Care Home: Priory (The)

Similar services:

• Manor Lodge
• Fairfields Country Rest Home
• Queensmount
• Poldhu
• Trevaylor Manor
• Didsbury Court Rest Home
• Belma
• Hunters Care Centre

What the care home does well The home makes sure that as much as possible is known about people`s care and support needs before they move in. People are encouraged to see the home before they move in, to see if it suits them. Care plans are very detailed in describing the way that people prefer their personal care to be provided. People have good access to healthcare professionals. People`s risk of malnutrition and pressure damage is regularly monitored. Staff ensure that people have drinks throughout the day and night. Care plans are regularly reviewed. Staff are very respectful of people`s privacy and dignity. People are encouraged to administer their own medication and have lockable storage in their bedrooms. Safe systems are in place for holding and administering people`s medication. Staff are trained in medication administration and have access to information about the medication that people are taking. People choose to continue to do the things they like to do. People are regularly asked about what they would like to do and what they like to eat. People benefit from a range interesting things to do and places to go. Relatives and friends are encouraged to keep in contact with people who live at The Priory. People can make complaints and tell the manager and the providers about things they are not happy with. Complaints are taken seriously and thoroughly investigated. Staff know how to report any abuse, using the local safeguarding procedure. People benefit from well maintained, interesting and accessible gardens. The home is cleaned and maintained to a very high standard. The providers and manager are always asking people about ways to improve the service. They make changes when people tell them things that could be improved. They also make sure that people know about events in the home. The providers and manager ensure the health and safety of people who use the service and staff. The home lets us know about any incidents in the home. What has improved since the last inspection? The home has a website where people can find out more about the home. Daily records are more detailed in describing how the care has been provided. Hot water temperatures in bathrooms and bedrooms are regularly checked, with records showing that they are consistently below 43 degrees Celsius. The actual date of staff receiving fire safety training is now recorded. What the care home could do better: Information and guidance about medical conditions and special prescribing instructionsmust be included in people`s care plans as well as in the medical and medication administration records. This is so that people`s care is better planned and monitored. Consideration should be given to the language used in care records and only report on observations and interventions. Body maps should be considered as further evidence of monitoring and healing of wounds. If people like to spend time in the bath without support, the care plan should identify how long the staff can be away. Also if people have been assessed as never to be left alone when bathing, this should be recorded in their care plan. Prescription labels should have more detail than "as directed." The prescriber should be asked to write more detailed instructions to avoid confusion. The home`s safeguarding policy should be amended in line with the multidisciplinary approach of the local safeguarding vulnerable people policy and procedure. Care staffing levels must be consistent throughout the week. This is so that people are receiving continuity of care at all times. Staff views should be sought as part of the quality audit. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Priory (The) Greenway Lane Chippenham Wiltshire SN15 1AA     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: Sally Walker     Date: 2 0 0 5 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: Priory (The) Greenway Lane Chippenham Wiltshire SN15 1AA 01249652153 01249464832 julieandjohng@ukonline.co.uk www.thepriorycarehome.co.uk Lower Green Ltd care home 24 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) : Number of places (if applicable): Under 65 Over 65 24 24 dementia old age, not falling within any other category Additional conditions: 0 0 The maximum number of service users who can be accomodated is 24. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care need on admission to the home are within the following categories: Old Age, not falling within any other category (Code OP) Dementia (Code DE) Date of last inspection Brief description of the care home The Priory is a detached property set in its own grounds, close to Chippenham town centre. People have their own rooms, all of which have ensuite facilities except one. Five new flats have recently been approved for registration. The home offers care and accommodation to older people, including those who may have dementia. There are two floors and access to the first floor is by passenger lift, stairs and a stair lift on the rear staircase. Bedrooms are on the ground floor and the first floor. There is a communal dining room and sitting room. There is a shower room and two assisted bathrooms. The recent extension has provided a larger laundry room, further sitting area and a room that can be used as a dining room or activities area. There is level Care Homes for Older People Page 4 of 32 Brief description of the care home access to the front of the home. In addition to the full time manager, there are at least three staff on duty during the morning, with two staff on duty during the afternoon and evening. At night, there are two waking night staff. Fees range from 545 to 616 pounds per week. Inspection reports are readily available in the home and the owner also writes a newsletter for people and their relatives, updating them on the current care issues. 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 took place on 20th May 2009 between 9.20am and 6.00pm. Mrs Julie Grimshaw, registered manager, was present during the inspection. We spoke with people who use the service. We looked at care plans, risk assessments, medication, menus, staff recruitment and training files and rotas. We made a tour of the building. As part of the inspection process we sent survey forms to the home for people who use the service, staff and healthcare professionals to tell us about the service. Comments are found in the relevant part of this report. Care Homes for Older People Page 6 of 32 We asked the home to fill out their AQAA (Annual Quality Assurance Assessment) so they could tell us about developments to their service. It was filled out in full and returned on time. Some of the information we received can be found in the body of this report Soon after this inspection we approved the providers application to increase the registration in numbers from 18 to 24. This includes the five apartments in the extension. The last Key inspection was on 15th May 2006. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the care home does well: What has improved since the last inspection? What they could do better: Information and guidance about medical conditions and special prescribing instructions Care Homes for Older People Page 8 of 32 must be included in peoples care plans as well as in the medical and medication administration records. This is so that peoples care is better planned and monitored. Consideration should be given to the language used in care records and only report on observations and interventions. Body maps should be considered as further evidence of monitoring and healing of wounds. If people like to spend time in the bath without support, the care plan should identify how long the staff can be away. Also if people have been assessed as never to be left alone when bathing, this should be recorded in their care plan. Prescription labels should have more detail than as directed. The prescriber should be asked to write more detailed instructions to avoid confusion. The homes safeguarding policy should be amended in line with the multidisciplinary approach of the local safeguarding vulnerable people policy and procedure. Care staffing levels must be consistent throughout the week. This is so that people are receiving continuity of care at all times. Staff views should be sought as part of the quality audit. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering moving to The Priory are involved in the detailed assessment of their needs, so that the home knows if they can meet their needs. People can visit the home to see if it suits them, before they decide to move in. Evidence: A copy of the service users guide was available in the main entrance, together with a copy of the last inspection report and the report and action plan of the last quality audit. People can also find information about the home on its website. One of the people we spoke with told us about when they came to live at The Priory. They said that their family had looked at a number of homes before deciding on this one. They said that Mrs Grimshaw had come to see them at the care home that they were living in. Another person told us that they had looked at other homes when they were considering their future care. Care Homes for Older People Page 11 of 32 Evidence: We looked at the pre-admission assessments for some of the people who had come to live at the home since we last visited. Mrs Grimshaw carries out detailed pre-admission assessments with people who are considering living at the home. All aspects of peoples medical and social care are assessed with them and anyone else involved in their support network. Care management assessments are obtained if a local authority is funding the care. Mental health assessments are obtained when people may have a dementia. The home was seeking peoples social history as part of the assessment process. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their own summary of their care plan. Generally the care plans are well documented. People have good access to healthcare professionals and staff are prompt at referring any concerns. People are encouraged to continue to manage their own medication. Safe systems are in place for holding and administering peoples medication. People benefit from staff who treat them with respect and dignity at all times. Evidence: Each person had a detailed care plan. The full copy was kept in the office and people had a summary copy in their bedrooms. We saw that care plans were regularly reviewed with people and updated when needed. Care plans had been introduced specifically to identify peoples needs during the night. Action had been taken to address the good practice recommendation we made at the last inspection that daily notes should record more detail about the care that had been provided. We found that the daily records were very detailed in recording how people were feeling, how they had been supported with their care, what people did during the day and what they had Care Homes for Older People Page 13 of 32 Evidence: eaten. We saw that some staff were writing no problems and toileted in the daily records. Body maps were not being used, but but these would be a way of providing further evidence of monitoring of healing of any wounds or marks. Mrs Grimshaw told us she had obtained body maps for this purpose. The home kept good notes on any medical interventions and appointments with healthcare professionals. The records showed that any concerns were promptly referred to the relevant healthcare professional. People had their nutritional needs assessed on the day they were admitted and every month thereafter. People also had their risk of developing pressure damage assessed regularly. We saw pressure relieving equipment in place where needed. We saw that information about some peoples conditions and diagnoses was only recorded either in the daily notes or in the GP notes. This meant that care plans were varied in the detail of how assessed needs are to be met and monitored. Much of the information in the assessments, daily record, medical intervention records and that added to the pre-admission assessment, was not always brought together and included in the care plan. Care plans did not show how people with diabetes had their condition managed and monitored. It was clear from discussions that staff were fully aware of how they were meeting peoples needs. Care plans did not always direct the care or identify how the need in the assessment was to be met and monitored. We saw that care planning training was on the agenda for the next staff meeting. We saw good detail in care plans about how staff were to provide personal care. There were separate care plans for day and night care interventions. Risk assessments were carried out on the use of any equipment. One example was the use of bed rails, often referred to as cot sides. Mrs Grimshaw told us that she had undertaken training in deprivation of liberty. She told us that she wanted to know if locking outside doors to keep people safe restricted their liberty. She had consulted with an Independent Mental Capacity Advocate who advised that no one would be deprived of their liberty if they were persuaded not to go out or if the front door was kept locked. People had free access to the gardens. We saw that staff gave those people who were in their bedrooms a fresh jug of juice and a glass. There was a tray of juice and glasses for those people in the sitting room to help themselves. People told us they could have a bath whenever they liked. They said that staff would be present if needed. We looked at the bathing risk assessments. There was no clear guidance in the care plan on monitoring peoples safety if they wanted to have time on their own when bathing. There was no record of how long staff would be away or if Care Homes for Older People Page 14 of 32 Evidence: people must never be left alone in the bath. The home had a policy that no one was left alone when bathing. One person who told us they had a visual impairment explained how staff supported them to move independently around the home. They said that staff told them what was happening although they said they preferred to ask staff rather than be told. They had various different pieces of equipment, for example a speaking clock, a telephone with large numbers and large wrist watch. They said that staff were aware that they should not move anything in their bedroom without telling them as they knew where everything was. We saw evidence of this when a member of staff returned some laundry to the person. The person told us that they liked their daughter to read the homes newsletter to them. They told us that the staff met with them regularly to discuss their care plan. They had a copy in their bedroom. They told us that staff would read the plan to them. We saw staff working in a professional and friendly manner with people who use the service. Staff knocked on peoples bedroom doors before being invited to enter. All personal care was carried out in private. One person told us that if they needed to see their GP, Mrs Grimshaw would arrange for an appointment. Another person told us that staff would take them to healthcare appointments. Most of the people we spoke with told us that staff administered their medication. One person told us that they administered their own pain killers. They said that they asked staff for the tablets. We looked at the arrangements for medication. People could administer their medication following a risk assessment which may include their GP. They signed the log to say they had received their medication. People had locked storage in their bedrooms in which to keep their medication. Staff could not give medication unless they had an NVQ Level 2, had undertaken medication training at Swindon College and were been deemed competent by the manager. Staff administering medication wore a fluorescent jacket to avoid being disturbed when giving medication. Medication was checked as it was received into the home. The home kept a record of any unused or unwanted medication returned to the supplying pharmacist. The homes medication policy was included in the file. The medication administration record also included details of what each medication was prescribed for and any side effects. Any allergies were included in this record. There was also a list of which homely remedies that the GP had agreed could be taken with peoples prescribed medication. The records contained guidance on expiry dates for topical creams and eye drops. The medication administration records were being satisfactorily maintained. We saw that some medication labels were printed with as directed. We Care Homes for Older People Page 15 of 32 Evidence: advised that the GP should be asked to write more detailed prescribing instructions to avoid confusion. As a matter of good practice we saw that the British Pharmaceutical Societys Formulary was available for staff to read about the different medication that people were taking. We saw that some peoples care plans did not record specific prescribing instructions for medication that was taken once a week. There was no detail about what action to take if this medication was refused or if the person was not awake when they needed to take it. We saw that the home obtains faxed instructions from the GP if medication is changed or amended. We also saw instructions for where to administer medication administered via an adhesive patch. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People choose to continue to do the things they like to do. People are regularly asked about what kind of activities they would like and what they like to eat. People benefit from a range of interesting things to do and places to go. Evidence: People who we spoke with told us they choose to spend their day where they wish. One person told us Youre not ordered about. You live your own life. Ive never heard anyone told off. There is a sitting room in the main part of the home. We saw some people sitting in the garden. One person told us about their daily walks in the area with a member of staff. They told us they looked forward each day to going out and see what was happening in the area. Another person told us that staff would take them out regularly in their wheelchair. They said Youve only got to say. Another person described the home as Next to home. One person told us they liked to spend time in their rooms and only went to the activities that interested them. They said they would be going to that afternoons music Care Homes for Older People Page 17 of 32 Evidence: session. Another person showed us the calendar they had made with a photograph of them making biscuits. They said they enjoyed joining in with some of the activities that they were interested in. They told us that there were meetings where they were asked what sort of things they wanted to do. Some people made crafts to raise money for a local hospice. Other trips out had been to two different garden centres. We saw that those people who were spending time in their bedrooms had their call bell within easy reach. We saw that staff always knocked on bedroom doors before being invited to enter. The newly registered extension provided a room where some activities can take place. Mrs Grimshaw told us that she planned to employ a part-time activity co-ordinator. She showed us the items she had gathered from a variety of different places which were used to talk about the past. There were copies of ration books and documents from the 1940s, kitchen items, toiletries, clothing, newspapers and books about Chippenhams history. Mrs Grimshaw told us that the items would prompt many discussions about the past and what people had done in their younger days. Other activities included: music for health, coffee in Chippenham, pub lunches, a National Trust garden, visits from a PAT dog, aromatherapy and yoga. Friends and family are invited to join any of the trips. Further trips were advertised in the newsletter: Weston super Mare, a local country house and another local garden centre. Records were kept of the different activities that people engaged in. The handyman had planted the vegetable patch with a variety of fruit and vegetable plants. Mrs Grimshaw told us that people liked to help harvest the produce which was used in the kitchen. Mrs Grimshaw told us that she had applied for the home to have an allotment. People make use of the gardens where patio furniture and shade was available. There were bird tables outside many of the downstairs bedroom windows. People told us they enjoyed feeding the birds. Mrs Grimshaw told us that people would often have some of their meals in the garden now that the weather had improved. She went on to say that there was a range of games for people to play in the garden if they wanted. We saw that sun cream was available for people to use. The home publishes a regular newsletter. This gives information about events in the home and forthcoming activities. Recent trips have been shopping in Chippenham with coffee in a pub, lunch at the Pump rooms in Bath and a tour of the Abbey and ten pin bowling. There were other trips planned, usually once a month, including to a local garden, to the seaside, and a country house. Mrs Grimshaw visits the venues to assess their safety and access for people. There were written records of these assessments. There was a pack containing peoples contact information, first aid equipment and mobile telephones if needed on any trip. Care Homes for Older People Page 18 of 32 Evidence: The new extension to the property provided a new hairdressing salon. A hairdresser comes to the home every Friday. We saw a good stock of activity resources that were age appropriate. The home kept a small stock of toiletries, tissues and sweets for people to buy. People were asked about things to keep in the shop. People told us that their family and friends could visit them at anytime. They said they were always made welcome with refreshments and a meal could be provided. People told us they enjoyed the range and quality of the meals. One person described the cook as excellent. Everyone we spoke to knew that the lunch was roast chicken. One person with a visual impairment told us that they liked to ask staff what the meals were for the day. They also told us that they liked to ask staff about the daily weather. They said they preferred to have all their meals in the dining room, I can catch up on the gossip. We looked at the menus. People told us they were asked about what sort of meals should be included in the menus. We saw a range of traditional dishes and choices were offered for some meals. There was always an alternative to the main course. Mrs Grimshaw had produced photographs of all the courses on the menus. This was so that people could see exactly what the meal was and helped with choosing. Meals were freshly prepared from local ingredients. People could help themselves to cold drinks in the sitting rooms. The lunch on the day we visited was roast chicken with three vegetables and potatoes with banoffie pie for pudding. The lunch menu was displayed on each of the dining room tables. We saw that people were served according to their appetite. The meals were well presented and looked appetising. People told us how they were enjoying the meal. Mrs Grimshaw told us that more roast dinners had been added to the menus following discussion with people. None of the people in the dining room needed support with eating, although some people had their meal cut into smaller pieces. Condiments were on the table for people to help themselves. People asked Mrs Grimshaw to put on some music during the meal. The meal was clearly a social event for people and staff presence was minimal, only clearing tables when everyone had finished. We saw guidance to relatives about how the home manages the safety aspects of any food they might bring as gifts to people living at the home. 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. Systems are in place to ensure that people can complain about the service. Complaints are taken seriously and thoroughly investigated. Although the homes safeguarding policy does not reflect a multidisciplinary approach, staff know how to make an alert using the local procedure. Evidence: The home has a complaints procedure which is made available to people and displayed on the notice boards. All of the people we spoke with told us that they would speak to Mrs Grimshaw if there was anything they were unhappy with, or needed to make a complaint. The complaints log showed that there had been one complaint investigated since the last inspection. The home had carried out a detailed investigation into an anonymous complaint. We saw that the policy referred to the home carrying out investigations and referred to the local police rather than the local safeguarding adults unit when making an alert. The manager had assisted with a recent investigation of an incident by the local authority who found that the home had acted appropriately. We saw that two copies of the local safeguarding procedure entitled No Secrets in Swindon and Wiltshire were displayed on the office notice board. This meant that staff could access the flow chart and know how to make an alert. We had discussions with Care Homes for Older People Page 20 of 32 Evidence: Mrs Grimshaw about getting a copy of the full safeguarding policy and procedure from Wiltshire Council. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a home that is very well maintained, warm, comfortable and cleaned to a high standard. Evidence: People told us that they liked their bedrooms. Most people had a view of the grounds. People had brought different items with them to personalise their bedrooms. All of the bedrooms were well decorated, light and airy. The newly registered extension provided two extra bedrooms and five flats, one of which has two bedrooms. The registration had been increased from 18 to 24 shortly after this inspection. There was also a new bathroom with a specialist bath and shower room. The extension also provided a large communal sitting area on the first floor, and a dining room which could also be used for activities, on the ground floor. The accommodation is on the ground and first floors. A new lift had been installed in the extension. People could also use the stairs and stair lift, if they wished. The main sitting room had been refurbished with carpets, curtains and furniture. The main stairs and landing had also been re-carpeted. The dining room had been extended as part the extension and a new kitchen installed. Mrs Grimshaw told us that there were plans to replace the call alarm system in the Care Homes for Older People Page 22 of 32 Evidence: main part of the house. The extension work had included a larger patio area which had been provided with patio seating and shade. In the AQAA Mrs Grimshaw told us that a pond and fountain is planned together with a sensory garden. We saw that memory boxes were placed by some peoples bedroom doors so that they could easily identify their room. The boxes contained photographs and pictures of pertinent aspects of their life. We saw that all the clocks around the home showed the correct time. We also saw different notices or diaries showing the days date. Action had been taken to address the good practice recommendation we made at the last inspection, that water temperatures should not be greater than 43 degrees Celsius in bathrooms and peoples bedrooms. The home regularly tested all of the hot water outlets in the bathrooms and wash hand basins in peoples bedrooms. The records showed that the temperatures were consistently below 43 degrees Celsius. All of the radiators were guarded to reduce the risk of scalding should anyone fall against them. All of the window openings to the first floor and the stairwells had been restricted to reduce the risk of anyone falling out. One of the people we spoke with told us The whole place is kept nice. In the AQAA Mrs Grimshaw told us that cleaning hours had been increased to include the extra rooms. The home was cleaned to a very high standard, including those areas not always visible. We did not notice any unpleasant odours at any time during the inspection. All of the bathrooms and toilets had soap dispensers and single use paper towels. Staff had good access to disposable gloves, aprons and other protective clothing. There was guidance on managing spillages and infected items. The majority of staff had been trained in infection control and signed up to the homes infection control best practice guidance. The newsletter gave information about good practice if anyone had a cold in relation to recent information about swine flu. The new extension provided a laundry area. People we spoke with told us they were very pleased with the laundry service. One person told us that their laundry came back Folded and ironed like it had been dry cleaned. They described the regular cleaning of their bedroom and changing of bed linen. There were systems to deal with soiled or infected linen. 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. People receive good care and support from staff, although staffing levels are inconsistent throughout the week. Staff have established good relationships with people who use the service. Staff are well trained and have exceeded the standard for NVQ qualifications. There is a robust recruitment process that protects people from anyone unsuitable. Evidence: We looked at the staffing rota. There was always a senior member of staff to lead the shift. During the weekdays there were a minimum of three care staff during the mornings, afternoons and evenings. At the weekends the morning shifts were reduced to two care staff. We saw that a cleaner worked from 8.00am to 2.00pm Monday to Friday. At the weekends there were no housekeeping staff. Care staff would be expected to do any cleaning. Mrs Grimshaw told us at the time that care staffing levels will be increased as the rooms in the extension are registered and occupied. Staff had good access to in house and external training. Some training took place at staff meetings and included: dementia care, fire safety, health and safety, infection control and use of topical creams. Planned training included: deprivation of liberty, person centred care planning, diabetes, osteoporosis, nutrition, abuse and moving and handling. The consultant psychiatrist had provided training on memory and dementia. Care Homes for Older People Page 24 of 32 Evidence: Staff had also received training in palliative care at a local hospice. All of the senior staff had NVQ Level 3. Nearly all of the staff had NVQ Level 2. New staff were expected to undertake the qualification if they did not already have it. We looked at recruitment files for recently employed staff. A robust recruitment process is in place. All the information and documents required by regulation were on file. No one starts work without checks on their suitability to work with vulnerable people. A volunteer also underwent these checks and attended the staff training. One of the people we spoke with told us that they were not rushed by staff. Another person told us that there were always staff available during the night. They described the staff as Jolly, you can have a laugh and a joke with them. We saw that staff took time to sit and chat with people in the sitting room. It was clear from our discussions with people who use the service that good relationships had been established with staff. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from providers and a manager who want to provide the best service for them. The home is run in peoples best interests. Peoples health and safety are promoted and protected. Evidence: Mrs Grimshaw has been the registered manager for more than four years. She has over twenty five years experience of working with older people. She is a registered nurse, although not employed in that capacity. She kept her nurse registration up to date with regular preparation training. Mrs Grimshaw had NVQ Level 4 in management and care and the Registered Managers Award. She had recently trained in: mental health in old age, care planning, diet and nutrition, safeguarding vulnerable people, end of life care, dementia and memory, managing behaviours, communication, fire prevention, the Mental Capacity Act 2005 and deprivation of liberty. Mrs Grimshaw was exclusive of the care staffing rota. However she was well known to Care Homes for Older People Page 26 of 32 Evidence: the people who use the service. Those people we spoke with told us that she regularly visited them to ask how they were. it was clear from talking with Mrs Grimshaw that she knew how she wanted to develop the service and had peoples interests at the centre of what she did. The providers spend at least two days a week at the home. It was clear from the AQAA and the quality audit that the providers continued to seek peoples views on ways to improve the service. A suggestion box was available to people in the main entrance. All of the people we spoke with told us that Mrs Grimshaw came to see them regularly to chat with them and ask them if things were going well. The providers were also well known to people. The newsletter told people about the results of the quality audits carried out by the providers. We saw a copy of the homes action plan and analysis of recent surveys available in the main entrance. We saw that staff views had not been included in the quality audit. Changes made following consultation with people have included: background music at mealtimes, a non-TV lounge, a fish tank and more trips out. The home planned to introduce a communication forum with families and supporters. The purpose being to keep families up to date with events and information and for them to discuss any issues. Mrs Grimshaw provides regular supervision to all staff, including night staff. Staff are required to attend the monthly staff meetings as part of their contract of employment. Records are kept of supervision and minutes of meetings. The providers and manager keep us up to date with things that are happening in the home and notify us immediately when incidents occur. One of the people we spoke with told us that they had a small safe in their bedroom to keep any valuables, money or medication. They told us that they looked after their own finances. They said that they had a bill each month for hairdressing. Mrs Grimshaw showed us the arrangements for billing people for any expenditure. She told us that she would pay for items from the petty cash account and showed us the individual records and receipts for these items. The records were available for people or their relatives to check and sign each month. Risk assessments had been carried out on the environment and were reviewed annually. The homes water systems were checked for Legionella bacteria in October 2008. The handyman carried out day to day maintenance and repairs. The providers contract for other repair and maintenance work. Care Homes for Older People Page 27 of 32 Evidence: Action had been taken to address the good practice recommendation we made at the last inspection that when staff receive fire safety training in house, the actual date of the training session should be recorded above their initials. The dates for all fire safety training were recorded. The providers had contracted for the homes fire risk assessment to be done by a company. Care Homes for Older People Page 28 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 29 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 1 7 17 Information and guidance about medical conditions and special prescribing instructions must be included in peoples care plans as well as in the medical and medicine administration records. So that peoples care is planned and monitored. 31/08/2009 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 7 If people like to spend time in the bath on their own, the care plan should identify how long the staff are away. Also if people have been assessed as never to be left alone when bathing, this should be recorded in their care plan. Consideration should be given to the language and content of the daily reports. Terms such as no problems and toileted should be avoided. Staff should only record observations, conversations and interventions. The use of body maps may enhance the recording and monitoring of healing of any wounds. Page 30 of 32 2 7 3 7 Care Homes for Older People 4 9 If a prescription label has as directed written on it, the home should ask the prescriber to write more detailed instructions to avoid confusion. The homes safeguarding policy should be amended to make sure that investigations are not carried out when allegations should be referred to the local safeguarding vulnerable people procedure. A copy of the full policy and procedure can be obtained from Wiltshire Council. Staff views should be sought as part of the quality audit. 5 18 6 33 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. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!