Care Home: Russell Court Nursing Home

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What the care home does well The service is good at involving residents in decisions about how the home should develop, and in obtaining their views about ongoing entertainment and outings. The home is always welcoming to visitors, and one relative commented that " we are always offered hospitality. And I can`t think of anything in the home they could do better." Residents are given good personal and health care, and this was evidenced by seeing the attention to detail with clothing and nail care; and reading care plans. Referrals are made to other health professionals as needed. Most residents said that the food is "very good" or "excellent". If residents do not feel like the dishes on the day`s menu, the chef is always happy to prepare an alternative. The home`s providers are fully aware of ongoing maintenance needs and are proactive in ensuring that the building is well maintained, and in obtaining new equipment and furniture according to need. The building is kept clean, and one resident commented that "they go out of their way to keep the home and our bedrooms in A1 order". Staff training is well managed, with opportunity for staff to develop further with NVQ training; and with courses available for staff to learn new competencies and skills. All mandatory training is kept up to date. The manager and staff interact well with each other and with the residents, which helps the home to run smoothly and efficiently. What has improved since the last inspection? The home ensures that prospective residents obtain the information they need, by sending out copies of the statement of purpose to enquirers; and by encouraging the person or their family to visit the home prior to a pre-admission assessment. Residents and relatives (as appropriate) are invited to take part in their care planning and monthly reviews; and they sign a statement to show their agreement with the care planning. An extension has been added on to the dining room, providing much more space, and enabling the providers to purchase new round tables. This makes it much easier for wheelchair users to use the dining room than previously. The staff training programme has been further developed; and numbers of staff who have completed NVQ training have risen by 30 per cent. What the care home could do better: The home is working well in all areas. Some minor improvements were pointed out in regards to documentation in different areas, and we are confident that these will be addressed. Key inspection report Care homes for older people Name: Address: Russell Court Nursing Home Russell Square Longfield Kent DA3 7RY     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 Hall     Date: 2 8 0 7 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: Russell Court Nursing Home Russell Square Longfield Kent DA3 7RY 01474708151 01474707371 russellcourt@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Russell Court Limited care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 40 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender; Either whose primary care needs on admission to the home are within the following category ; Physical disability (PD) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Russell Court is a privately owned nursing home situated in the semi-rural village of Longfield. This is near to the towns of Dartford and Gravesend, which have all the usual amenities. The home is easy to access via nearby motorways, and there are good public transport links. The owners are involved in the day to day running of the home. The home was purpose built approximately twenty years ago, and provides nursing care for up to forty residents. Accommodation is provided in single en-suite rooms, on two floors, and there is a passenger lift between the floors. The home has a choice of Care Homes for Older People Page 4 of 27 0 40 Over 65 40 0 Brief description of the care home communal areas, and pleasant gardens. The current fees are set at 752.00 pounds per week, and the nursing contribution of 106.30 pounds is deducted from this. The terms and conditions provide clear details of what is included in the fees. 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 home is assessed as having a rating of excellent, 3 stars. This was a key inspection, which includes assessing all the information obtained by the Commission since the previous inspection, as well as a visit to the home. Information is obtained from phone calls and letters about the service; legal notifications which the home is required to send in; any complaints or safeguarding issues in which we are involved; and an Annual Quality Assurance Assessment (AQAA) provided by the home. This is a comprehensive document which the home is required to complete each year, telling us about ongoing developments in the home, and any changes. We received the AQAA back within the specified timescale, and it was well completed. The visit took place over seven hours, commencing at 08:40 in the morning. The manager was not on duty, but was informed of the inspection visit, and decided to come into the home during the morning. She was then available throughout the rest of Care Homes for Older People Page 6 of 27 the visit, assisting us (i.e. CQC) with information. The registered provider and his wife also came into the home during the day, and we were able to meet them and talk about current issues and planned changes. They are both very involved in the ongoing day to day running of the home, and are well known by the staff and residents. During the visit, we talked with five residents, and met others briefly; one relative; and seven staff, apart from the manager and providers. We also sent out survey forms prior to the visit, and received eleven completed forms from residents, staff and health care professionals. All of these showed a positive view of the home, and some included additional comments. We viewed documentation such as care plans, pre-admission assessments, medication charts, staff recruitment files and maintenance records; and also viewed all areas of the building. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: The home is working well in all areas. Some minor improvements were pointed out in regards to documentation in different areas, and we are confident that these will be addressed. Care Homes for Older People Page 8 of 27 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. The home provides comprehensive information for enquirers and new residents. Evidence: The statement of purpose contains good details about the homes accommodation, the facilities, and how the home is run. It includes information about the provider and the manager, as well as staffing data; and states that the provider aims to have the majority of care staff trained to NVQ levels 2 or 3. The statement was seen to contain individual staff details, and it was pointed out that this was not appropriate, as it could contravene the Data Protection Act in regards to retaining staff confidentiality. The document did not contain details of fire precautions and emergency procedures, which should be included. The manager said that both of these matters would be amended, and so it has not been necesssary to issue a requirement. The Service Users Guide provides more detailed information about the homes admission procedures, and how individual care planning is implemented for new Care Homes for Older People Page 11 of 27 Evidence: residents. It contains helpful information such as the complaints procedure and what is included in the fees. All prospective residents have a pre-admission assessment carried out by the manager or a trained nurse, to ensure that the home will be able to meet the persons needs. We viewed two pre-admission assessments, and found that they were well completed, and contain information about all aspects of the persons needs, such as pysical healthcare, medication, personal care and social preferences. We also viewed one of the contracts, which are provided for all residents, and which include the terms and conditions of residency. Residents and their relatives are invited to view the home if possible, prior to making a decision about moving in. There is a trial period of four weeks, after which a review is carried out to decide if the placement is suitable for permanent residency. 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. Health and personal care is excellently provided by a competent and caring staff team. Evidence: Each resident has a named nurse, who is responsible for implementing and maintaining their care plan, and ensuring it is up to date. Care plans are discussed with the resident or their representative, and a form is signed and dated to confirm this discussion has taken place. We viewed five care plans, and found them to be very well completed, with excellent information. An admission assessment provides the initial understanding of the residents needs and preferences, and there are detailed assessments which are checked on a monthly basis. The care plans are drawn up to reflect the findings of the assessments, and how to meet the identified needs. The assessments cover aspects of care such as moving and handling, skin integrity, nutritional needs, and other physical needs; and there is a mental health assessment to determine any memory loss, orientation, the residents ability to understand and communicate, and any history of depression. Risk assessments include the risk of falls; and if bed rails are indicated, a risk Care Homes for Older People Page 13 of 27 Evidence: assessment associated with their use, is discussed and signed with the resident or their representative. Other risk assessments include moving and handling needs, and these clearly itemise if any special equipment is needed (such as a hoist) and identify the type of hoist and size of sling to use. Wound care is very well documented, with separate records for different wounds; body maps in place; and a separate written record for each time a dressing is changed. These records identify the dressings used; and state if there has been any noticeable change in the wounds healing. Care plans were seen to be well written and to contain sufficient data for providing effective care. For example, they state the persons preferred times for getting up and going to bed; if they prefer a bath or shower; any special assistance needed with eating and drinking; equipment and assistance with moving and handling; toileting needs; and if they would like to join in with social activities. The records show that there are good referrals to other health professionals, such as GPs, physiotherapist, speech and language therapist, optician, and dietician. One care plan showed that a physiotherapist had visited a resident every week for several weeks, and ensured that nursing staff knew how to assist the resident with their exercise programme. Daily records are written for day and night shifts, and are written in conjunction with the number of the care plan. These records were satisfactory, and showed that physical needs are being met, but provide little additional information. For example, rather than writing that a care plan for personal hygiene has been met, it would be more helpful to record how it has been met e.g. bath or shower given, nails cut, attended hairdresser. And most of the daily reports viewed did not give much insight into the mood of the resident; the reason for any confusion, or the action taken in response; and had little information about what the resident had actually been doing. These records could be improved to give a clearer picture; and some of the handwriting could be more legible. The home has recently developed a new form for determining the mental capacity of residents, so that it is clear if they are able to make small decisions such as choosing their clothes, or where to go out; and if they can make more difficult decisions such as end of life care. These are extremely detailed forms, and the nursing staff are in the process of discussing the content prior to implementing them. However, it demonstrates the homes awareness of the importance of clearly documenting where residents are unable to make their own decisions, and who will be making decisions on residents behalf and why. Care Homes for Older People Page 14 of 27 Evidence: Medication is stored in a small clinical room, except for the two administration trolleys which are stored in a designated area, and locked to the wall. There was evidence of good stock rotation, and cupboards were tidy and in good order. The clinical room includes a drugs fridge, and the room and drugs fridge temperatures are checked and recorded daily. Controlled drugs (CDs), are stored in a cupboard which meets legal requirements, and are properly recorded in a CD register. The register shows that routine and random checks are carried out on CDs, to check that the amounts tally with the records. Most medication is administered via a monitored dosage blister pack system. We viewed all of the Medication Administration Records (MAR charts) and these are well maintained and include a photograph of the residents. Any allergies are clearly stated. There are good records to show when as necessary medication is given and why (e.g. for pain relief). There were two signature gaps identified for thirty-eight records, which is minimal, but shows that this needs continual monitoring. Most handwritten entries on MAR charts had been signed by two nurses to check for accuracy and for accountability. However two MAR charts were seen where there was only one nurses signature for handwritten entries; and the manager said that she would address this issue. Residents were seen to be well groomed, with attention to detail, such as ladies with jewellery and nail polish. Staff were seen to have caring attitudes and to be relaxed and friendly. One resident said all the staff here are so kind to me, and Im so grateful for all their help. Staff ensure that residents privacy and dignity are maintained; and encourage them to do what they want to. Nursing staff take a lead in different areas of responsibility, and one is a link nurse for palliative care. She said that the home has good links with the Ellenor hospice, and the hospice nurse is very good at assisting the staff team with specific advice. The home tries as much as possible to enable residents to make their own decisions about end of life care, such as if they wish for medical intervention in hospital, or if they wish to stay in the home. The staff ensure that residents who are dying are kept as pain free and comfortable as possible. Relatives or friends can visit as much as the resident wishes them to. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are enabled to be in control of their own lives and to make decisions about the things they wish to do. Food is well managed in the home, and provides a wellbalanced and nutritious diet. Evidence: The home does not have an activities co-ordinator any more, as the manager and staff feel that they are able to provide more activities for all of the residents more easily without one. Residents and several staff said that there is always something going on; and care staff are developing an awareness that meeting social needs is as important as providing personal care. Ongoing daily activities include quizzes, ball games, film shows and going out into the gardens; and there is a fresh understanding of assisting residents with previous hobbies such as crafts and gardening. The providers are having the gardens altered so as to include raised beds with benches in between, and at the correct height for wheelchair users to be involved. The gardens will also contain a fishpond and a new water feature. Residents have been involved in the decision-making processes to alter the gardens. One of the nursing staff said that there is a now a greater emphasis on ensuring that time is spent on a one to one basis with residents who do not wish to leave their Care Homes for Older People Page 16 of 27 Evidence: rooms, or who are unable to do so; and activities no longer revolve around the same residents who enjoy group activities. The home has its own minibus, and the providers and manager are frequently involved in outings to take five or six residents to places such as Greenwich; Seasalter (near Whitstable); up to London; for boat trips on the river Medway; or just to local pubs for lunch; or a country ride. They ensure that these trips are offered to different residents in turn, so that all have the same opportunity; and that residents can go out with their particular friends. The home has regular themed days, and a popular idea from last year is being repeated as residents enjoyed it so much. This is to pretend that the home is going on an Orient Express trip, and different days are used to follow different cultures, food and entertainment for the various places being visited. Relatives are invited to join in with different events, and this includes a fun day held in the summer, and a winter pantomime put on by the staff. The manager is also increasing contacts with local schools and other groups in the vicinity. The home has frequent outside entertainers, and this includes music for health, and exercise classes. Residents are supported in maintaining their faith and religious preferences; and local clergy visit the home on a regular basis. Residents are actively asked to express their views, and are confident that these are taken into account in forward planning. The lounge and dining room have been redecorated during the last year, and residents were able to help choose the decor. They are also able to choose the paint colour for their rooms if these need redecoration. Residents are encouraged to bring in items to personalise their own rooms, and some were full of ornaments and pictures, according to their choice. Residents said that the food is very good, and that the chef always offers them sufficient choice. Although there is only one main hot meal at lunchtimes, the chef will make other dishes according to individual requests, such as fish, chicken, omelettes, home made soup etc. All food is home made, and using fresh ingredients. Residents can have a cooked breakfast if they wish, and croissants are served on one day per week, which is currently popular. Suppers include a choice of a hot dish, sandwiches or soups etc., and residents can have snacks at any time. The kitchens have been redesigned and re-equipped during the last year, and were seen to be very clean and well organised. There is a chef on duty each day from 7.30 to approximately 5.30 pm, and the chefs are assisted by kitchen assistants throughout the day. There are two kitchen assistants on duty at lunchtimes, providing extra asistance at this busy time. 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. Any concerns or complaints are taken seriously and are responded to appropriately. Evidence: The complaints procedure is on display in the entrance hall, and is also included in the Service Users Guide. It includes clear details of the manager and the provider, and local social services details, so that people wishing to complain know who to go to for assistance. Any concerns or complaints are taken seriously, and are investigated within twenty-eight days. The home keeps records of complaints, and the file contains good documentation. It shows that appropriate action is taken to deal with them, and prevent reoccurrence. Staff are trained during the induction process in understanding the prevention of abuse to vulnerable adults. Further training is given during the probationary period, and all staff have yearly updates. The manager demonstrated good understanding of the protocols and procedures by referring an incident to the Social Services Safeguarding Adults team. This incident was investigated by the team; who confirmed that there was no abuse by the home, and the manager acted correctly in reporting the matter concerned. 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 provides a comfortable and well maintained environment. The providers are pro-active in upgrading different areas, and ensuring that the premises and equipment reflect the needs of the residents. Evidence: The premises are a purpose built home on two floors, with a passenger lift providing access between the floors. All bedrooms have built in wardrobes and en-suite toilet facilities. The corridors are wide, and therefore make it easy for moving equipment around, such as mobile hoists. There is an ongoing maintenance programme for redecoration and repairs, and the home employs a full time maintenance man and two part time maintenance men to carry out the ongoing work. The home has two lounges and a quiet room, providing different areas to sit. The main lounge has been altered and redecorated during the last year, and now provides different seating areas so that it is more homely. The quiet lounge has patio doors leading out into the gardens, which are well maintained. During the day we were informed of re-landscaping which is due to commence shortly, and will provide raised beds, a fishpond, and a new water feature. Residents have been involved in the planning for this. An extension to the dining room has been recently completed, so that the dining room Care Homes for Older People Page 19 of 27 Evidence: is now large and airy, and has plenty of room for the newly purchased circular tables and chairs. The room was extended, and new dining furniture purchased, so as to make it easier for moving people who are in wheelchairs; and this room is now very attractive and suitable for its purpose. The home is equipped with three bathrooms and a shower room. One of the bathrooms is currently being totally refurbished, and the providers are discussing whether or not to alter this into another shower room. The bathrooms are equipped with assisted baths, one of which has a jacuzzi feature, which residents enjoy. There are a sufficient number of disabled toilets near to communal areas. The home is well decorated and presented in all areas, and with a good standard of furniture and fittings. Bedrooms have colour coded curtains and soft furnishings, and are all designed separately, so that they have individual characteristics. There are good processes in place to ensure that health and safety is maintained, such as ongoing checks for hot water temperatures, and wheelchair checks. All bedroom doors are fitted with dorguard fitments which activate to shut the doors in the event of the fire alarm sounding. The home has an adequate number of mobile hoists; and other equipment such as pressure relieving mattresses and cushions; raised toilet seats; and grab rails. Some new nursing profiling beds have been purchased during the last year. The laundry is equipped with three washing machines (two of which have sluice facilities), and two tumble dryers. There is a laundry assistant on duty seven days per week, ensuring a quick turnaround with clothing. The home usually has four domestic staff on duty each day for cleaning, and the home was seen to be clean in all areas. They have schedules in place to ensure bedrooms are deep cleaned; and use a carpet cleaning machine as needed throughout the week. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has good recruitment and training programmes in place, ensuring that staff are competent at their jobs, and well trained. Evidence: The home has two trained nurses on duty in the mornings, and one nurse at all other times. This is in addition to the manager, who is also a trained nurse. They are assisted in providing care by care assistants and senior care assistants. There is usually at least one senior care assistant on duty for each shift, and they take responsibility for supervising and organising other care staff. Numbers of care staff may vary according to the dependency levels of residents in the home. There are usually six care staff in the mornings, five in the afternoons and evening, and three at night. The home has recently appointed two other staff for morning duties during the week; one who gives residents a bath or shower as they prefer; and a room attendant who makes the beds and tidies the rooms and wardrobes. This enables other care staff to give more time to the residents. The home expects care staff to train for NVQ level 2, and some staff go on to train for level 3. There are over 80 per cent of care staff trained to at least level 2, and this is excellent, as care staff are confident in their abilities, and competent in carrying out their duties. Care Homes for Older People Page 21 of 27 Evidence: The home has good recruitment procedures in place, and we read three staff recruitment files to confirm this. Applicants are requested to provide a full employment history, and proof of identity; and have a POVA first and Criminal Record Bureau check, and two written references, prior to confirmation of employment. They are also asked to complete a health questionnaire, and a criminal declaration; and a record is retained of the interview. Staff identity has previously been confirmed by checking passport photographs, and we pointed out that copies of these photographs are insufficient to retain on file, as they are often unclear, and the home must keep a separate photograph on file. The home already has staff photographs on a notice board to help residents and relatives to know who they are; and the manager said that they will now ensure that a separate photograph is retained on individual staff files. We viewed the induction programme for two staff, and these records showed that there are very good induction procedures in place, covering all aspects of staffs individual job descriptions. All staff receive mandatory training during this time; and all staff have yearly updates for all statutory training (e.g. moving and handling, infection control, and health and safety). The administrator showed us the staff training matrix on the computers, to confirm this. There is a wide range of additional training available for all levels of staff, including nurses, who are able to increase their skills and competencies. Current staff training programmes include dementia training, palliative care, and understanding the Mental Capacity Act. 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 manager ensures that the home runs smoothly, and that all required documentation is kept up to date. Evidence: The manager is a trained nurse, and has completed the Registered Managers Award, and NVQ level 4 in Care Management. She has held the managers post for several years, and is familiar with the illnesses associated with older people. The manager leads the way in all aspects of the running of the home, and has a good rapport with other staff, and enables them to develop their own skills. This means that there is a good staff team, and staff are confident in her leadership. Nursing staff take responsibility for different areas of nursing care, such as palliative care, medication, and tissue viability; and can therefore assist each other in specific areas. The manager is assisted by an administrator with all aspects of documentation, such as dealing with enquiries and admissions, recruitment, invoicing and maintenance. Documentation was seen to be in good order and up to date. Care Homes for Older People Page 23 of 27 Evidence: The home has regular meetings for staff, which include general meetings and meetings for specific job roles, such as care staff. This enables staff to put forward their points of view, and help to develop good processes in the home. Staff have one to one formal supervision meetings four times per year, and a yearly appraisal. We saw two examples of staff supervision records. The manager has an open door policy for residents, relatives and staff, and has a daily presence in the home, so that they know her well. This enables daily feedback, and gives residents the confidence that things will be dealt with. There are also formal residents meetings, and the opportunity for feedback at ongoing social events and outings. Many of the changes implemented during the past year have been put forwards by residents, so there is clear evidence that they know they will be listened to, and taken seriously. The home carries out a quality assurance questionnaire each year, and the results of these are collated and help to formulate ongoing changes. The providers work closely with the manager, and are also well known by the residents. The home does not manage individual personal allowances for residents, but will purchase items on their behalf, and then invoice them or their representative each month. This includes payments for items such as hairdressing and chiropody. The AQAA was well completed by the manager, and included details of servicing records and policies and procedures. The policies are checked and revised as needed each year. Servicing records showed that required checks are reliably carried out. The maintenance man keeps records of day to day checks such as hot water temperatures and fire alarm checks, and these records are also well maintained. There is a routine fire alarm check each week, using a different fire zone each time. Accident and incident records are satisfactorily completed. 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 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. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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