Care Home: Quinton House Nursing Home

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What the care home does well We found that all the people we spoke to were happy with the care and support they receive at Quinton House. People are assessed prior to them living at the home so that their needs can be identified and a decision can be made on whether these can be met. We observed good interaction between staff and the people who live at the home. People told us staff were kind and attentive to their needs. One person commented, "I wouldn`t stay here if I didn`t like it. All the staff are kind and willing to help." There is a wide range of activities on offer which include people coming in to the home to provide activities for people to take part in if they wish. People told us they enjoyed the various leisure activities provided daily. One person commented, "There is always something to do, if you want to. Sometimes I just like to sit quietly and staff don`t force me to do anything I don`t want." People have confidence that a concern or complaint will be acted upon to their satisfaction. People find the management team approachable and staff told us that managers are supportive. We were told by a person, "I would speak up if necessary, but everything is perfect here." A visitor said, "I have no problems but if I did I would speak to the manager." What has improved since the last inspection? Care planning systems and documentation has improved since the last inspection. New care plan documentation has been introduced which was easy to read and understand. Information was up to date and contained enough detail to enable staff to provide care. Risk assessments had been completed and care plans developed where a risk was identified. These assessments had been reviewed on a monthly basis and updated as necessary. Medication management has been reviewed and improved. This should promote the health and safety of people using the service. The home continues to improve the environment with an ongoing refurbishment programme. The home does not manage the finances for people living in the home. This ensures people`s money is spent on items for them and they are aware of what they are spending. What the care home could do better: We consider the home to be performing well and provide positive outcomes for people who use the service. We have not issued any requirements following this visit. We have made some good practice recommendations that the service should consider implementing to improve the well being of people. A robust quality assurance system should be developed to assess staff practice in the safe handling of medicines. Medication avalaible at the end of the four week cycle should be carried over to the new Medicine Admistration Record (MAR) to enable audits to take place to demonstrate that staff are administering the medicines as prescribed. Key inspection report Care homes for older people Name: Address: Quinton House Nursing Home Lower Quinton Stratford On Avon Warwickshire CV37 8RY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Patricia Flanaghan     Date: 0 2 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Quinton House Nursing Home Lower Quinton Stratford On Avon Warwickshire CV37 8RY 01789720247 01789720245 angelabirioo@quinton.house.wanadoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Quinton House Limited care home 37 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 37 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) 37 Dementia (DE) 3 Date of last inspection Brief description of the care home Quinton House is situated in the village of Lower Quinton a short drive away from Stratford on Avon. The current provider Quinton House Ltd has owned the home since 1995. The home is registered to provide nursing care to 37 elderly residents, with three of these places registered for care of those with dementia. Accommodation is provided in two areas of the home. The main House, which accommodates up to 29 residents and a smaller annex, which is adjacent to the main building and accommodates up to eight residents. The main house has accommodation Care Homes for Older People Page 4 of 29 1 8 0 3 2 0 0 9 3 0 Over 65 0 37 Brief description of the care home on three floors with access via a passenger lift or stairs. Accommodation is provided on the ground floor of the annex. The majority of the accommodation for residents in the main house is provided in shared bedrooms. Gardens to the front and side of the main building are well maintained with access possible for all of the homes residents including those who may require a wheelchair. People should contact the service direct for information on fees charged for residency at the home. Care Homes for Older People Page 5 of 29 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This unannounced inspection took place over two days. A pharmacist inspector undertook an inspection of the medication on the second day. A completed Annual Quality Assurance Assessment (AQAA) was received from the service prior to the inspection detailing information about the care and services provided. Information contained within this document has been included within this report where appropriate. A range of evidence was used to make judgements about this service to include discussions with people using the service, visitors, the registered manager, deputy and Care Homes for Older People Page 6 of 29 staff. We also examined a number of records including care records of people living at the home, staff training, staff recruitment, complaints records and health and safety records. Information was gathered from case tracking two people who live at the home. Case tracking involves discovering individual experiences of living at the home by meeting or observing them, discussing their care with staff, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service We spent some time sitting with people in the lounge watching to see how they were cared for and how they spent their day. A tour of the home was undertaken to view specific areas and establish the layout and decor of the building. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: We consider the home to be performing well and provide positive outcomes for people who use the service. We have not issued any requirements following this visit. We have made some good practice recommendations that the service should consider implementing to improve the well being of people. A robust quality assurance system should be developed to assess staff practice in the Care Homes for Older People Page 8 of 29 safe handling of medicines. Medication avalaible at the end of the four week cycle should be carried over to the new Medicine Admistration Record (MAR) to enable audits to take place to demonstrate that staff are administering the medicines as prescribed. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 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 29 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. Pre admission assessments are completed so people can be assured their needs will be met when they move into the home. Evidence: It was stated in the Annual Quality Assurance Assessment (AQAA) that; A qualified nurse visits all prospective clients in their home or in hospital to conduct a preadmission assessment, which incorporates information from the multidisciplinary team, social worker, nursing, medical, psychiatric assessments and proposed plans of care already in place. We also involve family, friends and significant others in supporting the individuals choice. We establish a persons mental capacity and arrangements for advocacy, should this be required, prior to admission. We looked at the care files of a person who had recently come to live at the home to assess the pre admission process. We found a detailed pre admission assessment had been carried out by the manager. The home has a standard pre admission assessment Care Homes for Older People Page 11 of 29 Evidence: form which covers activities of daily life, which includes personal care, eating and drinking, continence, socialising, communication and spirituality. We also saw that information had been obtained from health and social care professionals before the person moved into the home. A comprehensive pre-admission assessment helps to make sure that the specific care needs of each person are identified and can be used to complete a plan of care. The person confirmed that their relative had visited the home on their behalf and the manager had visited them before they moved in. They told us they were pleased with the care they receive in the home. Care Homes for Older People Page 12 of 29 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 can be confident their health and personal care needs will be met and they are protected by robust medication management. Evidence: The manager told us in the AQAA; Our care plans are person centred and focus on promoting the persons strengths, abilities and choices. We conduct a full range of risk and needs assessments, utilising recognised assessment tools and consult with the service user and their family when completing their plan. People living in the home looked well cared for, their hair had been combed and nails were trimmed and clean. It was evident from our observation that the personal care needs of people are met. The care files of two people identified for case tracking were examined in detail and we partially looked at two other files. Each person had an individual care file. The service uses information gathered during Care Homes for Older People Page 13 of 29 Evidence: the pre-admission process to develop care plans to meet peoples identified needs. Care files were standardised and well organised making it easy to identify the needs of people and how these were to be met by staff. The care plans gave staff information about the actions they needed to take to meet peoples needs. For example, one person identified as having limited mobility had a care plan developed to give staff directions on how to move the person safely, directing staff to use the hoist for all transfers. The hoist to be used with sling size was specified. A care plan was available for another person with some dementia care needs describing how they needed to be supported to maintain their personal hygiene using a combination of physical assistance and prompting to undertake the tasks they could do for themselves to promote their independence. Documentation regarding wound care and dressings was very detailed and provided good information for staff. We saw that risk assessment tools were available on the files to identify whether people are at risk of developing pressure sores or have an increased risk of falls. Care plans were available to minimise identified risks. Making sure that people living in the home have risk assessments completed will give staff the information they need to help people and staff manage the level of risk identified safely. The care file of one person observed to have bedrails in place on their bed contained a risk assessment for their use and documented the decision by the person and staff to use the bedrails in the best interests of the person. This means that staff had given consideration to the best way of maintaining this persons safety. Daily reports completed by staff were detailed and demonstrated how the home were meeting the individuals health and personal care needs. These reports had been signed and dated with the time recorded. Signing, dating and entering the time daily reports were made will help to show the accuracy of care and information provided by staff responsible for ensuring the individual care needs of people in their care have been met. There was evidence that people are seen by external health care professionals such as the GP, dentist, optician and people are assisted to attend hospital appointments. This ensures that people receive specialist advice and that their care needs are met. Care Homes for Older People Page 14 of 29 Evidence: A visitor spoken with told us that they were very happy with the care their relative receives. They told us that their relatives healthcare needs are met and that the home keeps them in touch with important information about their relative. They were very complimentary about the staff and management of the home. Staff had a sensitive, kind and caring attitude towards the people living in the home. Personal care was provided in private, people were spoken to respectfully by staff and addressed by their preferred names. For example, we observed staff giving sensitive explanation and reassurance to a person when they were assisting them to move using a hoist. This should reduce anxiety for this person during intervention. The pharmacist inspection lasted two hours. Five peoples medicines were looked at together with their Medicine Administration Record (MAR) chart and care plans. Two nurses were spoken with and all feedback was given to the manager after the inspection. The medicines were stored in a dedicated medication room which had an air conditioning system installed to maintain the temperature below 25C at all times, to ensure that the medicines were stored correctly. Medicines requiring refrigeration were stored in separate locked refrigerator and the temperature monitored daily. All the medicines for the current cycle were stored in two trolleys, one for the morning round and one for the other times. Medicines dispensed in a box prescribed to administer more than once a day were transferred between trolleys depending on the time. Concern was raised that this may increase the risk of errors if the nursing staff failed to transfer the medicines and did not follow correct procedures to administer the medicines at all times. The staff though were used to the system and understood the correct procedures to administer medicines. The nurses record all the quantities of medicines received into the home on the current MAR chart but did not always carry over balances from previous cycles. This meant that audits were not able to be undertaken to confirm these medicines had been administered as prescribed. The manager was keen to ensure that this was rectified immediately. Audits indicated that the majority of medicines had been administered as prescribed and records reflected practice. A few mistakes were seen mainly because staff had failed to record the correct balances of medicines for that cycle on the MAR chart, or the incorrect code for non administration was recorded. The manager has installed a quality assurance system but this was not refined enough to assess individual nursing staff practice. Again the manager was keen to install a more robust QA system to Care Homes for Older People Page 15 of 29 Evidence: assess individual nursing staff practice. Both nurses spoken with during the inspection had a good understanding of the medicines they administered, enabling them to fully support the people they looked after. The care plans were good and supported the reasons why a medicine had been prescribed or discontinued. Important information was recorded to enable the staff to fully support their clinical needs, for example, if the person and was not able to tell the nurses that they required pain relief, information was available as to how that person expresses if he or she was in pain. Other good practice was seen. Any person prescribed an external cream or ointment had a corresponding body chart with the area marked where it was to be applied and the frequency for staff to easily follow. The manager had also asked the supplying pharmacy to print separate MAR charts for the following month so they could be kept with the creams in the persons bedroom. All controlled drug balances were correct and storage complied with current regulations. Care Homes for Older People Page 16 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident their social needs are met and they are supported to maintain relationships with families and friends. Evidence: People spoken to said that they are able to follow their preferred routines each day. This included times for getting up in the morning, going to bed at night, where they choose to eat their meals and whether they prefer a bath or shower and at what time of day. Activities were discussed with the manager, activity organiser and with a number of people who live at the home. There is a weekly and monthly activity rota displayed in the home. There are a wide range of activities on offer such as painting, craft sessions, gentle exercise, puzzles, walking, bingo, videos, DVDs and manicures. The manager confirmed that external entertainers come in to the home regularly and provide activities such as armchair mobility and musical entertainment. Outside activities are also organised to places chosen by the people living there. For example, a day trip was organised last summer to a local beauty spot for a picnic and a walk around the village. The home has a wishing tree where individual wishes are put and the home will then Care Homes for Older People Page 17 of 29 Evidence: try to help the persons wish to come true. We saw that this is helping people have and achieve individual goals which is another important aspect of care planning within the service. Wishes that we saw include going to a garden centre and meeting a pop star. Some wishes on the tree have turned gold to show that they have been achieved. Activity records are kept. Details are recorded for everyone which shows the activity offered and whether or not they have joined in. The hairdresser was visiting the home on the day of our visit, people spoken with say they enjoy this facility. One person commented, I have always liked to have my hair done weekly, and its lovely that the hairdresser comes here to do it for me. A church service is held once a month which means that people can follow their religious beliefs when they move into the home. There is an open visiting policy, which means that people can see their friends and relatives as they choose and can continue with relationships that are meaningful to them. A relative told us They always make me feel welcome. The home has a four week rotating menu. This showed a choice of hot meal at lunchtime and soup and sandwiches or a lighter hot meal in the evening. People are asked on a daily basis about their choice of food and alternatives are offered. At lunchtime people were sitting in the dining room eating their meal. Staff were seen offering discreet assistance to two people. Everyone appeared to be enjoying their food which was nicely presented and smelt appetising. People told us that they enjoyed meals at the home. Comments included, the food is good, you get a choice, they ask do you want this or do you want that, it is always hot and there is enough, The food is always good, served hot and there is plenty of it. It was evident that people are given a choice of meal on a daily basis and can request alternatives from the menu if they wish. During the day people were seen being offered drinks and biscuits or cakes on a regular basis. We asked people in our surveys what they thought the home does well. Comments received included, pastries and the cook makes excellent cakes. Care Homes for Older People Page 18 of 29 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 can be confident that any complaints or allegations of suspected abuse are taken seriously and managed appropriately. Evidence: Information in the AQAA told us, We promote a culture of openess and honesty and encourage staff to reflect and assess their practice. We train all staff in equality and diversity, whistle blowing, safeguarding, complaints and deprivation of liberty policies and procedures. We have a clear complaints procedure that is displayed in the home and incorporated into our statement of purpose. Service users are given a copy of the complaints procedure on admission to the home as part of their welcome pack in the Service User Guide. Families are also notified about the complaints procedure on admission and a copy of the procedure is displayed on the notice board. The complaints procedure is available in the service users guide which each person has a copy of. This document is also on display on notice boards in the home. People spoken to were aware of their right to complain and commented I have nothing to grumble about and that is no word of a lie, and I would speak up if necessary, but everything is good here. The home maintain a record of all complaints received. We saw that they have recorded one complaint since the last inspection, which was investigated through the Care Homes for Older People Page 19 of 29 Evidence: homes complaints procedure. This complaint was dealt with and fully recorded including the investigation and outcome details. We received an anonymous complaint about this service in September 2009 regarding medication management and negative staff responses to people. During our visit we did not identify any concerns regarding the management of medication and staff interaction. Feedback from people using the service, visitors and staff were all positive. People said, The staff are all so hard working and kind, there isnt a bad one amongst them, Id speak up if there was. A visitor commented, I cant thank the staff enough, they all work so hard. They treat my relative with such love and kindness, I can tell she is content. The home has a safeguarding policy which gave staff good details about what to do if they suspected or witnessed abuse. It also gave local contact numbers so that people would know who to call. In addition to this the home had a Deprivation Of Liberty Safeguards (DoLS) procedure which was detailed and gave staff guidance about when and how they should complete a referral. This policy should guide staff to know how to use this in every day practice when peoples freedom may need to be restricted in their best interest. Two staff members spoken with were aware of what abuse is and of the action to take if she suspected or witnessed abuse. They were both definite that no forms of abuse would be tolerated at the home. Care Homes for Older People Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Quinton House are provided with a clean and homely place to live, which is equipped to meet their individual needs. Evidence: It was stated in the AQAA, We ensure the home is kept clean and odour free. The home has been decorated throughout all communal areas and this is ongoing to maintain it in optimum condition. Bedrooms are decorated and re-carpeted as they become available. Quinton House is a large domestic building that has had some modifications to meet the needs of elderly residents. There is an annexe to the main house, which has been built to provide accommodation for up to eight people on the ground floor and the first floor provides accommodation for staff working in the home. Access to the first floor of the annexe is separate to that of the home, to ensure that visitors to staff living on the premises do not have to enter the home. A tour of the main building was undertaken and the home was found to be clean and tidy with no unpleasant smells. All fixtures and fittings seen were in a good state of repair and decor was well maintained. Bedrooms were light, airy and spacious. There are a large number of shared rooms, each have removable screens, which provide some privacy. We saw that people are able to bring in personal furniture and other Care Homes for Older People Page 21 of 29 Evidence: items to personalise their rooms. Equipment is available to assist residents and staff in the delivery of personal care, which includes assisted baths, and moving and handling equipment for example, hoists. There are en suite facilities provided in the bedrooms in the annexe and walk in shower room/bathroom is provided on the first floor of the main house. Pressure relieving equipment such as cushions and various types of mattress are available for people who have an identified need for them. The laundry was clean and well organised with no backlog of items waiting to be laundered. Commercial washer, and tumble drying facilities are available. An ironing room is also available. Hand wash sinks are in both laundry and in the ironing rooms. These help to reduce the risk of cross infection as does the use of disposable gloves and aprons which were seen in the laundry areas. Care Homes for Older People Page 22 of 29 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. There are sufficient staff who are appropriately trained and recruited to meet peoples needs and keep them safe. Evidence: It was stated in the completed AQAA; Residents needs are met by sufficiently trained staff of various skill mix dictated by the residents requirements, activity staff are also employed to support this. Additional support staff are employed to ensure that care staff are designated for more specific care duties. All staff receive induction and ongoing mandatory training additional workshops and training is given to support individual roles. People spoken with told us that the staff treat them well and that they are happy with the care and support they receive. We observed staff supporting people throughout the day; they did this with respect and were professional at all times. Some of the comments received during the inspection visit and through surveys returned to us include; I wouldnt stay here if I didnt like it. All the staff are kind and willing to help As far as the care is concerned, the home could do nothing better. The staff are first class and excellent with all the residents. Care Homes for Older People Page 23 of 29 Evidence: You need to know how well the residents are cared for. You will not find a more caring home or staff. Staff told us that they are given regular updates about people living at the home during handover on each shift, and supported through updated care plans. Staff we spoke to demonstrated a clear understanding of the peoples needs we case tracked. The manager told us that staffing levels are determined by the current needs of people living at the home, we saw sufficient staff cover during our inspection visit and staff spoken with told us the staff ratio is generally good. Staffing rotas reflected the home is currently staffed to meet the needs of the people currently living at the home. The personnel files of two recently recruited staff members were seen. Each file contained evidence to demonstrate that appropriate pre-employment checks had been completed. A criminal records bureau (CRB) and protection of vulnerable adults (PoVA) check were available and two satisfactory references obtained before they started working in the home. These robust recruitment practices should safeguard people living in the home from the possibility of abuse. Training for the staff is good. We looked at training completed by staff and saw the relevant training certificates on staff files. Training included dementia, moving and handling, infection control, COSHH, protection of vulnerable adults, health and safety, and fire safety. Staff told us that they thought the training at the home is good. The manager stated in the completed AQAA that over 61 of the care staff have obtained a national vocational qualification (NVQ) in care at level 2 or above. This should mean that staff are competent to provide care for people living at Quinton House. The homes induction process, consistent with Skills for Care guidelines, is thorough and conducted over a period of time. Care Homes for Older People Page 24 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager ensures the home is run in a competent manner and in the best interests of people living there. Evidence: The manager, who has applied to be registered with us, is a qualified nurse and has a number of years managment experience in the care sector. The staff receive clear guidance on how to perform their role and there is a clear understanding from staff of what is expected of them. This ensures that people living at the home receive consistent care and support of a good standard. The Annual Quality Assurance Assessment (AQAA) completed by the manager was done to a high standard. A range of information was provided as supporting evidence to tell us about what improvements have been made, any changes and areas that require action to be taken. Quality assurance systems were discussed. We saw that residents and family meetings Care Homes for Older People Page 25 of 29 Evidence: are held every quarter. Minutes are taken of these meetings and any action to be taken to address issues or suggestions raised is recorded. People living at the home, their relatives and visiting professionals are regularly consulted in what they think about the service and any improvements that could be made. We saw evidence of feedback from questionnaires given to people to seek their views and an action plan that addresses areas of development. Feedback was generally very good. We saw a number of thank you cards from people who had contact with the home. A professional commented, excellent nursing staff, who are efficient, caring and very organised. Various audits also take place to try to ensure that staff are working to the policies and procedures of the home. Audits of care plans, room checks, accidents and food are regularly completed. A senior representative of the organisation visits monthly to conduct unannounced inspections of various aspects of the service provision in the home. Our concerns raised at previous inspection visits about the financial arrangements for people have been addressed. The service does not manage monies on behalf of any people. Invoices for any expenditure such as hairdressing, chiropody, toiletries are sent out to families for payment. Staff supervision was discussed with the manager. It was noted that all staff receive supervision on a six weekly basis. The manager said that she walks around the home on a regular basis and also observes staff working practice at this time. The supervision records of the newly employed staff member were reviewed and found to be up to date. Two staff spoken to confirmed that they receive regular supervision and at these meetings they are able to discuss training needs, work practice issues and any other things that affect their work at the home. Regular supervision of staff should help staff to work safely in accordance with the policies and procedures of the home and provide the necessary care to those living at Quinton House. All checks required such as of the fire safety systems; hot water systems, lifting equipment and electricity are in place. People are protected through regular maintenance of systems and equipment. Records seen show that the health and safety of staff and people living at the home is maintained. Care Homes for Older People Page 26 of 29 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 27 of 29 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 9 It is advised that a more robust quality assurance system is installed which would assess individual nursing staff practice in the safe handling of medicines. It is advised that any balances of medicines are carried over to the new MAR chart to enable audits to take place to demonstrate that the nurses administer the medicines as prescribed and records reflect practice. 2 9 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - 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!