Care Home: Overslade House

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What the care home does well Pre admission documentation available within the care plans looked at confirmed that the manager of the service was satisfied that the home would be able to meet peoples` care and support needs prior to them moving in. Care planning documentation is comprehensive and detailed It includes pertinent risk assessments, and all of the documentation looked at was cross referenced in order to ensure that an audit trail could be followed. All of this information is reviewed regularly and updated as necessary to ensure that the staff have the most current information to work from. Medication policies and procedures in place ensure that this is managed safely on peoples` behalf. Relatives are free to visit the home at any time and are made welcome by friendly and courteous staff. People are offered a variety of activities throughout the week that are planned and coordinated by the homes activities person. Meals are wholesome, nutritious, tasty, and enjoyed by the residents. Residents and relatives can be sure that any concerns or complaints that they have will be treated sensitively and resolved as far as possible. The homes policies on complaints and protection from abuse safeguard the residents, as does the homes staff recruitment procedures. The environment is comfortable, homely, hygienic, clean and tidy, and is appreciated by both residents and visitors alike. An annual quality survey ensures that residents views are listened to and kept at the forefront of service delivery. Health and safety is managed well. What has improved since the last inspection? Four requirements were made at the last inspection of this home. Evidence was in place to confirm that the manager has addressed these as follows. Care plans and risk assessments for those people who may display behaviours that challenge were in place within care plan files that we looked at. They were clearly cross referenced to each other and staff were aware of their content. Clear records demonstrating how medication is managed in the home were in place. A risk assessment for lighting throughout the home has been undertaken and a programme of lighting improvement is ongoing.Accidents and incidents are recorded appropriately, and the relevant notifications are sent to us as required. What the care home could do better: No requirements have been generated as a result of this inspection visit. The home is reminded of the importance of ensuring that care plans are followed as appropriate to ensure that all of peoples` assessed care needs are met. Key inspection report Care homes for older people Name: Address: Overslade House 12 Overslade Lane Rugby Warwickshire CV22 6DY     The quality rating for this care home is:   two star good 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: Justine Poulton     Date: 1 0 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Overslade House 12 Overslade Lane Rugby Warwickshire CV22 6DY 01788522577 01788522507 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.barchester.com Barchester Healthcare Homes Ltd Name of registered manager (if applicable) Mrs Janet Hutchinson Type of registration: Number of places registered: care home 89 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 89 The registered person may provide the following category of service only: Care Home with Nursing To service users of the following gender: Both Whose primary needs on admission to the home are within the following categories: Dementia (DE) 44 Older Persons (OP) 45 Date of last inspection Brief description of the care home Overslade House is a large, detached, purpose built care home set amongst landscaped gardens approximately one mile from Rugby town centre. The home is set back off a busy road and close to local bus stops and schools. Car parking facilities are available near to the entrance of the building. Overslade House offers personal and nursing care to up to 89 people with physical frailty and dementia care needs. The Care Homes for Older People Page 4 of 29 Over 65 0 45 44 0 Brief description of the care home home also admits people for end of life care and is working with Macmillan Nurses to achieve the National Service Framework NHS standards Gold Standard for Palliative Care The home provides a total of 86 single accommodation rooms with en-suite facilities and includes 22 rooms in the recently built new wing. Three of the rooms are suitable for double occupancy if, for example, a married couple were to be admitted to the home. The dementia care unit is situated on the ground floor and comprises 43 rooms. The elderly frail unit is situated on the first floor and comprises 43 rooms. There is a passenger lift to enable people to access the upper floors and corridors are sufficiently wide enough to accommodate wheelchair users. There is a large communal lounge incorporating a dining area in each unit as well as another small lounge and dining room in the new wing of each unit. Communal bathrooms are located near to lounge and dining areas and these have assisted bathing facilities to support people with limited mobility. Written information about the scale of charges was not available on the day of the inspection visit but this information can be obtained by contacting the service direct. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out to establish the outcomes for people living in this home, and to confirm whether they are protected from harm. It was an unannounced inspection which means that the home did not know we were coming. Identified key standards were looked at, along with a review of the organisations progress towards meeting any requirements made at the previous inspection of this service. We assessed all of the information available to us, and undertook a site visit to the home, during which time staff, people living in the home, relatives, and the manager were spoken with. A completed annual quality assurance assessment was received from the service prior to the inspection. We also received eleven completed surveys. Three people were identified for close examination by reading their care plans, risk Care Homes for Older People Page 6 of 29 assessments, daily records and other relevant information. This is part of a process known as case tracking where evidence is matched to outcomes for residents. Records, policies and procedures were examined and the environment was looked at. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? Four requirements were made at the last inspection of this home. Evidence was in place to confirm that the manager has addressed these as follows. Care plans and risk assessments for those people who may display behaviours that challenge were in place within care plan files that we looked at. They were clearly cross referenced to each other and staff were aware of their content. Clear records demonstrating how medication is managed in the home were in place. A risk assessment for lighting throughout the home has been undertaken and a programme of lighting improvement is ongoing. Care Homes for Older People Page 8 of 29 Accidents and incidents are recorded appropriately, and the relevant notifications are sent to us as required. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 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 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available to prospective residents to enable them to decide whether to move into the home. Comprehensive assessments are undertaken prior to people moving into the home so that they can be sure that their needs can be met. Evidence: The home has a statement of purpose and service user guide available for prospective residents and their families. These were both on display in the reception area. As recorded in the previous inspection report for this home, an enquiries pack is given to prospective residents which provides them with the basic information about the services the home is able to provide. We spoke to the manager about the homes admission process. She told us that the home adheres to the Barchester admission policy and procedures, which include Care Homes for Older People Page 11 of 29 Evidence: ensuring that people are able to visit, and a pre admission visit from the manager to meet the person and complete the initial assessment documentation. We spoke to one relative about the homes admissions process. She told us that she was happy with the process. She said that she had visited the home with her mother to have a look round and had been able to participate in the assessment process to ensure that her mothers needs could be met. We chose three people who had moved into the home within the last six months for case tracking purposes. We examined their care plan files to assess the pre admission assessment process. We saw completed Pre Admission assessments and Total Care assessments within the care plans we looked at. This confirmed that pre admission information is obtained by the home prior to people moving in. Care Homes for Older People Page 12 of 29 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 living in this home can be confident that comprehensive, detailed care plans and risk assessments ensure that their well being and safety are promoted. People can be confident that their medication is managed safely on their behalf. Evidence: The three people chosen for case tracking purposes had care plans, risk assessments and key support records in place. We looked at these to determine whether and how their assessed needs were being met. We saw that they contained levels of information which informed staff about what support was needed and how they were expected to provide it for people. We asked a member of staff how soon the care plan is put in place when someone moves into the home. We were told that the care team aims to complete the care plans and risk assessments within seven days from admission in line with Barchesters policy. This was confirmed in one of the care plans we looked at. The care plans we looked at covered areas of care and support which included communication; continence; mobility and dexterity; tissue viability; nutrition and hydration; challenging behaviour and gender, sexuality and relationships amongst others. We saw that the care plans were clearly cross referenced to any relevant risk Care Homes for Older People Page 13 of 29 Evidence: assessments and daily living records. In one of the care plans we looked at we saw that X is prone to urinary tract infections as ... can be very reluctant with fluids at times We saw a fluid chart in place for this person which staff were filling in as necessary. We asked staff about the need to encourage fluids for this person and they told us that it was because they were prone to infections. In another we saw that Y likes to be dressed smartly. When we met this person we saw that he was dressed in clean, smart clothes appropriate for the weather. We also saw in one of the care plan files we looked at instruction regarding one the persons glasses. X must be offered her glasses when assisting with personal care as she forgets..... offer assistance to clean her glasses. When we met this person during the inspection visit we noted that she was not wearing glasses. We asked a staff member about the relevant care plan and were told we know X should be wearing glasses but they are lost, we think the optician might have been contacted. We looked back through the daily records for this person and found no recording to state that the glasses were lost. This was brought to the managers attention who immediately located the relevant glasses and undertook to reiterate to the staff team the importance of following a care plan, to ensure that people are receiving appropriate care. The AQAA tells us that From the last inspection it was highlighted that we need to document challenging behaviour more thoroughly. We now use behaviour charts more to monitor behaviour to assess patterns and change care plans if we need to. We didnt see any of these charts within the files we looked at but we did see care plans and risk assessments pertaining to challenging behaviour within one persons file. We asked the staff about any behaviours that this person might display and how they managed them and were told that the initial behaviours displayed had now minimised as the person had become more settled within their environment. We sampled the relevant daily records and found no evidence of any challenging behaviour recorded. In addition to the care plans in place each person also had a number of risk assessments mainly covering their heath needs. Current moving and handling assessments were in place accompanied by a mobility plan and falls risk assessment where applicable, as well as assessments covering nutrition and hydration, the use of bed rails, choking or aspirating, pressure area care and tissue viability and challenging behaviour amongst others. As with the care plans, all of the risk assessments were clearly cross referenced to the relevant care plan and daily records. The information contained within the risk assessments we looked at was detailed and clearly informed staff of the action to be taken to ensure that the risk was minimised. Records of review dates and any amendments made were also in place, and confirmed that they Care Homes for Older People Page 14 of 29 Evidence: were all being reviewed on a regular basis. Information available in the care plan files that we looked at confirmed that people are supported to maintain their health and well being. We saw records of appointments to see the doctor, dentist, optician, district nurses and a consultant pshychologist as well as referrals to the tissue viability nurse and dietician. Each of the three units manages medication separately in line with the organisations policies and procedures . We looked at medication management in the two dementia units during this inspection visit. Medication is stored within the home in locked trolleys which are located in lockable walk in cupboards. Medication is supplied to the home by a local pharmacy and is accompanied by a medication administration record (MAR) chart for each person. A photograph of each person was available with their MAR chart to assist with ensuring that medications are administered to the correct person. The medications and MAR charts of the people chosen for casetracking purposes were looked at and did not provide any cause for concern at the time of the inspection visit. Records were available on each MAR chart looked at of the date medications were received and the quantities, no signature gaps were noted and the blister packs looked at tallied with the administration records. We saw temperature record charts in each medication room to ensure that optimum temperature levels in line with manufacturers guidelines were maintained. Similarly the fridge temperatures were recorded on a daily basis. We also saw a sample signature sheet for the registered nurses responsible for administering medication in the front of each medication file. Individual protocols signed by each persons GP were also available for any homely remedies that might be requested and administered. A medication disposal record was in place, as was a controlled drugs record. Any controlled drugs the home handles were stored appropriately, the quantities available tallied with the records within the controlled drugs book, and administration records were clearly signed by two people each time. One requirement regarding medication was made at the last inspection of this home. This required that records must clearly demonstrate how medication has been managed. This includes the number of tablets/capsules that have been administered. We saw clear records on the MAR charts we looked at for as and when medications that confirmed the number of tablets that had been administered each time. We observed the medication administration process in one of the dementia units as part of this inspection visit. The Registered nurse undertaking the task wore a clearly marked tabard that identified that she undertaking a drug round. We saw that she Care Homes for Older People Page 15 of 29 Evidence: washed her hands before commencing the round. An explanation of what the medication was for was give to each person before she gave it top them to take, She remained with each person until they had taken their medication, then returned to the MAR chart to sign it. We asked her how she would judge if someone who was not able to say whether they needed painkillers actually required them. She told us we guage by facial expression and vocalisation generally. Care Homes for Older People Page 16 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A variety of activities are available for people to choose from if they so wish. Peoples relationships with families and friends are promoted and encouraged and they are made to feel welcome in the home. People can be confident that a healthy, nutritious diet is provided. Evidence: The home employs a small team led by and activities coordinator to plan and provide activities that are appropriate to peoples needs, and that take into account peoples interests and hobbies. The AQAA tells us that We have put on more activities after listening to service users and their families and the activities coordinator has contacted families and spoken to service users to ask their opinions and for suggestions. We saw an activities programme displayed around the home which had a varied programme throughout the week for people to participate in. We were told that the programme changes on a rolling weekly basis to ensure that there is a wider scope of things for people to enjoy each month. Activities available during the week that we visited in included art and craft sessions, musical bingo, mobility with Tim, and pets as therapy amongst others. On the second day of our visit people were looking forward to going out to the theatre for the evening. Church services continue to be facilitated in the home and are well attended. We spoke to a number of people Care Homes for Older People Page 17 of 29 Evidence: who live in the home about the activities available. They were all very complimentary about the activities coordinator, and said that they enjoyed the opportunities to participate in things that were available for them. Continued contact with families and friends is seen as being of paramount importance for the people living in the home. As such the manager and staff strive to ensure that people are supported with this as they wish. People are free to receive visitors at any reasonable time, and they can see them in either private or more communal areas as they so choose. A number of visitors were seen to come and go during the inspection visit. We spoke to two visitors during our visit, both of whom were very complimentary about the care and service their relatives or friends were receiving, my cousin seems happy and were very happy with her care, Mum is comfortable and always smartly dressed and nicely presented, I am more than happy with Overslade. Comments made in the surveys received include Both parents are very happy, Overslade is their home, ... is well cared for by staff and staff support mum and us as a family as well. The home has recently achieved the Gold standard in food hygiene following an inspection of the homes kitchen and food preparation areas. As such we did not inspect the kitchen on this occasion. During our visit we spent lunch time in one of the dementia units and the elderly frail unit observing. We saw that the tables were nicely laid with appropriate cutlery and condiments. Staff were available to assist people where necessary, and were sufficient in numbers to be able to support people through the whole of their meal. People were individually offered a choice of meals and drinks. The food available was plentiful and nicely presented. We spoke to people during their meal who told us The food is lovely, you need to get to the kitchen before its all gone and My only complaint is that I didnt get here sooner, the food is too nice. We saw people being offered alternatives such as soup or sandwiches if it appeared that they did not like the meal they had originally chosen. Facility for people to take their meals in their bedrooms is available should they wish to. Specialist diets such as diabetic or vegetarian are accommodated. Care Homes for Older People Page 18 of 29 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. The people living in this home can be confident that the policies on complaints and protection from abuse ensure that their views are listened to and acted upon, and that they are safeguarded from harm. Evidence: The home adheres to the Barchester policies and procedures for managing complaints and safeguarding vulnerable adults. A recommendation made at the previous inspection was for the complaints policy to be reviewed to ensure that it contained accurate details of other bodies that people could complain to including those of the Local Authority and the Care Quality Commission. This information was within the procedure we looked at. The AQAA tells us that We investigate all complaints and respond quickly. We invite families in to meetings to discuss issues We looked at the homes complaints file. There was a register of complaints received in the front of this file. This contained clear information pertaining to each complaint received, and included the allocated reference number, complainants details, type of complaint (eg. verbal, or letter), the date of the complaint, the date of the response and the outcome of the investigation. We saw that there were eighteen complaints recorded, ten of which were during the previous twelve months. The AQAA confirmed that the home had received ten complaints over the last year, all of which had been Care Homes for Older People Page 19 of 29 Evidence: upheld and subsequently resolved. We spoke to people during the visit about what they would do if they had a complaint or a grumble and were told that I would speak to the staff because I know they would listen, I dont have any complaints, the place is lovely. I had to grumble a while back but it was soon sorted for me. The AQAA tells us that All staff receive regular SOVA (safeguarding of vulnerable adults) training and the deputy manager has attended training on how to conduct effective investigations. We spoke to a number of staff throughout the home about safeguarding vulnerable adults. They all told us that they had received training in this area, and were able to explain what they would do should they suspect or witness any form of abuse. Training records confirmed that a large proportion of the nursing and care staff have received vulnerable adults training within the last twelve months. The home appropriately raises safeguarding referrals with the local safeguarding team within social services and reports them to us under the correct regulation. We saw recordings pertaining to a SOVA referral in the care plan file of one of the people we chose to case track. There was a clear audit trail and chronology of events that lead up to the referral. The SOVA reference number was recorded and notes within the persons daily records regarding the incident clearly cross referenced to the relevant care plan and risk assessment. This indicates that staff understand the procedure for reporting safeguarding referrals appropriately. Care Homes for Older People Page 20 of 29 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 benefit from a homely, clean and well-maintained environment, which they value. Evidence: The home is a large service that is registered to accommodate 89 people. The home is divided into two dementia care units on the ground floor and one elderly frail unit on the upper floor. The AQAA tells us that We are constantly investing in the environment. We have an ongoing programme of refurbishment. The home is decorated to a high standard throughout, with the communal space being comfortably furnished and, following a change in the layout of the elderly frail lounge, homely. Individual bedrooms were personalised to each persons taste with photos, pictures and personal items of furniture to help them feel at home. The AQAA tells us that We have made some changes in the Dementia care unit and service users have chosen the colours of their bedroom doors. We saw that both the dementia units continue to have separate areas dedicated to various reminiscence themes which include a sports area, an Oscar and Hollywood area with photographs of bygone actors and actresses, an old singer sewing machine and old fashioned clothes for people to dress up in if they wish. The manager told us that one person in particular likes to dress up in the wedding dress as it reminds her of her own wedding. Care Homes for Older People Page 21 of 29 Evidence: A requirement made at the previous inspection of the home was for a risk assessment to be carried out in the large lounge located on the ground floor to ensure that there is sufficient lighting available to prevent the risk of possible falls and to ensure the environment is suited to the needs of the people who use the service. The AQAA tells us that We have an ongoing programme to update all the lighting in the home. We were told that a risk assessment was undertaken on all the lighting in the communal areas, the result of which was that lights are replaced with brighter bulds or tubes as they require it. The lighting throughout the home appeared acceptable during the inspection visit. Comments made in the completed surveys we received included The environment created at Overslade House gives quality to the lives of the residents making them feel safe and secure and well cared for. The home was clean and tidy throughout with no odours apparent. Effective systems continue to be in place to manage the control of infection. We saw staff wearing appropriate personal protective clothing when necessary and during mealtimes. We noted that different coloured protective clothing was worn for different tasks. As recorded in previous inspection reports, the home has a large modern laundry. A recommendation made at the last visit to this home was for laundry baskets to be suitable labelled to clearly separate dirty laundry from that which is freshly washed. We noted when in the laundry are that this had been actioned as the baskets were clearly labelled appropriately. Care Homes for Older People Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in this home benefit from properly recruited sufficient numbers of competent and knowledgeable staff. Evidence: The AQAA tells us that the home employs 98 staff made up of a mixture of qualified nurses, care staff and ancilliary staff. Rotas we looked at confirmed that staffing ratios were being maintained as at the previous inspection. Staff spoken to said that the staff numbers were satisfactory to meet peoples care and support needs at the present time, and that they had the time to undertake the tasks they were required to do as well as spend a little time chatting to people throughout the day. The only comment made regarding staffing levels in the surveys we received suggested that the home would benefit from employing more bank staff to cover for annual leave. The AQAA tells us that Our recruitment procedures are good and we try to recruit the right people for the job. We checked the files of three recently recruited staff to determine the robustness of the homes staff recruitment procedures. They all contained evidence to indicate that Criminal Record Bureau (CRB) checks had been sought along with two written references. A full employment history and proof of identity were also in place to ensure that any risks to vulnerable adults is minimised. The AQAA tells us that 18 staff have completed their NVQ level two or above. The Care Homes for Older People Page 23 of 29 Evidence: manager told us that she is in the process of getting the qualifications of nine staff from overseas translated and then assessed against the NVQ programme by The National Agency for Recognition Information Cantre (NARIC) which is a translation and comparison service for overseas qualifications to match them against their english equivalent. She showed us evidence to confirm that those qualifications she has had looked at so far are sitting alongside an NVQ 4 qualification. She also told us that a further nine staff are now enrolled on the NVQ 2 programme. Although this doesnt meet the recommendation made in the last report that the service should be able to demonstrate that 50 of care staff have a National Vocational Qualification at level 2 or equivalent, this includes overseas nurses whose qualifications may not be equivalent to the NVQ 2 it does demonstrate a commitment by the manager and the organisation to work towards meeting this target. We were told that the responsibility for co-ordinating staff training and ensuring that all training is up to date has been delegated to one of the Team Leaders. She told us that she is given one day each week to undertake the task which includes ensuring that staff training records are up to date, and that the manager is aware of what training is due and for whom. Comments in the surveys we received included Overslade keeps all staff up to date with all external and internal training We were shown the induction pack that all new employees of the organisation are expected to complete upon commencement of their employment. We saw that this is a comprehensive six week programme that ensures that new staff reach an acceptable level of competency to care for people, and provides the foundation for then moving onto their NVQ II qualification. We were provided with a training matrix that summaries what training has been completed by whom, when and when refreshers are due. This confirmed that the majority of staff were up to date with their mandatory training in subject such as fire safety, moving and handling, safeguarding vulnerable adults and food safety for non catering staff. This matrix clearly identified when training was required by people, and the team leader responsible for managing the staff training told us that she keeps the matrix updated and uses it to inform the manager of what training is required. Care Homes for Older People Page 24 of 29 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 living in this home benefit from good management systems. Peoples views are sought via an effective quality monitoring system which ensures that their views are at the forefront of service development. People can be confident that that they are safe via effective health and safety management. Evidence: The home continues to be managed by competent, experienced and suitably qualified manager who has been in post for approximately 14 years. The home continues to have clear lines of accountability, with each of the three units having an identified deputy manager who report to the manager. An open door style of management was apparent, and both staff, the people living in the home and visitors appeared comfortable and at ease in approaching the manager or any of the staff. People we spoke to told us the manager is always around and you Care Homes for Older People Page 25 of 29 Evidence: can have a chat with her if you need to. Staff we spoke to told us that the manager is approachable and fair, shes a good manager. Comments in the completed surveys we received include Communication between staff and family is excellent .... Individuals one to one relations between care staff and residents is first class. The manager told us that the organisation had undertaken a satisfaction survey in 2009, to ascertain the views of people who live in the home, their relatives and staff. the results of which were collated into a report from which an action plan was generated to address areas of concern. We were shown the report that was produced following the survey. The results showed that from the completed surveys returned, the general indication of the opinion of the home was favourable, providing value for money and good care and attention from nurses and carers. It was again evident that regular visits are undertaken by the provider to assess the quality of care and services provided, with reports being provided to the manager. As recorded in the last report for this service, the home continues not to hold any personal monies or valuables for people. Charges for services such as hairdressing or chiropody continue to be invoiced on an individual basis. Information in the AQAA records that all of the necessary routine health and safety monitoring and checks are in place and up to date. A sample of these which included the landlords gas certificate, Legionella testing, lift servicing and portable appliance testing confirmed this. The home adheres to the organisations health and safety policy and staff are provided with health and safety training. Cleaning materials are stored safely and associated control of substances hazardous to health (COSHH) data sheets are in place. In addition we saw monthly audits for various elements of the service provided such as the management of nutrition, pressure sores and safeguarding of vulnerable adults. This all serves to ensure that everyone that lives in, works in or visits the home can be confident that they are as safe as practicably possible. Care Homes for Older People Page 26 of 29 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 27 of 29 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 28 of 29 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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