Care Home: Parkview House

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What the care home does well The managers and staff are working hard to meet the needs of the residents, many of whom have a diagnosis of dementia, which is very much appreciated by residents and their families. One relative told us, "I chose Parkview after viewing many other homes - Parkview ticked all the boxes I was looking for. Mum has been here for almost 2 years and seems very contented". The home has effective policies and procedures, including regarding monitoring the quality of care the home offers, which staff and managers implement well. The home also provides a high quality physical environment that complements the care and support that residents receive. What has improved since the last inspection? At the last key inspection ten requirements were made and we were pleased to see that all of these had been complied with. The ten requirements were in the following areas: to ensure that information about the home was up to date for the benefit of people considering using the service; to make sure that care plans were current so that staff had the latest information on people`s needs and preferences; to update the home`s medication procedures for better protection for residents who may spend short periods away from the home; for further discussion with residents to make sure that staff are fully aware of their preferences regarding the times they wish to go to bed; to make sure that residents` cultural dietary preferences are catered for; to make sure that verbal complaints and concerns are properly documented; to make sure that cleaning equipment was properly stored to minimise infection control; to review staffing levels to make sure that residents needs can be properly met; for identified staff to receive training in the care of people with dementia and to make sure records regarding any money held for residents were accurate and matched the amount of money actually held. What the care home could do better: One requirement is made at this inspection. This is to make sure that identified "doorguards", devices for holding doors open and releasing them when the fire alarm sounds, are properly working, to maximise fire safety in the home. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Parkview House 208-212 Chingford Mount Road Chingford London E4 8JR     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Peter Illes     Date: 1 6 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Parkview House 208-212 Chingford Mount Road Chingford London E4 8JR 02085249234 02085593115 Parkviewhouse@tesco.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Carebase (Parkview) Ltd care home 53 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 who can be accommodated is: 53 The Registered Person may provide the following category of service only: Care home Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Care Base (Park View) Ltd. is registered to accommodate 53 older people. The home is situated in South Chingford, in the London Borough of Waltham Forest. Care is offered in four units, each comprising a combined lounge/dining area plus near-by bedrooms designated for each unit. In addition, there is a quiet room to entertain guests. Most of the bedrooms are single but four are doubles, each shared by two people. All Care Homes for Older People Page 4 of 31 Over 65 0 53 53 0 Brief description of the care home bedrooms have en-suite facilities of wash hand basin and lavatory with some also having a step-in shower. There are separate offices for the manager and administrator and a hairdressing room. Meals are prepared and cooked in the central kitchen by catering staff, then passed through a hatch to one unit and transported in heated trolleys to the other three units. Each unit has a small kitchen area for serving meals or preparing drinks and snacks. There are central laundry facilities. The home is on a main road has a good parking area and is near to public transport and shops. There are several attractive courtyard gardens accessible to service users that are well used in the good summer weather. A stated aim of the home is to maximising the abilities of our residents to retain self-care, for independent interaction with others, and for carrying out the tasks of daily living unaided. At the time of this inspection, the home is currently charging a weekly fee of £650 p.w. for a shared room and £800 p.w. for a single room. Information about the home, including the Commissions inspection reports are displayed and available from the home. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of this service took place on 24th July 2007. This key inspection took approximately 10 hours over 2 days, 14th and 16th July 2009, and was undertaken by the lead inspector. However, terms such as we, our and us are used where appropriate within this report to indicate that the inspection activity was undertaken on behalf of the Commission. The registered manager and care services manager were available to assist throughout this inspection and 53 residents were living in the home at the time with no vacancies. The inspection activity included: meeting and speaking to the majority of the residents and relatives who visited during the inspection; detailed discussion with the registered manager and care services manager; independent discussion with a range of care staff on each the homes four units; discussion with other staff including the administrator, Care Homes for Older People Page 6 of 31 activities coordinator and kitchen staff; independent discussion with a community nurse and an external staff training assessor who both visited the home during the inspection; independent discussion by telephone with a commissioning manager from L.B. of Waltham Forest. Further information was obtained from a tour of the building, documentation kept in the home and from survey forms sent to us by residents, relatives and staff. The home sent us an up to date Annual Quality Assurance Assessment (AQAA) when we asked for it. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has up to date information available to help people make a decision about moving into the home; prospective residents and their families also benefit from being able to visit the home to help decide if they like it. The needs of people are properly assessed by the home before they are admitted to assist staff to meet these needs when they are first admitted. Staff continue to reassess peoples needs once they are living in the home to enable them to respond effectively to changing needs. Evidence: At the last inspection a requirement was made that the homes statement of purpose must provide all the information specified in Government regulations that apply to care homes. We looked at the statement of purpose and the service user guide and were pleased to see that this requirement had been complied with. We noted that information available to residents and other people interested in the home was clear and up to date. Care Homes for Older People Page 10 of 31 Evidence: The homes annual quality assurance assessment, AQAA, states; We continue to promote our home via visits for all potential residents and their families. We try to make these visits as welcoming and informative as possible with sample lunches and opportunities to integrate with our staff and other residents etc. We ensure any questions are answered and that all family members are aware of our open door policy. We saw evidence, including in documentation kept in the home, that a proper introduction and assessment process is operated by the home. One relative informed us, I chose Parkview after viewing many other homes - Parkview ticked all the boxes I was looking for. We looked at the files for eight residents. these all showed evidence that they had been properly assessed when referred to the home and their needs and preferences at the time of admission had been clearly recorded. The files showed evidence of assessment information from the persons placing authority where relevant and of an in-house assessment on all the files inspected, the latter having been undertaken by either the registered manager or the care services manager. We saw evidence that once admitted to the home residents needs and preferences are regularly reviewed so that staff are aware of individuals changing needs. The home allocates a key worker to the person and also gathers information to contribute to a life history for the person so that staff have an understanding of what was important to the person during their life before they moved into the home. We were pleased to see that the home has recently introduced a more structured way of recording the work undertaken by key workers. This included a written record of each key worker session and a clear monthly summary. We were told that this allowed the information to be more accessible when reviewing peoples needs. Key workers spoken to were able to describe the work they undertook in that role and were clearly familiar with the needs and preferences of the people they were key worker for. The home does not provide intermediate care. Care Homes for Older People Page 11 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from their needs and preferences being properly recorded on their care plans to assist staff in meeting these. People are supported to have their health needs addressed including by accessing a range of healthcare professionals. Effective medication policies, and procedures for its proper administration, protect people living in the home. Staff are working hard to treat people with respect and dignity, which is appreciated. Evidence: At the last inspection a requirement was made that peoples care plans contain consistent and accurate information on the identified needs of the residents and ensure that these are being correctly met by the service. This was because at that time one of the risk assessments seen for one resident did not correspond with their care plan. Evidence was seen at this inspection that this requirement is being complied with. At this inspection we inspected eight peoples files, including their risk assessments and care plans. We found these to be up to date with evidence that current risk assessments properly informed peoples care plans. The care plans seen contained information on a range of individual needs and preferences. The needs Care Homes for Older People Page 12 of 31 Evidence: identified included those in relation to personal care, addressing health needs, communication and mobility. We also saw information on peoples likes and dislikes. These included peoples preferences regarding food, how they liked their personal care delivered, preferences about hairdressing and any routines on the unit that people were living on to help them feel valued e.g. one person with a diagnosis of dementia likes to help staff fold the laundry and tidy up on the unit. We also saw evidence that the files contained a range of up to date risk assessments that informed the persons care plans. These included risk assessments in relation to peoples skin care; nutrition; mobility, including moving and handling as well as a general risk assessment. We saw evidence that the resident and/ or where appropriate a relative had signed the persons care plan agreement form. We also saw evidence that care plans are reviewed and evaluated at least monthly and elements of the care plan amended and updated where a persons needs had changed in that area. Although this was satisfactory it was noted that the information recorded to evidence the review of the care plan was more detailed in some cases than others, e.g. a few care plans just recorded no changes each month while others gave more detail of how this conclusion was arrived at. This was discussed with the registered manager and care services manager in the feedback from the inspection. Evidence was seen that staff had received training, including from the L.B.of Waltham Forest, on the Mental Capacity Act and on the Deprivation of Liberty Safeguards, the latter is part of the Act but only came into force in April 2009. Staff were making good progress on starting to record the areas in which people had the capacity to give informed consent to in relation to their daily lives. As part of this development the home had obtained a checklist that made it easier to record the areas that people could and could not give informed consent for. We were told that these would be filled in for each resident over the coming year as part of the individuals review process. The homes annual quality assurance assessment, AQAA, states; We have always had strong and positive relationships with all health professionals that visit our home and we continue to uphold and develop these. We spoke to a community nurse who attended the home during this inspection. She was very positive about the home and its staff. She went on to tell us that it was one of the best homes she visited, that pressure care (relating to the care of people with vulnerable skin) was very good and that she had provided relevant training to staff as part of her contact with the home. We saw evidence that peoples overall health care was properly addressed. This included records on peoples files that they had access to their G.P, dental, optical and chiropody services as well as specialist health care at hospital. We also saw evidence that peoples weight and nutrition is regularly monitored and people have access to Care Homes for Older People Page 13 of 31 Evidence: specialist equipment where required such as ripple mattresses and cushions where they have fragile skin. The home has a satisfactory medication policy and procedures that were seen. At the last inspection a requirement was made that controlled medication must be stored in a separate controlled drugs cupboard and that the home must have a procedure for when residents take medication out of the home (for example when a resident goes to stay with relatives). This requirement was being complied with. We were told that none of the residents were currently being prescribed controlled medication although we saw that the home did have a separated controlled drugs cupboard and register to record administration of controlled drugs for when this was needed. We also saw that the home had developed a separate procedure to record when residents took medication outside of the home and a copy of this was seen in each of the eight residents files that we inspected. Medication and medication administration record (MAR) charts were inspected for five people and indicated that people were being properly protected in this area. The medication corresponded to that recorded on the MAR charts and the charts were up to date. We also noted that some people are prescribed PRN medication, which means to be administered as required. The records of PRN medication sampled showed proper guidance to staff on how to monitor this process, including the maximum number of doses that can be administered within a given period. Medication received into the home and medication disposed of was being properly recorded. The home has four double rooms and evidence was seen that these had appropriate screening to help maintain each occupants privacy and we were told that only people who choose to share are offered a place in a double room. Evidence was seen throughout the inspection that residents privacy and dignity are respected at all times, including when they are receiving personal or health care. One relative informed us, Excellent care - residents are always treated with respect and dignity. Staff are so friendly and approachable. I feel so lucky to have found such a wonderful home so near me and know that my mum is looked after so well. It was noted that there was a section on each persons file to record their End of Life wishes or preferences in the event of serious illness or death. These were sampled and showed the preferences of the person or, where appropriate, the wishes of their family. Care Homes for Older People Page 14 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a range of activities being available within the home and within the community to meet their needs and preferences. Families and visitors are made welcome at the home, which they and people living there appreciate. People are encouraged to exercise as much choice and control over their lives as they can to maximise their independence. People are also served good quality and appetising meals that they enjoy. Evidence: The homes annual quality assurance assessment, AQAA, states; We endeavour to create an environment that offers full social involvement and integration at Parkview. We are situated near a park and several shops and coffee houses which we make full use of. We also continue with all of our standard activities, (regular exercise classes, organised days out, joint entertainment events with other homes etc). The home employs an activities coordinator who works five hours a day, five days a week, and who was spoken to independently. We saw an activities programme that showed a range of activities organised both within the home and in the local community. We also saw a record on each persons file inspected of the activities the individual had actually taken part in. The activities coordinator told us that she Care Homes for Older People Page 15 of 31 Evidence: normally plans the range of activities to be undertaken although care staff are fully involved in supporting these and that care staff cooperative and helpful. We saw evidence that residents are offered a range of activities in the home that included: art and craft work, we saw paintings and items such as hand painted flower pots for plants on show around the home; indoor board games and bingo and outdoor activities in the gardens. We saw photos of a recent session where residents in wheelchairs used a paddling pool with bubble mixture in it to paddle their feet in the recent hot weather, which residents were clearly enjoying. The activities coordinator has also started a small allotment patch in one of the gardens that residents enjoy and has also instigated the purchase of a pet rabbit for the home that has a hutch in one of the gardens, which residents enjoy being involved with. A timetable of one off activities was also seen that included a group of residents visiting a local church for a strawberry tea and a concert, a funday for family and friends, which we were told raised £200 that was used to supplement funds for more activities and a programme of visiting entertainers to the home. Residents spoken to were generally complimentary about the activities the home provides although one more independent person told us that they did not like taking part in such activities, preferring to go out on their own. Evidence was seen that the person could do this independently. At the last inspection a requirement was made that residents are consulted on their preferred daily routines and this is documented in detail in their care plan. This was because at that time one resident told us that although in theory they could go to bed when they wanted to in practice they went to bed at about 8.30pm, as that was the routine for the majority of other residents. We spoke to some residents on each of the four units and they indicated that they could go to bed and get up at times that suited them. Care plans seen also evidenced that the requirement was being complied with, one persons night care plan stated, likes to stay up late and their daily notes evidenced this. The ethnic origin of the majority of residents at the time was White British although a small number were from a range of ethnic minority communities. Care plans seen recorded peoples needs and preferences regarding equality and diversity. This included the extent to which the person preferred to practice their religion, if any, dietary preferences and needs and preferences regarding their sexuality. The home participates in a link mass service on a Saturday where a service from a London church is broadcast on a loudspeaker via telephone, two Eucharistic ministers attend the home to provide communion for those people that wish to participate and a female minister attends the home to provide a service for people of any denomination. Evidence was also seen that the home is aware of the the needs of staff from different Care Homes for Older People Page 16 of 31 Evidence: religions. Notes of a recent staff meeting showed that Ramadan was discussed, including arrangements for how Muslim staff were to be supported during this time. Peoples cultural preferences regarding food are known and responded to with dishes such as savoury rice and curries being available for people that request them. Evidence was also seen that the home tries hard to sensitively meet peoples needs regarding their gender and sexuality. The registered manager showed us a newly developed equality and diversity folder that included information from the organisation Stonewall that gave helpful information on meeting the needs of gay men and lesbians. The registered manager and care service manager were able to give an example of how they had sensitively supported a gay man during a respite stay. The home welcomes relatives and visitors to the home and we had positive feedback from relatives and visitors spoken to and from surveys returned to us before the inspection. One relative spoken to during the inspection told us, staff are very good, they will phone you if there are any problems. The manager is very helpful and the care service manager and the administrator are very reassuring and friendly whenever I have contact with them. Another relative informed us on their survey form, When Ive been to Parkview Ive always had a nice welcome; they remember my name (Reception) vases of fresh flowers look nice and give a nice touch. The home operates a four week menu for meals and we saw that the menu offered a choice of healthy meals for residents to choose from. We were invited to have lunch with the residents on one of the days of the inspection and the choice was between roast lamb and a pork chop although a vegetarian option was available for those that wanted this. We chose the lamb which was well cooked and well served. Residents are able to ask for an alternative to the meals on the menu and we were told that in the recent hot weather a number of people chose a salad in preference to the meals on offer. Feedback from residents and relatives was generally positive about the meals offered although since the last inspection one resident had complained to the home, and to the Commission, that the vegetables served were often overcooked. This was formally investigated and responded to under the homes complaints procedure. At this inspection we spoke to the resident concerned who told us that the home was trying but sometimes the vegetables were still not to their liking. Our judgement from the records of the investigation into the complaint and talking to a number of staff, including the cook, is that the home is working hard to meet the individual preferences of residents regarding their food. The cook confirmed that the home could deal with special diets with some people suffering from diabetes and some people requiring their food to be liquidised. She also confirmed that the home could meet the requirements and preferences of people from different cultures and religions. At the last inspection a requirement was made that residents cultural dietary needs are catered for and our Care Homes for Older People Page 17 of 31 Evidence: judgement was that this was being complied with. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home, and their relatives, benefit from having any concerns or complaints that they raise being taken seriously and acted upon appropriately by the home. The home has clear policies and procedures for protecting people from abuse, which staff are aware of. Evidence: The homes annual quality assurance assessment, (AQAA), states; We strive to make our policies regarding complaints user friendly and clear so that everyone involved feels able to voice any fears/ worries/ opinions/ suggestions/ concerns that they may have at the time. We actively seek feedback and constructive criticism to ensure that we are aware of any issues or potential problems. At the last inspection a requirement was made that all complaints, regardless of source, must be thoroughly investigated and responded to appropriately. This was because although formal complaints were being responded to appropriately there was no detailed evidence available to show how minor verbal concerns had been dealt with. This requirement was being met by a separate record system for action taken to deal with minor verbal concerns. We also saw a comments/ suggestion book in the lobby that relatives and visitors were regularly using with nearly all the entries being complimentary about the service. A satisfactory and easy to read complaints procedure is displayed around the home Care Homes for Older People Page 19 of 31 Evidence: and all the records seen regarding how the home deals with complaints and concerns were satisfactory as were comments received from residents, relatives and staff. The registered manager told us that she operates an open door policy for all and a notice in the homes lobby reinforces this. Feedback from questionnaires stated that people were aware of how to raise any concern or complaint. One relative commented that (the home) were very helpful when a minor query was raised and one resident told us, I feel happy and secure, the two most important factors. We saw the homes policy and procedures on how to deal with safeguarding (adult abuse) allegations and disclosures, which were clear and robust. The home also had a copy of the L.B. of Waltham Forests safeguarding procedures and the relevant forms for informing that authority of any safeguarding issue. Staff receive training in safeguarding issues and staff spoken to were aware of how to respond should an allegation or disclosure of abuse be made to them. Two safeguarding concerns had been dealt with under L.B. of Waltham Forests safeguarding adults policy since the last inspection and both were judged to be unsubstantiated as far as actions taken by the home were concerned. The Commission had been properly informed of these concerns as is required under Government regulations that care homes must comply with. There had been no other disclosures or allegations of abuse made to the home or to the Commission since the last key inspection. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a spacious, purpose built home that is well equipped, well decorated, well furnished, well maintained and provides a high quality environment that meets their needs. The home was clean and tidy throughout creating a pleasant experience for all that are using it. Evidence: The home is purpose built and provides accommodation in four units on two floors, connected by lifts and stairs. The four units are: Ching; this unit has six single rooms and three double rooms; Nelson; this unit has twelve single rooms; Park; this unit has fourteen single rooms and Larkswood; this unit has thirteen single and one double room. All bedrooms have en-suite facilities and in addition there are another five adapted bathrooms and an adapted shower room spread throughout the building. Each of the four units have a lounge/ dining room and kitchenette area. In addition the home has a pleasant entrance/ lobby area, office accommodation, main kitchen, laundry facilities and a multi-purpose room thats use includes for meetings and training. There are three separate and very attractive garden areas to the side and rear of the home and car parking at the front of the home. The homes annual quality assurance assessment,(AQAA), states; The environment is a fundamental part of the daily care we provide, so we put a lot of time and effort in maintaining the friendly, welcoming, safe and happy atmosphere that we pride Care Homes for Older People Page 21 of 31 Evidence: ourselves on. On a tour of the building we were impressed by the lay out of the building, which is spacious and meets peoples needs, and by the high standard of the decoration, furniture and equipment throughout. A number of bedrooms were seen and these were decorated to a high standard and had been personalised by the people living in them with photographs, ornaments and other possessions that are important to them. Comments from residents and relatives included, Very homely atmosphere - clean and never any unpleasant smells; and, The rooms are clean and attractive, nice that residents have cups and saucers and soft drinks in glasses, also a variety of fresh biscuits. The other communal areas were also well decorated and equipped, we were told that all the carpets were in the process of being replaced. We also noted that the home had introduced familiar objects of interest in some the units communal areas for the use of people with dementia. An example of this was a set of coat hooks that held a range of bags that residents were seen to take interest in, hold and use with an observed appearance of well-being. We saw the adapted bath and shower rooms that were well equipped. At the last inspection a requirement had been made that the environment must not pose a risk to health and safety as some bathrooms were being used to store wheel chairs and mops were being stored in the shower room. This requirement was being complied with and the bath and shower rooms were not being used for inappropriate storage. We were impressed with the work that had been undertaken to make the garden areas attractive and accessible to residents. This included a pleasant pagoda, that residents and visitors enjoy sitting in, the allotment area that residents enjoy participating in and the pet rabbit hutch that some residents were particularly interested in. The home currently has two laundry areas that meet residents needs although new laundry equipment is on order. We were told that when this arrives a more effective single laundry area will be created, which will be more efficient and will release further space to use as storage. The building was clean, tidy and free from unpleasant smells throughout the inspection. Care Homes for Older People Page 22 of 31 Evidence: Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported by staff team in sufficient numbers to meet their needs and who have a range of competencies. Staff have access to a wide range of training opportunities to help them support and care for people properly. The homes recruitment policies and procedures also help protect people living there. Evidence: At the time of this inspection care staff were deployed in the four units as follows: Ching Unit- 3 care staff morning shift, 2 care staff afternoon shift and 1 waking night staff; Nelson Unit- 2 care staff morning and afternoon and 1 waking night staff; Park Unit- 2 care staff morning and afternoon and 1 waking night staff; and Larkswood Unit- 3 care staff morning, 2 care staff afternoon and 1 waking night staff. The registered manager and the care services manager are in addition to the rota and the home also employs a range of other support staff including the activity coordinator, the administrator and ancillary staff such as cooks, kitchen assistants, domestic staff and a handyperson. At the last inspection a requirement was made that the service reviews staffing levels to make sure there are enough staff on duty to meet the needs of the residents. This requirement had been complied with. The staff rotas were seen and after spending time on each of the four units our judgement was that the current staffing ratio was satisfactory to meet the needs of the current residents. Care Homes for Older People Page 24 of 31 Evidence: The homes annual quality assurance assessment, AQAA, stated that of the 30 care staff employed by the home at the time 21 had achieved the national vocational qualification (NVQ) level two in care or above and 6 more were working toward this. This was confirmed by the registered manager and evidence to support this was gathered from individual care staff spoken to independently and from a NVQ assessor who visited the home during the inspection and was also spoken to independently. The NVQ assessor also told us that she had 4 weekly monitoring reviews with the registered manager, that in her judgement the mandatory training that staff received in the home was of good quality and that the policies and procedures that staff operated in the home, e.g. safeguarding adults and RIDDOR (Reporting of Injuries, Diseases and Dangerous Occurrences), were up to date. We inspected the files of three new members of staff that had been recruited in the six months leading up to this inspection, these showed that the home operated a robust recruitment procedure to help protect residents. Documentation seen on the files inspected included: proof of identity, including a recent photograph; a clear application form; two written references including a last employer reference, with evidence that they had been verified; an enhanced criminal records bureau (CRB) clearance and protection of vulnerable adults (POVA) check, that had been obtained by the home before the person had commenced work and a contract of employment. A staff training matrix was seen to evidence that staff training is kept up to date. This showed that staff undertake regular training, including in the following areas: caring for people with dementia, safeguarding adults, health and safety, moving and handling. safe administration of medication. food hygiene, care planning, infection control and fire safety awareness. Staff spoken to stated that the training was useful to them in undertaking their duties. At the last inspection a requirement was made that the activity coordinator undertook training in supporting people with dementia. At this inspection a new activities coordinator was in post and evidence seen that she had undertaken this training. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from the service being very well managed. People accommodated and other stakeholders are consulted in a range of innovative ways to promote and monitor the quality of the service they receive. Peoples financial interests are safeguarded while living in the home. Staff supervision is provided to support staff meet the needs of people accommodated and to assist in their own development. A range of effective health and safety procedures protect people living in the home although further attention is needed to maximise fire protection, although this is in the process of being actioned. Evidence: The registered manager is experienced and competent, she has completed her registered managers award and a national vocational qualification in management, level 4. In addition she has completed a recognised diploma in dementia since the last inspection. Feedback from residents, relatives and staff was very positive about her personally and about her management style. One relative told us, The managers door is always open. A staff member informed us, Management always take into Care Homes for Older People Page 26 of 31 Evidence: account ideas to improve the service. Since the last inspection the previous deputy manager has left the home. This post has been converted to a care services manager whose main role is to focus on the care and support residents receive as well as to deputise for the registered manager when required. The care service manager is also competent, experienced and is in the process of completing a diploma in dementia. Both managers are also supported by a competent administrator who operates robust and effective administrative systems, which the home benefits from. Feedback about the administrator was also positive with a number of people telling us how friendly and reassuring she was, especially when they visited or had contact by telephone with the home. The registered manager and care service manager told us that they had spent significant time over the past year in reviewing and improving the homes quality assurance systems. This has included introducing a system where each week one or both of them take two or three residents out into the local community, e.g. to the local shops or park, as a means of having individual time to talk to them outside of the home as part of their quality monitoring. They also telephone two or three relatives a week to ask them their views on the home. Records to evidence both of these activities were seen. In addition the home sends regular quality assurance surveys to residents and stakeholder and acts on the results of these, including by having a monthly action plan with specific objectives each month; holds a three monthly residents committee meeting and have regular monthly monitoring visits by the provider organisation. The L.B.of Waltham Forest has placed a number of people in the home and we spoke to a commissioning manager from that Borough. He told us that the L.B. of Waltham Forest had no concerns about the home and was satisfied with the service purchased. At the last inspection a requirement was made that all recordings of expenditure are correct and in line with the the amount of money in safekeeping for residents. This was because there was a slight discrepancy between the amount of money held for one resident and the corresponding record at that time. At this inspection we sampled both money held on behalf of residents and the corresponding records and found these to be accurate and up to date. We saw evidence that staff receive regular supervision and have 6 monthly appraisals, staff spoken to stated that these were helpful and useful. Evidence was seen, including through the homes annual quality assurance assessment and spot checks during the inspection, that satisfactory health and safety Care Homes for Older People Page 27 of 31 Evidence: checks are regularly carried out in the home by people competent to do so. These included the electrical installation, gas supply, hoists and fire safety/ protection equipment. We were pleased to note that immediately prior to this inspection the home had completed fitting doorguards to all the residents bedroom doors to further help keep residents safe from fire when their bedroom door is open. These are devices that hold the door open but release it when the fire alarm sounds. However, a few of these still needed adjustment as they did not always allow the door to properly close when released. A requirement is made regarding this. However, we were pleased to see when we returned on the second day of the inspection that these adjustments were almost complete and the the registered manager told us the work would be fully completed within the next few days. No other health and safety hazards were identified during the inspection. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 38 23 The registered persons must 14/08/2009 make adequate arrangements for detecting containing and extinguishing fires. This must include doorguards working properly so that the door they hold open closes and stays closed when the fire alarm is activated. This requirement is made to maximise fire safety to residents and other people that use the building. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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