Care Home: Raymond House

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What the care home does well People enjoy living at Raymond House; they made positive comments about many aspects of the service and these can be read in individual sections of this report. The service meets people`s individual care needs and supports them with their wishes and needs around the Jewish faith. The home is well managed in the interests of the people who live there. The manager is competent and experienced and well supported by the deputy manager, administrator and social care co-ordinator. There is a wide range of activities in place that are designed to meet people`s wishes and needs. The home makes good use of volunteers and befrienders to support people with activities in the home and in the wider community. The home encourages and promotes the involvement of family and friends. Relatives and visitors are made welcome and are consulted about their relative`s care. The service demonstrates a commitment to providing opportunities for people to express their views, opinions and preferences about how they live their lives and about the service provided. What has improved since the last inspection? Since the last inspection the one statutory requirement and recommendations made in the last report have been met. There has been redecoration and refurbishment throughout the home as part of the ongoing programme of maintenance and redecoration, including some individual bedrooms. The service continues to improve training and staff awareness of the needs of people with dementia. There are now two members of staff who are `dementia champions` to further develop this aspect of the service. What the care home could do better: The providers should continue with the ongoing programme of maintenance and refurbishment to improve the environment of the home. The home has introduced a pattern of twelve hour shifts for care staff. The providers should consider the impact long shifts have on staff and whether tiredness and long hours on duty could have an adverse effect on the standard of care provided. Key inspection report Care homes for older people Name: Address: Raymond House 7-9 Clifton Terrace Southend On Sea Essex SS1 1DT     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: Ray Finney     Date: 1 9 0 8 2 0 0 9 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 32 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 32 Information about the care home Name of care home: Address: Raymond House 7-9 Clifton Terrace Southend On Sea Essex SS1 1DT 01702352956 01702435027 Raymondhouse@jcare.org www.jewishcare.org Jewish Care care home 39 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 dementia old age, not falling within any other category Additional conditions: Care Home only Personal care to be provided to up to thirty-nine (39) older people who have dementia. Dementia, over 65 years of age (DE(E)) Personal care to be provided to up to thirty-nine (39) older people. Old age not falling within any other category (OP) The maximum number to be cared for shall not exceed thirty-nine (39). Date of last inspection Brief description of the care home Raymond House provides care and accommodation for thirty-nine older people some of whom may have dementia. It is owned and managed by Jewish Care. It provides specialised care for people of the Jewish faith and caters for all their cultural, religious and dietary needs. The building consists of four floors. Residents use the first three and each can be Care Homes for Older People Page 4 of 32 Over 65 39 39 0 0 Brief description of the care home accessed by way of a passenger lift. Thirty-seven rooms are single and one double room is used as single occupancy. All the rooms have a wash hand basin. None of the rooms have en-suite facilities. There is a lounge and separate dining room on the ground floor and a lounge/diner on the first floor. Raymond House is a lively, active home with a team of volunteers who support a range of activities. The home has access to three vehicles, which are shared with a nearby day centre, which is also run for people of the Jewish faith. The home is situated on the cliffs overlooking Southend sea front and has a large parking area to the rear of the property. All prospective residents are provided with a Statement of Purpose and Service User Guide that supplies them with up to date information on the home. Fees range from £675.00 to £725.00 and there are additional charges for hairdressing, chiropodist, and personal items such as toiletries. 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: 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 last inspection for this service was carried out on 13th April 2007. A range of evidence was looked at when compiling this report. Documentary evidence was examined, such as care plans, rotas, menus and personnel files. The manager completed an Annual Quality Assurance Assessment, which is required by law to be completed by the service, with information about the home and sent it to us at the Commission when requested. Throughout the report this document will be referred to as the AQAA. A visit to the home took place on 19th August 2009 and included a tour of the premises, discussions with people living in the home and members of staff. Completed surveys were received from people living in the home, members of staff and relatives. Observations of how members of staff interact and communicate with people living in the home have also been taken into account. Care Homes for Older People Page 6 of 32 On the day of the inspection we were given every assistance from the manager and staff team. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 32 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 choosing to move to Raymond House can be confident that the service will be able to meet their needs. Evidence: The manager told us in the AQAA that when prospective clients request information about the home, this has in the past been given out by the homes staff, but we now have a dedicated Jewish Care social link worker, this will be done by him and We are very quick to respond to requests for admission to Raymond House. We aim to assess clients within one week of a request. We have a full assessment process - visiting the client in their own surroundings and them inviting them to attend a guest day, so they may see the home, their prospective room, staff etc. On the day of the inspection a sample of three individual files examined contained comprehensive admission assessments. The range of information included the persons diagnosis or any relevant conditions (both past and present), medication and Care Homes for Older People Page 11 of 32 Evidence: whether self-medicating, hearing, vision, dental care and any other conditions requiring care. There is a comprehensive section on emotional or mental well-being and health, which covers orientation and insight, and spiritual needs covers the individuals personal history, preferences communication, memory, behaviour and mood or anxiety. The section on social, recreational nd needs around personal care, religious and cultural practices, indoor or outdoor activities and social interaction. Each of the sections of the assessment document contained sufficient information to ensure the service could be confident they could meet the persons needs. The assessment has a summary of care needs and preferences. This records what the person likes and what they are able to do for themselves as well as what they dislike or may need help with. This ensures that the persons needs are met in ways that they wish. Records examined confirm that the assessments form the basis of the care plans. Through discussions the manager was able to demonstrate an awareness of the importance of carrying out a thorough assessment. Completed surveys sent to us by people using the service confirmed that they received sufficient information about the service before they moved in so they could decide if it was the right place for them. It is evident that the assessment process is sufficiently thorough to ensure people choosing to move to Raymond House can be assured that the service will be able to meet their needs. 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 choosing to live in Raymond House can be confident their health and personal care needs will be met in the way that they wish. Evidence: The manager told us in the AQAA that one of the things they do well is, Care planning and auditing from assessment to end of life, encompassing social, personal, health and welfare needs. Regularly audited by both care staff and management with the assistance and agreement of the clients or their relatives. Each care plan has guidelines for care planning directing staff in how care plans should be completed. The guidelines state the Life Story should provide a picture of the life of the resident to include family, personal achievements, occupation, war service, significant dates including bereavements and anniversaries, personal likes and dislikes. Staff are directed that the care plan is based on the information gathered during the assessment and should be used daily for planned delivery of care. Records examined confirm that peoples life stories are completed with ample detail Care Homes for Older People Page 13 of 32 Evidence: and it is evident that every person is seen as an individual whose past life, experiences, family, likes etc are still important. The care plans have a description of the need; the goals and the desired outcomes are identified and there are detailed care instructions/plans/steps to take to meet the identified need. The range of care plans examined are tailored to each persons individual needs and circumstances. These include care plans about religious preferences, culture, washing and dressing, diabetes, chiropody, bed rails and social preferences. One of the care plans examined could have contained more detail about the persons preferences around personal care so that staff have sufficient guidance to ensure personal care is being delivered consistently. We discussed this with the manager who explained that they are in the process of reviewing the care planning process and staff are having training in care planning. This was an area that was identified in the organisations quality audit and the manager has acted promptly in taking action to update care plans and ensure that staff have the necessary skills to raise the standard. Overall care plans examined contained relevant information and staff spoken with were able to demonstrate a sound knowledge of peoples individual needs and how these needs are to be met. A relative who completed a survey told us that what the home does well is, they keep my [relative] clean and [their] physical appearance is quite good - nails manicured and hair done and a member of staff stated, provides good all round care for residents. When asked if they receive the care and support they need, a person living in the home who completed a survey told us, always and I couldnt be happier. Especially appreciated because of health reasons and another said, I try to care for myself but help is there if I need it. There is a range of risk assessments in place that describe the persons abilities or activities they take part in, what harm might be incurred whilst performing these activities, what is the likelihood for harm to occur and how can the harm be reduced. Risk assessments examined included falls prevention, bed rails, manual handling and nutrition. The manager and staff spoken with were able to demonstrate how they use risk assessments to help reduce the risks without being restrictive. The care plan guidelines for staff state, Risk Assessments: all residents have the right to make their own decisions, even if we disagree with that decision. The manager told us in the AQAA, Our team leaders are excellent at ensuring the outcomes for residents are met, in close liaison with health care professionals. Individual records examined contained a range of health care information including Care Homes for Older People Page 14 of 32 Evidence: charts for monitoring weight and elimination, details of doctors visits and outpatients appointments including the eye clinic. A healthcare professional who completed a survey told us that what the home does well is, good, caring staff and quick to raise any medical problems. The manager told us in the AQAA, We have implemented medication and care plan audits on a daily, weekly and monthly basis. On the day of the inspection the homes processes around the storage, administration and recording of medication were examined. There is a monitored Dose System (MDS) in place. Medication is stored in a dedicated, air-conditioned room. There are appropriate, secure lockable cupboards, a drugs trolley and a lockable fridge for medication that requires storage under controlled temperatures. Medication such as eye drops that have been opened are marked with the date of opening so that they can be discarded after the appropriate time. Controlled drugs are locked in a controlled drugs cupboard that is suitable for storing medication that requires this enhanced level of secure storage. Medicine Administration Record (MAR) sheets examined were completed appropriately. Controlled drugs are recorded in a book with no loose pages and each entry is signed by two members of staff. The MAR sheets have a photograph of the individual resident on the front to reduce the risk of administering to the wrong person. Through discussions the manager was able to demonstrate that there is a robust system in place to check the homes processes around medication. Records examined confirm there is a nightly audit carried out to ensure stocks of medicines tally with the MAR sheets and this is recorded. The manager also carries out monthly audits. Personnel files examined contained administration of medication capability forms. The person carrying out the audit observes the member of staff and looks at a range of areas to assess their competency in dealing with medication. Areas covered include whether the person has completed formal training, if they have a good understanding of the homes system, are they familiar with the policy, undertakes safe storage, understands guidelines for signing for signing for medication, awareness of importance of reporting errors and has administered medication under supervision. It was evident from our observations that the culture at Raymond House places a high value on treating people with respect and maintaining dignity. Interactions between staff and people living in the home were observed to be friendly, supportive and Care Homes for Older People Page 15 of 32 Evidence: professional. Staff knocked on doors and waited for a response before entering individual rooms. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People choosing to live at Raymond House can experience a lifestyle that they enjoy. Evidence: The manager told us in the AQAA that what the service does well is, Choice for clients in respect of their levels of involvement in the activities on offer, meals and mealtimes, religious observance, social and personal relationships. Each persons care plan contains an individual activities record that identifies what the person likes. There is then a personal timetable for what activities the person takes part in. For one person whose records were examined, these included befriending, bingo, playing Kalooki, sensory room, exercise with beach ball, manicures, chair based activity, chat with staff and relax with quiet music. One persons care plan stated, X has to go to bed in the afternoons on doctors advice. X has a TV in their room and should be offered a choice of having the TV on or background music. Through discussions the social care co-ordinator was able to demonstrate the range of activities and experiences people are offered to enhance their lifestyle and ensure their wishes about how they spend their time are met. She explained that there is a structured activity planner but they will use it flexibly to tailor activities to what people Care Homes for Older People Page 17 of 32 Evidence: want to do. If a planned activity does not appear to be what people want to do they will change it and do something else instead. A relative who completed a survey told us, They try to involve [my relative] in activities. When asked if there are activities arranged by the home that they can take part in, a person living there who completed a survey told us, I could if I wanted to but prefer to read the paper and watch TV. There are a number of befrienders who come in and either take people out or socialise with them in the home. The social care co-ordinator told us that the visits of one befriender with a young child are much enjoyed by the residents, who evidently enjoy seeing the child. On the day of the inspection we observed people going out socially with one of the visiting befrienders. The social care co-ordinator also made links with a local school and the children have visited the home to learn about the Jewish religion and culture. On these visits the residents have also enjoyed singing with the children. Other community activities enjoyed by residents included a pub group, meals out, one person who enjoys visiting a local casino weekly and a fish and chip restaurant where there is entertainment is popular. Some of the residents regularly use the facilities at the local day centre. The social care co-ordinator explained that some of the people in the home like to hold the dementia dolls that are available and they derive comfort from these. We were shown the sensory room where people are able to relax with soothing music, lights and projected images and aromas. People also benefit from aromatherapy hand massages. One person enjoys taking part in housekeeping tasks and is encouraged to continue to do this with the support of staff. We observed the social care co-ordinator talking to one of the residents at lunch time to encourage them to join in the entertainment planned for the afternoon. Throughout the course of the inspection we observed that people living in the home appeared to enjoy the social interaction with both staff and with other residents. A person living in the home who completed a survey told us, Im very content. The manager explained that they have a weekly food forum where people are able to discuss their wishes and preferences around food with the catering staff. Minutes are taken of what is discussed at these meetings and from the records examined it is evident that peoples views are acted upon. The manager also meets on a weekly Care Homes for Older People Page 18 of 32 Evidence: basis with the chef to discuss any issues relating to meals. The manager told us in the AQAA that what they do well is, Autonomy and choice in all areas of the clients life. Encouraging independence. On the day of the inspection we observed staff asking people what they wanted to drink with their lunch. Everyone was being given a choice of what they wanted to eat. The starter was soup or melon and the food was well presented and looked appetising. Rather than just asking people what they wanted, staff were showing them the plates to let them choose which they preferred. The main meal was fish with either chips or mashed potato or vegetable risotto and there was a choice of desserts including ice cream, fruit and jelly. We observed staff offering support where people needed some assistance, such as cutting up food or squeezing the lemon wedges over the fish. People were given the opportunity to do things independently and staff only offered assistance when necessary. Staff were having a chat with people throughout the lunch period and asking them about their day. People spoken with made positive comments about the food and from our observations at lunchtime it was evident that people were enjoying their meal in a relaxed and sociable way. 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. People using the service can be confident that they will be safe and their concerns about how they are treated are listened to and acted upon. Evidence: The manager told us in the AQAA that what they do well is, Recording and dealing with complaints. Safeguarding adults. Safe storage of finances for our residents and improvements in the past year include, Quality assurance. Complaints have been reduced. Compliments have increased. Both percentages for residents and relatives satisfaction in the running of the home have increased. Jewish Care has a robust process in place for dealing with peoples concerns and complaints. The manager explained that all concerns, no matter how minor they may appear, are dealt with in the same way. The complaints log was examined and it is evident that each concern or complaint is treated seriously and dealt with robustly. The issue is recorded and there is a full record of how the issue has been dealt with and of the outcomes. The manager was able to demonstrate a thorough understanding of the importance of taking peoples concerns seriously and acting upon them. Whether the concern or complaint relates to the service provided by the home of something that happens outside, the staff act on the issues raised. On the day of the inspection one person was unhappy about an experience whilst out at the day centre. Care Homes for Older People Page 20 of 32 Evidence: Staff spent considerable time with the individual supporting them with their complaint, recording what happened and discussing with them what they wanted to be supported to do about it. When asked if they know who to speak to if they are not happy a person living in the home who completed a survey told us, I speak to staff but Im content and another stated, there are always staff available if one should need to. The manager and staff spoken with were able to demonstrate a sound awareness of their responsibilities around keeping people safe. Personnel records examined confirm that staff receive training around safeguarding and people have Criminal Record Bureau (CRB) enhanced disclosures carried out before starting to work in the home. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can enjoy living in an environment that suits their lifestyle and which is homely, well maintained and clean. Evidence: The manager told us in the AQAA, The home is accessible by ramp for wheelchair access and zimmer frames. The communal areas are kept clean and tidy, with space allocated for manual handling and wheelchair users. We have aids and adaptations that make life easier for the clients and improvements in the last year include, We have purchased more nursing style beds for both the needs and the comfort of our residents. Decor, carpets, furnishings, snoozelem room. During a tour of the premises we noted that some of the rooms had been re-decorated since the last inspection. The manager explained that the lounges are also to be redecorated soon and the new carpet has been chosen for the main lounge. Peoples individual bedrooms were personalised with their own belongings, pictures, photographs, ornaments and memorabilia. The rooms were decorated to the individuals taste and one person was pleased to show us their newly decorated room and told us they were just waiting for new curtains that were on order. Some people had chosen to have photographs on their bedroom doors; one person had chosen to have a plaque with a musical instrument which reflected their lifelong Care Homes for Older People Page 22 of 32 Evidence: interest and skills in music. Toilets had pictorial signs on the doors to assist people with memory impairment. We discussed with the manager about using memorabilia on bedroom doors as well as or instead of photographs. The manager explained that they had been in the process of doing this recently with a resident but unfortunately that person was no longer with them. We discussed how the use of good, clear, pictorial signage or memory boxes containing items with some meaning for the individual can improve the environment. This can help people who are becoming forgetful because of the aging process or who have a condition causing memory impairment by assisting them to make more sense of their environment. The manager explained that they have two members of staff who are dementia care champions and the service is looking at ways to improve the lifestyle for people with dementia, including improving the environment. Although the structure of the building is old, every effort is being made to reduce the impact of this. The home is clean, well maintained and free from offensive odours throughout, including the kitchen and laundry areas. The manager explained that the organisation has carried out research into modernising the building and upgrading the bedrooms to include en-suite facilities. However, the research indicated that the costs would have been prohibitive and was not economically possible for the organisation. However, they are constantly looking at ways to improve the environment as part of the ongoing programme of maintenance, refurbishment and redecoration. Although the building is quite large and old, there is a homely feeling in the service. This is due, to some extent, to the good interactions we observed between staff and people living in the home. People were socialising, visitors were coming and going throughout the day and there was a real sense of community in the home. This atmosphere made the home feel much more personal and homely than could often be the case in a building of this size and age. When asked if the home is fresh and clean, a person living in the home who completed a survey told us, Spotless. The highest standard possible. 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 living in the home can be confident they are cared for by a competent staff team who can meet their needs. Evidence: The manager told us in the AQAA that what they do well includes, Staffing ratios - at least 1:4 for dementia clients and 1:6 for all others. Staff qualified to NVQ standards 2, 3 and 4. Training and development. On the day of the inspection we noted that peoples needs were seen to be attended to promptly by the staff on duty. The manager explained that staff have guidelines that ensure call bells are answered within four minutes. This is checked through a print out from the call alarm system which is audited by the manager. If there are any instances where people may have to wait longer than the four minutes, this is highlighted and the manager will discuss with staff to find out why it happened and identify if there are problems that need to be addressed or whether the circumstances were unavoidable. A member of staff who completed a survey told us, Staff retention is good. Staff get to know residents and offer a person centred service on the whole. Agency staff tend to be long term and have become a part of the team and know the residents as well as regular staff. Care Homes for Older People Page 24 of 32 Evidence: There are six care staff on duty during the day and four care staff at night. The manager explained that the organisation has introduced a new shift pattern that consists of two twelve hour shifts, a day shift from 8 a.m. to 8 p.m. and a night shift from 8 p.m. to 8 a.m. She acknowledged that twelve hour shifts can be tiring and they have tried to minimise the effect of this by planning the rotas carefully. The management team ensure that staff are not rostered on for more than three twelve hour shifts without having a day off. They have also rostered one person on a basis of one day on and one day off because that is a better option for the member of staff. Whilst we recognise that this is a corporate decision made by Jewish Care, some consideration should be given to the possible adverse effects of staff tiredness on the quality of care if this pattern of long shifts is sustained over a long period. A member of staff who completed a survey told us,In my opinion residents have not had as good a service since 12 hour shifts began. Carers become tired and do not work as well. Through discussions the manager demonstrated that the organisation has a strong commitment to supporting staff to achieve National Vocational Qualifications (NVQ). At least 11 out of 15 permanent care staff have already attained the award and the rest are currently working towards it. Some staff, including the deputy manager are working towards NVQ level 4. A sample of three personnel files were examined and all were found to be well organised. The administrator was in the process of updating all staff files. Each file had a comprehensive checklist on the front and all the relevant documentation as required by regulation, including a photograph of the member of staff, relevant proofs of identity, health questionnaires and appropriate references. Staff training records confirm that the service provides a range of relevant training for staff. Recent training includes medication administration, record keeping and storage, first aid, understanding respiratory conditions, moving and handling, age matters, dementia care awareness, fire training, Deprivation of Liberty Safeguards (DOLS), oral health awareness, bone health and falls prevention. Two members of staff are dementia care champions. The manager has achieved a Train the Trainer qualification in Safeguarding Vulnerable Adults and she rolls out safeguarding training to the staff team. A member of staff who completed a survey told us, I am Dementia Champion for the home and have regular training regarding dementia and another stated, have Care Homes for Older People Page 25 of 32 Evidence: regular dementia training and another stated, as a part of Jewish Care training is excellent. Care Homes for Older People Page 26 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is appropriately managed in the best interests of people living there. Evidence: The manager told us in the AQAA, The manager is fully qualified to run the home and continues to develop herself personally and professionally. As reported at the last inspection of the service, the manager has appropriate skills and qualifications to manage the home. Through discussions the manager was able to demonstrate that she continues to update her knowledge with ongoing training, including recent training around the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DOLS). The day-to-day management of the home is carried out by a well structured team, each with their areas of responsibility. The registered manager is ably supported by the deputy manager, administrator and social care coordinator. The manager further told us in the AQAA, The management work to a cycle of Care Homes for Older People Page 27 of 32 Evidence: improvement using the cycle of idea, implementation, monitoring and review for all ideas and practices within the home and in the past year, we have improved the way in which we communicate with the residents in offering one to one sessions instead of large resident forums. It was also previously reported that the organisation developed positive quality assurance procedures for the home that involved residents, relatives and other stakeholders. There was ample evidence at this inspection that the process has been further developed and is now very robust. As part of the quality assurance process staff and residents are asked to complete questionnaires yearly and relatives twice a year. The information from these questionnaires are collated and an action plan is developed. Records examined confirm that people living in the home have opportunities to make their wishes known through weekly meetings with the manager and also in the regular food forum. We observed people being consulted on a one-to-one basis about their wishes. The organisation uses a range of audit tools to assess the service and make improvements. They carry out a Care Plan Audit that looks at 35 separate areas, including a range of evidence to confirm that peoples wishes are being taken into consideration. These include Staff have established how the resident wishes to be addressed and this is clearly recorded, The residents preferences regarding the gender of those who provide them with personal care is clearly recorded, There is evidence such as life history, listening form etc that shows the resident and/or relative have been included in putting together the care plan, Social and cultural/religious preferences are recorded in detail and there is evidence that these are being addressed and met, There is evidence that residents exercise choice in issues relating to care and daily life and Daily reports are legible, free of jargon or judgemental labelling. These processes for seeking the opinions and wishes of people living in the home and relatives, and acting on this information, confirm that the home is managed in the best interests of people using the service. People are supported appropriately to manage their finances. Records of expenditure are recorded and receipts of all monies spent are kept. People living in the home pay for services such as hairdressing, chiropody or dry cleaning and for personal purchases such as toiletries and newspapers. The manager explained that they do not directly manage peoples finances, only supporting people with personal spending Care Homes for Older People Page 28 of 32 Evidence: money. In the main, peoples finances are managed by their families and where there is no family input the local authority apply to the Court of Protection and an appointee is put in place. Health and Safety information was available for inspection and documents examined were all found to be in order. It was evident from a tour of the home that the premises are maintained to a standard that ensures people are safeguarded. We observed that staff followed good practices around hand washing and use of personal protective equipment to ensure good infection control. Care Homes for Older People Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 27 The service should consider whether the implementation of twelve hour shifts for staff could have a detrimental effect on the quality of care delivered to people living in the home. Care Homes for Older People Page 31 of 32 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). 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