Care Home: Park View Nursing Home

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What the care home does well Care plans accurately reflect the individuals` needs and how they will be met. People who live in the home and their families are involved in this process wherever possible. Systems are in place to help ensure that there is consistency in assessing, planning, implementing and evaluating the care when required. We saw improvements in people making choices about how they choose to live their lives, this is detailed in the care documentation and staff we spoke with told us about the people living in the home, their likes and dislikes and their preferred routines. Safe, effective systems of practice are in place in receiving, storing, administering, and disposing of drugs which will help protect the health and wellbeing of people living in the home. Staff have a good awareness of individuals` needs and treat people in a warm and respectful manner, which means that they can expect to receive care and support in a sensitive way. Mealtimes were dignified and unhurried. The dining experience was a sociable occasion and people were given adequate support where needed. The complaints policy and procedure in the home is effective and all concerns are taken seriously and acted upon efficiently. People can be sure that they will be listened to and that their thoughts and feelings are taken into account. Recruitment procedures have meant that vacancies have been filled with people that are suited to the job with the right skills, this will also help ensure more continuity of care to the people who use the service. The home encourages and supports staff with training in order for them to develop their knowledge so that they have the required skills to meet the needs of the people. What has improved since the last inspection? The home is well organised and managed by an effective, stable management team that promotes the views and interests of all people who use the service. The home has continued to improve following the last inspection and further examples are detailed throughout this report. What the care home could do better: All of the National Minimum Standards assessed at this inspection were met. No statutory requirements have been made as a result of this inspection. We would like to thank everyone who took part in the inspection, their enthusiasm and support was greatly appreciated. Key inspection report Care homes for older people Name: Address: Park View Nursing Home Broad Bush Blunsdon Swindon Wiltshire SN26 7DH     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: Wendy Kirby     Date: 0 3 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 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 32 Information about the care home Name of care home: Address: Park View Nursing Home Broad Bush Blunsdon Swindon Wiltshire SN26 7DH 01793721352 01793721365 ang9286@yahoo.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Bothwells Limited care home 41 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category terminally ill Additional conditions: No more than 2 persons to be in receipt of terminal care at any one time The only service users who may be in receipt of nursing care, under the age of 65, are, the service user named in the original application to register the home in June 2004 and the service user named in the application received 24th January 2006. Date of last inspection Brief description of the care home Park View is registered to provide nursing care for up to 41 service users aged 65 or over. Mrs Rogers, a registered nurse, is the manager and registered nurses are on duty at all times, supported by care assistants. Catering, laundry, housekeeping, activity, maintenance and administration services are also provided. A property manager has responsibility for the environment and health and safety. Park View is situated on the outskirts of Blunsdon in a semi-rural area within easy Care Homes for Older People Page 4 of 32 Over 65 41 2 0 0 Brief description of the care home reach of Swindon. There is easy access from the M4 motorway and the A419, and there is also a rural bus service that runs past the home. Park View is situated in its own grounds and has accommodation on two floors. Bothwells Limited, based in Wembley, Middlesex owns the home. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced Key Inspection which included a visit to the home. The visit was completed by one inspector and lasted approximately nine hours. Prior to the inspection we (The Commission) looked at various pieces of information to gather evidence in preparation for our visit, which included the following: The previous inspection report. The inspection was conducted in December 2006 and resulted in a 3 star rating. The homes inspection record, which gives us an account of any information we have received about the home since the last inspection. The Annual Quality Assurance Assessment, known as an AQAA. The home is requested annually to complete and return this assessment to us by a specified time. We received the AQAA on time, which contained detailed information about what the home Care Homes for Older People Page 6 of 32 considers it does well and what plans they have for further improvements in the coming year. We sent surveys Have Your Say to people who live in the home, staff and health and social care professionals, thirty one were completed and returned. Comments received from the surveys will be referred to throughout this report. During our visit we spoke with some of the people who live in the home, visitors, the registered manager, and other staff members who were on duty. We also looked at how effectively staff engage with people in the home and how they were interacting and communicating with each other. We looked at four individuals care files, which included, pre admission assessments, care plans and risk assessments. We also looked at a number of records and files relating to the day to day running and management of the home. We spent time in all communal areas of the home and some of the bedrooms. Feedback was provided to the manager throughout our visit. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: All of the National Minimum Standards assessed at this inspection were met. No statutory requirements have been made as a result of this inspection. We would like to thank everyone who took part in the inspection, their enthusiasm and support was greatly appreciated. Care Homes for Older People Page 8 of 32 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 32 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 32 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. Peoples needs are assessed prior to admission to determine the suitability of placement. They can be confident that staff will have the resources and skills to meet their assessed needs. Evidence: We looked at the pre admission assessments, these were comprehensive covering all activities of daily living, a full health screen and personal history background. The information gathered pre admission should provide a sound benchmark of the persons ability, state of health prior to admission and subsequent needs when they move into the home. The home has also reviewed their pre admission assessments to include sections that relate to The Mental Capacity Act and Deprivation of Liberty Safeguards. People wishing to live in the home, family and carers are involved in the pre admission Care Homes for Older People Page 11 of 32 Evidence: assessment wherever possible and all information is used to determine the suitability of the placement. Where possible the manager also obtains comprehensive assessments and care plans from other health and social care professionals involved, for example, social workers and hospital staff. We spoke with the manager who clearly demonstrated the importance of pre admission assessments in order to ensure that the home can meet individuals identified needs. People are encouraged to visit the home either for the day or perhaps for lunch dependent on their wishes. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Because they are consulted about their health and personal care needs people should be assured that their views and expectations will be considered. The health and personal care that people receive is based on individual needs. There are safe systems of practice are in place in receiving, storing, administering, and disposing of drugs which will help protect the health and wellbeing of people living in the home. People can be confident that staff have a good awareness of their needs and that they will be treated with dignity and respect. Evidence: From the pre admission assessments the staff are able to develop a set of care plans based on identified needs. During the first months trial period the plans are reviewed weekly and developed accordingly. Care plans were completed with regards to health and social needs including, psychological, emotional, and cultural needs which Care Homes for Older People Page 13 of 32 Evidence: demonstrates that the home takes an holistic approach to the provision of care. The plans that we looked at were detailed and fairly person centered, including personal preferences and like and dislikes. Plans told us that people had specific requests and routines, this is very good practice and helps demonstrate that people are involved in deciding how they wish to receive care. Recent training in the Mental capacity Act (MCA) has helped staff understand about empowering people to make choices about how they want to receive care, which in turn is helping staff develop more person centered care plans. The AQAA states, The care plans have continued to improve and develop and we have ensured that they are person centered and meaningful. We have considered the Mental Capacity Act and have had training to help us understand the principles of the Act. Residents and relatives have been involved in the care plans either by adding to the plan or by agreeing to it. This has instigated some good discussions with both residents and relatives and they have felt empowered in their care. The plans showed consistency in assessing, planning and evaluating care as required. Regular care reviews take place for people living in the home, which can include family members and Key Workers wherever possible. This allows the opportunity to discuss and evaluate care and any issues or concerns people might have. Staff agreed that they had up to date information about individuals needs and confirmed that care plans were reviewed at least monthly unless there were any other significant changes. The manager audits the care files on a monthly basis and gives written feedback and any action required to staff members. Health care needs are monitored and documented in peoples care files. Nutritional assessments are completed on admission and reviewed monthly, people are weighed as part of this review. Care plans are written for people who are nutritionally at risk and how this is to be managed. Specialist health care support is often sought and referrals are made to community dietitians and the speech and language therapists. Records of General Practitioner (GP) visits and the outcomes were recorded. Specialist referrals and visits from other professionals including, Chiropodists, Dentists and Opticians were also seen. Our surveys told us that people living in the home feel that they are receiving the medical support they need. We received very positive comments in the surveys from community health and social care professionals and we spoke with a GP who was visiting the home on the day of the inspection. Comments included, I am extremely impressed by the standards of nursing and social care at Park View, Park View is a very highly regarded home that provides a very high Care Homes for Older People Page 14 of 32 Evidence: standard of care, and The staff are very caring and always work very hard to look after their residents. We spoke with some staff who demonstrated very good relationships with individuals and were knowledgeable about the care needs of those living in the home. They told us, Carers and nurses work unitedly to provide the best and most effective service, The residents always come first, All staff from carers to nurses have a high regard for those in our care and The individual care given is excellent, staff have a good understanding of their residents and are able to meet their needs, our end of life care is excellent. Policies and procedures for receiving, storing, administering and disposing of medications were examined and discussed with the trained nurses. All systems in place are effective, well managed and audited. Fridge temperatures are recorded daily, the administration charts were legible and continuity of administration was shown with a signature from the person dispensing. Staff responsible for the medication have appropriate and accredited training and take in house competency assessments. The home promotes privacy and dignity to all people who use the home. Staff attend training on induction, which covers aspects such as closing doors and pulling curtains when delivering personal care and knocking on doors and waiting for an invitation to enter before going in to their bedrooms. We saw staff knocking on peoples doors before entering, members of staff spoke respectfully about individuals needs and referred to them in the term of address that they preferred, this information was also recorded in the care files. Care Homes for Older People Page 15 of 32 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 benefit from a varied activities programme, which is both enjoyable, stimulating and meets individual preferences and expectations. People maintain family contact and staff encourage family and friends to join in with activities and any outings. The home actively promotes individuals to exercise choice and control over the lives they choose to live. People receive a varied and wholesome diet that they are able to influence. Evidence: There does not appear to be any unnecessary rules and it seemed that daily routines are flexible within the home. We saw evidence that people can get up and go to bed when they like, have their meals in their bedrooms, they can go out when they wish and participate in activities they have a particular interest in. This was confirmed in discussion with individuals and through observation during our visit. This is what the manager tells us in her AQAA, Park View respects all residents and Care Homes for Older People Page 16 of 32 Evidence: treats them as individuals and maintains their dignity at all times. I manage the home with this belief and my priority is to ensure my residents make choices and decisions over their life and their care. My residents choose their routines, they make choices about their room and are encouraged to bring in personal items to make it homely. They have choices about their meals and when they want to rest and when they want to join in activities. We met with one of the activity coordinators who was very enthusiastic about her role. Although she is fairly new to the role, she was very knowledgeable about the people in her care, including their likes, dislikes, communication needs, personal history, hobbies and interests. The coordinator has also joined a group forum with other coordinators from other homes. They meet regularly and share information and ideas. The manager told us that she was looking at courses for the co coordinators to attend to develop their skills and expertise so that activities are meaningful for all people that live in the home. Lounges in the home provide good entertainment systems including televisions, videos, DVD players and musical systems. People living in the home told us that there were activities arranged in the home that they could participate in should they wish to do so. Comments included, There is a lot of entertainment and activities to participate in, There are plenty of activities and outings for everyone and There is always something going on and I like it when children from the school visit us. The AQAA states, We have a full time and a part time activities coordinator and they provide the residents with personal time to develop interests and hobbies. Some of the residents love to play quizzes and games and others love to have singing sessions. Even some of the more reserved residents have chosen to become involved in arts and crafts and one person has produced some amazing art work. We are very much a part of the Blunsdon community and have the local school children in every week to meet the residents. The local church choir come in and sing and the local parishioners come in monthly to provide a service for those residents who wish to attend. The manager told us, I always do a detailed assessment of our new residents prior to admission so that we can prepare a plan of care which will be mindful of any cultural or spiritual needs especially with preferences regarding diet and religion. People are supported to satisfy their religious preferences. Several denominations will visit the home for individuals and people are also taken to local places of worship when they wish to go. Care Homes for Older People Page 17 of 32 Evidence: The home continues to strive for excellence and look at innovative ways to do this. The AQAA tells us about many new ideas that they wish to initiate for the benefit of all people who use the service. The manager tells us in the AQAA, I had intended on organising Internet access within the home for our residents to use but I havent managed it up until now, however I have spoken to our Head Office and we should have some progress on this shortly. This will enable residents to email their relatives and receive pictures and images that may enhance their lives. One relative wants to use SKYPE to see and speak to her relative when she is away working abroad. I am always receptive to new ideas and thoughts and will continue to attend study days and seminars to improve my knowledge so that we can improve our care. One member of staff has successfully passed their bus driving test and is now able to drive the Dial a Ride buses so we will be organising more trips out, especially to the theatre, local parks and garden centres which have always been popular with the residents. We saw lots of evidence that the the manager and staff are supporting and empowering people by encouraging them to maintain independence, autonomy and choice. The manager told us in the AQAA, I have been very interested in the impact that the MCA has on the way we care for our residents. I have initiated training to inform all the staff about the Act and particularly the recognition that we must be mindful of the Deprivation of Liberty Safeguards (DoLS). I would like to develop this by continuing with the education programme and to involve myself in any groups that support the act. I think we all have more understanding about assessing residents capacity to make decisions particularly empowering residents to make choices even if that choice may not be our choice or may even put the resident at some risk. That has been hard for all the staff to appreciate as some wanted to covet and protect the resident so much that they were not always respecting their right and their choice. This is a great step forward in understanding the MCA and DOLS and I feel the training and the professional discussions we have had as a team have helped this development. The home operates an open door policy for visitors and people are able to see visitors in the privacy of their own rooms and there are several semi private seating areas around the home and in the gardens. One separate room has been refurbished for families to meet with their relatives or friends in complete privacy. We spoke with visitors during the day who told us that they enjoyed visiting and were always made to feel welcome by staff. Care Homes for Older People Page 18 of 32 Evidence: The size and layout of the dining room makes it possible for everyone to enjoy the social advantages of dining together. The dining room is light and spacious with good quality dining furniture. Staff members supported people that required assistance with eating their meals in a respectful sensitive manner. Staff sat at the same level and assisted them without rushing. We saw jugs of juices, beakers and glasses and these were being handed to people whilst waiting for lunch. Later when we visited people in their rooms we saw that jugs of fluid had also been provided for individual use. The cook and staff were able to demonstrate an awareness of individual requirements and needs including special dietary requirements and personal preferences. The food is home cooked offering various choices of hot and cold alternatives and fresh fruit is available at all times. The menus display traditional meals and menus are reviewed to reflect seasonal trends and availability of produce. Extras are ordered on request for birthdays and special occasions. The kitchen was very clean, well equipped and spacious. Stores exhibited a good range of foods. Food hygiene training was up to date for all staff. Documentation shows provided that the required temperature checks are being carried out on fridges and freezers and that food was also being probed after being cooked. The home was recently inspected by Environmental Heath and awarded 4 stars. Care Homes for Older People Page 19 of 32 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. There are good policies and procedures in place to manage complaints and people can be confident that their concerns will be listened to and acted upon. There are good arrangements in place for staff training and the awareness of protecting vulnerable adults so that people living in the home are further protected from abuse. Evidence: The complaints policy and procedure is detailed and contains all the relevant information required, this can be found in the service user guide and welcome pack, which is given to people on admission. It is also displayed on notice boards throughout the home. We would receive details from the home about any internal complaints investigations and safeguarding referrals. There has been one concern raised this year which has been dealt with openly and effectively. The manager told us that she is committed to encourage an open culture within the home so that people feel comfortable and able to make a complaint or a suggestion without fear of reprisals. The manager makes every effort to see people living in the home Monday to Friday. Being available means that people can discuss any concerns or issues with the manager before they potentially escalate into complaints. Systems that are in place at Care Homes for Older People Page 20 of 32 Evidence: the home such as regular care reviews, key workers and holding meetings for people living in the home, relatives, and staff means that there is opportunity to communicate and share information. This further promotes people becoming less frustrated thus relieving anxieties and any potential complaint referrals. All of our surveys told us that people knew how to make a complaint and who to talk to if they were unhappy. The manager told us, I feel we have grown as a team and we all feel safe with one another and able to discuss any concerns or worries we may have. There are policies and procedures as well as a range of guidance information on the topic of protection of vulnerable adults from abuse. The availability of this information should increase staff awareness and the understanding of their role in protecting vulnerable adults who live at the home. We were told that the home actively promotes staff training and education in the protection of vulnerable adults on induction and on an annual basis the staff receive an update. We spoke with staff who confirmed that they had received this training and they were able to demonstrate its effectiveness when discussing the content of the training. A number of staff have either completed or are enrolled on the National Vocational Qualification (NVQ) in care award and a component of the award addresses issues around the topic of the protection of vulnerable adults from abuse. Care Homes for Older People Page 21 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home meets, and in some areas, exceeds the standards, providing a clean, comfortable, well equipped and a safe environment for people to live in, which meets their individual needs. Evidence: The home is fully accessible and has a number of aids and adaptations throughout the premises to enable physically disabled people to maximise their independence. This includes wide corridors and pathways, passenger lifts, specialised bathing facilities, grab rails and assisted toilet facilities. We walked around the inside of the home and viewed some of the bedrooms and the communal areas including the dining rooms, lounges and bathrooms. Most room sizes are spacious for their stated purposes, particularly the lounges and dining room. Bedrooms have en suite facilities provided and communal bathing areas, showers and toilet facilities are located throughout the home. All areas of the home were tastefully decorated, clean and well maintained. Attention has been given to ensure that all areas are homely.Various lounge areas allow for people to be seated together enjoying the entertainment systems on offer. People had been supported to personalise their bedrooms with pictures and ornaments Care Homes for Older People Page 22 of 32 Evidence: and they are able to bring items of furniture should they wish. All rooms contain a lockable unit so that people can keep their personal possessions secure. All rooms had profiling beds, and good quality matching bedroom suites, lounge chairs and a small table. The AQAA states, The residents rooms reflect the likes of the resident with personal items and colours that the resident has chosen for the paint, bedlinen and curtains. People said that the home was always clean and smelled fresh and pleasant throughout. These are just some of the improvements made to the home in the last twelve months as detailed in the AQAA. The main lounge, porch and dining room have been completely refurbished to a very high standard. The residents were able to choose pictures they liked and ornaments they wanted close to them. The dining room has meant more residents come for lunch together and the new furniture has given the area a real homely feel to it. The residents rooms are being decorated regularly and their choice of colour and decor have been respected. Most en suites have been replaced with modern suites and most of the furniture has been replaced. We have changed one of our shared rooms into a more spacious single room for a resident joining us who prefers the privacy a single room provides. There is now a quiet room for residents, relatives or visiting professionals who want to see the residents in private. The gardens have been kept to a high standard throughout the year and the new sensory garden is very popular. It is completely accessible for wheelchairs users and residents walking with assistance or aids. The approach to Park View has improved with brand new signs and lighting. The trees and hedges have been trimmed and kept tidy. The manager said in the AQAA, I feel I cannot fault the upkeep of the home and I thank the owners for their generosity in funding anything that our residents would like to make them comfortable and safe. The home continues to look at ways to improve the environment and these are some of their plans for the coming year. Care Homes for Older People Page 23 of 32 Evidence: The parking has been an issue at times and we have looked into ways of improving this and will endeavour to do so in the near future. We will maintain the very high standard of redecoration throughout the inside and outside of the building. We hope to refurbish the smaller bedrooms to make them more homely and let more light in. We hope to renovate our two existing double rooms so that they are single rooms. We also hope to renovate another space to provide us with a lovely single room for a resident who requires a lot of space. We are going to set aside a room especially for the residents to do art and crafts and we hope to provide extra equipment for activities. We are also looking at having an area for a computer access for the residents. Care Homes for Older People Page 24 of 32 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. The relationships between staff and people living in the home are good and create a warm positive environment to live in. People are supported and protected by the homes recruitment policy. The people are cared for by skilled staff that are trained, supported and supervised by management. Evidence: Staffing levels are indicative of needs and the level of care required and the manager confirmed that levels of staff would rise should dependency levels increase. People living in the home and staff agreed that there were enough staff to meet their needs. We know that the home also increases the levels of staff at certain busy times of the day to ensure that needs are met. When there have been staff vacancies regular bank staff have been used to provide continuity and the permanent staff will often cover extra shifts. The manager said in the AQAA, I complete a staff rota which shows an excellent team with a strong skill mix. We have very good staffing levels which is reflected in resident satisfaction. Care Homes for Older People Page 25 of 32 Evidence: The AQAA tells us that that it is paramount to find suitable staff in order to fulfill the roles and responsibilities expected of them. The home is vigilant in taking their time in this process so that they can find the right person for the job where they have the right skills and attitude to look after people in their care. We know that the home follows a good recruitment procedure. This will help ensure that people living in the home will be further protected. Records contain completed application forms with a full employment history, two or more written references and Criminal Records Bureau (CRB) disclosures. Staff confirmed that relevant checks had been completed before they started working in the home. There is an induction programme which covers all mandatory training. The home has a mentor system where all new staff are linked with and shadow a senior staff member during shifts to help with continued training throughout the induction process. Staff told us that the induction was good and covered everything they needed to know in order for them to do their job. The home provides the staff at the home with training and development opportunities tailored to individual needs. The manager and all staff are conscientious in attending training relevant to the care needs of the people they are caring for and those relevant to the roles they perform. The manager told us, I am really proud of our staff. They are incredibly hard working and loyal and really care about the residents. They work as a team and support each other and me in order to give excellent care. The staff communicate well with the residents and always report any concerns. They are trustworthy and honest and obviously love their work. Other comments received about the staff included, The home does everything well and the care is excellent, The staff consider the needs of the residents and make the relatives and visitors feel welcome, The staff are welcoming and always smiling and They look after us well and tend to all our needs. Care Homes for Older People Page 26 of 32 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. Peoples needs and best interests are central to the management approach in the home. Good accounting methods are followed when handling peoples money so they can be sure that their finances will managed correctly. The home continues to improve its quality assurance by introducing continuous monitoring of polices, procedures and practices in order to ensure that the home is run in the best interests of the people who use the service. Staff feel that they receive supervision and support that is appropriate to their roles and responsibilities in the home. The health and safety of people who use this service should be protected by systems in place. Care Homes for Older People Page 27 of 32 Evidence: We spent a lot of the day in the company of the registered manager who consistently demonstrated effective leadership skills within her role. Her passion, knowledge and enthusiasm of the home, the people living there and all staff was very evident. We received very positive comments about the manager from staff and visiting health and social care professionals including, The manager is so good with the people living in the home, The home is very well run and led by the matron, Matron is always approachable, Matron always has time to listen and, The manager is respected by everyone in the home. The manager told us, I think we communicate well, I have an open door system where residents, relatives and staff can come and see me. I try and make myself available to answer queries and worries and I always support my staff through any problems they may have. Many people we spoke with expressed very positive comments about their experiences of the home. Comments included, This is an outstanding home, I cannot recommend this home enough, It makes one feel that it is a pleasure to visit, I have worked here for 20 years and I think that speaks volumes and We are very lucky, the owners are always happy to spend money in order to improve the outcomes for people. The manager told us, We have very supportive and generous directors who will give our residents anything they want. If I feel a resident needs a new profile bed they will supply it within 24 hours. The home continues to monitor and assess the quality of services provided by giving people questionnaires to complete, any weaknesses identified are put into an action plan. Regular audits are carried out in the home including health and safety, care documentation, medication and other procedures in the home. The AQAA was very detailed and the service fully recognises the importance of it. The service has used the content to form part of their quality assurance. The policy and procedure for holding peoples personal money was looked at. We looked at the statements of four individual accounts and saw that good accounting methods are maintained and receipts for sundries were available. There is an annual appraisal process which ties in with the supervision arrangements. The manager has established a formal recording of any supervision for all staff. A plan is devised for discussion including people living in the home, work issues staff issues, personal development and training. The manager felt that staff find the sessions are Care Homes for Older People Page 28 of 32 Evidence: useful and confirmed that they received them on a regular basis. The home also encourages and supports practical supervisions in addition to the formal ones they receive. This has enabled staff to develop their skills on the floor. The home has written policies and procedures in relation to the promotion of the health and safety for all people who use the service and associated training was provided for staff in all health and safety matters. Some of the Health and Safety records in the home were examined. Documentation showed that relevant checks were maintained correctly and at the required intervals including all fire alarms, equipment and emergency lighting. The homes records showed all necessary service contracts were up to date including, gas and electrical services and the passenger lift. Care Homes for Older People Page 29 of 32 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 32 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 31 of 32 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 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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