Care Home: Rossmore Nursing Home Limited

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What the care home does well The home continues to ensure that people have their needs assessed prior to admission. This enables staff to be sure the home can meet their needs safely. The home continues to provide an excellent stroke rehabilitation service with input from health professionals and the homes care staff team. This enables people to recover as many of their skills as possible following a stroke, in readiness for a return home if that is what is planned. People described the environment as homely, friendly and having a good atmosphere. The home was clean and fresh. There is an ongoing redecoration and refurbishment plan. People told us they liked the meals provided and the home offered alternatives to the main menu. The home had gained an, `A` in the local authority`s, `scores on the doors` food safety assessment system and a `healthy heartbeat` award for the last eleven years for providing a healthy alternative to the main meals on offer. The staff spoken with said they enjoyed their jobs and they had a good team, `there is job satisfaction` and `good staff morale`. They were aware of how to promote independence, privacy and dignity. Residents said they received the care and support they required. Relatives told us they were made to feel very welcome and were kept informed of issues. Staff training continues to be planned and carried out for mandatory training and some additional courses related to the health conditions of people living in the home. New staff were inducted into the way the home worked and also completed skills for care induction standards to evidence their competence. The provider is accessible on a daily basis as he works in the home. This enables the residents and staff team to meet with him when required and discuss any concerns. The home managed complaints well and documented what action had been taken. The home managed residents finances well and maintained clear records. What has improved since the last inspection? The way the home managed and administered medication had improved, which meant that people received their medication safely and as prescribed. The care plans had improved and there were clearer tasks for staff. There was more information about peoples` preferences for how they wished to be cared for. Staff had also started to complete wall charts of life histories with residents, which included wishes and choices, some of which were in picture form. Recording of the daily care had improved and it was easier to audit the care that had been provided to people. A new activity coordinator had been employed for thirty-seven hours a week. This had made a difference to the social stimulation some residents received. The range of questionnaires had been broadened to include professional visitors to the home in addition to those sent to the residents and their relatives. This enabled a wider view of how the home was managed and the quality of the services provided. There was evidence that comments and suggestions were listened to and addressed. Staff told us they received supervision and the recording of the supervision sessions covered training and development needs, working practices and support. Staff also told us that some of their practices were observed, for example medication administration. The provider had purchased several specialised beds with integrated rails for residents that require the safe use of bedrails. Staff check that bedrails are used safely. What the care home could do better: Staff had received training in how to safeguard vulnerable people from abuse, however, there was one occasion when a safeguarding of adults alert, occurring out of normal working hours, could have been dealt with more effectively by the home. This would have prevented a delay in reporting. Full criminal record bureau checks must be in place prior to the start of employment. The home sometimes employs people after an initial check but before the return of the full criminal records bureau check. This will help to ensure only appropriate people are employed to work in the home. In view of the high turnover of care staff for the second year running, management should hold exit interviews to establish the reasons why staff are leaving. This will help to ensure that any issues can be addressed. Key inspection report Care homes for older people Name: Address: Rossmore Nursing Home Limited 68 Sunny Bank Spring Bank West Kingston upon Hull East Yorkshire HU3 1LQ     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: Beverly Hill     Date: 2 1 0 4 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 29 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 29 Information about the care home Name of care home: Address: Rossmore Nursing Home Limited 68 Sunny Bank Spring Bank West Kingston upon Hull East Yorkshire HU3 1LQ 01482343504 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): dnd@rossmorecare.co.uk Rossmore Nursing Home Limited Name of registered manager (if applicable) Mrs Veronica Eugenie Slee Type of registration: Number of places registered: care home 56 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: Registration includes twelve (12) stroke rehabilitation patients and 6 day places. Date of last inspection Brief description of the care home Rossmore Nursing and Residential Home is a two-storey building, which has been converted from a number of terraced houses for its present use. It is situated about a mile and a half from the centre of Hull in a quiet residential area overlooking the playing fields of Hymers College. There is a range of shops and pubs nearby. There are bus stops close to the home and the main train station is within walking distance. Car parking is available on the street outside the home. The home provides nursing and residential care to people over the age of 65 years for needs associated with physical Care Homes for Older People Page 4 of 29 2 7 0 5 2 0 0 9 0 0 8 Over 65 56 56 56 Brief description of the care home disabilities or dementia. The home also has a contract with Hull Primary Care Trust to provide a stroke rehabilitation service to eight people. The main unit has accommodation provided over two floors within single or shared rooms; one of the shared rooms has en-suite facilities. Access to the upper floor is available through the use of stairs or the passenger lift. The main unit has four assisted bathrooms and two shower rooms and the stroke unit has two shower rooms. Communal areas consist of a large lounge with doors into a dining room, which in turn leads into a small quiet room. Four shared bedrooms for the stroke unit are located at one end of the main unit and the communal areas are in a separate building. These consist of a lounge, rehabilitation kitchen, a therapies room and offices for health professionals. There is a small courtyard garden leading off from the quiet room on the main unit and a courtyard accessible for the stroke unit. Fees for the home range from £359.50 - £536.42 per week plus a £10 top fee, which is determined on an individual basis. Additional charges include hairdressing, toiletries, newspapers and chiropody. Information regarding the services the home provides can be located in the service user guide and statement of purpose, both available from the managers office. Care Homes for Older People Page 5 of 29 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 quality rating for this service is 2 star. This means that the people that use this service experience good quality outcomes. This inspection report is based on information received by the Care Quality Commission (CQC) since the last key unannounced inspection on 15th April 2009 and a random inspection carried out by a pharmacy inspector on 27th May 2009. It included information gathered during a site visit to the home, which took approximately eight hours. Throughout the day we spoke to people that lived in the home to gain a picture of what life was like at Rossmore. We also had discussions with the provider, the registered manager and staff members. Information was also obtained from surveys received from residents and staff members. Comments from the surveys and discussions have been used in the report. Care Homes for Older People Page 6 of 29 We looked at assessments of need made before people were admitted to the home, and the homes care plans to see how those needs were met while they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them, and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. We would like to thank the people that live in Rossmore, the staff team and management for their hospitality during the visit, and also thank the people who had discussions with us and who completed surveys. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the services are not being put at significant risk of harm. In future if a requirement is repeated it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? The way the home managed and administered medication had improved, which meant that people received their medication safely and as prescribed. The care plans had improved and there were clearer tasks for staff. There was more information about peoples preferences for how they wished to be cared for. Staff had also started to complete wall charts of life histories with residents, which included wishes and choices, some of which were in picture form. Recording of the daily care had improved and it was easier to audit the care that had been provided to people. Care Homes for Older People Page 8 of 29 A new activity coordinator had been employed for thirty-seven hours a week. This had made a difference to the social stimulation some residents received. The range of questionnaires had been broadened to include professional visitors to the home in addition to those sent to the residents and their relatives. This enabled a wider view of how the home was managed and the quality of the services provided. There was evidence that comments and suggestions were listened to and addressed. Staff told us they received supervision and the recording of the supervision sessions covered training and development needs, working practices and support. Staff also told us that some of their practices were observed, for example medication administration. The provider had purchased several specialised beds with integrated rails for residents that require the safe use of bedrails. Staff check that bedrails are used safely. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 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 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are only admitted to the home after an assessment of their needs has been completed and the home is sure the persons needs can be met. The home continues to provide excellent intermediate care facilities for people following a stroke. This enables people to regain their skills and adapt, and prepare for independent living at home or for a move to more permanent care. Evidence: There was evidence that people had their needs assessed prior to admission to the home. The home used documentation called, standex system. This had been introduced last year and included a range of documentation from an initial assessment prior to admission, further assessment tools after admission, for completion when more information about the resident was available, and through to care planning and ongoing monitoring of care. Care Homes for Older People Page 11 of 29 Evidence: The registered manager confirmed they completed the assessments prior to admission, either by visiting people at home, other residential homes or in hospital. There was scope for the assessments to be kept updated each year or when significant changes occurred. The home obtained assessments and care plans completed by care management teams for people funded by the local authority. Those residents at the home who receive nursing care have undergone an assessment by a registered nurse from the Primary Care Trust (PCT), to determine the level of nursing input required for each individual. There were also some residents that had had continuing health assessments completed by the PCT, when extra funding was required for their care. The home continues to provide specialist facilities to enable people to rehabilitate following a stroke. The stroke unit is a separate building in the grounds of Rossmore Nursing Home, although the eight people it can accommodate at any one time sleep in the main building in four shared bedrooms. Facilities include a rehabilitation kitchen, a dining area, a lounge and a therapy room. Health professionals had offices upstairs and managed the process of rehabilitation. They completed assessments and care treatment plans, which followed on from those commenced during the persons stay in hospital. These included physiotherapy, occupational therapy, speech and language therapy, specialist nursing services and GP facilities. The home allocated specific care staff during the day to assist in completing care programmes. The care staff have a precis of information produced to run alongside treatment plans and staff are quite happy that this gives them sufficient information to care for people. Care Homes for Older People Page 12 of 29 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. People had their health and personal care needs planned for and met in ways that promoted privacy and dignity. The management of medicines had improved and people received the medicines that were prescribed for them. Evidence: We looked at four care files during the day and it was noted that the care plans had improved. The ones seen reflected the needs identified in the assessments and had clear tasks for staff in how to meet the needs. The care plans were evaluated monthly and updated when needs changed. Where possible the resident signed the care plan to evidence they agreed with the contents. Staff have started completing a document for each resident called, what is important to me. This is person-centred and details specific information about people and how they wish to be cared for. Staff keep these information sheets close to hand for daily reference. The activity coordinator showed us how residents had participated in Care Homes for Older People Page 13 of 29 Evidence: developing large wall charts kept in their own bedrooms, which included information about personal preferences, wishes and life histories. People has access to a range of health and social care professionals for advice, guidance and treatment. There were risk assessments in place for nutrition, skin integrity, moving and handling, falls, the need for bed rails and for specific behaviours that could be challenging to others. One of the risk assessments and corresponding care plans for specific behaviour could be more detailed about the actual behaviour and control measures to minimise risk. However, in discussions with staff they were aware of what to do and how to manage any behaviour. We saw in one care file that a resident had sustained several falls so they were referred to a local falls team for assessment and advice. Staff recorded the care they provided day and night and the documentation had charts for recording bathing and bowel care. Weights were recorded monthly or more frequently if there were issues to monitor. Staff had completed a, patient passport, for each resident. This was a document that detailed specific information about how they need to be cared for should they be admitted to hospital. Staff recorded specific one to one time spent with residents as, key worker time. Some of these were documented as, chats during personal care, whilst others spoke more comprehensively about specific interaction aside from personal care tasks and gave more of a feel of the relationship between the resident and staff member. Residents spoken with were happy with the care they received and this was also reflected in surveys and in discussions with relatives. Comments were, Rossmore is a first class home, very friendly staff and they do everything they can to make you feel at home, yes they look after us well, I feel well looked after, they have nursed her really well - coaxed her, the care is good and I have seen a marked improvement in her health. All five surveys from residents stated they received the medical attention, and care and support they required, either, always or usually. Although the care plans had improved substantially, some could include even more personalised information. However, as the document, what is important to me, runs alongside the care plan, when it is completed for all residents this issue will be addressed. The management of medication had improved. The home had good support from their local pharmacist and they had visited the home to offer guidance and ongoing support. The report that they produced stated, overall standard of medicine management - excellent. Medication was stored appropriately and recorded as Care Homes for Older People Page 14 of 29 Evidence: received into the home and on disposal. There were no gaps in administration and if a resident did not receive their medication, the reason was clearly defined. Care Homes for Older People Page 15 of 29 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 had improved the provision of social stimulation, which helped to improve the quality of life for people. Peoples nutritional needs were met and they were provided with choices for each of their meals. Evidence: Since the last inspection the home has employed an activity coordinator for thirtyseven hours a week. This has made a difference to the stimulation that some residents receive. In discussion with the activity coordinator, they advised that they are investigating specific training courses for their role and have already completed person-centred training with the local authority. Each week residents receive a diary of planned events attached to the menu. The week of the site visit included bingo, a music project, a music, movement and memory session, a textiles project and, arts and crafts. The home has taken part in a pilot project for twelve weeks run by an art group and has included interesting stimulation facilitated by the group. The activities covered working with textiles, media participation (laptops and camera use) and music including singing and instruments. Care Homes for Older People Page 16 of 29 Evidence: This has been very successful and some activities are to be carried on by staff in the home. The home is trying to obtain further funding for some of the activities. The activity coordinator also spoke about one to one and group activities such as, individual chats, bowling, movement games, household tasks such as folding napkins, pairing socks, setting tables and tidying drawers, board games and dominoes, and manicures. Some residents like to go for short walks, some prefer to sit and read their newspapers and books or watch television and others enjoy joining in bingo sessions. A gardening session is to start next week now the warmer weather has arrived. Care files have profiles and histories and person-centred work, in the form of large wall charts, has been completed for 6-7 residents and is displayed in their bedrooms. All four surveys received from residents stated they had sufficient activities, always. people spoken with confirmed there had been an improvement in this area, although one person stated they would like to have access to a computer. People told us they had choices about rising and retiring, what meals they had to eat and whether they wanted to remain in their own bedroom. Visitors confirmed they were welcomed at any time and were offered refreshments, its a marvelous place the best I have ever been in, it has a good atmosphere, its homely - not regimented and they are nice to relatives. Bedrooms were personalised and people could bring in small items of furniture, pictures and ornaments to make their bedroom more homely. The meals provided met peoples nutritional needs and the home had been awarded a, Healthy Heartbeat award for the last eleven years for providing a healthy alternative. Catering staff had also been awarded an, A in the local authoritys, scores on the doors system of assessing food safety management. Comments about the food were, the food is lovely - I come at lunchtime and help to feed her, Ive had lunch here once or twice and it was lovely, I dont always like the food so they give me alternatives like chicken, which is good, the meals are alright and Ive been off food for a long time but I do get some enjoyment from it - I would like it hotter though. In surveys all four people said they liked the meals either, always or usually. Catering staff provided alternatives to the main menu and information about these was provided to each resident on a weekly basis. Residents were then able to let catering staff know each day if they preferred the alternative. The home provided a range of special diets to suit specific nutritional needs. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides an environment where people feel able to complain in the knowledge that any complaints will be listened to and addressed. Staff in charge of shifts are now more aware of their safeguarding referral responsibilities should any incident occur out of normal working hours. Evidence: The home had a complaints policy and procedure that was on display. Staff were aware of what to do if people raised concerns with them. Residents and three relatives spoken with stated they felt able to make complaints and that they would be listened to. Comments were, I have no grumbles at all - I would complain if needed, I would tell one of the nurses, he (the provider) comes sometimes and checks to see if we are alright, I would go straight to David (provider), he would sort it out, Any niggles go to staff, complaints I would go to David and there are no complaints. The manager maintained a log of complaints and the three received by the home since the last inspection had been addressed. The Care Quality Commission has not received any complaints about the home. The home had a copy of the local authority policy and procedure for safeguarding adults from abuse. Staff had received training and the registered manager and qualified nurses had received more in-depth training from the local authority regarding Care Homes for Older People Page 18 of 29 Evidence: the referral and investigation role, when in charge of shifts. There have been five safeguarding of adults referrals made to the local authority since the last inspection. Two related to care issues, and the outcome of checks by the local authority was that the home was meeting the residents needs appropriately. Two referred to incidents between residents and the home provided more monitoring for them. The remaining incident was also between residents and could have been dealt with more effectively by the home. The incident happened during the night and staff were unaware that they could still report this to the local authority out of hours. This caused a delay in reporting and could have affected any action that may have been advised. However, the provider has evidenced that all nurses in charge of shifts are fully aware of policies and procedures and all have completed safeguarding training in the past with the local authority. Care Homes for Older People Page 19 of 29 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 provided a clean, warm and well equipped environment. Evidence: The home had a redecoration and renewals plan and any maintenance issues were addressed quickly. The home has a separate building to support people admitted for rehabilitation following a stroke. This consists of a lounge, rehabilitation kitchen, two shower rooms, a therapies room and offices upstairs for professional staff involved in the support. Bedrooms are located in four shared rooms at one end of the main house. The stroke unit is well equipped and suitable for its intended purpose. The main part of the home has a large lounge with a dining room leading off it. The lounge is used by several residents on a regular basis but the majority of people continue to remain in their bedrooms. Those people spoken with on the day expressed that this was their choice. Staff were trying to encourage more residents to use the dining room to enable meal times to be more of a social event. There is a small quiet room at the end of the dining room and this leads outside via patio doors to a secure patio area. This area has been upgraded and is a pleasant outdoor space for people to sit in the warm weather. Care Homes for Older People Page 20 of 29 Evidence: The bedrooms seen were personalised to varying degrees according to the taste and choice of the occupant. Shared rooms had privacy screens and all bedrooms had lockable facilities as required. The home had sufficient bathrooms, showers and toilets. The home continues to be warm, clean and odour-free. Five surveys received from people living in the home stated it was fresh and clean either, always or usually. People spoken with on the day also confirmed they were satisfied with the cleanliness of their bedrooms and the home in general. One person told us they were very pleased with their new bed. Relatives commented that the home was, homely and had a good atmosphere. Another said, it smells clean and fresh and staff are always washing carpets. There were sufficient domestic staff employed and all staff had alcohol gel, paper towels, gloves and aprons to use to minimise cross infection. The laundry was suitable for the size of the home and contained commercial washing machines and tumble driers, a clothes press and ironing facilities. Designated staff were employed to work in the laundry. Care Homes for Older People Page 21 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by caring and well trained staff in sufficient numbers to meet their needs. Full staff recruitment records must be obtained routinely prior to the start of employment. Evidence: The home is operated with eleven care staff on duty in the morning plus three qualified nurses. In the afternoon there are six care staff on duty plus one qualified nurse after 5pm. During the night the home has three care assistants and one qualified nurse. These figures include the stroke rehabilitation unit. The registered manager, who is also a nurse, is supernumerary and the provider worked in the home on a daily basis and completed some managerial and financial tasks. Staff in surveys told us there was sufficient staff, always or usually. People spoken with, and surveys received from residents, had positive comments about the care staff. All five surveys received from residents stated staff listened to them and acted on what they had to say, always. One resident told us that staff were, nice and another stated they were, very good. Relatives spoken with stated, I really couldnt fault any, they always ring me up and keep me informed, there are kisses and cuddles from the staff to the residents, the staff are lovely and the staff Care Homes for Older People Page 22 of 29 Evidence: are brilliant - I cant say more. The home has a training plan and maintains records of who has attended mandatory training and when an update is due. Additional training included stroke rehabilitation, dementia awareness and person-centred thinking. As well as distance learning and inhouse training, staff are able to access training provided by the local authority, which includes conditions affecting older people. Nursing staff completed a range of additional clinical training to support their ongoing professional registration. All four staff surveys returned, indicated they received training that was relevant and kept them up to date. The home had 45 percent of care staff that had gained a National Vocational Qualification (NVQ) in care at level 2 and 3. This was a good achievement and when the additional eight care staff progressing through the course complete it, the home will have exceeded the target of 50 . The home has had a high staff turnover in the last year but those staff spoken with stated the team has now stabilised, morale is high and it is a friendly environment. One person stated that since the last inspection the home was more structured and staff can spend more time with residents. New staff completed, skills for care induction standards, which could take up to twelve weeks depending on their progress. This was in addition to three supernumerary days to formally induct them into the way the home worked. In surveys staff told us induction covered the things they needed to know. The homes recruitment process generally follows guidance and policies and procedures. Staff complete an application form, references are obtained and criminal record bureau checks are completed. However, of the four recruitment files examined, three staff were employed after a preliminary check had been made of the register barring people from working with vulnerable adults but before the return of the full criminal record bureau check. The provider aways carries out all other checks and ensures the staff member is supervised when on shift. This practice should only be in exceptional circumstances and not routine practice. The home has a system of checking that qualified nurses have up to date registration with the Nursing and Midwifery Council. Care Homes for Older People Page 23 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed with ongoing input from the provider. People are consulted about how the home is managed and staff members are supported in their role. Evidence: The registered manager had completed her registered managers award and had completed various relevant training courses in the last year in order to keep herself up to date. These included, diabetes, moving and handling refresher, Parkinsons disease, safeguarding of adults briefing session, person-centred thinking and a fire safety update. The provider advised that a new manager has been appointed to take over but there is a delay in transferring the role and the current registered manager has agreed to carry on for the time being. In surveys, all four staff stated that they received management support either, regularly or often. There was also the opportunity to meet the provider and discuss any issues with him. He works at the home five days a week and one staff member wrote, he is a good owner - always has time for the residents and employees. Staff Care Homes for Older People Page 24 of 29 Evidence: spoken with on the day described both the manager and provider as, approachable, as having an open door and they will listen to you and act on it. The residents knew the manager and providers names and other comments were, he comes sometimes and checks to see if were alright, its an excellent place - good care and David (provider) is here all the time. He bought Easter eggs for everyone and ordered an ice cream van to come to the home. Meetings for management, trained staff, general staff and residents/relatives were held to ensure an exchange of information. The home also produces a periodic newsletter. The home has a quality assurance system that consists of audits and questionnaires. The questionnaires were sent out to a range of residents, relatives and professional visitors to the home. Comments from questionnaires and discussions in meetings were addressed, which showed that people are listened to and have a say in how their home is managed. The home had completed their Annual Quality Assurance Assessment on time. This was a self-assessment and detailed what they did well and what areas they would like to improve. Formal, one to one supervision has improved and people were on track to receive a minimum of six sessions per year. Staff also had annual appraisals to look at their training and development needs. Finances were not assessed at this inspection but we had a discussion with the provider. The computerised system remains the same for the management of individual personal allowances. Records were maintained and receipts obtained for purchases. Monies were held securely with restricted access. The home continues to be a safe place for people to live in and staff to work in. Equipment was serviced and maintained, fire alarm checks carried out and staff completed mandatory training in health and safety, moving and handling, fire safety, first aid and infection control. Maintenance personnel were on hand to complete repairs, audit hot water outlets and bed rail use, and service equipment. We are always informed of any incident affecting the welfare of residents. Care Homes for Older People Page 25 of 29 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 26 of 29 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 29 19 Full criminal record bureau 31/05/2010 checks must be in place prior to the start of employment. The practice of employing care staff after an initial check against the barring register but prior to the full return of the CRB should be in exceptional circumstances and not be routine practice. This will help to ensure only appropriate staff work with vulnerable people. 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 18 The home should ensure refresher updates in safeguarding policies and procedures for all staff, especially those in charge of shifts and responsible for the referral of allegations to the safeguarding of adults team. The home should continue to work towards 50 of care staff trained to NVQ level 2 or above. Page 27 of 29 2 28 Care Homes for Older People 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 3 29 In view of the high turnover of care staff for the second year running, management should hold exit interviews to establish the reasons why staff are leaving. This will help to ensure that any issues can be addressed. Care Homes for Older People Page 28 of 29 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). 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