong position to make an informed judgement in qualifying that statement. 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 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 included asking people that live at the home about what the thought about the care and support they received, the meals and menu provided, activities available, cleanliness of the home and how staff at the communicated with people living there as well as relatives. The audit on communication found that people that lived at the home said that communication was excellent. People living at the home and relatives were asked if communication could be improved by meetings between people that live at the home and the manager or manager and relatives. Twenty two relatives were asked about having a relatives meeting and only three people wanted this type of communication. Feedback from relatives was that the level of communication between the home and them worked well and they did not want many changes. Relatives requested more information about what they could do to support people choosing to move into the home so they were aware of how they could help their relatives with their day to day living. 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 Care Homes for Older People Page 28 of 33 Evidence: where restrictions had been used for example in supporting people to remain safe and well, permission had not been given to use them by the local council or the people who had an interest in the person where restrictions had been used. This matter had been dealt with under the safeguarding adults process with the local council who were satisfied the home was not restricting a persons liberty but using a restriction to safeguard their health and welfare so they were not at risk of falling and injuring themselves. The home does not act as appointees for any people that use services or manage finances on their behalf. No monies are kept at the home on behalf of people living there so they or their relatives are responsible for managing their own finances. Any additional services that people have to pay do so directly with the home and have bills sent to them by the home. 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 29 of 33 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 30 of 33 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 more individual recreational and social activities of their choice so they can live fulfilling lives. Staff should receive training on The Mental Capacity Act so they are clear that decisions to restrict people to ensure they remain safe and well do not restrict their liberty. Staff should receive training in how to provide care and support for people living with dementia so they can recognise how this affects their physical and mental health, lifestyle choices and how their capacity to make decisions is reduced so staff can better understand the personal difficulties that people have and support them in these areas. Page 31 of 33 2 12 3 18 4 30 Care Homes for Older People 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 32 of 33 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 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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