Care Home: Popham Court

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What the care home does well Popham Court provides people with a homely and well maintained environment. Popham Court consists of two buildings within the same grounds; Popham House provides care to people who require general nursing care and The Court provides personal care only. Appropriately qualified registered nurses are on duty 24hrs a day at Popham House. People benefit from a very stable and appropriately qualified management team who promote an open and inclusive style of management. People have the opportunity to `test drive` the home through day care and respite facilities along with introductory visits and a trial period. The home have produced detailed information about the home and services offered and we were informed that this is also available in braille and audio format. The home ensure that people who are thinking about using the service are appropriately assessed before a placement is offered. This is to ensure that the home is able to meet peoples` assessed needs, preferences and aspirations. Each person using the service has a care plan which clearly sets out their assessed needs. Information for staff ensures that care is delivered in a consistent manner. Care plans include information about peoples` preferences and this helps to ensure a person centred approach to care is delivered. People are supported to be involved in the care planning and review process. The home have established very good links with health care professionals and care plans contained evidence that people had access to a range of visiting health care professionals. Safe procedures are followed for the management and administration of peoples` medication. End of life care plans are implemented to ensure that peoples` needs and wishes are respected and met. Staff have been trained in the `Liverpool care pathways` which is a continuous quality improvement framework for the care and support of the dying and their relatives. We were provided with a recent example where the individual`s wishes during their final days and following death had been fully respected. We were also informed that the person`s relatives had been able to stay with their relative at the home. We were informed that the home received excellent support from palliative care nurses and that additional staff are always put in place to support people during their final days. The home supports and encourages people to make choices about their day. Social history`s and individuals` preferences assist staff to provide a person centred approach to care. The home employs designated activities staff and an activity programme is displayed in each house which identifies a range of activities such as bingo, quizzes, one to one time and crafts. Regular hairdressing and religious services are also provided. People spoken with told us that there was `always something going on`. People benefit from a wholesome and varied menu. Special diets are catered for and people are consulted about their likes and dislikes.People know how to make a complainant and we were able to see that the home takes all concerns seriously. Appropriate procedures are in place to ensure that people are protected from the risk of harm or abuse. Staff training is promoted and people benefit from a very well trained workforce. No concerns were raised with us regarding current staffing levels at the home. Staff indicated that staffing levels were `safe` and people using the service told us that their needs were met by the home. Appropriate procedures are in place to ensure the health and safety of persons at the home. What has improved since the last inspection? There were no statutory requirements raised at the last inspection. What the care home could do better: This was a positive inspection and no statutory requirements were raised. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Popham Court Courtland Road Wellington Somerset TA21 8NE     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: kathy McCluskey     Date: 1 5 0 4 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 32 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 32 Information about the care home Name of care home: Address: Popham Court Courtland Road Wellington Somerset TA21 8NE 01823662513 01823669216 hazel.jones@somersetcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Somerset Care Limited care home 74 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: May accommodate up to 74 persons aged 65 years and over (OP), and within the registered numbers 32 persons over the age of 60 years requiring nursing care can be accommodate. Date of last inspection Brief description of the care home Popham Court is registered with the Commission to provide General Nursing care to 32 service users over the age of 60 years and personal care to 42 service users over the age of 65 years. Somerset Care Ltd owns the home and the Registered Manager is Hazel Jones. Social services currently have a block contract for 21 nursing beds and 18 personal care beds. Three nursing beds are interim (Nursing Block Contract) allocated for delayed discharges from acute beds and managed by the Adult Social Work team at Care Homes for Older People Page 4 of 32 Over 65 74 0 Brief description of the care home the local hospital. One bed is a respite nursing bed funded by social services. Included in the personal care beds is a step up, step down reablement bed and a respite/short break bed. The home is situated in a convenient location just a short distance from Wellington town centre where there are a range of shops, banks and other facilities. Adjacent to the home is a Community Park. Popham Court benefits from award winning, large and beautifully maintained gardens, which are easily accessible to wheelchair users. A range of garden furniture is available to service users. All areas of the home have been suitably adapted for wheelchair users/mobility difficulties. The homes current fee range is between £520 to £715 per week. Additional charges include: chiropody, hairdressing, magazines/newspapers, personal toiletries/items and a small contribution to outings. 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 unannounced key inspection was conducted over one day (8.5hrs) by regulation inspector Kathy McCluskey. The registered manager and deputy managers were available throughout the inspection. We were given unrestricted access to all parts of the home and all records required for this inspection were made available to us. We were able to meet with the majority of people using the service, staff on duty and a number of visitors to the home. At the time of this inspection 28 people were receiving nursing care and 28 people were receiving personal care only. The home completed its Annual Quality Assurance Assessment (AQAA) and returned it to the Commission within agreed timescales. The AQAA is a self assessment which focuses on how well outcomes are being met for people. It also gives us some Care Homes for Older People Page 6 of 32 numerical information about the service. Extracts from the AQAA have been included in this report as appropriate. The term we used throughout this report refers to we the Commission. We would like to thank all those involved, for their time and cooperation with the inspection process. The following is a summary of the inspection findings and should be read in conduction with the whole of the report. What the care home does well: Popham Court provides people with a homely and well maintained environment. Popham Court consists of two buildings within the same grounds; Popham House provides care to people who require general nursing care and The Court provides personal care only. Appropriately qualified registered nurses are on duty 24hrs a day at Popham House. People benefit from a very stable and appropriately qualified management team who promote an open and inclusive style of management. People have the opportunity to test drive the home through day care and respite facilities along with introductory visits and a trial period. The home have produced detailed information about the home and services offered and we were informed that this is also available in braille and audio format. The home ensure that people who are thinking about using the service are appropriately assessed before a placement is offered. This is to ensure that the home is able to meet peoples assessed needs, preferences and aspirations. Each person using the service has a care plan which clearly sets out their assessed needs. Information for staff ensures that care is delivered in a consistent manner. Care plans include information about peoples preferences and this helps to ensure a person centred approach to care is delivered. People are supported to be involved in the care planning and review process. The home have established very good links with health care professionals and care plans contained evidence that people had access to a range of visiting health care professionals. Safe procedures are followed for the management and administration of peoples medication. End of life care plans are implemented to ensure that peoples needs and wishes are respected and met. Staff have been trained in the Liverpool care pathways which is a continuous quality improvement framework for the care and support of the dying and their relatives. We were provided with a recent example where the individuals wishes during their final days and following death had been fully respected. We were also informed that the persons relatives had been able to stay with their relative at the home. We were informed that the home received excellent support from palliative care nurses and that additional staff are always put in place to support people during their final days. The home supports and encourages people to make choices about their day. Social historys and individuals preferences assist staff to provide a person centred approach to care. The home employs designated activities staff and an activity programme is displayed in each house which identifies a range of activities such as bingo, quizzes, one to one time and crafts. Regular hairdressing and religious services are also provided. People spoken with told us that there was always something going on. People benefit from a wholesome and varied menu. Special diets are catered for and people are consulted about their likes and dislikes. Care Homes for Older People Page 8 of 32 People know how to make a complainant and we were able to see that the home takes all concerns seriously. Appropriate procedures are in place to ensure that people are protected from the risk of harm or abuse. Staff training is promoted and people benefit from a very well trained workforce. No concerns were raised with us regarding current staffing levels at the home. Staff indicated that staffing levels were safe and people using the service told us that their needs were met by the home. Appropriate procedures are in place to ensure the health and safety of persons at the home. 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 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensure that people are provided with a range of information which ensures that they are able to make an informed decision about using the service. People are appropriately assessed by the home before a placement is offered so that all parties can be sure that an individuals needs and aspirations can be met. People are given the opportunity to test drive the service so they can be sure that the home is suitable for them. The home have procedures in place to ensure that staff have the skills and training needed to meet peoples assessed needs. Evidence: The home has a Statement of Purpose and Service User Guide which detail information about the home, staff and services offered. Both documents were Care Homes for Older People Page 11 of 32 Evidence: displayed in the reception areas of the home. The homes completed AQAA told us that the service user guide is also available in braille, on CD and audio. We were informed that the Statement of Purpose had been updated to reflect the recent changes in the management structure. In the care plans examined we were able to see evidence that people are appropriately assessed by the home before a placement is offered. The pre-admission assessment covers all aspects of an individuals needs, abilities, aspirations and preferences. The homes completed AQAA states that in the last twelve months, the pre-admission assessment has been updated to include aspects of the Mental Capacity Act. The home also liaise with other health care professionals as appropriate and copies of any assessments are obtained. The homes completed AQAA states that people who are thinking about using the service and their representatives, are encouraged to visit the home before making a decision. People are encouraged to stay for lunch and a trial period is offered, A choice of room is offered where available and administrative staff and managers are well informed, helpful and welcoming. We were able to meet with some people who had recently moved to the home. We were informed by their relatives that they had received sufficient information about the home to enable them to make an informed decision about moving there. We were also able to meet with people who were currently using the homes respite facility. A step up, step down bed is available in the residential side of the home (The Court). We were informed that this was well utilised by the local authority for those who require rehabilitation. The purpose of this bed is to reduce unnecessary admissions or prolonged stays in hospital or residential care (step up) and to facilitate early discharge from hospital for those who are clinically ready to transfer but are needing a further period of rehabilitation (step down). People using this bed will have received a multi-disciplinary assessment which will clearly identify their individual care needs. The home ensure that agreed outcomes are achieved. The usual placement is six weeks. People using the service are issued with a contract which clearly identifies the terms and conditions of residence. Local Authority financial agreements are in place where applicable. Somerset Care promote and support training and development programmes for all staff to ensure that staff have the skills needed to meet the needs of people using the service. During this inspection we were able to speak to a number of staff and all were Care Homes for Older People Page 12 of 32 Evidence: very positive about the training and support they received. We also spoke with many people using the service. All commented on the kindness of staff and all told us they felt well cared for. Care Homes for Older People Page 13 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. The homes care planning procedures ensure a consistent and person centred approach to care. People have access to a range of appropriate health care professionals to ensure that their health care needs are met. The home follows safe procedures for the management and administration of peoples medication. End of life care at the home is very good and people can feel confident that their wishes will be respected. Evidence: The home are using the companys computerised care planning programme. Staff spoken with were positive about this and confirmed that care plans contained up to date information about peoples assessed needs and preferences. We found care plans to contain a range of appropriate assessments which included moving and handling, Care Homes for Older People Page 14 of 32 Evidence: reducing the risk of pressure sores and falls, nutrition, and assessments for the use of bed rails. We were able to see evidence that care plans had been raised to address all assessed needs. Care plans contained detailed information for staff as to how an individuals assessed needs should be met. Care plans also contained very good information about peoples abilities and preferences. This practise ensures a consistent approach to care and that peoples preferences are respected. It was positive to note that life historys had been obtained for people where ever possible. During this inspection we spoke with a number of people using the service. No concerns were raised with us and people told us that their needs were met. The staff are wonderful and kind, Yes, they know what I like and they help me, I think the care here is very good and I wouldnt want to be anywhere else. Two relatives spoken with confirmed that they were very satisfied with the care their relative received. They also confirmed that they were kept well informed by the home. Care plans contained evidence of monthly reviews and that the person using the service or their representative had been involved in the care planning process. Daily entries are made by staff for every person using the service, at the end of each shift. These records contained clear information about each individual. Staff told us that they experienced no problems in meeting the needs of people currently using the service. They told us that staffing levels were sufficient to allow quality time with people as well as attending to their needs. Records are maintained relating to each persons contact with heath care professionals. Care plans examined confirmed that people had access to a range of appropriate health care professionals. We were informed that the home received very good support from local GPs, district nurses and specialist health care professionals. The Commission did not receive any completed comment cards from health care professionals. We examined care plans relating to two people at the home who were being treated for pressure sores. Appropriate wound management plans were in place and entries made by staff confirmed a consistent approach to care. One care plan contained evidence that further advice and support had been requested from a district nurse and tissue viability nurse following concerns about the progress of the wound. The home monitors peoples weights on a monthly basis. Nutritional care plans had been raised where concerns had been identified. We were able to see that nutritional supplements and thickeners were in place and administered appropriately by staff. We observed this throughout the day, including meal times and when drinks were offered. Care Homes for Older People Page 15 of 32 Evidence: We also observed staff assisting people in a relaxed and dignified manner. We examined the homes procedures for the management and administration of peoples medication both in both buildings (nursing and residential). The home uses the monitored dosage system (MDS) with pre-printed medication administration records (MAR). MAR charts examined were found to be fully and appropriately completed. These also contained a photograph of each person and clear information about any allergies. Signed letters were available from GPs confirming the use of a range of homely remedies where required. Medicines were seen to be securely stored and no excess stocks were apparent. On the nursing side, medicines are only administered by the registered nurses on duty. On the residential side, medicines are administered by senior staff who have been appropriately trained. The home have robust procedures in place for the management of controlled drugs. Medicines are appropriately stored and clear records are maintained. Medicines are checked at the end of each shift with additional records maintained. The homes completed AQAA told us that as part of the risk assessment process, people are supported to manage their own medicines where appropriate. The home has up to date procedures in place for the management and administration of medication. The homes completed AQAA told us that these were last reviewed in December 2008. Where ever possible, the home supports people to remain at the home during their final days. End of life care plans are implemented to ensure that peoples needs and wishes are respected and met. Staff have been trained in the Liverpool care pathways which is a continuous quality improvement framework for the care and support of the dying and their relatives. We were provided with a recent example where the individuals wishes during their final days and following death had been fully respected. We were also informed that the persons relatives had been able to stay with their relative at the home. We were informed that the home received excellent support from palliative care nurses and that additional staff are always put in place to support people during their final days. Care Homes for Older People Page 16 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to designated activity staff and this provision has improved for people receiving nursing care. The home promotes links with the local community and supports people to maintain contact with family and friends. The home has procedures in place to ensure that peoples dietary/nutritional needs are met. Evidence: We were informed that designated activity staff are employed to cover three to five days a week on the nursing side with an additional activities person covering 5 days a week to the residential side. As recommended at the last inspection, activity hours on the nursing side have increased. An activity programme is displayed in each house which identifies a range of activities such as bingo, quizzes, one to one time and crafts. Regular hairdressing and religious services are also provided. Care plans contain information about peoples social history and any past hobbies/interests. The home is very active in maintaining links with the local community. People and their families recently enjoyed an easter fare and plans are already underway for the Care Homes for Older People Page 17 of 32 Evidence: homes fete in May which will be opened by a celebrity. We asked people about the activities at the home. The general consensus was that there is plenty going on if you want to join in. Staff told us that they endeavour to spend one to one time with those people too poorly to join in with activities. A trolley shop is available to people and the home have a wheelchair accessible mini bus. As previously mentioned, the home obtain information about peoples preferences which is recorded in their plan of care. This helps to ensure that people are supported to make choices about their lives. Those people who were able to mobilise independently told us that they choose how and where to spend their day. A number of people were observed moving freely about the home. Many people receiving nursing care are more dependant on staff. People who were able, told us that staff respected their wishes and would assist them to their bedroom when they requested. We observed staff asking people after lunch, where they would like to sit or whether they wanted to go to their rooms. On the nursing side we noted that a high number of people remained in a wheelchair during the morning of the inspection, (pressure relieving cushions were in situ). When we discussed this with the management team, we were informed that due to current building works to improve communal areas for people, the number of arm chairs in use were reduced. We were informed that people are monitored and that this was a short term measure. The home welcomes visitors at any reasonable time in line with the preferences of the individual. People can choose where to see their visitors and can use the privacy of their own bedrooms if they wish. Visitors spoken with during this inspection told us that they were always made to feel welcome and were offered refreshments. Meals are prepared and cooked by the homes catering staff. We were informed that catering staff cover a 7 day period. During this inspection we were able to see lunch and tea being served. Meals appeared wholesome and appetising and soft diets had been attractively presented. Hot and cold drinks were available. Tables were attractively laid and condiments were available. The atmosphere in both dining rooms was relaxed. Staff were observed assisting people as required, in an unhurried and dignified manner. Comments from people using the service about the food were generally good. People confirmed that they had choices and that staff were aware of their preferences. People said; there is always plenty to eat, you never go hungry here. Care plans examined contained information about peoples dietary preferences and of any special dietary requirements. Care plans also detailed the level of assistance that people required. The Homes AQAA told us that catering staff have all attended training on nutrition for Care Homes for Older People Page 18 of 32 Evidence: the elderly. It also told us that the home have been awarded a three star Good rating by the environmental health department for their food hygiene standards. 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. The home has an effective complaints procedure in place which ensures that concerns are responded to and acted upon. Procedures are in place which reduce the risk of harm or abuse to the peoples living there. Evidence: The home has a complaints procedure titled Seeking your views. This is displayed within the reception areas in the home and is also available in the homes statement of purpose. No concerns were raised with us during this inspection and people spoken with told us that they would feel confident in raising concerns if they had any. This was also confirmed by visitors spoken with at the inspection. The home have investigated recent complaints which had been raised directly with the Commission, relating to standards of cleanliness in the home providing residential care. We were able to see that concerns had been fully investigated by the companys area manager. During this inspection the standards of cleanliness in both parts of the home were noted to be good. The home has a range of up to date policies and procedures in place to ensure that people are protected from the risk of harm or abuse. Staff spoken with were clear on action to be taken should they suspect any form of abuse. Care Homes for Older People Page 20 of 32 Evidence: The home also have a copy of Somersets policy on safeguarding adults. Staff receive appropriate training on induction and through regular updates. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable environment and a programme of routine maintenance and refurbishment is in place. People have their own bedrooms which they can personalise. Appropriate procedures are in place to reduce the risk of the spread of infection. Evidence: Popham Court provides nursing and personal care for up to 74 older people. The home consists of two separate buildings within the same grounds. Popham House provides general nursing care and The Court provides personal care only. The home employs maintenance staff and a rolling programme of routine maintenance and refurbishment is ongoing. The Court has a good range of communal space. Popham House is more limited but work is currently underway to improve this. An existing conservatory has been removed and will be replaced by a more spacious one. Pleasant and spacious gardens surround both houses and the homes completed AQAA told us that the gardens at The Court continue to win Somerset Care Ltd and Wellington in bloom awards. Care Homes for Older People Page 22 of 32 Evidence: Appropriate aids and adaptations are available throughout the home. A nurse call system is installed and ramps and grab rails are appropriately sited. Shaft lifts give access to the first floors. The home have a good supply of hoist and other equipment to assist people with their moving and handling needs. Adjustable and profiling beds are in place for those receiving nursing care. During this inspection we sampled some bedrooms and viewed all communal areas. We found all areas to be clean and free from malodours. It was apparent that people were able to personalise their bedrooms. People spoken with at this inspection told us that they were happy with their rooms. Some bedrooms at Popham House appear quite small though no concerns were raised with us during this inspection. Storage space at Popham House remains limited meaning that some areas can appear cluttered. This has also been acknowledged by the home in their completed AQAA. The home has appropriate procedures in place to reduce the risk of the spread of infection. Staff hand washing facilities are appropriately sited and staff have access to a good supply of protective clothing. Care Homes for Older People Page 23 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 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 met by adequate numbers of staff and people can be confident that their needs will be met by staff who are appropriately skilled and qualified. The homes procedures for staff recruitment reduce the risk of harm or abuse to the people living there. Staff are encouraged and supported to maintain and develop their skills and knowledge Evidence: At the time of this inspection, 28 people were receiving nursing care at Popham House with a further 28 people receiving personal care only at The Court. We were informed that staffing levels were currently as follows; POPHAM HOUSE; Morning - 2 registered general nurses and 6 care staff Afternoon - 2 registered general nurses and 4 care staff Evening - 1 registered general nurses and 6 care staff Night - 1 registered general nurse and 2 care staff. THE COURT Morning - 4 carers Afternoon/evening - 3 carers Night - 2 carers The home ensures that senior staff are on duty at all times. The registered manager is based at Popham House though covers both homes. The Care Homes for Older People Page 24 of 32 Evidence: registered managers hours are in addition those shown above. A deputy manager is based at both Popham House and the Court. At the last inspection it was recommended that the home reviews care staffing numbers at night at Popham House. Although no concerns were raised with us during this inspection, the home should continue to keep this under review to ensure that care staffing levels remain appropriate to the dependency levels of people using the service. In addition to care staff, the home employs catering, laundry, domestic and maintenance staff. During this inspection we were able to speak with a number of staff and no concerns were raised about current staffing levels. Staff spoken with confirmed that staffing levels were safe. People get very good care and we are able to meet peoples needs. People using the service did not raise any concerns about the homes ability to meet their needs; I feel very well cared for and the staff are very kind, I feel safe here and the staff are very attentive. We spoke with three visitors and all were satisfied with the care that their friend/relative received. Somerset Care Ltd and the home remain committed to ensuring that all staff have the skills and training needed to enable them to meet the assessed needs of people using the service. Staff spoken with were very positive about training opportunities available to them. The homes completed AQAA told us that of the 73 permanent care workers, 53 have achieved a minimum of an NVQ 2 in care. This equates to 73 which exceeds the 50 of the National Minimum Standards. The AQAA also told us that all newly appointed staff are enrolled on this award. The home follows appropriate procedures for staff recruitment. We examined four files for staff most recently employed by the home. Files contained all required information and we were able to see evidence that staff do not commence employment until receipt of two satisfactory references and checks against the Criminal Records Bureau (CRB) and protection of vulnerable adults register (POVA). We did note that two people had commenced employment on a POVAFirst, pending a full CRB. Although arrangements are in place to ensure that the employee does not work unsupervised, it has been recommended that the home documents a risk assessment with the employee which identifies the restrictions imposed on the individual during this period and the arrangements that will be put in place to ensure that the employee does not work unsupervised. The risk assessment should be signed by the employee and the home. Care Homes for Older People Page 25 of 32 Evidence: Newly appointed staff follow an induction programme which follows the recommended Skills for Care Common Induction Standards. 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 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 stable and appropriately qualified management team who promote an open and inclusive style of management. The home has systems in place to ensure the quality of the service delivered is regularly reviewed and monitored. Systems are in place to ensure that staff are appropriately supervised. The home has procedures in place to ensure the health and safety of persons at the home. Evidence: The registered manager Hazel Jones has been a registered nurse for 27 years and has worked in health and social care for over 35 years. Ms Jones continues to keep her clinical skills updated and she is the end of life care lead for Somerset Care Ltd. She has also completed an appropriate management qualification. Care Homes for Older People Page 27 of 32 Evidence: The registered manager is supported by two deputy managers, one who is based at Popham House and the other at The Court. Staff spoken with were very positive about the support they received from the registered manager and both deputys. People using the service and visitors spoken with told us that they found the management team approachable and helpful. The completed AQAA stated; Popham Court management and administration is ethical, professional and accountable, Managers have an open door policy and concerns and suggestions are acted upon and contributions are valued. An area manager from Somerset Care Ltd supports the management of the home and monitors the quality of the service delivered. Reports are completed on a monthly basis. Procedures are in place to enable staff, people using the service and other stakeholders to express their views as to the quality of the service delivered. Regular meetings are held for all staff and quarterly meetings are held for people using the service and their representatives. Quality questionnaires are sent out out to people using the service and their representatives on an annual basis. We were able to see a selection of questionnaires completed in January this year and responses were noted to be positive. Systems are in place to ensure that all staff are appropriately supervised. Staff receive formal supervision at least six times a year and appropriate records are maintained. Staff spoken with were positive about the support they received and they told us that they were encouraged to express any training needs or preferences. The home has appropriate procedures in place for the management of peoples money. At the request of an individual, the home will assist people to manage small amounts of money. Records of transactions and receipts are maintained and monies are securely stored. We toured the premises and examined records and were able to see that appropriate procedures were in place to ensure the health and safety of persons at the home. Systems and equipment are regularly serviced. Appropriate fire safety procedures are in place. Staff have received mandatory training and in house health and safety checks are carried out. To ensure the safety of people using the service, upstairs windows have restricted openings and free standing wardrobes are secured to the wall. Hot water outlets are fitted with thermostatic controls so that temperatures do not exceed HSE safe upper limits. The home conducts monthly checks on outlets to Care Homes for Older People Page 28 of 32 Evidence: ensure temperatures remain within safe upper limits. The home maintains appropriate records relating to all accidents in the home. At the last inspection it was recommended that systems are introduced to audit accidents on a monthly basis so that any traits can be identified and action taken to reduce the risk of recurrence. This recommendation remains in place at this inspection. The home continues to inform the Commission of all significant events at the home. 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 1 27 The home should continue to keep night care staff levels under review to ensure that they remain appropriate to the dependency levels of people receiving nursing care. The home should ensure that systems for analysing accidents clearly identify and traits and any action to reduce the risk of recurrence. This was also recommended at the last inspection. 2 38 Care Homes for Older People Page 31 of 32 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. 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. 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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