Care Home: Ross Wyld Nursing Home

Similar services:

• Ashlong House
• Henry Nihill House
• Birchwood
• The Infirmary
• Orchard House Nursing Home
• St Josephs Rest Home
• Red Court Nursing Home
• Spinney (The)

What the care home does well The home is working hard to develop the service it provides and residents benefit from a staff group who are enthusiastic and who tell us that staff morale at the home is good. The physical environment is comfortable and is well maintained. People living at the home benefit from good quality recording practises, which help to keep staff up to date and to assist with people`s changing needs. Residents also benefit from an improved range of activities and from good quality meals that they enjoy. One resident told us, " The care staff most of the time are very helpful in lots of ways". Another resident told us, "I enjoy the food and I enjoy the activities very much". What has improved since the last inspection? At the last inspection five requirements were made and we were pleased to see that these were all being complied with. The requirements were in the following areas: three relating to improving people`s care plans and risk assessments and in keeping these up to date; to make sure that medication administration records for all medicines are properly completed and lastly to make sure that records of in-house fire equipment, tests and drills were kept up to date. What the care home could do better: At this inspection one requirement is made to make sure that identified fire doors close properly when released, to maximise fire protection. Two good practise recommendations are made: to supplement the recordings made by the GP in plain English, to further assist staff understand what is expected of them following the GP`s visit, and to consider providing Internet access as an option for residents to enjoy. Key inspection report Care homes for older people Name: Address: Ross Wyld Nursing Home Ross Wyld 458 Forest Road Walthamstow London E17 4PZ     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: Peter Illes     Date: 1 8 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Ross Wyld Nursing Home Ross Wyld 458 Forest Road Walthamstow London E17 4PZ 02085218773 02085200690 ross.wyld@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Tamaris (South East) Limited (a wholly owned subsidiary of Four Seasons Health Care Limited) care home 54 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 physical disability Additional conditions: To allow the home to provide continuous care for two named service users and to permit admission of one named service user with mental health needs. Date of last inspection Brief description of the care home Ross Wyld is a care home registered to provide care, including nursing care, for up to 54 residents. The registered provider is Tamaris Ltd, part of the Four Seasons Health Care Group. The home is a large purpose built, three storey detached home with 48 single bedrooms and three double bedrooms located across all three floors. All floors are accessible via a lift. The home has three units, one on each floor. Baldwin Unit is situated on the ground floor and caters primarily for younger adults; Churchill Unit is on the first floor and caters primarily for people with nursing needs and William Morris Care Homes for Older People Page 4 of 30 0 6 0 4 2 0 0 9 0 0 7 Over 65 22 25 0 Brief description of the care home Unit is on the second floor and caters primarily for people with a diagnosis of dementia. The home is situated close to shops, transport networks and other local amenities. The William Morris Museum and Lloyd Park are local landmarks just opposite the care home. A stated aim of the home is to provide its residents with a secure, relaxed, and homely environment in which their care, safety, well-being and comfort are of prime importance. At the time of this inspection the fees were between £550 to £750 p.w. Information about the home, including the Commissions inspection reports, is available from the home on request. 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of this service took place on 6th April 2009. This key inspection took approximately nine and a half hours and was undertaken by the lead inspector. However, terms such as we, our and us are used where appropriate within this report to indicate that the inspection activity was undertaken on behalf of the Commission. There were twenty eight residents living at the home at the time of the inspection and twenty six vacancies. No new residents had been admitted to the home since the last inspection. A new manager, Mr Wayne Hughes, has been appointed to the home recently and he was available to assist throughout this inspection as was the previous peripatetic manager, Ms Brenda Roach, who had managed the home for the majority of the last twelve months. The inspection activity included: meeting and speaking to the majority of the residents present although conversation was limited with some due to their communication Care Homes for Older People Page 6 of 30 needs; detailed discussion with the current manager, previous manager and the provider organisations regional manager; independent discussion with a number of staff including; the deputy manager, nursing staff and care staff; the residents activities coordinator; the administrator and an an assistant cook. We also spoke independently to a relative that visited on the day. Further information was obtained from a tour of the building, documentation kept in the home and from survey forms sent to us by residents and staff working at the home. The home sent us an Annual Quality Assurance Assessment AQAA when we ask for it . Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. 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 8 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 9 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has up to date information about the services it provides to assist people who are considering living in the home know what to expect. The needs and preferences of people living in the home are regularly reviewed to help staff in meeting these. Evidence: The homes annual quality assurance assessment, AQAA, states: We have up to date information about the services we provide in the form of an updated service user guide. We have a clear and comprehensive admissions procedure that allows potential residents to visit the home prior to being admitted, to view the building, taste the food, and assess the atmosphere. We are more than happy to accommodate a prospective resident for the day. We were sent a copy of the homes statement of purpose/ service user guide, which Care Homes for Older People Page 10 of 30 Evidence: was detailed and contained relevant information about the home and how it operates. Residents spoken to indicated they had enough information about the home at the time they were considering living there. The AQAA also told us, We have detailed and comprehensive pre-admission assessments that focus on the needs, likes, and dislikes of all potential residents, which after admission are kept under review to identify and assess any changing needs or preferences. No new residents have been admitted to the home since the last key inspection. However, the home has an up to date admission policy that was seen. The manager also confirmed that potential residents are encouraged to visit the home prior to being admitted, to view the building, to taste the food, and to assess the atmosphere and that the home is happy to accommodate a prospective resident for the day. He went on to tell us that the home also welcomes unannounced visits from families of prospective residents so as they can be sure that no special efforts have been made for the visit and that the visitors see the home in its normal high standards. We looked at the files of seven residents who have lived at the home since the last inspection. A reassessment of need had been carried out on all of these people since the last inspection using an appropriately detailed assessment format. The assessments seen included evidence of the persons current needs regarding nutrition, oral health, continence, pain management, and a range of other specialist assessment information where required such as where an individual needed to use bedrails. Information was also recorded on the files seen of any preferences that people may have about how they would like their assessed needs to be met. We also noted that the assessment information was being properly evaluated at least monthly, updated as necessary and the information was in turn being used to inform the individuals care plan. Our judgement was that the assessment information seen was of good quality and was up to date. We were told by managers at the home that staff had put a lot of work into reviewing the assessment process and records over the past twelve months to assist keep them up to date. Staff spoken to confirmed this with some satisfaction. The home does not provide intermediate care. Care Homes for Older People Page 11 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from the homes improved care plans that describe in some detail peoples needs and preferences and provide guidance for staff on how to meet these. People are properly supported by the home regarding their health care needs and have access to a range of healthcare professionals. Satisfactory medication policies and procedures are in place to assist protect people living in the home. Peoples privacy and dignity is promoted, which they appreciate. Evidence: The homes annual quality assurance assessment, AQAA, states: We have improved our communication links and relationships with the GP practises which ensures that the health care needs of our residents are fully looked after, (and), Care plans and risk assessments for all residents have improved significantly, are kept up to date and are reviewed monthly. At the last key inspection three requirements were made in respect of peoples care plans. These were that care plans are improved; that risk assessments are kept up to Care Homes for Older People Page 12 of 30 Evidence: date and that care plans are kept up to date. Evidence was seen that significant work has been undertaken in the past twelve months to ensure that these three requirements are being complied with. The files of seven people living in the home were inspected and these contained clear, detailed and up to date care plans. The care plans seen contained a range of relevant information regarding the persons needs including: personal hygiene, eating and drinking, skin integrity, communication, risk of falls. It was noted that most care plans seen had been discussed and signed by the resident and/ or a relative. Care plans also gave guidance to staff on meeting peoples preferences regarding their care and were being reviewed at least monthly. One person whose care plan was inspected is a non practising Muslim. Their care plan gave detailed guidance to staff on how to sensitively meet the persons religious/ cultural needs and wishes with evidence seen that this had been agreed with the persons family. Care plans were also supported by up to date risk assessments, including a moving and handling risk assessment/ profile. Those seen had been updated within the last six months and were being reviewed at least monthly. Evidence was seen that the home is working hard to promote the health care needs of residents. We were told that that all the residents are registered with a GP and that the GP most people are registered with visits the home on a weekly basis. Evidence was seen in peoples files to corroborate such visits and residents and staff spoken to also confirmed this. On some of the files seen the GP had written notes of his input for the individual but we were not always able to read the writing on some of these and staff were not able to fully decipher what was written either. Although staff spoken seemed to be clear of the GPs instructions a good practice recommendation is made that staff also record on the files, in plain English, the outcome of the GPs input with each individual. Evidence was also seen that people have regular access to health care professionals including; optician, dentist, chiropodist and other specialist health care professionals where needed. We were pleased to see that one person who is deaf and blind has a specialist occupational therapist visit them once a week. The occupational therapist is from the organisation for deaf/ blind people, Sense. The visits were being funded by the local Primary Care Trust, and visits are made to assist the person and to assist and advise staff with the persons care. We noted that one person was choosing to purchase some health care privately, which was their choice. We also spoke at length with the homes deputy manager who is a qualified nurse. Care Homes for Older People Page 13 of 30 Evidence: She presented as being competent and knowledgeable and was clear about how the home deals with those people with identified nursing needs. The deputy manager told us that none of the residents were suffering from pressure ulcers at the time. She was able to describe satisfactory measures the home was taking to monitor skin integrity and the measures used, such as pressure relieving mattresses, to assist protect people. This was evidenced in the files sampled. We noted on the files of two people who have identified nursing needs that the Local Primary Care Trust had reviewed their care in 2010 and the review notes showed positive outcomes for those people. At the last inspection a requirement was made that medication administration records for all medicines are properly completed and evidence was seen that this requirement was being complied with. We sampled the medication and medication administration records for four people in the home, including people prescribed controlled medication. These were accurate and indicated that people were being given their medication as prescribed. The home has a detailed medication policy that was seen and staff that administer medication that were spoken to presented as being clear about the homes medication procedures. We had also been informed by the home of several medication issues/ incidents for individuals since the last inspection with satisfactory details of how the home had addressed these. Evidence was seen at this inspection of work the home has undertaken in the past twelve months to improve medication procedures including introducing weekly audits by the deputy manager. The current manager also told us that he was currently discussing with the GP the frequency of issuing repeat prescriptions to assist the management of medications in the home. We saw up to date records on the medication files inspected that medication was being recorded when entering the home and when disposed of. Throughout the inspection staff were seen to interact with residents in an appropriately friendly and respectful manner. Residents were appropriately dressed and presented. The majority of residents talked warmly about the staff and most knew who their key worker was. One resident we spoke to was paying for a private telephone in their room, which they appreciated. We were told that the home did have a number of double rooms but now all the current residents were accommodated in single rooms, which was their choice and met their needs. Care Homes for Older People Page 14 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 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 working hard to develop meaningful activities that meet residents needs and preferences. Families and visitors are made welcome at the home, which is appreciated by all. People are encouraged to exercise as much choice and control over their lives as they can to maximise their independence. People are also served good quality and appetising meals that they enjoy. Evidence: The homes annual quality assurance assessment, AQAA, states: We have now employed a full time activities leader who has been in post for the last 2 months and is being trained under the companies PAL system (Personal Activity Leader, who is responsible in leading the team in activities for the residents). We spoke independently to the homes activities leader who presented as being very enthusiastic. She told us that before taking up her present post she was employed as a carer at the home so has a range of previous knowledge about peoples interests. We were pleased to see that she was undertaking a range of life history work with residents, which is valuable to all staff in helping to understand the things people liked and did not like, before they needed residential care. Care Homes for Older People Page 15 of 30 Evidence: We were told that a different activities programme was developed each week and we saw the programme for the current week. This included arts and crafts, beauty treatments, aromatherapy, gentle exercises incorporated into a range of activities including music, foam darts and Wii (computer) games and a St Patricks Day celebration. A number of residents told us that they really enjoyed the activities that were now provided at the home. One person was very pleased with the Wii games and was keen for the home to arrange Internet access for residents, a good practice recommendation is made regarding this. We were also told that people enjoyed the St Patrick Day celebration, which included the option for people who wished to and were able in trying a glass of Guinness. We were told that some outings had been arranged recently including to a local museum and to an Internet cafe. The activity coordinator also told us that more outings would be planned in the better weather and residents were being consulted on this, which some residents confirmed. The majority of residents are white European in origin although there are also a number of residents from a range of black and ethnic minority communities. The home is working hard to meet the diverse religious and cultural needs of all the residents. We were told that visits from religious groups are ongoing, church services and holy communion are given on a regular basis and representatives of different faith groups visit the home when requested. One resident told us they appreciated being able to take communion. Peoples preferences regarding their faith and how they practice it are recorded on their care plans; those sampled were clear and gave helpful guidance for staff. Relatives and friends are encouraged to visit the home at any time during the day and evening. We were told that many relatives visit the home several times a week. One relative told us, The staff try hard to look after my Mum; and another person told us, Staff make me welcome. Evidence was seen that residents are helped to exercise choice and control over their lives to the extent they are able. The home has satisfactory systems for dealing with residents finances. People living in the home are encouraged to personalise their rooms and evidence was seen that the home is providing training for staff on the Mental Capacity Act and Deprivation of Liberty Safeguards, to assist safeguard residents interests. We received a range of positive feedback about the meals provided at the home, both orally and from survey forms received. Comments included, I think the food is good; Care Homes for Older People Page 16 of 30 Evidence: and, I enjoy the food and the activities very much. We spoke independently to the assistant cook who was in charge of the kitchen on the day. He showed us a four week seasonal menu that provided a choice of main meals and told us that the home also provides a range of diets to cater for peoples different cultural needs and preferences. This including Halal meals and soft meals for those people who needed them. The choice of lunch on the menu on the day was either Cumberland sausage or macaroni cheese, both of which were pleasantly presented and which people enjoyed. The assistant cook confirmed that if a resident did not fancy the meal they had ordered they would be offered an alternative from the kitchen. The assistant cook also told us that the cook sought feedback from residents after each main meal. The kitchen was clean and tidy on the day, food was seen to be stored properly and the kitchen had a range of satisfactory and up to date health and safety records, which were sampled. Care Homes for Older People Page 17 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home, and their relatives, have any concerns they raise taken seriously and acted upon appropriately. The home has clear policies and procedures to assist protect people from abuse and staff are aware of these. Evidence: The homes annual quality assurance assessment, AQAA, states: (The home:) listens to and takes appropriate action with regard to complaints. Ensures residents are not at risk and undertakes a Weekly Risk Monitoring Report. Provides training in safeguarding adults and robust investigation and reporting of any safeguarding concerns. Unannounced spot checks on staff, day and night and weekends to ensure the home is being run properly in the absence of the manager. All complaints are treated seriously and investigated professionally and fully. The homes complaints procedure is followed as set out in the Statement of Purpose and complaints are acknowledged and responded to in a timely manner as per Four Seasons policy. The homes complaints policy was seen and was satisfactory, a copy of this policy was also seen in the statement of purpose/ service user guide and was displayed in the home. We looked at the complaints log, which showed four complaints recorded since the last inspection. The records of these showed that they had all been properly dealt with in accordance with the homes complaints procedure. A number of residents told Care Homes for Older People Page 18 of 30 Evidence: us that they felt confident that staff would deal with any concerns they raise. One resident told us, I have raised issues with staff and they always help. However, one resident told us that they had a number of current concerns and had raised them through the homes complaints procedure. They went on to tell us that they had an appointment arranged with the provider organisations regional manager to discuss these further and this was confirmed by the regional manager. We were also informed by the manager that the home was assisting that resident in using the services of an independent advocate. No complaints have been made to the Commission since the last inspection. The home has a satisfactory in house safeguarding adults (adult abuse) policy and a copy of the L.B. of Waltham Forests safeguarding adults policy and procedure, both of which were seen. Four safeguarding alerts have been made to L.B. of Waltham Forest since the last inspection and evidence was seen that these had all been dealt with satisfactorily. Evidence was seen that staff had undertaken safeguarding adults training since the last inspection and this was confirmed by staff spoken to. We were pleased to note that managers are taking safeguarding seriously at the home and have taken clear action to ensure that these are dealt with properly, including informing the Commission promptly of any concerns raised. No other safeguarding issues have been reported to the Commission since the last inspection. Care Homes for Older People Page 19 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 purpose built home that is comfortable, well equipped, well decorated, well furnished, well maintained and which meets their needs. The home was clean and tidy throughout creating a pleasant environment for people accommodated, staff and visitors. Evidence: The homes annual quality assurance assessment, AQAA, states: Residents are encouraged to personalise their rooms with the decor of rooms being to that of residents requirements. Ross Wyld Care Home has a trained fire warden in situ. Trained fire wardens from FSHC do quarterly training with staff. Ross Wyld Care Home provides a homely atmosphere and is free from unpleasant odours. Ross Wyld Care Home has a dedicated team of long standing domestics. A new maintenance person is able to ensure the decor of Ross Wyld Nursing home is maintained to a excellent standard. Where necessary there are adaptations to suit the needs of residents that require more assistance, these adaptations and specialist equipment are maintained and serviced regularly. All equipment for moving and handling, inclusive of wheelchairs, has been serviced regularly and staff receive regular updates on training. The home has three units, one on each floor. Baldwin Unit is situated on the ground Care Homes for Older People Page 20 of 30 Evidence: floor and caters primarily for younger adults; Churchill Unit is on the first floor and caters primarily for people with nursing needs and William Morris Unit is on the second floor and caters primarily for people with a diagnosis of dementia. In practice we were told that Baldwin and Churchill Unit were effectively operating as a single unit at the time. During a tour of the building it was noted that the home had sufficient and satisfactory toilet and bathroom facilities. At the time of this inspection there were twenty eight residents accommodated and a significant number of vacant rooms although the vacant rooms seen were well decorated and equipped to receive new referrals. We were also told that double bedrooms were being used for single occupancy at the time to better meet the current residents needs. Residents bedrooms seen were comfortable and had been personalised by the person occupying them. We were pleased to see that on William Morris Unit the bedroom doors provided information to help their occupant recognise the room as theirs. Comments from residents about the accommodation was overwhelmingly positive and included, I am very happy with my room; and, My room is nice, I have my own TV and a notice board. The home has a range of comfortable and well decorated communal areas including a main games/ activities room and a sensory room. Lounges and dining room facilities are situated on respective floors. We were also pleased to note that a range of art work undertaken by residents was displayed around the home, some of which we thought was impressive. The overall feel of the home was that it was clean, fresh smelling and provided a pleasant environment for people to live in. The laundry facilities are suitable to meet peoples needs and the home had suitable infection control procedures that staff spoken to were aware of. The home was clean and tidy throughout during the inspection. Care Homes for Older People Page 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported by a staff team with sufficient numbers to address their needs, and who have a range of competencies. People also benefit from staff that have access to a range of training opportunities to help them develop their skills and knowledge and keep these up to date. People accommodated are protected by the homes recruitment procedures. Evidence: The homes annual quality assurance assessment, AQAA, states: Ross Wyld has a high number of staff that are studying or have completed NVQ 2 and 3 in health and social care, housekeeping and catering. This percentage exceeds the current recommended standard. Ross Wyld ensure that all staff attend courses in mandatory training and seek to develop staff skills by putting staff on specialist training. Ross Wyld have a number of carers from different backgrounds and ethnicity that are able to meet the diverse cultures of Ross Wyld Care Home. Staffing levels are appropriate with good staff retention and correct skill mix on each shift. Ross Wyld has a robust recruitment procedure which protects the needs of residents and zero agency use. Staff rotas were seen on each unit and were correct at the time of the inspection. Staff at the home were deployed as follows: Baldwin and Churchill Units, which Care Homes for Older People Page 22 of 30 Evidence: currently operate as one unit, has a minimum of one 1 qualified nurse and four care staff on duty during the day and 1 qualified nurse and 2 care staff on duty at night. William Morris Unit has 1 senior carer and 2 care staff on duty during the day and 1 senior carer and 1 care staff on duty at night. The manager is in addition to the above and the home also employs a range of other staff including: an activity coordinator, administrative staff, kitchen staff, a house keeper, laundry staff and domestic staff. From observation throughout this inspection and from feedback from people living at the home the staffing levels were judged to be sufficient to meet the needs of the people living at the home at that time. However, the manager is aware that staffing numbers will need to be kept under review as and when the home accepts more residents, to ensure that peoples needs continue to be properly met. Documentary evidence was seen that the home is working hard to support care staff to work toward the national vocational qualification (NVQ) in level 2 and level 3 in care, with currently 54 of care staff achieving this. Staff spoken to confirmed that the home supported them in achieving the NVQ qualification. We sampled staff recruitment files including for two newly recruited staff; a registered nurse and a care assistant. Both of these files showed evidence of a robust recruitment procedure and included: proof of identity; an independent safeguarding authority clearance, a criminal records bureau clearance and two references. In addition evidence was seen that the home had checked the registration of the qualified nurse with the Nursing and Midwife Council (NMC) to ensure that this was still current. We saw evidence from a staff training matrix and from individual staff files inspected that the home was providing staff with a proper induction and training in core subjects. Recent training had included: moving and handling, fire safety, safeguarding adults and care of people with dementia.We also saw evidence that ongoing training was being planned in the Mental Capacity Act and Deprivation of Liberty Safeguards for care staff. The deputy manager confirmed that nurses employed were supported to keep their professional portfolio up to date and that the following had been made available to nurses in the past year: seminars in end of life care and wounds assessment; catheter training from Whipps Cross, the local hospital, and specific training in the Mental Capacity Act and Deprivation of Liberty Safeguards. Care Homes for Older People Page 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home and staff are supported by a clear management structure and should benefit further from the appointment of a permanent manager. Residents and other relevant people are consulted to monitor and improve the quality of the service the home provides. Peoples financial interests are appropriately safeguarded. Staff receive regular supervision to assist them meet the needs of people accommodated and to assist in their own development. People living at the home are generally protected by the homes health and safety procedures although further identified work is needed to maximise fire protection. Evidence: The homes annual quality assurance assessment, AQAA, states: The manager receives good support from the regional manager on a weekly/ bi weekly basis. The manager is nearing completion his LMC (Leadership and management in Care) Level 4 to compliment his National Vocational Qualification level 4 in management. The manager has attended his Deprivation of Liberty Safeguarding Care Homes for Older People Page 24 of 30 Evidence: and Mental Capacity Act training. Residents monies are looked after appropriately. Staff supervisions are done every 2 months. Spot checks and visits from manager and regional manager (are carried out regularly). Health and safety checks (are carried out regularly). Regular residents and relatives meetings are held to hear the views of the people who use the service. A new manager, Mr Wayne Hughes, had just been appointed at the home having previously been the manager at another of the provider organisations registered care homes in the L.B. of Waltham Forest. Mr Hughes is not a qualified nurse although the deputy manager at Ross Wyld is a qualified nurse. The home has not had a registered manager in place since the last inspection and we have emphasised to the provider organisation that we feel it is very important for the manager of the home to be formally registered with CQC. We have been assured in writing by the responsible individual for the home that Mr Hughes would be supported to apply to CQC to be the registered manager as a matter of priority. Mr Hughes presents as having a range of relevant knowledge, skills and experience and was able to able to tell us how he wants to further develop the home. The manager that Mr Hughes took over from, Ms Brenda Roach, is a provider organisation Peripatetic Manager and she was also present to assist at this inspection. Ms Roach has been in charge of the home for the majority of time since the last inspection in April 2009. We were told that she had driven forward much improvement in the home during that period, particularly around recording practises. Feedback during the inspection from both staff and residents was that the hand over of management arrangements had been completed well and staff reported that morale at the home was good. We also noted that the provider organisations regional manager has regular contact with the home, particularly to support the manager, and spent the majority of the day in the home during this inspection. Both the home and the provider organisation has a range of ways of monitoring the quality of care that it provides, including: questionnaires being sent out to stakeholders on a regular basis, a twice yearly Team Audit Process a three monthly review by the regional manager and monthly unannounced visits to the home, also by the regional manager. We sampled documentation from the above processes and found them to be clear, detailed and evidenced a range of identified progress over the past year. The home employs an administrator who was spoken to independently. She has worked at the home for a number of years and also presented as being very competent and knowledgeable about the home and its administrative systems. We Care Homes for Older People Page 25 of 30 Evidence: were shown the systems used to monitor and check residents finances and found these to be detailed and effective, including a monthly reconciliation of each residents money. We were told that the provider organisation undertakes unannounced audits on a six monthly basis of residents finance systems and we were shown documentation of the last audit in October 2009. All the information seen indicated that residents were properly protected and supported where the home assisted with their finances. We saw documentary evidence that staff receive formal recorded supervision on a regular basis and this was confirmed by staff spoken to. At the last inspection a requirement was made that the records of in-house fire equipment tests and fire drills were kept up to date. We saw evidence that this requirement was being complied with. In addition we saw evidence of a current fire risk assessment and plan and that fire fighting equipment was being serviced annually. However, during a tour of the premises with the manager it was noted that identified fire doors did not fully close and remain closed when released; a requirement is made regarding this. We saw a range of satisfactory health and safety documentation including: a gas safety certificate, an electrical installation certificate; portable appliance certificate and evidence that the homes water supply has been tested to minimise the danger of legionella. Care Homes for Older People Page 26 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 27 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 1 38 23 The registered provider 16/04/2010 must ensure that there are adequate arrangements in place for detecting, containing and extinguishing fires. This must include ensuring that all fire doors operate effectively. This requirement is made to maximise fire protection for everyone that uses the building. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 8 Staff should record on peoples files, in plain English, the outcome of visits to individuals from GPs to supplement the GPs own recordings to further assist staff in meeting the persons health care needs. The home should consider providing Internet access for the use of residents to assist them in sampling and experiencing access to new technology as part of their day to day lives. Page 28 of 30 2 12 Care Homes for Older People 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!