Care Home: Rock House

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• St Vincents
• The Cotswold Home
• Winton House
• Rush Court
• Hillyfield Rest Home
• The Maypole Nursing Centre
• The Briars

What the care home does well Potential service users receive a thorough needs assessment to ensure the home can meet the care needs of the service users. A visiting relative said "I chose the home because it is local to me and I can visit at any time. The staff have made the transition much easier than I thought it would be". Residents and families feel the Christian ethos and strong church links of the service are a positive factor in the decision to move into the home. Care plans have been produced for all people who use the service, and these inform the care staff what they must do to meet the needs of the individual. One visiting relative spoken to on the day of the visit said, "the staff are very kind here. I come for lunch with my relative every day and they show us such kindness" and one person using the service said, "its very good. I love the caring atmosphere of the home and the wonderful staff." One comment received in a returned survey is "the home cares for people with challenging care needs exceptionally well. All the residents are well cared for." Residents feel they are treated with respect and examples of their dignity and privacy being upheld, were noted during the inspection. A good range of activities and opportunities for social stimulation are provided, and the home provides well for the spiritual needs of residents, from various Christian denominations within its overall Christian ethos. A comment made by a relative is " the staff at Rock House are very friendly, helpful and patient. I feel that the Christian values of Rock House are very evident" Two comments received in surveys are, "activities are plentiful and people are encouraged to take part" and "the home are very good at keeping people stimulated and there is always lots of activities for people to join in with". One comment received in a survey was, "a little bit more exercise would be nice. Perhaps a class one morning a week". Contact with family and friends, is encouraged wherever possible and the home has positive links with the local community via the local church and its befrienders. A comment made in a returned survey was, "the staff are very kind and I can visit the home at any time of the day". Residents are supported to make choices in their daily lives and follow their chosen lifestyle wherever possible. Communication between people who use the service and staff was observed to be positive and open. The home ensures that people using the service are provided with a choice of wholesome and appealing meals in pleasing surroundings. Comments made about the food include, "the food is lovely, and I am very happy with the food" and "the food is excellent". The home provides a pleasant and comfortable environment in which people can live. People spoken to on the day of the visit said, "its a lovely home and I like it here. I`m very happy." and "if I can`t be at home then this is the next best place." One visiting relative said, "its very homely here and thats why we chose it." The home has an appropriate complaints procedure, of which residents and relatives are aware. Issues raised are appropriately investigated. The numbers and skill mix of the staff team meet the current needs of the resident group. Comments received in surveys said that staff are "friendly, helpful and patient with the residents" and "the staff are patient and interested in everyone". There is a robust recruitment procedure in place that ensures service users are protected from harm. Staff training is good and updated regularly ensuring staff have the skills to look after people using the service. A comment received in a returned survey said, "the staff seem to be encouraged to participate in trainng to advance their understanding of dementia". An appropriate quality assurance system has been developed to ensure service users and relatives can air their views about the home. The evidence seen and comments received indicate that this service meets the diverse needs e.g. religious, racial, cultural, disability of individuals within the limits of its Statement of Purpose. What has improved since the last inspection? The home has updated the Safeguarding policy and the Whistle Blowing policy. All fire doors have now been fitted with appropriate self- closing devices. The use of bed rails is now supported by an individual risk assessment in every instance. Regulation 26 monitoring visits now take place monthly and a copy of the report is provided to the manager. Residents files are now properly secured and in good order. Copies of completed accident forms are now filed within the relevant resident case record. Continuous improvements to the home have been completed. An example of this is: -the dining facilities have been split into two rooms, with the use of the activities room in addition to the dining room, in order to provide more space. This has been successful, and the dining area in the activities room has been redecorated, making it bright and spacious. -The home is leasing a specialised bath. -The health and safety ramp outside the main door is now finished and the handrails fitted. -The home has purchased a 42 inch Plasma screen TV for the lounge. -The entrance hall to the home has been improved by removing the reception area and moving it away from the front door. -A separate training room has been created to provide in house training for staff. What the care home could do better: The home has changed the care plan format several times in the previous two years and should decide on which style they intend to use. Some entries in the care plans need more detail, for example,"one carer and bath hoist needed for bathing" and "staff to assist with personal hygiene." These are vague statements and should describe in more detail the actions staff need to take to fully meet the needs of the individual. Some entries in the daily record notes were difficult to read and the home should address this. In one file examined the tissue viability assessment scored the individual as at "high risk" of developing a pressure sore. There was some reference made under "personal hygiene" regarding the prevention of pressure sores but no specific plan of care. If an individual using the service has been assessed as "at risk" of developing pressure sores, the home should ensure a plan of care is in place that details the action to be taken by staff to ensure the promotion of tissue viability and prevention of pressure sores. There is guidance in place for `when required/when needed` medicines, but these should contain further detail to include when the medicine is to be given and when it is not and include a strategy for when variable doses can be given. The home should address this. The practice of administering peoples eye drops at the dining table is not appropriate and this practice should be reviewed by the home. Key inspection report Care homes for older people Name: Address: Rock House Austenwood Lane Chalfont St Peter Bucks SL9 9DF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Barbara Mulligan     Date: 1 7 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 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 31 Information about the care home Name of care home: Address: Rock House Austenwood Lane Chalfont St Peter Bucks SL9 9DF 01753882194 01753893395 office.rockhouse@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Gold Hill Housing Association Limited The registered provider is responsible for running the service care home 38 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 38 The registered person may provide the following category 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 category : Old age, no falling within any other category (OP) Dementia (DE) Date of last inspection Brief description of the care home Rock House is a care home for older people, offering personal care and accommodation for thirty-eight service users who are elderly and physically or mentally frail. 38 0 Over 65 0 38 Care Homes for Older People Page 4 of 31 Brief description of the care home The home is owned by Gold Hill Housing Association, a Friendly Society and is located in Chalfont St Peter, at the top of Gold Hill Common. It is close to shops, public houses, the post office and other amenities. The home has a strong Christian ethic. Rock House was developed from two large semi-detached houses and has three floors. Access to all floors is via a passenger lift. The home has thirty-six single bedrooms and one double bedroom, of which twelve have en suite facilities. The home has its own landscaped garden. The fees for the home range from £558 to £700 per week. Additional charges are made for manicures, hairdressing, chiropody, newspapers, dry cleaning, additional care provided through a buddy system and transport to external events. Information about the home can be obtained by visiting or telephoning the home, or by visiting their website www.rockhouse.org.uk . Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was conducted over the course of a day and covered all the key National Minimum Standards for older people. Inspecting for Better Lives (IBL) involves an Annual Quality Assurance Assessment (AQAA) which is completed by the service. This document, which includes information from a variety of sources, was received in good time, was fully completed and contained the information we needed. This initially helps us to prioritise the order of the inspection and identify areas that require more attention during the inspection process. This document is referred to throughout the report. The manager of the home was unable to be in attendance for the inspection, however the deputy manager assisted with the inspection throughout the day. The information contained in this report was gathered mainly from observation by the inspector, speaking with a number of service users, visiting relatives and care staff and Care Homes for Older People Page 6 of 31 returned Care Quality Commission surveys Further information was gathered from records kept at the home. The home has responded positively to the issues raised in the previous inspection report with all requirements met, demonstrating a positive approach to the inspection process. A key theme of the visit was how effectively the service meets needs arising from equality and diversity. Feedback on the inspection findings and areas needing improvement was given to the management of the home at the end of the inspection. The management of the home, the staff and service users are thanked for their cooperation and hospitality during this unannounced visit. Care Homes for Older People Page 7 of 31 What the care home does well: Potential service users receive a thorough needs assessment to ensure the home can meet the care needs of the service users. A visiting relative said I chose the home because it is local to me and I can visit at any time. The staff have made the transition much easier than I thought it would be. Residents and families feel the Christian ethos and strong church links of the service are a positive factor in the decision to move into the home. Care plans have been produced for all people who use the service, and these inform the care staff what they must do to meet the needs of the individual. One visiting relative spoken to on the day of the visit said, the staff are very kind here. I come for lunch with my relative every day and they show us such kindness and one person using the service said, its very good. I love the caring atmosphere of the home and the wonderful staff. One comment received in a returned survey is the home cares for people with challenging care needs exceptionally well. All the residents are well cared for. Residents feel they are treated with respect and examples of their dignity and privacy being upheld, were noted during the inspection. A good range of activities and opportunities for social stimulation are provided, and the home provides well for the spiritual needs of residents, from various Christian denominations within its overall Christian ethos. A comment made by a relative is the staff at Rock House are very friendly, helpful and patient. I feel that the Christian values of Rock House are very evident Two comments received in surveys are, activities are plentiful and people are encouraged to take part and the home are very good at keeping people stimulated and there is always lots of activities for people to join in with. One comment received in a survey was, a little bit more exercise would be nice. Perhaps a class one morning a week. Contact with family and friends, is encouraged wherever possible and the home has positive links with the local community via the local church and its befrienders. A comment made in a returned survey was, the staff are very kind and I can visit the home at any time of the day. Residents are supported to make choices in their daily lives and follow their chosen lifestyle wherever possible. Communication between people who use the service and staff was observed to be positive and open. The home ensures that people using the service are provided with a choice of wholesome and appealing meals in pleasing surroundings. Comments made about the food include, the food is lovely, and I am very happy with the food and the food is excellent. The home provides a pleasant and comfortable environment in which people can live. People spoken to on the day of the visit said, its a lovely home and I like it here. Im Care Homes for Older People Page 8 of 31 very happy. and if I cant be at home then this is the next best place. One visiting relative said, its very homely here and thats why we chose it. The home has an appropriate complaints procedure, of which residents and relatives are aware. Issues raised are appropriately investigated. The numbers and skill mix of the staff team meet the current needs of the resident group. Comments received in surveys said that staff are friendly, helpful and patient with the residents and the staff are patient and interested in everyone. There is a robust recruitment procedure in place that ensures service users are protected from harm. Staff training is good and updated regularly ensuring staff have the skills to look after people using the service. A comment received in a returned survey said, the staff seem to be encouraged to participate in trainng to advance their understanding of dementia. An appropriate quality assurance system has been developed to ensure service users and relatives can air their views about the home. The evidence seen and comments received indicate that this service meets the diverse needs e.g. religious, racial, cultural, disability of individuals within the limits of its Statement of Purpose. What has improved since the last inspection? The home has updated the Safeguarding policy and the Whistle Blowing policy. All fire doors have now been fitted with appropriate self- closing devices. The use of bed rails is now supported by an individual risk assessment in every instance. Regulation 26 monitoring visits now take place monthly and a copy of the report is provided to the manager. Residents files are now properly secured and in good order. Copies of completed accident forms are now filed within the relevant resident case record. Continuous improvements to the home have been completed. An example of this is: -the dining facilities have been split into two rooms, with the use of the activities room in addition to the dining room, in order to provide more space. This has been successful, and the dining area in the activities room has been redecorated, making it bright and spacious. -The home is leasing a specialised bath. -The health and safety ramp outside the main door is now finished and the handrails fitted. Care Homes for Older People Page 9 of 31 -The home has purchased a 42 inch Plasma screen TV for the lounge. -The entrance hall to the home has been improved by removing the reception area and moving it away from the front door. -A separate training room has been created to provide in house training for staff. 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 10 of 31 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 11 of 31 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. Effective needs assessments are completed for prospective service users, to ensure that individual needs are identified and that the home is able to meet these needs. Evidence: During this visit four completed needs assessments were examined, including those most newly admitted to the home. The home has changed the assessment format several times in the previous two years. Two files examined contained the new computerised assessment format and two files contained the previous hand written assessment. Each needs assessment examined was fully completed and shows that all areas and conditions of people using the service were assessed prior to offering them a place in the home. Each assessment contained further information about the persons family and friends, a life history, likes, dislikes and preferences. This information is readily available to staff who are expected to refer to the documentation to meet service users care needs. Care Homes for Older People Page 12 of 31 Evidence: One person spoken to on the day of the visit said they had been able to visit the home with their family before making a decision and that staff had been very welcoming and answered all their questions. A visiting relative said I chose the home because it is local to me and I can visit at any time. The staff have made the transition much easier than I thought it would be. The assessment demonstrates that prospective service users, family members or representatives are included in the assessment process if this is appropriate. The home does not provide intermediate care, so this standard is not applicable. Care Homes for Older People Page 13 of 31 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 home meets the health, personal and social care needs of the residents, by developing good quality care plans and responding to their changing needs, as appropriate. Evidence: The home has changed the care plan format several times in the previous two years. Two files examined contained the new computerised care plan format and two files contained the previous hand written care plans. The home has not decided which format they will use for future use. At the previous inspection it was identified that care plans were disorganised and not user friendly. This has been addressed by the home and all care plans are kept within a ring binded file, have a contents sheet and are organised into different sections. All care plans examined are up to date and contain sufficient detail for staff to learn about the people they support. Specific needs have been identified within the care plans and there is a detailed action plan in place to provide staff with the details of how these needs are to be managed and fully met. Some entries in the care plans need more detail, for example,one carer and bath hoist needed for bathing and staff to assist with personal hygiene. These are vague Care Homes for Older People Page 14 of 31 Evidence: statements and should describe in more detail the actions staff need to take to fully meet the needs of the individual. The care plans identify and describe the changing needs of people using the service. Individual preferences, likes and dislikes and reference to end of life care are recorded in care plans and describes how these will be met. The care plans show that service users, family members or representatives are included in the care planning process. The staff spoken to are knowledgeable about service users care needs and preferences. There is evidence that care plans are reviewed monthly and updated when appropriate. Daily notes are detailed and informative and record the personal care received and activities that the individual has undertaken through out the day. However some entries were difficult to read and the home should address this. Visual observations of people using this service showed that people were smartly dressed including jewelery, make up and nail varnish, and people were seen to be wearing the aids needed, for example hearing aids and clean glasses. One visiting relative spoken to on the day of the visit said, the staff are very kind here. I come for lunch with my relative every day and they show us such kindness and one person using the service said, its very good. I love the caring atmosphere of the home and the wonderful staff. Comments received in returned surveys include, the staff at Rock House are very friendly, helpful and patient. I feel that the Christian values of Rock House are very evident and the home cares for people with challenging care needs exceptionally well. All the residents are well cared for. The home receives district nurse support and they are available for advice regarding pressure area care and assist in the provision of pressure relieving equipment and these were observed to be in place on the day of the visit. There were no individuals with pressure sores at the time of the visit. Tissue viability assessments are in place for service users and these were seen to be reviewed on a monthly basis and pressure relieving equipment was in place for individuals who need it. In one file examined the tissue viability assessment scored the individual as at high risk of developing a pressure sore. There was some reference made under personal hygiene regarding the prevention of pressure sores but no specific plan of care. If an individual using the service has been assessed as at risk of developing pressure sores, the home should ensure a plan of care is in place that details the action to be taken by staff to ensure the promotion of tissue viability and prevention of pressure sores. Further risk assessments are in place covering areas such as falls, moving and handling, nutrition, wound assessment and there is a falls diary in place. At the previous inspection a Care Homes for Older People Page 15 of 31 Evidence: requirement was issued so that the use of bed rails is supported by an individual risk assessment in every instance. These are now in place and were examined on the day of the visit. In addition to a risk assessment there is a pre-use checklist and a monthly maintenance check of the bed rails which is recorded. All risk assessments are up to date, signed and dated by the person completing the assessment. Residents are registered with two general practitioner (GP) surgeries. The deputy manager said people can register with their own GP if this is practical and agreeable to both parties. A domiciliary optical service visits the home or individuals can use the local optician if this is their choice. Referrals for a hearing test go through the service users G.P. Nutritional risk assessments are completed for each person and weight monitoring is undertaken on a monthly basis and recorded. This was evident in the four files examined. Chiropody services visit the home on a six to eight weekly basis. At the previous inspection it was identified that health screening was poorly recorded within service user files. The home has implemented a multidisciplinary record sheet and this was seen in the four files examined. These contained records of visits to opticians, podiatrist and the local hospital. There are separate doctors notes which again show regular visits. Feedback received in the surveys was positive about how people access medical treatment and healthcare services. One comment made was, I know if my relative is poorly they will be well cared for and will see the doctor if it is necessary. I am always kept informed. The procedures for the administration of medicines were examined during this inspection. At this visit we looked at the medication administration record (MAR) charts, medication supplies and care plans for the four people whose care was being looked at as part of this inspection. At the time of the inspection there were no service users who were able to self administer their medication. The home uses a monitored dosage system (MDS) and medicines are stored in two mobile, lockable trolleys. Medication administration records (MAR) show no omissions.There is guidance in place for when required/when needed medicines but these should contain further detail to include when the medicine is to be given and when it is not and include a strategy for when variable doses can be given. The home should address this. Controlled drugs were recorded appropriately in a separate bound log for the purpose, and a double signatory system was in place. Observed administration practice was overall appropriate, and staff avoided handling the tablets, using dosage cups and spoons to pass medication to residents. However the practice of administering peoples eye drops at the dining table is not appropriate and this practice should be reviewed by the home. All medicines are administered by senior staff called leaders who have received training in the safe administration of medicines and who have then been deemed competent. Staff training records demonstrate this to be the case. Care Homes for Older People Page 16 of 31 Evidence: Care Homes for Older People Page 17 of 31 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. There is a range of activities available to residents who are encouraged and supported to remain in contact with their families and friends and to use local community facilities ensuring people do not become socially isolated. The presentation and standard of food is good and meets the nutritional needs of people who use the service. Evidence: The routines in the home are flexible and care plans show that people have a choice as to when they get up and when they go to bed, a choice of meals, participation in activities, whether to spend time in the lounge or their bedrooms and their clothing. People can have meals in their rooms if they wish. Relatives and friends are welcome at any time and this was confirmed in the surveys returned to the Commission. One comment received told us, my relative likes to take their meal in their room sometimes and the home are good at allowing this to happen. As part of the admission process, the home completes a life history of the individual which gives staff information about previous leisure pursuits, hobbies and other interests. The home employs an activities organiser and there is a range of activities organised and displayed in the home. The range of activities include quizzes, crosswords, card Care Homes for Older People Page 18 of 31 Evidence: games, scrabble, bingo, reading newspapers to/with residents, art and craft sessions, bible readings, music sessions, songs of praise and one-to-one activities. The home also has a library of old films. Three monthly progress reports are completed for each individual about their participation in activities and how they have enjoyed them and if any activities can be provided to meet their social care needs. Two comments received in surveys are, activities are plentiful and people are encouraged to take part and the home are very good at keeping people stimulated and there is always lots of activities for people to join in with. One comment received in a survey was, a little bit more exercise would be nice. Perhaps a class one morning a week. The homes self-assessment tells us that special events held in the home have included a fete, celebrations of special birthday events, Christmas gatherings and other religious or traditional gatherings. Examples of involvement in the home by local community groups and individuals are visits by mobile hairdressers, various visiting entertainers, local schools and members of the local church visit the home regularly, to provide church services in the home. A TV link has been installed in the home to the local church, so residents can take part in church services in the comfort of the home. Service users are able to receive visitors in the privacy of their own rooms and are able to choose whom they see and do not see. Family and friends are invited to participate in some of the social events organised. On the day of the visit one person was visiting their relative and providing them with support with their lunch time meal. A comment made in a returned survey was, the staff are very kind and I can visit the home at any time of the day. An invitation to bring in personal items of furniture and other belongings is included in the service users guide and this was evident during a tour of the premises. Service users and/or their families are encouraged to look after their own financial affairs whenever possible. If this is not practicable a chosen solicitor will be responsible for individuals financial dealings. Service users are offered three meals a day. The inspector had the opportunity to join residents for lunch. Lunch is taken in two dining areas, one which has recently been refurbished and the second is currently being redecorated. Both rooms are bright and spacious and tables are attractively laid with tablecloths and napkins. The meal was relaxed, unrushed and well organised. People were well supported by staff and the food was attractively presented and tasty. It was pleasing to see that where two people who required extra help with their meal, they were joined by two support staff who sat with them and had a meal but gave discreet support at the same time. People who responded to the survey and spoken to on the day all responded positively about Care Homes for Older People Page 19 of 31 Evidence: the food provided in the home. Comments made include,the food is lovely, and I am very happy with the food and the food is excellent. The catering staff are aware of service users individual likes and dislikes and these are also documented in care plans. Care Homes for Older People Page 20 of 31 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. The home is able to effectively manage complaints and safeguard service users ensuring service users are listened to and kept safe from harm and abuse. Evidence: At the previous inspection it was identified that papers associated with a complaint were stapled into the complaints log, making the log bulky, and risking the possible loss of these documents, as well as presenting issues regarding confidentiality. It was recommended that only brief details regarding a complaint are entered in the log itself, without identifying individual staff, and that the entry is cross-referenced to a confidential record containing any related correspondence, statements taken, etc, within which individuals can be identified. It is pleasing to see that this has been complied with and the home has commenced a new complaints log which only records the brief details of complaints. There is a complaints policy and procedure, which clearly describes the way in which complaints should be handled and the deadlines that are set for response. The complaints procedure is accessible to service users and their representatives and a copy is included in the Statement of Purpose and the Service Users Guide. The Annual Quality Assurance Assessment (AQAA) tells us that the home has received six complaints in the previous twelve months. A record of all complaints is maintained and this was viewed during this inspection. Complaints received are well recorded and responded to within the stated timescales. Care Homes for Older People Page 21 of 31 Evidence: During the previous inspection it was identified that the organisations policies and procedures for safeguarding vulnerable adults and whistle blowing needed to be reviewed and a requirement was issued for improvement. These policies and procedures have been reviewed and were updated in May 2009. The home has an up to date copy of the local authority safeguarding policy. The Annual Quality Assurance Assessment (AQAA) tells us there have been no safeguarding referrals since the previous inspection. Training records demonstrate that staff have completed safeguarding training and this is regularly updated. Care Homes for Older People Page 22 of 31 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 standard of the environment within the home is good, providing people who use the service with an attractive and homely place to live. Evidence: The home has been adapted from a pair of semi-detached period houses and is operated by the Gold Hill Housing Association as one of a range of services to older people, including sheltered housing and a Domiciliary care agency. The home has one large lounge area. This was filled to capacity with chairs making the room overcrowded and cluttered. The carpets in this area would benefit from a clean. The dining facilities have been split into two rooms, with the use of the activities room in addition to the dining room, in order to provide more space. This has been successful, and the dining area in the activities room has been redecorated, making it bright and spacious. The second dining area is in the process of being redecorated at the time of the visit. The home has appointed a building and maintenance supervisor and part of his remit is to ensure that the environment is clean and hygienic and free from odours. He has compiled maintenance and decoration programmes. Some improvements to the environment made since the previous inspection include: Care Homes for Older People Page 23 of 31 Evidence: The installation of keypad exits and entry on the doors for added security of residents and these have been linked to the fire alarm. The home is leasing a specialised bath. The health and safety ramp outside the main door is now finished and the handrails fitted. Several bedrooms have been refurbished. The home has purchased a 42 inch Plasma screen TV for the lounge. The entrance hall to the home has been improved by removing the reception area and moving it away from the front door. A separate training room has been created to provide in house training for staff. There are accessible toilets available for service users throughout the home and several are close to the lounges and dining area. Bathrooms and toilet areas have the appropriate aids and adaptations to meet the needs of individuals and to promote independence. People spoken to on the day of the visit said, its a lovely home and I like it here. Im very happy. and if I cant be at home then this is the next best place. One visiting relative said, its very homely here and thats why we chose it. Laundry facilities are sited so that soiled articles, clothing and infected linen are not carried through areas where food is stored, prepared, cooked or eaten and do not intrude on service users. The laundry floor finishes are impermeable and these and the wall finishes are readily cleanable. The home has an infection control policy and training records show that care staff have completed infection control training. Care Homes for Older People Page 24 of 31 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. The staffing numbers and skill mix is satisfactory and staff training is sufficient and up to date to ensure that people who use the service benefit from staff who are competent to do their job. Recruitment procedures are undertaken to ensure staff have the right skills and competencies to support the people who live there. Evidence: The homes staff rota demonstrates that there are adequate numbers and skill mix of staff on duty at all times.The home presently employs twenty two care workers and at the time of the visit the inspector was told that there were two full time vacancies for care staff. The manager is extra to the staff on the roster, allowing for flexibility during peak and holiday periods. The care team are also supported by full time housekeeping laundry and catering teams. Comments received in surveys said that staff are friendly, helpful and patient with the residents and the staff are patient and interested in everyone. The home continues to support care staff on NVQ training and the Annual Quality Assurance Assessment (AQAA) tells us that 50 of care staff have achieved a national vocational qualification in care as set out in the national minimum. Care Homes for Older People Page 25 of 31 Evidence: The recruitment files for a selection of staff were examined, including those people new to the service. All files looked at contain the necessary documentation. There is evidence that all staff CRB checks had been obtained and references had been undertaken before the staff member started work. All staff complete an induction programme that covers the common induction standards for social care and this was seen in the four files examined. The home has its own induction checklist which is specific to the home. During the initial induction to the home staff are extra to the numbers on the staff rota and work alongside more experienced staff. Training records show that staff are up to date with their mandatory training. There is specialist training available for staff, and an example of this is dementia care, oral care for the elderly and managing challenging behaviors. Care Homes for Older People Page 26 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed by a stable experienced management team and service users are protected by safe working practices ensuring the health and safety of people using the service. Evidence: The manager is Sue Shadloo and she has many years experience in care and is appropriately qualified and experienced to manage the home. The manager has attained her NVQ level 4 and is a member of the Chartered Management Institute. She is supported by a deputy manager and the chief executive who plays an active part in the service. The registered manager was unavailable to assist with the inspection on the day of the visit. One comment received in a surveys was, the manager is always available and approachable and I would always go to her with a problem. The organisation and home has a clear and accountable management structure and the manager is supported by the organisation. The inspector noted good teamwork in progress and all the staff spoken to had a good working knowledge of the individual residents and their care needs. At the previous inspection a requirmenet Care Homes for Older People Page 27 of 31 Evidence: was issued for residents records to be properly secured and in good order. It is pleasing to see that this has been complied with. At the previous inspection it was identified that Regulation 26 monitoring visits were not being completed on a monthly basis and a requirement was issued for the provider to ensure that regulation 26 monitoring visits take place monthly and that a copy of the resulting report is provided to the manager. These were observed to be in place and they follow a detailed format that shows speaking with staff and people who use the service is a regular feature of the visits, plus good practices such as examining a sample of individuals money and staff training records. The service undertook a quality assurance survey of relatives sent out in June 2009 and a separate residents quality assurance questionnaire was sent out in April and May 2009. The deputy manager said that completed surveys were still being received by the home. The chief executive said that some comments received in the service satisfaction questionnaires were being individually addressed through Regulation 26 monitoring visits. Service users are encouraged to look after their own financial affairs where at all possible. If this is not practicable then families will undertake this role. There are secure facilities available for the safe-keeping of money and valuables and record and receipts are kept of possessions left for safe keeping. At the previous inspection a requirement was issued for copies of completed accident forms to be filed within the relevant residents case records and this has been complied with. There is a comprehensive health and safety policy in place and health and safety training is completed and up to date for all staff. Records were seen for fire safety. These cover the homes fire procedures, practice fire drills, fire prevention, fire alarm testing and emergency lighting testing. Testing of the homes fire alarm system is undertaken on a weekly basis and evidence was seen of this. There is a fire based risk assessment dated 21/03/2009. Service reports are in place for Portable Appliance Testing, gas appliances and electrical installation. The latest visit from the environmental health department was on 11/09/2008 and two recommendations were issued which have been complied with. Health and safety training demonstrates that staff are up to date with all mandatory training. The Annual Quality Assurance Assessment tell us that 80 of care staff and 100 catering staff have completed training in safe food handling and thirty seven staff have completed Infection Control training. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 31 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 30 of 31 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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