Care Home: Rossendale Nursing Home

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What the care home does well The majority of persons cared for have dementia and high dependency needs. Staff work well together as a team to provide a high quality of service. The home is not purpose built but, every effort is made to to allow the persons cared for to have freedom of movement without compromising their safety. Close liaison takes place with other health professionals over the care provided. Every effort is made to find out the previous background of the individual concerned to ensure that the care provided is appropriate and the person`s individual wishes and choices are recognised. One of the persons spoken with and a visitor commented on how good the quality of care provided was and that it had not taken long for the person cared for to settle down and feel like the place was their home. Staff were kind and responsive to needs. Comments included the following: `The staff are wonderful and I am very happy here` and `They help me to have a bath and I never feel uncomfortable.` `I would recommend this home to anyone without reservation.` `I think you all do a great job, sometimes in difficult situations.` `We are more than happy with the care our mother receives and could not wish her to be anywhere better.` What has improved since the last inspection? A new Service User Guide has been devised that has been designed to be particularly `user friendly` with pictorial representations for persons who are lacking in mental capacity. When compiling the care plan, the previous social history of the person is taken into account and recorded on a new pro-forma that provides a rounded picture of the individual concerned. Individual wishes and choices are recognised at all times and any religious or cultural requirements are respected and put into place. For any person who has difficulty communicating their needs to staff, a new pro-forma the Disability Distress Assessment Tool has been devised for helping staff to reach a conclusion about care needs and whether the individual concerned is in pain. Communication between families, GP`s and out of hours services has improved. The home has been working towards The Gold Standards Framework Award and is due to be assessed for the award at the end of September 2009. The Gold Standards Framework is a planning tool aiming at better communication and recording of decisions about the individuals care needs and wishes as well as their family. A policy has been devised to reduce crisis hospital admission at the end of life. A training programme has commenced for palliative care. At the last key inspection, footplate`s were not in position because the wheelchairs would not fit beneath the dining room tables with the footplate`s in place. This could possibly cause injury to the feet by being dragged on the floor. New dining tables have been purchased that allow for the extra height of a wheelchair. Music for Health workshops have been found to be very beneficial and enjoyed by all the persons cared for and staff. A part of the home is going to have a `bus stop`; if a person is agitated and confused and wants to `go home`, a staff member can take them to the bus stop and this may alleviate the person`s agitation. There are plans to try out new menus in the future with meals and mealtimes on a themed basis such as an Italian day. The menu is changed regularly and provides choice. There have been a number of major improvements to the building and outside area. There is now a safe patio area with a table and chairs that can be enjoyed by both the persons cared for and staff. A `memory` garden has been established to the front of the property. A new lift has been installed in a less obtrusive part of the home. This has allowed much more space for both the people cared for and staff to move from room to room and the access of wheelchairs to the dining room. New carpets have been fitted in the hallway and office. All the windows have been replaced and double glazed. The lounges at the front of the home have been fitted with double glazed French windows and have been decorated. Planning permission has been applied for to Fylde Borough Council for a conservatory. New chairs have been purchased for the lounges with a foot stool. Small tables are now provided for when drinks are served. Eight new hospital beds have been purchased and the majority of bedrooms have been decorated, new curtains and bed covers have been purchased. New furniture has been purchased for all the bedrooms. Two additional bedrooms have been fitted with ensuite toilets. The bedroom doors now have a new name plate and photo. The doors to the old lift shafts has been turned into secure cupboards for storage. Staff now have a new staff room where they can make drinks and provision is being made to improve the line connections and provide a computer so that staff can access the internet for training purposes. The home has increased the number of trained staff with over 50% of staff obtaining a qualification. There are currently 6 nursing staff who have a nursing qualification and 17 care staff. Eleven care staff have a National Vocational Qualification (NVQ) at level 2 or above in Care; a further 4 staff are in the process of obtaining the qualification. The NVQ in Care is nationally recognised award in the provision of care. What the care home could do better: A signature and date should be included on risk assessments for clarity as to when the risk assessment had taken place and to assist any review of the care plan. The monthly review of the care plan requires additional details to show that new risk assessments have been undertaken where necessary for any area of potential concern. Key inspection report Care homes for older people Name: Address: Rossendale Nursing Home 96 Woodlands Road Ansdell Lytham St Annes Lancashire FY8 1DA     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Susan Dale     Date: 1 5 0 9 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 27 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 27 Information about the care home Name of care home: Address: Rossendale Nursing Home 96 Woodlands Road Ansdell Lytham St Annes Lancashire FY8 1DA 01253737740 01253795702 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Caroline Taylforth care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category/ies of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 27) Dementia - Code DE (maximum number of places: 27) The maximum number of service users who can be accommodated is: 27 Date of last inspection Brief description of the care home The Rossendale Nursing Home is registered with the Care Quality Commission to provide personal and nursing care for 27 older persons of either sex. Care is offered to persons with physical/medical needs and with dementia. The Rossendale Nursing Home is a detached Victorian property, which retains many of its original features. The home is situated in a residential area of Ansdell Lytham St Annes, overlooking Grannies Bay. The home is within easy reach of shops and local amenities. It is Care Homes for Older People Page 4 of 27 Over 65 0 27 27 0 Brief description of the care home situated on a bus route and within five minutes walking distance of Ansdell railway station. Accommodation is provided in nineteen single rooms and four double rooms, eleven of which have en-suite facilities. Communal areas are provided in two lounges, a dining room and a conservatory. There are attractive gardens to the front and side of the home, accessible to the persons cared for and car parking facilities at the rear of the home. Information about fees can be obtained from the manager of the home. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The site visit was unannounced and took place over five hours. Various records were examined belonging to the people being cared for as well as staff records and policies and procedures. Prior to the site visit, the registered manager completed an Annual Quality Assurance Assessment (AQAA) which, is a self assessment that provides information about how well outcomes are being met for people using the service as well as some numerical information. Various people were spoken with including the registered manager, the registered provider, people being cared for, staff and a visitor. The last key inspection was on the 18th September 2007 and an Annual Service Review took place on the 16th September 2008. Care Homes for Older People Page 6 of 27 What the care home does well: What has improved since the last inspection? A new Service User Guide has been devised that has been designed to be particularly user friendly with pictorial representations for persons who are lacking in mental capacity. When compiling the care plan, the previous social history of the person is taken into account and recorded on a new pro-forma that provides a rounded picture of the individual concerned. Individual wishes and choices are recognised at all times and any religious or cultural requirements are respected and put into place. For any person who has difficulty communicating their needs to staff, a new pro-forma the Disability Distress Assessment Tool has been devised for helping staff to reach a conclusion about care needs and whether the individual concerned is in pain. Communication between families, GPs and out of hours services has improved. The home has been working towards The Gold Standards Framework Award and is due to be assessed for the award at the end of September 2009. The Gold Standards Framework is a planning tool aiming at better communication and recording of decisions about the individuals care needs and wishes as well as their family. A policy has been devised to reduce crisis hospital admission at the end of life. A training programme has commenced for palliative care. Care Homes for Older People Page 7 of 27 At the last key inspection, footplates were not in position because the wheelchairs would not fit beneath the dining room tables with the footplates in place. This could possibly cause injury to the feet by being dragged on the floor. New dining tables have been purchased that allow for the extra height of a wheelchair. Music for Health workshops have been found to be very beneficial and enjoyed by all the persons cared for and staff. A part of the home is going to have a bus stop; if a person is agitated and confused and wants to go home, a staff member can take them to the bus stop and this may alleviate the persons agitation. There are plans to try out new menus in the future with meals and mealtimes on a themed basis such as an Italian day. The menu is changed regularly and provides choice. There have been a number of major improvements to the building and outside area. There is now a safe patio area with a table and chairs that can be enjoyed by both the persons cared for and staff. A memory garden has been established to the front of the property. A new lift has been installed in a less obtrusive part of the home. This has allowed much more space for both the people cared for and staff to move from room to room and the access of wheelchairs to the dining room. New carpets have been fitted in the hallway and office. All the windows have been replaced and double glazed. The lounges at the front of the home have been fitted with double glazed French windows and have been decorated. Planning permission has been applied for to Fylde Borough Council for a conservatory. New chairs have been purchased for the lounges with a foot stool. Small tables are now provided for when drinks are served. Eight new hospital beds have been purchased and the majority of bedrooms have been decorated, new curtains and bed covers have been purchased. New furniture has been purchased for all the bedrooms. Two additional bedrooms have been fitted with ensuite toilets. The bedroom doors now have a new name plate and photo. The doors to the old lift shafts has been turned into secure cupboards for storage. Staff now have a new staff room where they can make drinks and provision is being made to improve the line connections and provide a computer so that staff can access the internet for training purposes. The home has increased the number of trained staff with over 50 of staff obtaining a qualification. There are currently 6 nursing staff who have a nursing qualification and 17 care staff. Eleven care staff have a National Vocational Qualification (NVQ) at level 2 or above in Care; a further 4 staff are in the process of obtaining the qualification. The NVQ in Care is nationally recognised award in the provision of care. What they could do better: A signature and date should be included on risk assessments for clarity as to when the Care Homes for Older People Page 8 of 27 risk assessment had taken place and to assist any review of the care plan. The monthly review of the care plan requires additional details to show that new risk assessments have been undertaken where necessary for any area of potential concern. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 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. Good information about the services provided by the home is available and the initial assessment ensures that an appropriate service can be provided. Evidence: The home has a Statement of Purpose that describes the facilities provided by the home and this has been updated with the various changes that have taken place. A new Service User Guide has been devised that has been designed to be particularly user friendly with pictorial representations for persons who are lacking in mental capacity. The families and any person considering entering the home are provided with enough information to make an informed choice before living at the home. The records belonging to four persons living at the home were examined. The records showed that a full assessment is undertaken prior to commencement at the home. The assessment took into account the persons mental capacity and whether their admittance to the home would deprive them of their liberty in particular areas of their Care Homes for Older People Page 11 of 27 Evidence: life. Close liaison takes place with other health professionals before a person is admitted and visits are undertaken to the persons home or hospital prior to admittance. A new assessment form is to be devised that will take into account any mental incapacity and the steps that need to be taken and recorded to ensure that the home will be able to meet their needs. Any areas of risk are examined and the registered manager confirmed that the process taken had led then to quickly recognise an inappropriate placement and the person had been re-assessed by Social Services and placed elsewhere. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical and health needs of the persons cared for in the home are being met and staff are respectful and understand the importance of privacy. Evidence: Four care records were examined and the records showed that a full and comprehensive care plan is devised. Where possible the previous social history is taken into account and recorded on a new pro-forma that provides a rounded picture of the individual concerned and ensures an appropriate care plan that meets physical and emotional needs. Individual wishes and choices are recognised at all times and any religious or cultural requirements are respected and put into place. The registered manager has provided dignity awareness sessions to staff within the home. Staff were observed to be patient and caring, one of the persons cared for confirmed that staff are respectful and made the following comments: The staff are wonderful and I am very happy here and They help me to have a bath and I never feel uncomfortable. Care Homes for Older People Page 13 of 27 Evidence: Life books have been put in place that detail the previous background of the person concerned and photos are included where it has been possible to obtain them. The care plans have been reviewed once a month, a key worker system is in operation and staff spoken with confirmed that a meeting is held with staff at each review and relatives views are also taken into consideration. The care plans seen could be improved by the inclusion of a date and signature on the individual recordings so that it is clear when a document had been reviewed and updated from the original assessment. There could also be some expansion in the details recorded at each review to show how the conclusions had been reached at the review and whether a new risk assessment had been completed. The review should also include the signature of the staff member completing the documentation. Several of the persons cared for have a learning disability as well as health problems due to their age. These persons have difficulties communicating their needs to staff and a new pro-forma has been put in place which is a Disability Distress Assessment Tool for helping staff to reach a conclusion about their care needs and whether they are in pain. Staff also confirmed that they have looked after the persons concerned for some time and are able to recognise from their body language and facial expressions as to how comfortable they are. There was evidence of close liaison with other health professionals such as General Practitioners (GPs), Community Psychiatric Nurses, Audiologists and Dieticians. Communication between families, GPs and out of hours services has improved. The home has been working towards The Gold Standards Framework Award and is due to be assessed for the award at the end of September 2009. The Gold Standards Framework is a planning tool aiming at better communication and recording of decisions about the individuals care needs and wishes as well as their family. A policy has been devised to reduce crisis hospital admission at the end of life. A training programme has commenced for palliative care. There are policies and procedures with regard to the recording and storage of medication. The Medication Administration Records (MAR) were examined and found to be correct. Medication is provided only by the staff who have a nursing qualification and they are checked once a month by the registered manager who has a nursing qualification. Three nursing staff have attended syringe driver training. At the last inspection it had been noted that footplates on wheelchairs had not always been in position and that this was potential risk for feet to drag along the ground. The Care Homes for Older People Page 14 of 27 Evidence: reason why footplates were not in position was because the wheelchairs would not fit beneath the dining room tables with the footplates in place. This has now been rectified as new dining tables have been purchased that are higher than previous and can accommodate wheelchairs much easier. Care Homes for Older People Page 15 of 27 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. Leisure and recreational activities are provided that are suitable for the persons cared for. Contact with relatives, friends and the local community is encouraged. Meals are varied and nutritionally well balanced. Evidence: Consideration to the high percentage of persons cared for with dementia is taken into account when activities are planned. Activities include games skittles and dominoes. Trips out are undertaken where possible and according to the weather; the home has the advantage of being close to Fairhaven Lake and Grannies Bay. Interests and hobbies are recorded in the life histories. Consideration has been given whether to employ an activities co-ordinator but the registered manager considers that it has been better to spend money on entertainment and they have found Music for Health workshops to be very beneficial and enjoyed by all the persons cared for and staff. The persons cared for are encouraged to maintain their religious beliefs and the home is visited by religious clergy on a regular basis. Visitors are encouraged and a visitor spoken with confirmed that she is always made welcome and can visit at any time. Care Homes for Older People Page 16 of 27 Evidence: Dementia training has provided new ideas for the stimulation of persons with confusion and a part of the home is going to have a bus stop; there are already pictures on the wall of buses. The idea is that if a person is agitated and confused and wants to go home, a staff member can take them to the bus stop and this may alleviate the persons agitation. A large proportion of the persons cared for require assistance and encouragement with feeding. A number of staff are available to provide assistance and they were observed to be assisting discreetly and a record is maintained of the amount of food and fluids taken by persons who are at risk of losing weight. Every person cared for is weighed once a month and a note is made of their body mass index in the care records. Special diets are catered for. There are two cooks and the one on duty confirmed that there are plans to try out new menus in the future with meals and mealtimes on a themed basis such as an Italian day. The menu is changed regularly and provides choice. The outside area now has a safe patio space with a table and chairs that can be enjoyed by both the persons cared for, staff and relatives in good weather and where meals and snacks can be taken. Each person cared for has a key worker who is a member of staff that ensures they have detailed knowledge of individual requirements, for example working alongside the laundry staff member to keep clothes in good repair and informing relatives if anything needs replacing. Various comments have been received by the home including: I would recommend this home to anyone without reservation. I think you all do a great job, sometimes in difficult situations. We are more than happy with the care our mother receives and could not wish her to be anywhere better. Care Homes for Older People Page 17 of 27 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. A suitable complaints procedure is in operation and policies and procedures are in place that ensures the persons cared for are protected. Evidence: The home has a suitable complaints procedure and the information about how to raise any concerns is provided to the people cared for as well as their relatives. There have been no complaints raised with the Care Quality Commission since the last key inspection. The home has a safeguarding procedure in place and staff are taught at induction training how to raise any concerns if they think that a person cared for may have been abused. The manager of the home has followed the safeguarding procedures correctly by raising concerns in the past about a persons family situation. Some staff have further safeguarding training and according to the manager it will be mandatory for all staff to attend the training. Any potential risks involved with the care to be provided are examined and assessed as the person enters the home and at each review. A Deprivation of Liberty assessment is undertaken for persons whos liberty may be compromised by living at the home. An independent advocate has been asked to attend a review meeting for one of the persons cared for at the home. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and safe and provides a very pleasant environment for the persons cared for and staff. Evidence: The home is not purpose built and has a very homely atmosphere. Many of the rooms are large and full of character. Some of the rooms have good views overlooking Grannies Bay. A tour of the home took place and all parts of the home were clean, tidy and hygienic. The home has been transformed by the removal of the old lift and a new lift has been installed in a less obtrusive part of the home. This has allowed much more space for both the people cared for and staff to move from room to room and the access of wheelchairs to the dining room. New carpets have been fitted in the hallway and office. All the windows have been replaced and double glazed. The lounges at the front of the home have been fitted with double glazed French windows and have been decorated. Planning permission has been applied for to Fylde Borough Council for a conservatory, if this is denied a decking area will be built to be accessed from the French doors. Some new chairs have been purchased for the lounges with a foot stool. Small tables are now provided for when drinks are served. Care Homes for Older People Page 19 of 27 Evidence: Eight new hospital beds have been purchased and the majority of bedrooms have been decorated, new curtains and bed covers have been purchased. New furniture has been purchased for all the bedrooms. Two additional bedrooms have been fitted with en-suite toilets. A number of the rooms have been shared by the same persons for a number of years; the rooms are large and screens are available as necessary. The bedroom doors now have a new name plate and photo. The doors to the old lift shaft have been turned into secure cupboards for storage. Staff now have a new staff room where they can make drinks and provision is being made to improve the line connections and provide a computer so that staff can access the internet for training purposes. Outside there is a memory garden and a new secure patio area with a table and chairs for use by the persons cared for and staff. A visitor spoken with confirmed that the home is always clean and tidy when they had visited. There was evidence that all maintenance checks had been completed and a Fire Safety assessment had been completed. Care Homes for Older People Page 20 of 27 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. Staff are suitably recruited and provided with training and support that enable them to be competent and confident in the care they provide. Evidence: The number of staff on duty is sufficient for the number and needs of the persons currently being supported. Eight staff are on duty between the hours of eight am to eight pm and three staff are on duty between eight pm and eight am. There were several staff able to provide assistance at meal times as the majority of persons cared for require assistance with feeding. Staff files were examined and there was evidence of induction training that is comprehensive. Mandatory training included, Manual Handling; Dying, Death and Bereavement; New Fire Training; Food Handling; Nutrition and Assisted Feeding; Person Centred Care, Protection of Vulnerable Adults (POVA) and Philosophy of Care. There is a suitable recruitment policy and procedure and the records seen showed that security checks had been undertaken including with the Criminal Records Bureau (CRB) and Protection of Vulnerable Adults register; two appropriate references had been obtained and the pro-forma for references has been improved. There are currently six nursing staff who have a nursing qualification and seventeen Care Homes for Older People Page 21 of 27 Evidence: care staff. Eleven care staff have a National Vocational Qualification (NVQ) at level 2 or above in Care; a further four staff are in the process of obtaining the qualification. The NVQ in Care is nationally recognised award in the provision of care. The registered manager is also an NVQ assessor Staff confirmed that the training received is good and helps them to be confident in their role and the tasks required. There is sufficient time allowed for them to provide care and also quality time with the people supported. Care Homes for Older People Page 22 of 27 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 health, safety and financial interests of the people cared for are protected and both the persons cared for and staff benefit from the leadership skills of the management of the home. Evidence: Both the registered manager and the registered provider are appropriately qualified having completed the Registered Managers Award. Both the staff, the persons cared for and a visitor confirmed that management staff were approachable and caring. The routines and procedures in the home are organised around the choices and wishes of the persons cared for. It was observed that if a person wished to stay in their room and sleep they could do so and if they did not wish to join any activities for example, this was recognised. The registered manager speaks with the persons cared for and their families on a regular basis and surveys are delivered regularly to families. A newsletter is produced Care Homes for Older People Page 23 of 27 Evidence: once a month and sent to relatives and General Practitioners. The home is a member of the Alzheimers Society and also the National Association for Providers of Activities for Older People (NAPA). The home has Investors in People Status which is a recognised award for quality. Working towards the Gold Standards Framework has encouraged staff who confirmed that a team approach is taken at all times and they feel valued. Staff meetings take place on a regular basis and one to one supervisions takes place 3 or 4 times a year and the details are recorded. Staff confirmed that informal meetings also take place with the manager and there is an open door policy. None of the persons cared for in the home are able to manage their finances and all fees and expenses are either by relatives or via a solicitor. The home keeps records of all financial transactions taken on behalf of the persons cared for. Risk assessments are carried out in all areas including the environment and all aspects of care. Policies and procedures are in place with regard to health and safety and regular maintenance of equipment takes place. All accidents and incidents are recorded appropriately. Care Homes for Older People Page 24 of 27 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 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 A signature and date should be included on risk assessments for clarity as to when the risk assessment had taken place and to assist any review of the care plan. The monthly review of the care plan requires additional details to show that new risk assessments have been undertaken where necessary for any area of potential concern. 2 7 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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