Care Home: Prestwood (Coach House) Nursing Home

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What the care home does well We found that Prestwood Coach House offers a genuine commitment to care with a competent, yet open and personable approach, which reflects the professionalism and homeliness of a confident relationship between carer, and those people using the service: "I cannot express the love and care that is given to my mother and father in law. It is a great comfort to the family to see that love and care are given. They are a very special team of people". "A very pleasant environment, the home achieves a high standard of cleanliness". From our examination of care records we established that there was an effective assessment, care planning and review of individual needs, which are meaningful and robust in formulating an excellent standard of care. When we discussed the quality of care with those people using the service, it was made clear that they appreciated this highly personable attitude and approach to care. The service`s AQAA states: "We provide a very personlised outcome focused care plan with the person using the service, to ensure that they are at all times treated with respect and are valued as a person", this we found to be true. We considered that the overall management style demonstrated a very positive approach in maintaining an environment conducive to the care of the physically disabled and elderly. There is a regular appraisal and review process of facilities and services, to maintain that environment by the senior care management and Providers. What has improved since the last inspection? We found that the home has addressed the issues raised in the last CSCI Inspection Report, with a review and update of policies, procedures, and the Service User Guides and Statement of Purpose. We recognise improved training undertaken to ensure that staff are proficient and aware of changing needs, the care environment. We found that there has been a review of activities, and change or introduce new activities that reflect the interests of the people in the home at any one time. We have found a continuing development in the physical appearance and structure of the home to ensure that it remains a safe and homely environment. What the care home could do better: The achievements in establishing an excellent standard of care have been recognised, areas of detail outlined through recommendations will continue to play a part in the ongoing development and maintenance of an excellent service. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Prestwood (Coach House) Nursing Home Coach House Prestwood (Coach House) Nursing Home Prestwood Stourbridge West Midlands DY7 5AL     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: Keith Jones     Date: 2 1 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 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: Prestwood (Coach House) Nursing Home Prestwood (Coach House) Nursing Home Coach House Prestwood Stourbridge West Midlands DY7 5AL 01384877111 01384877900 enquiries@prestwoodcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Completelink Limited care home 40 Number of places (if applicable): Under 65 Over 65 40 0 old age, not falling within any other category physical disability Additional conditions: 0 40 The maximum number of service users who can be accommodated is: 40 The registered person may provide the following category of service only: Care Home with Nursing (Code N); 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 (OP) 40, Physical disability (PD) 40 Date of last inspection Brief description of the care home Prestwood Coach House is a registered care home that provides residential and nursing care for older people, the home is also registered to provide a service for individuals who have a physical disability. The home is located in Stourbridge, Staffordshire off the main A449 near the village of Kinver. The two-storey property is set within its own grounds, some rooms having very impressive views of the surrounding countryside. The home is registered to offer accommodation for 40 people, providing a combination of shared and single occupancy bedrooms, located on the ground and first floor level, Care Homes for Older People Page 4 of 31 Brief description of the care home with en suite facilities provided. Toilets and bathrooms were also located on both floors. The layout and design of the property facilitates people who have a physical disability, having wide corridors and doorframes to commode wheelchair users. One lounge area and two dining areas are provided, equipped with essential furnishings and items for comfort and relaxation. Staffing is provided on a 24-hour basis, to ensure the total support and supervision of people using the service. People have access to relevant healthcare services if and when required. Details of the fees charged are not included in the Service User Guide, should people want up to date information they are advised to contact the Manager of the home direct. 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: We conducted this unannounced inspection with the Registered Care Manager, acting Home Manager, senior nursing and care staff on duty, whose input contributed to this report. Our inspection of the building allowed us free access to all areas and open discussion with people who use the service, relatives and staff. There were 30 people in residence on the day of our inspection. We looked at how care is being arranged and supported for a range of people with health care needs. To do this we looked at (case tracked) four peoples care records from pre-admission to the present time, and three staff records were examined. We also looked at other information such as complaints, incidents, events and other professional reports. We took the opportunity to speak with a number of people who use the service, Care Homes for Older People Page 6 of 31 relatives and members of staff, who took an active role in the inspection process, and contributed to the subsequent report. We acknowledged receipt of the Annual Quality Assurance Assessment (AQAA), and nine survey forms we issued to people who use the service some weeks before the inspection. The AQAA is a self-assessment that focuses on how well outcomes are being met for the people using the service. It also gave us some numerical information about the service. We inspected a sample review of administrative procedures, practices and records, confirming consistent good practice and effective management. There followed a report feedback, in which we offered an evaluation of the inspection, indicating those recommendations resulting from the inspection. 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 Care Homes for Older People Page 8 of 31 printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 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 10 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 needs of people are appropriately assessed before they are offered a place. They and their relatives can be confident that the service will be able to meet their needs. Evidence: We examined the services recently revised Statement of Purpose and Service User Guide, and found them to provide an excellent, informative description of the homes aims, objectives, and the way it operated. It is recognised that the Statement of Purpose represents the foundation on which the Home operates upon, offering those people who may use the service, and their relatives the opportunity to make an informed choice about where to live. We saw that the Statement of Purpose could be produced in large print, as and when necessary. We consider that the Service User Guide presented in an audio and pictorial version would help people who have difficulty reading small print. The Statement of Care Homes for Older People Page 11 of 31 Evidence: Purpose clearly indicates the terms and conditions, which are discussed prior to admission. We noted that the Service User Guide does not contain up to date fees payable. Through our case tracking of four peoples care records we clearly identified that the Care Manager, or her deputy, at the point of reference, conducted the pre-admission assessment. We found that the documentation identified a clear dependency assessment, forming a comprehensive foundation for care planning to meet needs, which included a copy of the care plan from social services, prior to admission. The objective is for this assessment to be produced with the full involvement of people who may use the service and their family, allowing them to influence the direction of care. We found this to be true, with each individual having a plan of care, which included a detailed care plan, daily care programme, risk assessments with goals and outcomes. Any special needs of the individual were discussed fully and documented, ensuring their personal needs would be met. Comments we received from surveys we sent out before the inspection to people who use the service: Before my mother went into Prestwood Coach House my sister and I researched carefully. Now we have experience of this many more questions have arisen which should have been asked at the time. But we have not regretted the final choice of care home. My sister had visited several times from her church and she thought it was suitable. We are very happy with the care given to us. From our discussions it was evident that people are able to visit and assess the quality, facilities and suitability of Prestwood Coach House at any reasonable time, to meet with staff and management. During the course of our inspection we had opportunities to sit and talk with people who use the service, staff and a number of visitors. We found evidence that care had been taken in involving people, and their families in the admission process. From us talking with people we received plenty of comments and descriptions about the home, and how easy it was to get used to the changes. The information I received was very informative and helpful. People are admitted for a trial period initially to enable all parties to evaluate whether the home is an appropriate placement and mutual adjustment before any contractual agreement is signed; this is usually a period of four weeks. Staff are aware of the Care Homes for Older People Page 12 of 31 Evidence: special period of personal anxiety that people have under those conditions, a point well illustrated through our discussions, and examining records on case tracking. There were no people assessed and referred solely for intermediary care at the time of inspection. Care Homes for Older People Page 13 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care, which people receive, is based on meeting personal needs, with clear principles of respect, dignity and privacy put into practice. Medicine administration systems are safe and secure. Evidence: Those care records and case tracking we examined provided clear evidence to show that the pre admission assessment represented the foundation for a well considered, and detailed care planning process, in association with Social Services reports. We found that the profile of each persons social, physical and psychological status offered an individual plan of care, based upon dependency assessment and activities of daily living, frequently reviewed in an individual plan of care. A comment we received from a relative in the course of inspection: I cannot express the love and care that is given to my mother and father in law. It is a great comfort to the family to see that love and care are given. They are a very special team of people The AQAA stated, and we confirmed, that those people who use the service, families Care Homes for Older People Page 14 of 31 Evidence: and friends are invited to participate in the care planning process, and established monitoring systems following a process of goals, care, and evaluation of quality care plans. A daily report is maintained to control monitoring, and offer a very comprehensive account of care and service given. Risk assessments were carried out on an individual basis and frequently reviewed. Included in the care records were applications of established monitoring systems. Our case tracking of four peoples care confirmed to us that specialist support and advice are sought as needed, with each person having access to a local Doctor, Dentist, Optician, Chiropodist, and Occupational Therapist as required. Our observations showed that generally people using the service appeared to be content, comfortable and happy with their life style, complimentary regarding the quality of their lives and the care they were receiving at the Coach House. All as good as gold, and The staff are very kind. The staff at Prestwood Coach House are excellent. They are friendly, caring, conscientious and always helpful. A doctor is always available on request. If paramedics and first responders needed, no time is wasted to call out. We confirmed that the administration of medicines adhered to procedures to maximise protection for people who use the service. We found that the Care Manager is responsible for overseeing all matters relating to medicines, with a senior nurse taking operational responsibility for day to day actions. The manager has effected a well developed, and smooth process of ordering, receiving, storing, administering and disposing of medicines. Records were seen to be complete and easy to follow through, with no observed breaches in the system. The manager was advised to obtain a receipt when handing over unused medicines to the contractors. Controlled Drug management was comprehensive. The Statement of Purpose, admission assessment and care plans are geared to engender a sense of individuality and privacy. Case tracking confirmed that the policies were implemented, with all people spoken with being complimentary of the degree of respect given, by each and every member of staff. The inspector observed the free, courteous interaction between people and staff based on a level of confidence of mutual trust and respect. Several comments we received from visitors on the day indicated: She is encouraged in all aspects of her welfare, and we are well looked after, and Care Homes for Older People Page 15 of 31 Evidence: I know all the staff who are extremely kind, I am very pleased with my situation. We come and go as we please, there are no visiting restrictions. In our examination of care records, we established that a policy and procedure on care of the dying and death had been introduced to meet individual needs, and were in place with the full knowledge of those who use the service and relatives. It is stated in the services Statement of Purpose and the AQAA, that independence, privacy and dignity are encouraged, with the full involvement of family in all matters concerning the well being of people. This was confirmed in our discussions with people who use the service, visitors and staff. Relatives and friends have freedom of visiting, which emphasised the importance of maintaining social contact. We looked at bedrooms presented to facilitate privacy for the individual, which included medical examinations and personal care procedures being performed in private. Our discussions with people confirmed that individual spiritual persuasions, and individual diversity was seen to be respected. People are able to attend the local church services on a weekly basis. Communion and Church of England services, and Roman Catholic services are given as requested. Our discussion with visitors on the day was a fruitful exchange, with all being very complimentary of care. We noted the confidence and closeness within the Home of staff, people who use the service and visitors, and the mutual respect that prevailed. It was also acknowledged that there exist extremely good working relationships with regular professional contacts, and General Practitioners for the Home. Care Homes for Older People Page 16 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. Peoples rights to live a meaningful life are promoted, and people are offered opportunities to exercise choice and control over their lives. People are offered a healthy, well balanced diet. Evidence: We found daily life to be flexible to accommodate peoples needs and capabilities, offering choices at meal times, and during personal and social activities, including recognition of varied religious needs. Our discussions with people who use the service and staff, identified a relaxed atmosphere in which peoples needs were respected, with the security that there are familiar events to the day they could relate to. Our discussions with people clearly identified a relaxed and informal atmosphere in which the peoples needs were paramount. An activity co-ordinator has a high profile in contributing to the care planning process, and is clearly well accepted by people who use the service and staff alike. On the day of the inspection, a number of people were engaged in painting, and general chatting. Some comments we received from surveys sent out before the inspection: Activities are arranged each week, but I am not interested in taking part in them. Care Homes for Older People Page 17 of 31 Evidence: More than satisfied. The activities are fun, various ideas. A hard working practical and committed team. I cant always take part, Im disabled. Families and friends are actively encouraged to participate in the daily life of the home, with no restriction being placed on visiting times. During the course of the inspection we saw staff and visitors interact with people in a positive and polite manner. Comments received from relatives on the day confirm their appreciation and involvement with the progress of their loved ones health and social status Its always a pleasure to come out to Prestwood Coach House, no matter what time it is, the staff are wonderfully patient and always helpful, and I get a cup of tea, and X is limited in what he can participate in, but he is invited by staff encouragement. It is stated in the Statement of Purpose and AQAA, that personal choice, dignity and self determination are respected in policy and action, which we found to be true. Those individuals rooms we inspected showed a very positive influence of personalisation in the inclusion of belongings, some furniture and general decor, demonstrated a degree of expressed individuality. The Home offers a good catering service, observed to provide a menu on a four weekly cycle offered a wholesome, varied choice. We confirmed that the cook knew most of the people using the service, and some of the relatives, but agreed that he did not go out as much as he would have liked, due to time pressures. We discussed diversity with the cook, who indicated an awareness in meeting individual needs; there were no special cultural needs at the time. Individual preferences were conveyed to the catering staff, who met with, and discussed their requirements. A very pleasant lunch of lamb steaks with choices available, were served during inspection, served in pleasantly furnished and clean dining rooms. Staff were seen to offer discreet assistance to those who required it. The choice of dining room, lounge or bedroom was at the discretion of people in the home. People interviewed confirmed that that the quantity and quality food provided was good: Comments we received in the course of inspection: A little more variety in sandwich meals, a little more taste in meals. Although at the age of 97 I always enjoyed tasty meals. Excellent service. Care Homes for Older People Page 18 of 31 Evidence: The meals are generally satisfactory and we appreciate being able to dine in our own room. Care Homes for Older People Page 19 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 are given opportunities to freely express any concerns, and these are quickly responded to. People are protected from abuse, and their human rights are promoted. Evidence: Through the course of inspection we confirmed that peoples legal rights are protected by the systems in place in the home to safeguard them, including the continual review and assessment of care planning, and policies in place, including the complaints procedure. The complaints policy was seen and records examined. All people who use the service had received information on the procedure to complain, including reference to the Care Quality Commission (CQC). On discussions it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. A complaints book would enhance quality control on this issue, with clear recognition of concerns, complaints and allegations. Comment we had received in the course of inspection stated: The staff are very kind, I do know how to make a complaint, but so far no complaints. Staff are ready to listen when we point things out. Care Homes for Older People Page 20 of 31 Evidence: Staff are guarded when we point things out. Case tracking confirmed the effectiveness of a Provider, Care Manager and staff sensitive to peoples needs, and a readiness to test the robustness of their information and report structures. No complaints or safeguarding issue had been received by us since our last inspection. The overall policy of openness and transparency was acknowledged. We were informed that all the people who used the service had received information on the procedure to complain, including reference to us. Individuals legal rights are protected by the systems in place in the home to safeguard them, including their contract, the continual assessment of care planning, and policies in place, including the complaints procedure. The care management showed satisfactory evidence of a protocol and response to anyone reporting any form of abuse, to ensure effective handling of such an incident. The Annual Quality Assurance Assessment completed by the service prior to the inspection confirms all staff employed have undertaken a satisfactory Criminal Records Bureau (CRB) check, confirmed by examining three staff files. Staff induction and inhouse training programmes led by the training and development manager, clarified the responsibilities of all staff in their daily contact with people who use the service, especially their privileged position in protecting those people from abuse of all natures Care Homes for Older People Page 21 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. The Home provides a safe, well-maintained, clean and comfortable environment for the people who use the service, which encourages independence. Evidence: A tour of the Home verified that the premises were fit for purpose, clean warm and tidy, and being satisfactorily maintained. External car parking and grounds are spacious and well maintained. The open garden and patio offers a very pleasant area for fresh air and reflection. The state of repair and maintenance is generally very good, offering a comfortable, homely yet secure environment. External access is via a long and well maintained driveway, set in beautiful pastoral countryside. Visitors and people who use the service take advantage of very attractive gardens and grounds; pathways were safe and recently attended to, after a harsh winter. On admission the Care Manager assesses each individual persons needs for equipment and necessary adaptations. Internal access was facilitated with suitable fittings of hand and grab rails, in adequate, well lit and airy corridors. Wheelchair access was satisfactory throughout all areas of the Home. All communal areas are of a high standard, offering social as well as private reflection, as the mood takes. The lounge spaces allow activities to be presented in very pleasant areas of the home, with furniture and fittings of good quality. The dining areas are well furnished, and Care Homes for Older People Page 22 of 31 Evidence: presented to provide a conducive environment to enjoy a good meal. Staff supervision is available throughout the day. Bedrooms were well maintained to meet peoples personal preferences. On inspection most bedrooms were highly personalised, displaying the persons own furniture, and personal belongings. Efforts had been made to provide a homely atmosphere, and the decor was found to be of a good standard. Each bedroom has adequate space to assist with personal care and dressing assistance. The nurse call alarm system was satisfactorily tested, and personal appliance tested (PAT) equipment, that is televisions, radios, where seen to be tested. Several people spoken to expressed a sense of belonging and satisfaction in the quality and presentation of their living areas. Corridors were seen to be free from obstruction, fitted to aid mobility and well lit to facilitate safe access throughout the Home. The housekeeping services in the home were seen by us to be of a high standard. The people spoken to generally remarked that they find the environment always very clean and fresh. To complement the presentation there were numerous floral and decorative displays. A comment from a survey we sent out: Very much so, a very pleasant environment. Cleaned every day, excellent. The home achieves a high standard of cleanliness. The standard and presentation of all the toilets and bathrooms were of a high quality, clean, uncluttered and freshness. Adequate attention has been given to ensure maximum privacy within risk assessed boundaries. Infection control figures highly within the staff induction and supervisory training programmes. The Annual Quality Assurance Assessment completed by the service prior to the inspection confirms that the building complies with the requirements of the local fire service and environmental health department, and records are kept accordingly. 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. Staff in the Home are trained, skilled and in sufficient numbers to fulfill the aims of the unit and meet the changing needs of people using the service. Evidence: There were 30 people receiving nursing care from a total of 40, at the time of the inspection. We examined two weeks of duty rotas, in which the daily care staffing showed a satisfactory balance between skills, qualifications, and numbers to provide a foundation for a high standard of care. The Registered Care Manager worked supernumerary, but is supported by a Home Manager who contributes fully to the staffing rota. Agency coverage has been used to support shortages of care staff, in tandem with overtime and flexible rostering to meet shortfalls. Our discussions with staff confirmed their commitment to providing a quality service and their awareness of the principles of good practice. At the time of the inspection there were two Registered Nurses and seven care staff on duty. We acknowledged that maintenance, catering, and housekeeping hours were e appropriate for the size of the Home, and the needs of people living there. We also recognize the high profile of the Registered Providers, who work full time in administrative and management support. We sampled three staff files, and found them to be consistent and up to date. Staff are employed in accordance with the code of conduct and practice set by the General Care Homes for Older People Page 24 of 31 Evidence: Social Care Council. We recognise that the management have established a comprehensive procedure for interview, selection and appointment of staff, reinforcing the policy that the thoroughness of staff selection has a significant effect upon the provision of care to ensure protection of people. The Providers are committed to a learning environment. Staff induction programmes are well established; very well designed, forming the base upon which in service supervision and training are planned and achieved for all staff. The records we examined showed that 50 of care staff are in receipt of National Vocational Qualification (NVQ) level II or level III, with a further 10 undertaking NVQ training at the time of inspection. Overall the evidence shows a substantial account of a meaningful schedule of training to meet mandatory and specific demand. Three staff on duty were interviewed, each member of staff spoke well of the training and supervision offered to them, and of the good working conditions that prevail. All of them told us that there were very settled and enjoyed their positions, and were proud of the high standards of care given. There were no problematic issues raised by the staff. Comments we received from people prior to the inspection showed us: Senior staff, carers and other staff are all excellent and dedicated. The staff are lovely people, very kind and very helpful. The full time staff are very good, most of them have been at the home a long time, so they know the needs of the patients if there are any problems. Prestwood Main has held the Investor in People Standard for the past nine years, which is reviewed each year to ensure appropriate protocols are in place to promote equality and diversity throughout the Home. 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 can be assured that the home is run in their best interests. The ethos of the service is based on openness and respect. The care team, through good working practices, promote the health, safety and welfare of people who use this service. Evidence: The Registered Care Manager, Jayne Tatler, has demonstrated a long term commitment and competence in running the Prestwoods, in establishing a solid professional policy portfolio that has been implemented, to achieve a high standard of set aims and objectives. A qualified general Nurse with an extensive professional portfolio of practical and managerial experience. She is supported by a Home Manager, a Registered Nurse who has the Registered Managers Award, who is presently on sick leave. We were accompanied by the acting Home Manager, a senior Nurse with extensive professional and clinical experience. The Registered Providers have a high profile and involvement in the smooth running of the Home, and are prepared to Care Homes for Older People Page 26 of 31 Evidence: delegate a wide range of management responsibility to good effect. We were impressed by the openness and confidence in the observed interactions of staff, relatives and people using the service. The relationships were seen to be of mutual trust and respect. Comments we received from staff interviewed on the day: I have found the management and the acting care manager to be very approachable and fair, leading by example, and has my full commitment in keeping the standards of care as high as we possibly can. Since coming back to work at Prestwood I have been very impressed with the highly professional approach to providing a quality service with high standards. The managers have always been seen to lead, and to deal directly to people in a very caring manner. We saw that appropriate risk assessments were in place for people, through care planning and recording, staff selection and the maintenance of the general environment; these are up to date and accurate. The Provider with the Care Manager, have developed a formal approach to monitoring quality across a wide range of activities. The services completed AQAA states that the home has quality monitoring systems in place, and they also consult the people who use the service and their relatives about the service. This we found to be true. We identified that people are encouraged to be independent with regard to financial affairs with the assistance of their relatives. Small amounts of cash were efficiently handled by the administrative officer, through the Providers office. We acknowledged that a staff supervision policy and procedure is in place in the home, established as part of the routine management/training process, with all care staff receive six sessions of individual formal supervision annually. We also discussed equality and diversity issues with staff and people using the service, covering a wide range of issues, including food, religion and staffing. Our examination of administrative, monitoring, planning and care records showed an organized, and professional attitude to effective record keeping. The procedures manual was randomly examined, and found to offer a very comprehensive reference. The Care Manager offered evidence to us of safe working practices including: Movement and handling training, medicines, and complaints management. Health and safety notices can be seen throughout the home. We recognize that the administration and management of the home is efficient, uncomplicated and sensitive to the needs of people. Care Homes for Older People Page 27 of 31 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 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 1 That the Statement of Purpose and Service User Guide be updated to reflect change and that consideration be given to producing the documents in an audio versions, to assist people with poor eyesight to make an informed decision. 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. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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