Care Home: Risedale At Aldingham Nursing Home

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What the care home does well Risedale at Aldingham has been judged as providing people with an excellent service. People told us the home was friendly and welcoming. We saw that there was good information about the service. The admission process was thorough and helped people to know if the home would be suitable for them, and helped them settle in quickly. The planning and delivery of personal care was very good, with people being consulted about their wishes and choices. People told us they experienced high levels of satisfaction with the care provided. There were good health care arrangements in place and people were able to access the health care they needed. Staff were highly trained and the registered nurses held specialist clinical skills in areas such as wound care, nutrition and end of life care. Medicines were managed safely and people received the medication they needed to maintain their health. People told us staff respected their privacy and dignity, treated them with respect and enabled them to make choices about their daily lives. We saw the routines of the home were flexible to accommodate peoples` individual needs and wishes. Staffing levels were good and staff were well trained and supported to their jobs well. There was a dedicated activity organiser who provided a good variety of social activities and recreation, both in and outside of the home. Activities were planned in consultation with people and took into account their religious and cultural needs. There was a strong emphasis on individual attention for those people who preferred or needed to stay in bed. People told us they were very happy with the choice and quality of meals provided, and we saw that special dietary needs were catered for. Peoples` weight was monitored and staff were alert to ensure that everyone got enough to eat and drink. The home receives very few complaints, but we have seen when concerns are raised, management listen and take prompt action to put things right for people. The home was clean, fresh and comfortable throughout, and people were happy with the environment. The home was well maintained with a regular programme of decorating and renewal of furniture and equipment. Infection control arrangements were good and people were pleased with the laundry service. Overall management of the service was robust, they listened to people and protected their health, safety and welfare. There was clear leadership and strategic forward planning to ensure the quality of the service is maintained. What has improved since the last inspection? Since the last inspection the Risedale group have employed the services of an occupational therapist to support the activity organiser. This has enabled the activity organiser to extend her skills and knowledge and she has since completed training in reminiscence therapy. A new, more suitable, hot trolley has been purchased and staff have received training in serving meals, to ensure the food is hot enough. The laundry service has been reviewed to ensure peoples` clothing is properly ironed and nicely presented. Staff training has continued with some new subjects such as Mental Capacity Act and Deprivation of Liberty Safeguards being added. Training materials in all subjects is routinely updated to ensure staff are taught current best practice. Significant upgrading work has taken place in the home. The central staircase tower has been repaired and redecorated. There was new flooring in the hallway, new dining chairs and tables, some new lounge seating and curtains. There were four new hoists, one with built in weighing scales. Four of the five bathrooms had been completely refurbished with new baths and decoration. Bedroom furniture was being replaced and rooms decorated as part of the rolling five year plan. What the care home could do better: There were no requirements or recommendations made as a result of this inspection. The manager continues to listen to people and provides a good quality service. Key inspection report Care homes for older people Name: Address: Risedale At Aldingham Nursing Home Aldingham Ulverston Cumbria LA12 9RT     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: Jenny Donnelly     Date: 0 9 0 3 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 30 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 30 Information about the care home Name of care home: Address: Risedale At Aldingham Nursing Home Aldingham Ulverston Cumbria LA12 9RT 01229869203 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Risedale Estates Limited Name of registered manager (if applicable) Mr Graeme Redshaw Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following categories of service only. Care home with Nursing - code N, to people 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 - Code OP. The maximum number of people who can be accommodated is: 40 Date of last inspection Brief description of the care home Risedale at Aldingham Nursing Home is set in the small hamlet of Aldingham, just off the coast road between Ulverston and Barrow-in-Furness, overlooking the Morecambe Bay estuary. The home is an imposing grade II listed building with many original features and is set in its own grounds. The home is one of six in Cumbria run by the Risedale Estates Limited Group. The registered manager is Mr Graeme Redshaw. Accommodation is provided over three floors, the ground floor plus a split level first Care Homes for Older People Page 4 of 30 Over 65 40 0 Brief description of the care home floor, served by two passenger lifts. The bedrooms are individual in size and shape; there are 20 single and 10 double rooms, which the company refer to as companion rooms. All bedrooms have an en-suite toilet and wash hand basin. There are five bathrooms equipped with specialist bathing/showering facilities. There is plenty of communal space in the form of lounges, dining areas and a conservatory. The main kitchen and laundry are shared with the sister home St Cuthberts; which is an adjoined building run as a separate entity. The home has large landscaped gardens and sea views. A statement of purpose and a service user guide is available from the home, and the weekly charges at the time of this inspection ranged from £422.00 to £490.00 plus any government registered nursing care contribution. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was the main or key inspection for the year. The lead inspector Jenny Donnelly asked the manager to fill out a form called the Annual Quality Assurance Audit (the AQAA). This asks for details of what has improved in the home since the last inspection and for the plans for the coming year. This was fully completed and returned to us by the date we asked. We also sent surveys to some of the people who live in the home, and to the staff. Inspectors, Jenny Donnelly and Jan Yates made an unannounced visit to the care home on 9th March between the hours of 09.30 and 16.45. During this visit we (the Care Quality Commission) toured the building, spent time in the lounges, and dining room where we watched lunch being served. We spoke with people living in the care home and their visitors. We also spoke with the manager and the staff on duty. We looked at files and documents that backed up what we were told and what we saw. Care Homes for Older People Page 6 of 30 Since the last key inspection in April 2007, we have completed two Annual Service Reviews, one in 2008 and another in 2009. An annual service review is where we look at all the information we have gathered about a service in the last year, including the managers Annual Quality Assurance Audit and surveys that we send to people who live in the home. From this we make a judgement about whether the home is continuing to provide a good service to people, or whether we need to inspect sooner than planned. We received positive feedback about Risedale at Aldingham at each annual service review, and did not alter our inspection plan. Copies of all these reports are available on request from us, or from the care home. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? Since the last inspection the Risedale group have employed the services of an occupational therapist to support the activity organiser. This has enabled the activity organiser to extend her skills and knowledge and she has since completed training in reminiscence therapy. A new, more suitable, hot trolley has been purchased and staff have received training in serving meals, to ensure the food is hot enough. The laundry service has been Care Homes for Older People Page 8 of 30 reviewed to ensure peoples clothing is properly ironed and nicely presented. Staff training has continued with some new subjects such as Mental Capacity Act and Deprivation of Liberty Safeguards being added. Training materials in all subjects is routinely updated to ensure staff are taught current best practice. Significant upgrading work has taken place in the home. The central staircase tower has been repaired and redecorated. There was new flooring in the hallway, new dining chairs and tables, some new lounge seating and curtains. There were four new hoists, one with built in weighing scales. Four of the five bathrooms had been completely refurbished with new baths and decoration. Bedroom furniture was being replaced and rooms decorated as part of the rolling five year plan. 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 30 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 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People received very good information about the service and underwent a thorough assessment of their needs and wishes. This helped people to know the home would be able to meet their needs before they decided to move in. Evidence: There was good written information for people about the care home, detailing the services and facilities offered. Notice boards showed photographs and adverts for the social activities available, as well as menus, so people could see what life in the home would be like. People were welcome to visit the home to look around and speak with the staff and people living there. We looked at the admission arrangements for three people and saw that the manager had assessed their health, personal and social care needs in detail before offering them a place in the home. The service also obtained copies of social worker assessments, and community nurse assessments for any entitlement to free nursing Care Homes for Older People Page 11 of 30 Evidence: care. The manager used all this information to make a decision about whether they would be able to meet the persons needs, and wrote to them confirming this. We saw that people had been issued with a copy of terms and conditions of residency, and there was a contract in place stating the level of fees and who was responsible for payment. People were asked to sign their agreement to share a companion room, and the manager held a waiting list for those who wished to move to a single room when one became available. The thorough assessment process helped staff prepare for new people arriving in the home, and enabled them to have any necessary equipment ready for them. Each person was allocated a primary nurse and a key worker carer, to take a special interest in their care, and this helped people settle into the home quickly. People we spoke with said they were made welcome and had settled well in the home. We saw that after the first four weeks of admission, there was a review meeting with the person and their family, to make sure the placement was working for all parties and to make any necessary changes to the care plan. One staff survey said, I think we make residents feel very welcome ... if my Nana had to go into a home this is one I would choose. The service does not provide intermediate care. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were receiving a high standard of individual personal and health care delivered in a way that was acceptable to them. Evidence: Following on from the pre-admission assessment, each person had a full written care plan in place setting out their individual health, personal and social care needs. We looked at three care plans in detail, for people with different care needs and levels of ability. Each person had a primary nurse responsible for planning and overseeing their care, and a key worker carer to take a special interest in them. We saw the care plans were very individual to the person and took account of their personal wishes and choices. This helped people receive care in a way, and at a time, that was acceptable to them. Care plans had been reviewed and updated each month, and where possible people had agreed to their plan of care. People we spoke with told us they were, very happy with the care, were treated with dignity and respect, were happy that staff will leave the bedroom door open for Care Homes for Older People Page 13 of 30 Evidence: me, and I am able to get up early. The surveys we received indicated people experienced a high level of satisfaction, saying they aways or usually received the level of care and support and medical attention they needed. Staff felt proud of the work they do and believed they delivered a high standard of care. Staff surveys told us, We provide for residents needs, especially when it comes to facilities such as suitable beds, chairs etc ... Risedale is a company that can be trusted, always providing care at the highest level and, We promote choice and individuality. Risk assessments had been documented for peoples moving and handling needs, skin care, nutritional needs and risk of falls. These had been updated monthly and plans put in place to reduce any identified risks. We saw specific individual instructions about how to move a person safely, stating the type of hoist and which sling was to be used. We looked at management of wound care and saw very detailed wound assessments, and clear treatment plans in place. There was photographic and written information tracking the wound healing progress and evidence that specialists had been consulted for advice. People who needed them, had special pressure reducing mattresses and seat cushions. We saw that peoples weight was monitored and some people had gained needed weight since moving into the home. People who experienced weight loss were monitored more carefully and professional advice was sought as necessary to help them maintain a healthy weight. Records showed people had good access to outside health care and had seen their doctor as necessary. We saw the dentist and the chiropodist visiting whilst we were in the home. The Risedale group maintains a skills register of staff with specialist skills and knowledge in particular areas of care such as nutrition, wound management, continence care and safe moving and handling of people. This means staff can always access specialist advice for people with complex care needs. Nursing staff also had a range of advanced clinical skills including taking blood, inserting catheters, passing nasal tubes and managing stomach tube feeds. We looked at the management of medication and saw all nurses completed comprehensive medicines training. There were written guidelines in place covering the ordering, receipt, storage, administration and disposal of medicines. We looked at medicines records and storage, and stock checked a few items which showed the amount of medicines received, the amount administered, and we found the amount left was correct. We also saw that medicines due at odd intervals, such as alternate days, once a week or in variable doses were well managed. People who wished to, were able to manage their own medicines within a risk assessment framework. Privacy and dignity was given a high profile in the home and was included in all staff Care Homes for Older People Page 14 of 30 Evidence: training events. People we spoke with were happy with the way staff treated them, and felt their privacy and dignity was maintained. Staff knocked on bedroom doors before entering and people who shared companion rooms had their privacy maintained by the use of curtains or screens across the room. All toilets and bathrooms had door locks fitted, and we saw people being covered with blankets whilst being hoisted in case their clothing rode up. The Risedale group has implemented the NHS Gold Standard Framework for end of life care and staff have been trained in palliative care. They employ an end of life care nurse specialist, and nursing staff have been trained in the use of syringe drivers, core drugs and are able to verify death. We saw that end of life care wishes had been discussed with people and their wishes documented. The home used the NHS Preferred Priorities of Care document, so people could have a record of their wishes that would be respected by all health and social care staff once the person was no longer able to speak for themselves. Care Homes for Older People Page 15 of 30 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. The home had flexible routines, offered people choices and enabled them to lead a fulfilling lifestyle. Attention was paid to ensuring people received well balanced appetising meals and took sufficient food and drink to maintain their health. Evidence: People told us the care home was flexible and enabled them to choose how to spend their time. People we spoke with confirmed they were able to get up early, or lie in bed late, whichever they preferred. We saw that people made a choice about which lounge area to use and tended to gather in their own social groups to chat or watch television together. The home employs an activities organiser who works five days a week and people told us they greatly appreciated her input. During the inspection we saw activities including flower arranging, dominoes, and walks outside taking place. The activity organiser also told us she was spending some individual time with people who needed, or preferred, to stay in their bedroom. This individual time was given a high priority and consisted of a good half an hour chatting with or reading to people, or giving massage and nail care. Group activities in the lounges included games, flowers and plants, crafts, exercises and music. There were small group or individual outings for meals, Care Homes for Older People Page 16 of 30 Evidence: shopping and theatre trips. The local dial a ride transport was used for outings and people were asked to make a £2 contribution to this, with the remainder paid by the amenity fund. Between external theatre trips, the activity organiser invited entertainers into the home, and we saw photos of these events. There was a visiting Pat Dog scheme. People were asked about their social and recreational interests and the activity organiser used this information to ensure she provided something suitable for everyone, taking into account their choice, religious and cultural needs. Activities were discussed and agreed on a daily basis, as a set weekly programme had not proved popular with people. There were visiting clergy of different faiths and there was a church very close by. There was a salon for visiting hairdressers to use. Last year Risedale employed an occupational therapist to support the activity staff across their homes, and this enabled activity staff to access new ideas and information and to attend training in reminiscence therapy. Activity staff also completed all other mandatory training including safe moving and handling, infection control and equality and diversity training. One person who completed our survey wrote, Very good activities ... always have good fun when we go out on trips. We spoke with a number of visitors in the home, and they told us they were always made welcome, could visit at any time and were offered refreshments. A number of visitors told us they regularly had meals in the home with their spouse. We asked people about the provision of meals in the home, looked around the kitchen and at menus, spoke with the cook, and observed breakfast and lunch being served. There was a four week menu, updated seasonally, and this showed there were cooked items served for breakfast each day, and two choices of main meals and desserts at lunch and again in the evening. People were asked to make their choices one day in advance and the kitchen had copies of these order sheets. We saw there were additional alternatives should people not want either of the main dishes. Catering and care staff were aware of peoples nutritional needs and preferences, and special or restricted diets were catered for. Since the last inspection a new more suitable hot trolley had been purchased, and staff had received training to make sure meals were served at an appropriate temperature. People we spoke with confirmed they had enjoyed their meal, saying, the food is very good, and it is very nice and there is plenty of it. The completed surveys we received told us people were always or usually happy with the meals served. One person wrote, Im very happy with the food, it is always nice and hot, another commented that the food could be better. Care Homes for Older People Page 17 of 30 Evidence: We saw that all staff were present at meal times to serve and help people with their food. We saw people being assisted discreetly and with patience. People chose where, and with whom they wanted to eat. Nutritional assessments were in place and peoples food and fluid intake, and weight was monitored. Care plans were in place for people with swallowing difficulties and staff were trained in how to support them, and in ensuring they had adequate nutrition and hydration. Care Homes for Older People Page 18 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples rights are protected, staff are well trained and people felt reassured that any concerns or complaints would be listened to and acted on promptly. Evidence: There was a complaints procedure on display describing how to raise complaints or concerns. A copy of this was given to each person living in the home, or their relatives at the time of admission. The manager told us there had been no complaints made in the last year, and none had been made directly to the Care Quality Commission either. The majority of surveys we received told us people knew how to make a complaint, those that were not sure, told us there was someone they could speak to if they were unhappy. Surveys told us, Its all good, there are no bad bits and, They couldnt do more. People we spoke with on the day told us if they had any worries they would speak with the manager, who they knew by name, or one of the nurses. Visitors told us they were happy with everything and had no cause for complaint. They said if they were worried they would speak with staff and felt they would be listened to. There was guidance for staff on recognising and reporting suspected abuse, and staff received training on this in their initial induction and through ongoing annual updates. All staff had received training on the Mental Capacity Act, Deprivation of Liberty Safeguards and managing challenging behaviour. A number of senior staff were trainers in these subjects. Care Homes for Older People Page 19 of 30 Evidence: We have knowledge that the service has managed concerns, complaints and protection issues very well in the past. The manager and registered provider work well with the commission and with the local authority, and have been pro-active in making safeguarding referrals when they have been concerned for a persons welfare. Where there have been concerns or complaints, these have been fully investigated and any shortfalls have been put right very quickly. Care Homes for Older People Page 20 of 30 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 live in a very clean, comfortable, well maintained home. This historic building has been suitably adapted, and provided with good quality equipment, to support peoples mobility needs. Evidence: Risedale at Aldingham is an imposing grade II listed building situated in the small hamlet of Aldingham, overlooking the estuary. Accommodation is provided over three floors accessed by two passenger lifts. There was a five year development plan in place setting out a planned maintenance and renewal programme. The home employed a full time maintenance man and there was a lead engineer and a health and safety manager for the Risedale group. Bedrooms vary in size and shape, and there are 20 single and 10 shared bedrooms, each with a toilet and hand basin. People signed their agreement to share these companion rooms and screens or curtains were provided for privacy. There was a rolling programme to decorate bedrooms and replace furniture so as to maintain a good standard of accommodation. Communal rooms were all on the ground floor and comprised of a large lounge, a smaller lounge, a dining room and a conservatory. There was a kitchen area in the large lounge for staff and visitors to make drinks, and there were plans in place to Care Homes for Older People Page 21 of 30 Evidence: replace this and decorate the lounges. Since the last inspection new dining tables, dining chairs and arm chairs had been purchased, there were new lounge curtains and new flooring in the main hallway. The central tower staircase had been decorated. There was good access to large gardens with plenty of seating areas and level paths for walking. There were five assisted bathrooms, four of which had been redecorated and refurbished with new equipment since the last inspection. The manager told us they planned to refurbish the remaining bathroom shortly. There were sufficient spacious toilets located near to the main living areas in the home. There were sufficient aids and adaptations to help people with mobility problems including handrails in the corridors and bathrooms. The home had purchased four new electric hoists, one with built in weighing scales. There were assisted baths with seats, electric profiling nursing beds and a range of specialist mattresses. People also had their own personal equipment such as wheelchairs and walking frames. Staff we spoke with told us they had plenty of equipment and had no problems with supplies. Staff received compulsory annual training in infection control which included basic hand washing practice and updated information on the management of infectious diseases and illnesses. There were good hand washing facilities around the home, with each room supplied with liquid soap and paper towels. There were also hand gels for visitors to use. Staff had ample supplies of gloves and aprons, and there was a contract in place for clinical waste disposal. There were plenty of domestic staff and the home was clean and fresh throughout. The laundry was well organised and operated a one way system, with dirty laundry coming in to the washing area via one door, then moving through the drying and ironing areas before leaving by a second door. This is a good way to keep dirty and clean items separate and reduce cross infection. People told us they were satisfied with the laundry saying, My clothes are clean and ironed well, they are returned promptly, and my bed linen gets changed regularly. Laundry staff confirmed there were good supplies of bedding and towels, enough to provide four changes for each person. Any shabby items were removed from circulation and replaced. Care Homes for Older People Page 22 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported and cared for by a highly trained, competent and caring staff team. Evidence: We found the staffing numbers and skill mix were appropriate to meet peoples needs. Rotas showed that staffing generally comprised of 2 registered nurses and 6 care staff during the day, with 2 nurses and 2 carers at night, for 40 people. On the day of this unannounced inspection there was also a third nurse on duty, a student nurse doing a work placement and a new carer completing an induction shift. There was also the activity organiser, 3 kitchen staff, 5 domestics, a receptionist and the maintenance man. The manager worked Monday to Friday office hours, but regularly came in early or stayed late to see the night staff. He also told us he would come in at the weekend to meet relatives if needed. Risedale operate their own accredited training department and therefore run the majority of their staff training in house. New care staff work a number of shifts in addition to normal staffing numbers and complete a short induction which covers fire, moving and handling, health and safety and infection control. They are then enrolled on a 10 day full induction course based at the Risedale training department. This induction course runs four times a year, and incorporates the Care Sector Alliance and Social Care Training programmes. Carers were also supported to gain National Care Homes for Older People Page 23 of 30 Evidence: Vocational Qualifications (NVQ) in care, and 13 of the 25 current carers have completed this to at least level 2. Another 3 carers are working toward an NVQ and a further 3 are to be registered to start this. Catering and domestic staff were also supported to gain an NVQ relevant to their roles. For all existing staff there is a compulsory comprehensive annual training programme. The manager monitors staff attendance at these events and we saw individual training records were in place for each staff member. For the registered nurses there was a skills carousel where they could update their clinical skills, such as taking blood. Staff we spoke with confirmed they felt well supported, received good training, felt valued here and would not work anywhere else. We saw the trainers themselves were suitably qualified to teach. All the surveys we received told us that staff thought they were provided with training suitable to their role. We also received the following comments, We have excellent staff support and opportunities to extend training, Training for staff is given regularly and, We have a good working atmosphere, staff and residents are happy to be here. Two staff thought there could be more staff on shift. We looked at staff recruitment practice and saw that robust procedures were followed. These included criminal records bureau checks, written references, and interviews. Staff received a statement of terms and conditions and were provided with thorough induction and ongoing training. Risedale regularly employs newly qualified registered nurses and provides good post registration training and support to help them settle into their new professional role. The service plans ahead and has good strategies in place for covering staff absence so they never need to use agency staff who do not know the home. People we spoke with during the day told us they liked the staff very much, and surveys told us, The staff at this home have looked after me very well indeed, They are very good staff and, All staff are very very nice and work very hard. I was very down when I came here but now I feel very happy. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a care home that is robustly managed and has a strong commitment to excellence and to listening to the people who live there. Evidence: The registered manager Mr Graeme Redshaw has been a registered manager for the Risedale group for many years, and returned to manage Aldingham in December 2008. He is registered with the Care Quality Commission and has demonstrated he is suitably qualified and competent to the manage the service. The manager is supported by senior nurses and by the Risedale directors, who make regular unannounced day and night visits to the home. We saw that the manager was knowledgeable about the people living in the home and had a good understanding of peoples individual situations. It was clear that people knew him by name, and felt comfortable calling out and talking with him. Staff also told us the manager was approachable and open to their ideas and suggestions. We saw that regular staff meetings took place for all grades of staff. Care Homes for Older People Page 25 of 30 Evidence: The company operated a comprehensive quality assurance system which included out of hours visits by the manager and directors, surveys and audits. The manager had sent out resident/relative surveys in October 2009 and we saw the completed responses. These showed generally high levels of satisfaction with most respondents grading the service as excellent or good. If shortfalls are highlighted the manager would draw up an action plan to address the issues raised, but this had not been necessary this time. Monthly audits were carried out by the manager and senior staff to check on care planning, management of medicines, kitchen hygiene, the general environment and safety of equipment, and any accident reports. This is good practice and helps to ensure that high standards are maintained in all areas of the service. There was a five year development plan in place for the service detailing planned refurbishment and renewal of equipment. There was clear evidence of strategic planning, and ongoing investment and improvement in the service. The manager holds spending money on behalf of some people and we looked at the way this was managed. The individual records, receipts and monies were held securely, and audited regularly by two staff. There was formal staff supervision in place, with staff having five individual supervision sessions per year with their allocated senior, and one annual appraisal. The records of these were held in staff training and development files. One staff survey told us, The manager is always there for support if needed. I have assessments with the staff nurse at six week intervals. Risedale employ a health and safety manager who also works as a senior nurse at Aldingham. She has dedicated time to deliver staff training and meet regularly with the maintenance team to ensure the health and safety of residents and staff is protected. We saw the service records for the home which showed that hoists, bath seats, lifts, fire safety and other equipment underwent regular safety checks and inspections. Health and safety training for staff was robust and took place at frequent intervals including fire safety, moving and handling, infection control, food hygiene and management of challenging behaviour. All shift leaders were qualified 1st aiders. The kitchen had been awarded an excellent food safety rating by the environmental health officer. We looked at accident / incident records, and saw that very few accidents had occurred in recent months. We judged the health, safety and welfare of Care Homes for Older People Page 26 of 30 Evidence: residents and staff was being sufficiently promoted and protected. Care Homes for Older People Page 27 of 30 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 28 of 30 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 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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