Care Home: Rayners Residential Care Home

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What the care home does well Prospective users of the service are provided with a comprehensive and informative package of information. The assessment of the needs of prospective users of the service is of a good standard and aims to ensure that the home can meet the person`s needs. People living in the home have access to a varied range of activities and are well supported in maintaining contact with family, friends and the local community. Meals are of a particularly good standard and menu planning is informed by specialist advice on the nutritional requirement of older people in residential care homes. Care and support is provided by a well trained and well supported team of staff. The quality of the service is monitored by managers through day to day encounters with residents, relatives and staff, observation of activity, and an annual service user survey. The standard of the material environment is good. Standards of hygiene are good and the home is well maintained. The home maintains high standards of practice in areas where food is prepared. While conducting this inspection we received many positive comments on the quality of the service from people living in the home, a relative, health and social care professionals, and from staff. What has improved since the last inspection? Fire Safety. The home has made improvements to the safety of fire doors. This work was completed a year in advance of the date specified by the fire authority. Service User survey. The home continues to carry out its own annual survey of service users. The results of the 2009 survey showed high levels of satisfaction with the service and in many areas a significant improvement over 2008. This inspection was carried out before the 2010 survey was carried out. Nutritional advice. The home has obtained the advice of a nutritionist on good practice in meeting the nutrition needs of older people in care homes. It has taken account of this advice in drawing up its menus. The nutritionist`s report includes a list of useful references for staff to sources of expert advice on current good practice in meeting the nutritional needs of older people. Gold Hygiene award. The home has been awarded a `Gold Award` by Chiltern District Council for good standards of practice in areas of food preparation. New tables have been bought for the dining areas. This provides seating for four people at each table and is aimed at creating a more comfortable `restaurant feel` to dining in the home. The home has continued to make improvements to the environment and the garden, thus maintaining good standards across all areas of the home. What the care home could do better: This inspection report includes just one requirement relating to the maintenance of information on staff recruited to the home. The home has failed to fully meet the particular standard on this occasion. We have not, however, allowed that single requirement to affect the otherwise excellent rating of this home. There are a number of other matters which managers are asked to address. Managers should review and update documents to avoid inadvertentedly misleading current and prospective residents with regard to the position of CQC on complaints. Managers should review clause 24 of the Terms of Residence which appear to impinge on a person`s right to refuse a medicine if they wish. Managers should ensure that handwritten entries on medicines administration records are signed and dated. Managers are advised to review the rating scale on the home`s own annual survey form to allow for a more even spread of responses. Key inspection report Care homes for older people Name: Address: Rayners Residential Care Home Weedon Hill Hyde Heath Amersham Buckinghamshire HP6 5RH     The quality rating for this care home is:   three star excellent 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: Mike Murphy     Date: 2 0 0 1 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 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Rayners Residential Care Home Weedon Hill Hyde Heath Amersham Buckinghamshire HP6 5RH 01494773606 01494793529 chris@careatrayners.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Rayners (Extra Care Home) Limited Name of registered manager (if applicable) Mr Christopher James Matthews Type of registration: Number of places registered: care home 45 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 to be accommodated is 45. The registered person may provide the following category/ies of service only: Care home only - (PC) 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) Dementia (DE) Date of last inspection Brief description of the care home Rayners Extra Care home is family owned and managed. The home was purpose built in 1990 for the care of older people in Buckinghamshire. The home is situated in Hyde Heath, a Chiltern Village two miles from Amersham. The local amenities include a Care Homes for Older People Page 4 of 32 Over 65 0 0 0 0 Brief description of the care home village store, public house and an attractive green. Access to the local town would be via the homes minibus. The home is registered for the care of forty-four older persons, not falling into any other category. The home has forty-four spacious single bedrooms a large percentage of which have en-suite facilities. All bedrooms have a hand washbasin and are in close proximity to toilet and bathing facilities. The second floor of the home is accessible via a five-person passenger lift. Communal space consists of a large lounge and dining area, which are both set in a homely and attractive fashion. A large glazed area opens out onto the terrace and landscaped gardens. The front entrance of the home is welcoming and contains a small-seated area for the use of visitors. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We carried out this inspection in January 2010. The inspection included an unannounced visit to the home on Wednesday 20 January 2010. The inspection included examination of care plans and other documents relating to the care of people living in the home (residents), discussion with residents and staff, observation of practice, inspection of some areas of the home, discussion with the Registered Managers, examination of documents (such as the homes Statement of Purpose, Service Users Guide, contract, information for prospective residents), examination of personnel files, and consideration of information submitted in advance of the inspection by the managers in the form of its Annual Quality Assurance Assessment (AQAA). We carried out a survey for this inspection. We received completed survey forms from staff, relatives and health and social care professionals.The results have been taken Care Homes for Older People Page 6 of 32 into account in this report. We have also taken account of the homes own annual survey carried in 2009. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? Fire Safety. The home has made improvements to the safety of fire doors. This work was completed a year in advance of the date specified by the fire authority. Service User survey. The home continues to carry out its own annual survey of service users. The results of the 2009 survey showed high levels of satisfaction with the service and in many areas a significant improvement over 2008. This inspection was carried out before the 2010 survey was carried out. Nutritional advice. The home has obtained the advice of a nutritionist on good practice in meeting the nutrition needs of older people in care homes. It has taken account of this advice in drawing up its menus. The nutritionists report includes a list of useful references for staff to sources of expert advice on current good practice in meeting the nutritional needs of older people. Gold Hygiene award. The home has been awarded a Gold Award by Chiltern District Council for good standards of practice in areas of food preparation. New tables have been bought for the dining areas. This provides seating for four people at each table and is aimed at creating a more comfortable restaurant feel to dining in the home. Care Homes for Older People Page 8 of 32 The home has continued to make improvements to the environment and the garden, thus maintaining good standards across all areas of the home. 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. 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. The home provides prospective users of the service with comprehensive information. Its arrangements for assessing the needs of prospective users are good and aim to ensure that it will be able to meet the needs of a person should they accept the offer of a place. The detail of some aspects of the Statement of Purpose require amending to avoid misleading current and potential users of the service. Evidence: The home has a Statement of Purpose and Service Users Guide. The contents of the Statement of Purpose include a concise statement of the homes aims and objectives. It goes on to give a comprehensive outline of the rights of residents - i.e. entitlement to privacy, dignity, independence, security, fire safety, civil rights, choice, and fulfilment. Care Homes for Older People Page 11 of 32 Evidence: It details the homes aim to provide quality care - choice of home, health and personal care, daily life and social activities, complaints and protection, and a good quality environment. It includes details of management and staffing and finally a summary of what it describes as The Underpinning Elements. The document is comprehensive, informative, thoughtfully written and well presented. The Service Users Guide includes the aims and objectives statement, a summary of the Statement of Purpose, a Contract of Admission, a summary of the complaints procedure, and extracts of feedback from residents, relatives and representatives. We have three observations to make on this document. First, the document does not include all of the information required in a Service Users Guide by the National Minimum Standards - however, if read in conjunction with the Statement of Purpose that information is provided. Second, paragraph 24 of the contract includes the statement The resident agrees to the administering of prescribed drugs and medication and undertakes to take all prescribed medication. This should be modified. Everyone has a right to refuse medication. Third, the section on complaints includes the statement If the complaint cannot be satisfactorily resolved within Rayners it will be referred to the Care Quality Commission. A person living in a care home may refer their complaint to CQC at any time. We do not normally investigate complaints in care homes. We do however, take a view on how managers handle complaints, in particular on whether they have conformed to the relevant regulations and standards. People enquiring of a place in the home are provided with an informative illustrated brochure which summarises the service offered by the home and the fee structure. The majority of residents fund their own care (wholly or in part). The brochure pack also includes an informative guide on financing a place in the home. A prospective resident or a person acting on their behalf is provided with information on the home at the point of enquiry. If they wish to progress the enquiry then they will be invited to visit the home, view its facilities and meet managers and staff. On conclusion of the visit the person is given a checklist - Does Rayners tick all the boxes? - in part a useful information document written in question and answer form, and in part a checklist with seven or so questions for the person to consider and to assist them in their decision. If the person wishes the matter to move forward then arrangements are made for an Care Homes for Older People Page 12 of 32 Evidence: assessment of the persons needs to be carried out by one of the managers or the deputy manager. Consideration of the outcome of the assessment may lead to an offer of a place. A Resident Enquiry Form includes details of the enquiry, a summary of the persons requirements, a summary care needs assessment, brief medical history and other information. Examination of some care plans of people who had taken up residence in the home since the last inspection showed very good standards of practice in pre-admission assessment of needs. The enquiry and assessment process is designed to ensure that the home is able to meet the persons needs. Through its resources, the skills of its staff, and liaison with community health services where required, the home endeavours to meet the needs of residents. There is an initial month or sos trial period to enable both parties to decide if they have made the right decision. We were informed that most people settle down after a month or two. The home does not offer intermediate care therefore standard 6 does not apply. Care Homes for Older People Page 13 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes arrangements for planning and providing care are good and ensure that the assessed care needs of people living in the home are met. The privacy and dignity of people living in the home is respected and maintained. Evidence: All residents have a care plan. The care plans examined during the course of our visit were generally considered to be comprehensive, in good order and relevant to meeting the needs of the person. Care plans were noted to include a photograph of the person, a good assessment of needs, risk assessments, a care plan to meet assessed needs, evidence of liaison with community health services, daily summary notes, and periodic reviews of care needs and progress. Care plans specified the support required by the person. This included the support needed with morning and evening activities (where required) and night care, as well as that required for specific problems such as pressure area care where a particular Care Homes for Older People Page 14 of 32 Evidence: risk was identified. It is felt that the use of some terms in care plans would benefit from elaboration if the needs of the person are to be effectively met by care staff. For example the terms confusion or confused were noted in one care plan without more specific information on the nature of the confusion, in what circumstances it was observed to get worse, or to get better. In one care plan the term expressive dysphasia (a condition where a person experiences difficulty in forming words or sentences) was used. It is felt that some specific guidance notes on the care of people experiencing such a condition would contribute towards a shared understanding of the condition among care staff. Care plans included a brief life history of the person and notes of the persons interests or hobbies. Risk assessments covered such matters ( among others), as moving and handling, walking to the village, the use of a residents own furniture in their room, the potential hazard of the fish pond in the garden, walking around the grounds unaided, risks associated with the windows (although windows have safety catches to prevent them opening to an unsafe extent), residents accidentely finding themselves locked in their room, and risks associated with alcohol consumption (where relevant). While the risk assessments are comprehensive and relevant, it was noted that in many cases they were undated. This would make it difficult to assess when the baseline risk assessment was made and to measure progress in terms of a change in the level of risk over time. Care plans are usually reviewed and updated monthly Care plans included evidence of liaison with health professionals in the community and a record is made of the date of all such contacts. Residents are registered with a number of GPs in the area. The majority of residents are from the area and have retained their own GP. District nurses are accessed through the relevant GP. A chiropodist visits the home on a regular basis. The services of an optician are obtained either through an appointment with a local optician or with a visiting optician. A similar arrangement exists for a dentist - either by appointment at the surgery or through a visiting dentist. A physiotherapist runs an exercise session weekly but can also see individual residents by appointment on a private basis. Specialist mental health services for people with dementia are accessed through a specialist social worker. Care Homes for Older People Page 15 of 32 Evidence: Medicines are prescribed by the residents GP and are dispensed by a local pharmacy. Where possible, most routine medicines are dispensed in individual cassette boxes. Around the time of this inspection the home was planning to change to a monitored dosage system using blister packs. The deputy matron has a lead delegated responsibility for practice in the home. Staff practice is governed by the homes own policy which was last reviewed in April 2008. Around 10 - 15 experienced staff are responsible for the administration. At a minimum all have attended a one day training course run by Boots chemists plus update training. Arrangements for the storage of medicines appear satisfactory. Medicines are stored in portable trolleys. Controlled medicines are stored in a metal cabinet. There are two medicines refrigerators. On occasions approved staff need to transcribe prescriptions onto a medicines administration record (MAR sheet). It was noted that some such records were not signed (preferably by two staff) and dated. Otherwise, the medicine administration records examined during the course of our visit to the home were in good order. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home maintain contact with family and friends and with the local community. Staff provide support as necessary. People enjoy a varied range of activities. People living in the home enjoy good quality food and can be assured that the menus are based on sound nutritional advice. Evidence: The home is conveniently located for the amenities of the village. It is within walking distance of the a local shop, pub and other amenities and for village events such as a summer fete. The village is roughly two and a half miles from Chesham and Amersham for rail, underground and bus conections. Great Missenden is a mile or so further away. Most residents have local connections, having either lived in the area or moved there to be close to their families. The homes Statement of Purpose states that it aims .....to provide a lifestyle for residents, which satisfy their social, cultural, religious and recreational interests and Care Homes for Older People Page 17 of 32 Evidence: needs. The results of the January 2009 Residents Quality Control Questionnaire reported 80 satisfaction with Activities and Events in the home. This was reported to be a significant increase over the results of the 2008 survey. Residents are free to pursue their own interests and are not obliged to participate in organised activities. This was evident over the course of the day of our visit. Some residents seemed happy reading, chatting or just observing life in the home, while others participated in an exercise class and a quiz during the afternoon. A number received visitors. For those who wish to pursue their religion the home is in contact with Church of England, Free Church, Baptist, and Roman Catholic ministers. An experienced care worker has a lead responsibilty for organising care activities. The home produces a monthly newsletter which includes a list of activities or events for the coming month. Activities and events for the day are also displayed on a large TV screen near the reception desk. The activities for January 2009 included Sing-a-longs, armchair exercises, a musical entertainer, DVD films, quizzes, board games, bingo, hand massage and manicure, and a visit from the mobile library. the diary for the month also included dates and times of religious functions. Residents seemed very happy with the pace of life and ambience of the home. Two residents described it as Wonderful, they said that no one bothered you if you wanted to be left alone but at the same time there was always someone to talk to. Staff respected the choices of residents. A relative respondent to our survey wrote I cannot fault Rayners care Home at all. It is clean, bright and airy and a wonderful friendly atmosphere. Relatives are always made to feel welcome. The food is excellent and help with feeding is readily given to those residents unable to feed themselves. A great sense of fun from the carers and entainment is good. Residents and a relative commented on the good quality of the food. Lunch was taken with residents on the day of our visit. The quality of the meal was very good and those with whom we shared a table told us that that was typical of the food in the home. Staff were available to provide support as required. Menus are based on a four week cycle with changes every three months. The chef told Care Homes for Older People Page 18 of 32 Evidence: us that the home uses local suppliers as much as possible. Breakfast is Continental with porridge and cereals as required. Lunch, served around 12:30 pm is a two course meal consisting of a main course and dessert. In keeping with tradition a fish dish is on the menus on Fridays and a roast meat based dish on Sundays. Fish, such as Salmon fillet, is also served on one other day of the week. Supper, served around 5:30 pm, is a three course meal consisting of soup, a main course (lighter than lunch) and dessert or cheese and biscuits. Coffee or tea is served mid morning and mid afternoon. Coffee, tea and biscuits is served around 7:30 pm. Pureed meals are prepared as required. In November 2009 the home sought the opinion and advice of a nutritionist on its menus. The results were summarised in a report presented to the managers (A nutritional review of food served to older people in residential care (4 week menu cycle) at Rayners Residential Care Home...... A copy of the report was made available to this inspection. The author concluded It appears that these menus do meet the food-based guidelines outlined by the FSA (Food Standards Agency) in the 2007 report for residential care homes and Caterers at Rayners should be commended for providing so many homemade choices, and therefore are creating fantastic opportunity to include the healthiest types of ingredients within the meals. The main body of the report compares practice at the care home with FSA guidance. The report includes a list of useful references on meeting the nutritional needs of older people. This is an excellent initiative on the part of the home and it is good to see this important guidance being applied in practice. The views of residents on the food are sought through a comment sheet two or three times a week. 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. Managers are responsive to any concerns or complaints by people living in the home. The detail of some aspects of the written complaints procedure requires amending. Arrangements for safeguarding the interests and well-being of people living in the home are good. Evidence: A summary of the complaints procedure is included in the Service Users Guide. This is a straightforward account of the process. It includes timescales for responding to written complaints i.e. acknowledgement of the complaint within two days and an aim to complete the investigation and notify the complainant of the outcome within 28 days. While we have no reason to doubt that the home would not treat all complaints seriously - as it states in its complaints notice - the current distinction between oral and written complaints would merit review. Some people may be reluctant to put a complaint in writing. Others may be unable to because of a disability or because English may not be their first language. The fact that a complaint is not in writing should not detract from its significance and the response should be proportionate to the nature of the complaint rather than the means through which it is communicated to managers. Care Homes for Older People Page 20 of 32 Evidence: A complainant may refer a complaint to CQC at any stage (Standard 16.4) and not only when the home and the complainant have failed to resolve the matter as stated in the homes current procedure. We do not normally investigate complaints. We do however, take a view on how a care provider has investigated a complaint and in particular on whether the provider is meeting the relevant standards and regulations. Contact details for CQC will need to be updated when the document is revised. The home has not received any complaints during the 12 months prior to this inspection. The manager told us that the four weekly care reviews provides a regular opportunity for residents to raise any concerns. These can then be dealt with quickly. We have not received any complaints about this home during this period. Residents names are included in the electoral register. In the past most have decided to make a postal vote. If a resident wishes to vote then the village hall, a short walk away, is the nearest polling station. The home has its own policy on safeguarding vulnerable adults. This was revised in April 2008. A copy of the current Buckinghamshire Joint agency policy on safeguarding adults was also available in the office. Staff are informed of the homes policy and practice on safeguarding at induction. Further training is provided through the local cluster group training programme which the home particpates in with other care homes in the area. There have not been any safeguarding referrals from this home since the last inspection. The home does not manage monies on behalf of residents. There are lockable facilities in all residents rooms. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides the people living there with a pleasant, clean, safe and well maintained environment. Evidence: The home is located in the centre of Hyde Heath village. There are limited public transport connections to the village. The nearest rail stations are in Chesham, Amersham and Great Missenden. There is limited car parking in the grounds of the home plus parking in nearby streets. The home was purpose built in 1990 with an extension added in 1994. The Statement of Purpose includes comment on the environment and broad indicators of the standards the owners wish to maintain. The accommodation is over two floors connected by stairs and a passenger lift. There are 44 single rooms, 27 of which have en-suite facilities. All communal areas are accessible to a person in a wheel chair. The entrance hall leads to an open reception area. There is a large lounge and dining area. A corridor on the ground floor leads to offices, the kitchen, laundry ,and staff WCs and changing rooms. There is also a hair salon on the ground floor. Bedrooms are located on the ground and first floors. There are four assisted bathrooms equipped to support residents who require assistance with bathing. All bedrooms have a telephone and television point. All bedrooms and WCs have a staff call alarm. Care Homes for Older People Page 22 of 32 Evidence: There is limited car parking to the front of the home. There is a pleasant landscaped garden to the rear. The garden includes a small fenced pond. Care plans were noted to include risk assessments with regard to the pond. Standards of decor throughout the home are good. We were informed that a redecoration programme of all lounge and dining areas, corridors, bathrooms and communal areas was carried out in 2008. All areas seen on the day of our visit were tidy and clean. Standards of maintenance are good. All food areas were inspected by Environmental Health Officers from Chiltern district Council in May 2009. No action was required as a result of the visit and the home was awarded a Gold certificate under the Food Safety Award scheme, denoting excellence in all aspects of food preparation. The managers informed us that this is the sixth year in succession in which the home has achieved a Gold award. A very good achievement. The home was last inspected by the Fire Authority in June 2008. All aspects of fire safety were considered to be satisfactory. A fire safety requirement made at an earlier inspection, to be completed by September 2009, was completed one year in advance of this date. 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 are cared for by sufficient numbers of well trained and well supported staff. The detail of some aspects of staff recruitment processes need management attention to ensure that good standards of practice are maintained. Evidence: At the time of this inspection the staffing consisted of the following. 7:00 am - 2:00 pm - 7 care staff and 4 room service assistants. 2:00 pm - 8:00 pm - 3 care staff and 2 room service assistants. 8:00 pm to Midnight - 3 care staff. Midnight to 7:00 am - 2 care staff. A Deputy Matron/Head of Care is duty between 8:00 am and 4:00 pm. A manager (Registered Manager or Deputy Manager) is on duty between 8:30 am and 6:00 pm. A manager is on call at all times. In addition there is a Chef Manager, Catering Assistant, Kitchen assistant, and domestic assistants. Staff respondents to the survey we carried out for this inspection told us that there was Usually enough staff to meet the individual needs of residents. According to information provided by the registered managers in the AQAA 23 of 28 permanent staff have acquired NVQ qualifications in care at level 2 or above. All staff undertake NVQ training at Amersham College. Care Homes for Older People Page 24 of 32 Evidence: All staff are recruited locally and the service reports no problems in recruiting care staff. Four personnel files were examined on this inspection. In all cases an application form had been completed, two references obtained, an Enhanced CRB Disclosure or ISA Adult First check (where appointed in advance of the full disclosure) obtained, and the applicants fitness for the post been checked. Not all files had a recent photograph of the person. A photograph is preferable to a photocopy because it is less likely to be affected by technical problems. In one case only the years of previous employment had been supplied on the application form. It is not suggested that there was anything untoward here but requiring applicants to supply both the date and the month of previous employment (wherever possible) would facilitate checks on previous employment. This is particularly important where that employment has been in the care sector. In one case the CRB Disclosure had inadvertently been shredded. A record of the date, level and disclosure number was available. CRB Disclosures in registered services should be retained until the first inspection. New staff are required to complete staff induction and foundation training within three months of appointment. A copy of the programme was supplied to this inspection. As well as orientation to the home, company policies and procedures and staff terms and conditions, the programme also covers matters relating to the personal care of residents, moving and handling, responding to challenging behaviour, fire safety, infection control, health and safety, and abuse awareness (now Safeguarding Adults). There is an assessment process on completion. Ongoing staff training for care staff includes Moving and handling, Health and Safety, Food Hygiene, First Aid, Fire Awareness, Medication, Safeguarding Vulnerable Adults (SOVA) and Infection Control. Staff training is in part carried out through a local care home cluster group arrangement but also through an independent training company and take up of training opportunities offered by the Primary Care Trust (PCT) and Buckinghamshire County Council. The Head of Care is a Registered General Nurse (RGN) and a moving and handling trainer. Staff supervision was currently taking place quarterly. Group supervision meetings on Care Homes for Older People Page 25 of 32 Evidence: specific topics were held at other times. A regular programme of staff meetings was due to be established. An annual appraisal for each member of care staff was scheduled for to take place over the first quarter of 2010. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This is a well managed service which has a clear focus on maintaining good standards in the care and support it provides to people living in the home. The overall quality of the service ensures that the home is run in the interests of the people living there. Evidence: The home has two registered managers. Both are members of the family which own the business and have managed the home since it opened 20 years ago. Both are very experienced. One is a Registered General Nurse (RGN). The other holds the Registered Managers Award (RMA). The registered managers maintain their skills through their involvement in day to day care in the home, by participating in the local care cluster group, and by attending training events with staff. The managers maintain a positive and open ethos in the home. Comments by residents, a relative, staff, and by social or healthcare professionals reflect this e.g.: Care Homes for Older People Page 27 of 32 Evidence: Relatives are always made to feel welcome; This is a wonderful place, they really do care; ....(staff) work well together and senior management are on hand and very supportive; and, ...all residents are treated with dignity and respect. The quality of the service is monitored on day to day basis by managers and senior staff walking around the home and their informal encounters with residents, relatives and staff. On a more formal basis the home carries out a survey of residents once a year. A copy of a summary of the results of the February 2009 survey was made available to this inspection. This included reference to the results of the survey carried out in February 2008. The next survey is scheduled for February 2010. The summary report lists the area of assessment, the results of the survey on a four point rating scale ( Excellent, Very Good, Good and Poor), residents and relatives comments, and a management action plan for each section. The results show an improvement in all areas since 2008 with an overall satisfaction rate (Excellent and Good scores combined) in 2009 of 97 . The inclusion of a category between Poor and Good (such as satisfactory or adequate) would provide a more even spread of responses. This need not involve a change in the four point scale of the questionnaire. The results of a survey we carried out for this inspection were also positive. A relative wrote I cannot fault Rayners Care Home at all. Health or Social Care professionals were also positive. Responses to the question What does the service do well? included: Communication;Provides consistent high quality care....resident have the opportunity to participate in social activities and recreational exercise. All staff are approachable; Efficient, kind and polite. Clean and tidy; I have no complaints whatsoever. The home is clean, well managed and well staffed; A very caring team with good communication communication skills; and All the residents seem to be very well looked after and there is a real feeling of caring for the residents.....There is a lovely feeling of space at rayners. the place is kept clean. The garden is lovely. Money is spent to keep the grounds and house in good condition. Staff responses were also positive. In terms of what the home does well, staff reported: Care for each resident according to their needs. Provide all staff with up to date training. Make sure the residents have activities. Good variety and quality of food;Staff training/Support/Induction...Good catering/laundry and domestic services..;Activities. Support Individual needs. Support staff. Good training..... Other Care Homes for Older People Page 28 of 32 Evidence: responses from staff echoed these thoughts. Residents either manage their own money or make arrangements with their families or other representative. The home does not manage money on behalf of residents. All rooms have a lockable facility where required. Arrangements for safe working practices and for maintaining a safe environment are good. The staff induction and training programme include training on health and safety matters. The home was inspected by the fire service in 2008 and no requirements were made. The homes food preparation areas were inspected by environmental health officers in 2009. All was found to be in order and the home was awarded a Gold certificate for its standards of practice. Contracts are in place for the maintenance of fire safety equipment, lifts, hoists and the staff call system. Contracts are in place for the maintenance of the homes electrical circuits, portable electrical equipment and gas appliances. 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 1 29 19 The Registered Persons must 25/05/2010 ensure that staff records include the information required under Schedule 2. To provide evidence of conformance to the regulations governing the appointment of staff. 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 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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