Care Home: Rusthall Lodge Nursing Home

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What the care home does well The service is very good at involving residents in making decisions about their own lifestyles, and the day to day running of the home. This includes ensuring that residents understand the care planning processes, and discussing any risks associated with meeting their care needs. They are asked to sign documentation to confirm that they agree with decisions made about their care. There are opportunities to complete ongoing questionnaires; and opportunities to attend residents` forum meetings. Residents said that they know that their viewpoints are taken into account, and that action is taken in respect of their wishes. The home provides a good range of interesting activities and events, so that residents have a choice of joining in with social events, or staying quietly in their own rooms. The activities include cultural events, such as a Chinese themed evening; and current planning for an Indian themed evening. The home provides a wide variety of home cooked food, and plenty of menu choices. Residents said that "the food is excellent"; and "the chef comes and talks with us, and will make menu changes according to what we ask". The home has been purpose built, and provides a very pleasant and comfortable home, with well designed facilities, and different sitting areas. Staff training is very well managed, ensuring that all staff complete mandatory training, and have the opportunity for additional training. The current level of seventyseven per cent of care staff, who have completed NVQ 2 or 3 training, is excellent. The registered manager works closely with the general manager, a bed manager (who arranges admissions), and other administrative staff. They form an excellent team together, supporting one another, and providing a stable and friendly staff environment. What has improved since the last inspection? Changes have been implemented in the home as a result of listening to residents` views. Some of these include: Residents have requested that all staff wear name badges. Specific activities such as an exercise programme have been added into the activities schedule. A computer has been purchased for residents` use, and training for residents is available. Other changes include: Relatives forums have been set up, and are carried out four times per year. A second activities co-ordinator has been appointed. New menus have been agreed, providing a wider variety of options for residents. A large wall mounted television has been purchased for the ground floor lounge, so that larger groups can view the screen more easily. There has been an increase in the amount of outdoor activities, and trips out. What the care home could do better: Documentation in care plans could be more specific in regards to recording wound care, as it is currently difficult to follow the healing pathway for individual wounds. Documentation in regards to the Mental Capacity Act 2005 could be improved, so that it can be clearly demonstrated if residents lack the mental capacity to make their own decisions. Documentation should show how decisions have been made on residents` behalf; who has made the decisions, and why. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Rusthall Lodge Nursing Home Nellington Road Rusthall Tunbridge Wells Kent TN4 8SJ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Hall     Date: 2 9 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 28 Information about the care home Name of care home: Address: Rusthall Lodge Nursing Home Nellington Road Rusthall Tunbridge Wells Kent TN4 8SJ 01892531378 01892517816 jane@rusthall-lodge.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Rusthall Lodge Housing Association Ltd care home 66 Number of places (if applicable): Under 65 Over 65 66 0 old age, not falling within any other category physical disability Additional conditions: 0 66 The maximum number of service users to be accommodated is 66. The registered person may provide the following category/ies of service only: 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 categories: Old age, not falling within any other category (OP) Physical disability (PD). Date of last inspection Brief description of the care home Rusthall Lodge is a purpose built care home, which was completed in 2007. It has been built on the site of a previous old building, which was donated by the owner for use as a residential care home for the local community. Rusthall Lodge is run as a charitable trust; and the trustees are involved in the ongoing life and development of the home. The home is situated in the village of Rusthall, which is approximately two miles from the spa town of Tunbridge Wells. Rusthall has local shops and other amenities; and Care Homes for Older People Page 4 of 28 Brief description of the care home provides access to public transport. The premises provide an attractive and well-designed home for residents. Accommodation is provided in single rooms on two floors, with two passenger lifts providing easy access between floors. There are several communal areas, including lounges and dining rooms on each floor. The gardens surround the building, and there is a large patio area at the front. There is plenty of car parking space. Current fee levels range from 785:00 to 975:00 pounds per week, depending on the assessed needs of individual residents. Additional charges are payable for items such as hairdressing and chiropody. Care Homes for Older People Page 5 of 28 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, three 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. Care Homes for Older People Page 6 of 28 The visit to the home commenced at 08.50, and lasted until 4.15. The registered manager and the general manager were present throughout the day. During the visit, we talked with fourteen staff apart from the managers; one relative, two volunteers, and ten residents (some together outside, and some individually in their own rooms). We also met several other residents briefly, and observed staff interaction with residents and with each other. We examined documentation such as admission information, care plans, medication charts, staff recruitment and training files, and some servicing and maintenance records. We viewed all areas of the home, and it was extremely clean and very well maintained in all areas. What the care home does well: What has improved since the last inspection? Changes have been implemented in the home as a result of listening to residents views. Some of these include: Residents have requested that all staff wear name badges. Specific activities such as an exercise programme have been added into the activities schedule. A computer has been purchased for residents use, and training for residents is available. Other changes include: Relatives forums have been set up, and are carried out four times per year. A second activities co-ordinator has been appointed. New menus have been agreed, providing a wider variety of options for residents. A large wall mounted television has been purchased for the ground floor lounge, so that larger groups can view the screen more easily. There has been an increase in the amount of outdoor activities, and trips out. Care Homes for Older People Page 8 of 28 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 set out 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 28 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 28 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 suitable information for enquirers and prospective residents. There are good assessment and admission processes in place to ensure that the home can meet individually assessed needs. Evidence: The statement of purpose and service users guide are available for enquirers to view at any time; and a copy of these documents is provided in each residents bedroom. Enquirers are invited to visit the home and look round, and meet some of the staff. The statement of purpose explains the original vision for Rusthall Lodge, which was previously a large old building which was donated by the owner for use as a residential home for older people. There has been a complete re-build of the original premises. The home is set up as a charitable trust, and the Trustees are involved in the ongoing development and running of the home. The statement of purpose contains clear data Care Homes for Older People Page 11 of 28 Evidence: of the current facilities, contractual arrangements, and the items included and not included in the weekly fees. Additional payments are required for items such as hairdressing and chiropody. The service users guide contains helpful data, such as explaining staffing arrangements, and providing information about staff uniforms, so that new residents can quickly become accustomed to different staff. It also gives details of activities available, meeting religious needs, visiting arrangements, meals and meal times, and how to voice concerns or complaints. We discussed the print size (normal),and the manager said that they are considering producing the guide in larger print to make it easier for residents to read. All prospective residents have a pre-admission assessment carried out by the homes bed manager, who is a trained nurse, and who is able to focus on the importance of assisting people with making a decision about moving into the home. We viewed four pre-admission assessments, and these contained sufficient information to enable the bed manager to assess the suitability of the home to meet the residents needs. Residents are admitted for a trial period, after which a review is carried out with the resident, and their relatives or care manager (as applicable), to decide whether or not to make the placement permanent. All residents, or their authorised representative, are provided with a contract which states the terms and conditions of residency. The home will admit residents for short term respite care if there is a bed available, but do not admit residents needing intermediate and rehabilitation care; therefore standard 6 does not apply in this home. Care Homes for Older People Page 12 of 28 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. Care plans are well completed, and confirm that residents health and care needs are met in the home. Evidence: Residents health and personal care needs are clearly identified in individual care plan files. The care plans are initially set up from the residents pre-admission assessment, and are then developed on an ongoing basis. Each resident has a named nurse and keyworker, and this enables them to form a more secure relationship with one or two members of staff. We viewed four care plan files, two from the ground floor, and two from the first floor. Care plan files show that the content is discussed with the resident, or with the person acting on their behalf, and a form is signed to confirm this. The care needs are assessed according to what is known as the activities of daily living, and these include items such as mobility needs, nutrition, personal hygiene and skin care, communication, medication and continence. This system is explained to the resident Care Homes for Older People Page 13 of 28 Evidence: where possible. There was very good evidence for relevant discussions with the resident or their representatives, and this is seen as good practice. Monthly assessments are carried out for moving and handling, pressure area care, dependency levels, and identified risks. Risk assessments include items such as the risk of falls, and the risk of using bed rails, if they have been assessed as needed. The risk assessments are well documented, and include action to take to avoid risks. Where bed rails are needed, the associated risk assessment is discussed with the resident or relatives as applicable, ensuring that risks associated with using bed rails such as entrapment are also discussed. Signed consent forms were seen for this in care plans. Wound care is assessed at each dressing change, and recorded on assessment charts. There were also written evaluations for some wounds, but not for others. Some residents have more than one wound, and the care pathway was difficult to follow as the evaluations for different wounds were on the same pages. There is good evidence for input from other health professionals, including GPs, tissue viability nurse, dietician, physiotherapist, speech and language therapist, and occupational therapist. The home is fortunate to have a medical centre adjacent to the building, and most residents prefer to register with the GP who is the visiting medical officer from this practice. There is some documentation about end of life care, and decisions about resuscitation in care plans. Some of this is good documentation, but some is unclear. Where residents lack the mental capacity to make their own decisions, there should be clear documentation to show how their mental capacity has been assessed; and who has made decisions on their behalf, and why. Medication is well managed. There is a clinical room on each floor, and we inspected the clinical room and the Medication Administration Records (MAR charts) on the ground floor. Medication is mostly administered using a monitored dosage system. The trolley and stock cupboards were inspected, and seen to be in good order, with no overstocking, and with evidence of good stock rotation. One item was found which had gone past the expiry date. A list of homely remedies available has been signed by the GP, and there is a good audit trail to account for the number of tablets given for each item. The drugs fridge and room temperatures are recorded daily, and were satisfactory. The controlled drugs cupboard and register were seen to be well maintained. Residents who wish to manage their own medication are checked according to a specific assessment, to ensure they fully understand their medication, and can take it properly. All MAR charts were viewed for the ground floor. These were Care Homes for Older People Page 14 of 28 Evidence: basically well completed, and correctly had two signatures for all handwritten entries. The Unit Manager had noticed some signatures were missing, and had highlighted this on the charts for the nurses attention. The home ensures that residents are treated in privacy, and that their dignity is maintained. One of the ways in which this was demonstrated was that residents have a Do not enter sign hanging on doors if they are using the toilet in their en-suite facility, to ensure they are not disturbed. The home has a relaxed atmosphere, and residents know that they will not be rushed with personal care, and can get up and go to bed as they choose. They also have a choice of bath or shower, and this is noted in care plans. Care Homes for Older People Page 15 of 28 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 able to take part in activities and social events, according to their preferred lifestyles. Menus are discussed with the residents; and provide a varied and nutritious diet. Evidence: The home employs two activities coordinators, who work together one day per week so that they can plan together, and discuss forthcoming events and ideas. They provide each resident with a weekly activities plan, so that residents can make decisions about the activities that they wish to attend. There is a different activity for each morning and afternoon, and the current programme included a beetle drive, card making, singsong, watching a film together, watching Wimbledon finals, a quiz, bingo, ball games and one to one time. The one to one times are especially put in place for residents who are unable to leave their rooms, or who do not wish to do so. One afternoon also included an outing to a bowling alley. The activities are held in different lounges, and the venue is noted on the programme. The home has large, pleasant lounges on each floor, and a spacious reception area, which is a daily focal point for residents to relax and chat together. There is a Care Homes for Older People Page 16 of 28 Evidence: receptionist on duty most days, who goes out of her way to ensure residents comfort while they are sitting nearby. She was not on duty during the inspection visit, but two volunteers were helping in this capacity. The home has seven to eight volunteers, who help out practically, and join in with organising and attending outings and events. The home has a large patio area with different areas for garden furniture, and this includes raised beds of flowers which residents have helped to choose and plant. There were approximately fifteen residents enjoying sitting outside during the afternoon of the inspection visit. A monthly church service is held in the home for residents who wish to attend; and arrangements can be made for residents to go out to church if they wish to do so. There are regular outings for shopping or to places of interest; and ongoing events, such as visits from local schoolchildren, travel talks by a relative, and musical entertainment and tap dancers. Some of these take place at weekends. Visitors are made welcome in the home at any time, and can stay for meals by arrangement. The lounges have designated kitchen areas where visitors can make drinks. Residents are encouraged to follow their preferred lifestyles, and to bring in personal possessions to help them to feel more at home. Residents spoke highly of the food, and said that their views are taken into account. A recent residents forum meeting had included decisions to have some food based events, such as strawberries and cream tea outside, and a chicken curry night. A decision was also made to take semolina off the menu. The chef is involved in these discussions, and had recently asked the residents to complete questionnaires about the food. A trial was put in place to provide residents with a full English cooked breakfast one day; and this was so popular, that it is being added as a monthly highlight. Residents said they would not want this every day, or it would be too much. The home has a dining room on each floor, and tables were attractively laid with tablecloths and napkins, menus, and fresh flowers. Residents can choose to stay in their own rooms for meals if they wish to do so. The kitchens are situated on the lower ground floor, and there is a servery area adjacent to each dining room. The kitchens are well equipped, and were very clean in all areas. The chef said that they had been awarded a gold standard award for hygiene by the Council. Fresh fruit and vegetables are used every day, and items such as cakes and soups are usually home made. Residents said that there is always plenty of choice. The chef is fully trained, and carries out food hygiene training for the kitchen Care Homes for Older People Page 17 of 28 Evidence: staff. Care staff have a separate training programme, and the chef checks their knowledge and competence. Care Homes for Older People Page 18 of 28 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. Concerns and complaints are taken seriously and are addressed appropriately. Residents are protected from abuse. Evidence: The homes complaints procedure is displayed in the reception area and in other areas of the home, such as near the lounges. It is also included in the residents file in each bedroom. It states that all complaints and concerns will be investigated and followed up within twenty-eight days. People are encouraged to speak to the nurse on duty, or one of the managers in the first instance. We viewed the complaints log, and it showed that all concerns and complaints are taken seriously, are fully investigated, and are followed up appropriately. All staff are trained in the recognition and prevention of adult abuse, and the managers are familiar with any concerns which should be referred to the Social Services Safeguarding team. Staff receive basic training about the protection of vulnerable adults during their induction period, and then have further training and yearly updates. There are also discussions with staff about whistle blowing, ensuring that all staff understand the importance of this if indicated. Care Homes for Older People Page 19 of 28 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 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 been purpose built, and provides residents with an excellent environment. The premises are well maintained. Evidence: The home was originally an old building which has now been completely demolished and replaced with a new building. This work was carried out in two phases, and is now complete. The premises provide an excellent environment, which has been purpose built, and includes wide corridors for easy moving of equipment; lifts, storage areas (e.g. for hoists and wheelchairs), bathrooms with different types of baths, and single bedrooms with en-suite toilet facilities. Some rooms also have en-suite showers. There are good records for general maintenance; and a full time maintenance man is employed to carry out weekly and monthly checks, and ongoing repairs. All bedroom doors are linked into the fire system; and all rooms are connected to the call bell system. Communal areas include spacious lounges, and sitting and dining areas on each floor, as well as a large patio and garden, with seating areas outside. There are bathrooms and shower rooms on each floor, and these have assisted baths Care Homes for Older People Page 20 of 28 Evidence: or showers, and plenty of room for wheelchairs and other equipment. The home is equipped with overhead tracking for hoisting in all bedrooms and bathrooms, and there are also some mobile hoists and stand aids. Other equipment includes grab rails, pressure-relieving mattresses and cushions, and raised toilet seats. All beds are profiling nursing beds. These have integral bed rails. All bedrooms are for single use, and are roomy and well presented. Furniture and fittings are of high quality. Residents are able to bring in small items of furniture and personal possessions, and are encouraged to do so. All hot water outlets are fitted with thermostats, and the temperatures are checked every month. Other items such as the fire system, window restrictors, and wheelchairs, have routine checks carried out by the maintenance man. The laundry is situated on the lower ground floor, and includes two separate areas for dirty and clean laundry. It is well equipped, and run by designated laundry staff. There are usually five domestic staff on duty each day, with different staff for each floor. Each bedroom is spring cleaned once per week. Carpets are cleaned as needed by the housekeeper, or by contract cleaners for large areas. The home was seen to be extremely clean in all areas. Care Homes for Older People Page 21 of 28 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. Staffing levels are well maintained. Residents benefit from being cared for by a stable and competent staff team, who have good standards of training. Evidence: The home has trained nurses on duty at all times. There are usually three nurses on duty during the busy morning times. This allows for one nurse on each floor to concentrate on giving out medication at the prescribed times, and another nurse available to deal with all other nursing matters. There is at least one nurse on each floor at other times; and the registered manager and the bed manager are on duty during week days, and are also trained nurses. The nurses are supported by care staff, who have different levels of training. Senior care staff who have completed NVQ level 3 are designated as nursing assistants, and have additional responsibilities to the rest of the care staff. There is usually one nursing assistant on duty for each floor throughout the day. Total numbers of care staff on duty in the day times are approximately ten to eleven, divided between the floors. The management ensure that there are sufficient numbers of care staff in relation to the dependency levels of the residents. In addition to nursing and care staff, there are administrative and reception staff, a bed manager, activities coordinators, and cooking, domestic, laundry and maintenance Care Homes for Older People Page 22 of 28 Evidence: staff. Recruitment processes are well managed. We viewed four staff recruitment files, and these contained the required checks such as POVA first and Criminal Record Bureau (CRB) checks; NMC checks for nursing staff; proof of identity; records of previous employment; training records and two written references. Two files viewed did not show a full employment history, but the application forms have been amended during the last few months to request applicants to provide a full employment history. Staff are requested to complete a health record, and an interview record is retained. All staff are provided with a contract. Staffing files included completed induction records. These show that detailed inductions are carried out; and that staff are assessed at the end of their probationary period. A training matrix was viewed and shows that mandatory staff training is being kept up to date. The matrix shows who is responsible for different areas of training. The home has some staff who are trained as moving and handling trainers; and the chef is trained to carry out basic food hygiene training. Staff have yearly updates in moving and handling and infection control, as well as POVA training. Fire training is carried out every three months. Seventy-seven per cent of care staff have achieved NVQ level 2 training in health and social care; and there are a good number who have achieved level 3. This shows an excellent commitment to training. There is opportunity for training in additional subjects such as palliative care, dementia, equality and diversity, and the Mental Capacity Act 2005. Nursing staff are encouraged to develop their skills with further training in subjects such as medication, use of syringe driver, and catheterisation. The home has link nurses for infection control, tissue viability, Parkinsons disease, nutrition, and communication. This enables them to carry out additional study in these subjects, and pass on the knowledge to their colleagues. Care Homes for Older People Page 23 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run by an experienced and competent management team, led by the registered manager. Residents are fully involved in the ongoing life of the home; and in decisions to produce changes. Evidence: A new manager has been appointed by the home, and registered with the Commission during the last twelve months. She is a trained nurse, and is in the process of studying for leadership and management training. She is very well supported by a general manager, and by a team of administrative staff. It was clear throughout the inspection that although the management team have clearly designated roles and responsibilities, they are also able to take part in backing each other up in different areas. Documentation is very well managed, and there are good procedures in place which give people confidence in the management team and the day to day running of the home. The senior staff are relaxed and friendly, and ensure that residents and staff Care Homes for Older People Page 24 of 28 Evidence: are valued and respected. Staff were seen to interact well with each other and with residents. Staff meetings are held regularly for different departments, and a general staff meeting is held every six months. Twenty-one staff attended the last general meeting. Minutes are taken and circulated to staff who are unable to attend. One to one staff supervision has been commenced this year, and is being carried out every two months for each staff member. This will enable them to identify training needs, and any areas of tension more easily, and take appropriate action. Staff also have yearly appraisals. Residents are asked for their feedback via questionnaires on a regular basis. In the last year, questionnaires have been given to residents and families to ask their opinions of the care and admission processes, and separate questionnaires about the food. A plan of action was drawn up as a result, and then action was taken in response. The management are available in the home on most days, and residents said they know that they can always ask the staff for anything they want to know, or can speak to the managers as they wish. The registered manager oversees all the clinical care, and has a daily presence around the home. Residents can keep small amounts of money in the home, and these are stored as individual amounts with individual records for all debits and credits. All receipts are retained. The accounts are audited every month by one of the trustees. Servicing records are kept together in a file which is available for authorised people to view. This includes the building completion certificate, a fire emergency plan, and servicing certificates for the lifts, hoisting facilities, electricity, emergency lighting etc. All certification was seen to be up to date. We also viewed some of the ongoing records for hot water temperatures, and PAT testing. There was clear evidence that staff are aware of the importance of keeping up to date with health and safety precautions. This includes clear directions in the event of fire, (which includes keeping residents informed); and designated staff for maintaining good infection control in the home. Care Homes for Older People Page 25 of 28 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 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 8 To document wound care more clearly, so that different wounds are not evaluated on the same pages. Separate documentation would show the progress of healing for individual wounds more clearly. To obtain consent for taking photographs of wounds. 2 11 To implement clearer documentation in regards to decisions made according to the Mental Capacity Act 2005, showing why and how decisions are made on the behalf of residents, and who has made the decisions. This includes decisions about end of life care and resuscitation. Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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