Care Home: Sir Thomas Lipton Memorial Home

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What the care home does well This home consistently provides a very good quality of care and the residents express a high level of satisfaction with the service they receive. The home has enrolled with Barnet PCT on the Gold Standards Framework programme. This scheme is designed to enhance the care of elderly people in care homes, particularly focusing on end of life care through advanced care planning. The home is well run and residents and staff are confident about the manager`s ability. No one is admitted without a comprehensive needs assessment being carried out to ensure that the home is suitable to meet the person`s needs. All people who live in the home have a written care plan to guide staff about how best to meet their needs and they say that the staff treat them with courtesy and respect. The residents have an excellent lifestyle that reflects their interests and the activities provided are stimulating and prevent boredom. There is a homely and relaxed atmosphere, and the residents say that the food is very good with plenty of choice. Residents benefit from spacious, well maintained grounds and comfortable and attractive communal lounges and dining areas. There is a good standard of decoration in the bedrooms and residents are encouraged to bring personal possessions with them to the home. There are good systems in place to safeguard people from abuse. The staff are trained in subjects that are appropriate for the needs of the people who live in the home and staff are properly screened before starting employment, which protects the welfare of the residents. What has improved since the last inspection? Two statutory requirements were identified during the previous key inspection. One requirement was in respect of a risk assessment for an individual resident and the other requirement was in regard to signing the medication records. Both requirements have now been met. During the inspection we carried out a site visit and the manager brought to our attention new purchases for the home, which included new furniture and carpet for the main lounge and a new washing machine. The main lounge had also been redecorated and a first floor bathroom refurbished. A number of bedrooms had been redecorated as part of the home`s ongoing maintenance programme. Radiator guards had been supplied throughout the home. Part of the ground floor had been rewired. Improvements had also been made in respect of the care plans that now included an assessment of capacity and details of end of life care. What the care home could do better: Only 1 statutory requirement was identified during this inspection. Regulation 26 visits to the home must take place on a monthly basis and a copy of the report of the visit must be kept in the home. These independent visits to the home monitor the quality of care and check the smooth running of the home. They provide the manager with feedback and any action plans drawn up ensure that residents benefit from an improved service. Key inspection report Care homes for older people Name: Address: Sir Thomas Lipton Memorial Home Bungalow Sir Thomas Lipton Memorial House, 151 Chase Side London London N14 5HE     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: Julie Schofield     Date: 1 8 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 30 Information about the care home Name of care home: Address: Sir Thomas Lipton Memorial Home Bungalow Sir Thomas Lipton Memorial House, 151 Chase Side London London N14 5HE 02088861396 02088862101 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Friends of the Elderly Name of registered manager (if applicable) Noreen Ross Type of registration: Number of places registered: care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Sir Thomas Lipton Memorial Trust is located within a large estate in Southgate, North London. It provides care and support for up to twenty four women over the age of 65, in Osidge House. The home is managed by The Friends of the Elderly, through a board of trustees. The home was originally established to accommodate retired nurses. It is easily accessible by public transport and there are shops, restaurants and many other amenities nearby. The home consists of a three storey building, with a basement. A colonial style veranda overlooks an extensive attractive garden at the rear of the building. There is also a large landscaped garden at the front of the premises. The accommodation is provided in twenty four single rooms, located on the ground and Care Homes for Older People Page 4 of 30 0 Over 65 24 Brief description of the care home first floors. Each bedroom has a wash hand basin. A stair lift provides access to the first floor. There are three communal lounges, two on the ground floor and one on the first floor. There is a kitchen and a large dining room on the ground floor where there are also offices. The laundry is located in the basement of the building. The home aims to provide high quality personal care, including terminal care, for older women. Currently the fees for the service are £517 per week. For information about the service please contact the manager of the care home. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: We inspected the home on the 18th January 2010. We started at 8.15am and finished at 4.35am. During the inspection we carried out a site visit and we observed the serving of the midday meal. We case tracked the care of residents. We examined records relating to residents, members of staff and to the day to day running of the home. We referred to policies and procedures. During the day we spoke to residents and we also spoke with members of staff, the deputy manager and the manager. We checked compliance with the statutory requirements identified during the previous key inspection. We would like to thank everyone for their assistance and participation in this inspection. Care Homes for Older People Page 6 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Only 1 statutory requirement was identified during this inspection. Regulation 26 visits to the home must take place on a monthly basis and a copy of the report of the visit must be kept in the home. These independent visits to the home monitor the quality of care and check the smooth running of the home. They provide the manager with feedback and any action plans drawn up ensure that residents benefit from an improved service. Care Homes for Older People Page 7 of 30 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering moving in to the home can be confident that their needs will be assessed before admission and they will have good information about the service to enable them to judge whether the home is suitable for them. Evidence: We discussed the information made available to prospective residents. The Statement of Purpose and the Service Users Guide have been updated since the last key inspection to reflect the new management structure of the Friends of the Elderly and its relationship to the care home. Copies were made available during the inspection. We noted that the documents were informative and comprehensive. At the time of the inspection, there were twenty people living in the home. The records of 2 residents that had recently been admitted to the home were examined. One had been placed on an emergency basis by the local authority, under their safeguarding adults procedure, and the other resident was self-funding. We noted that Care Homes for Older People Page 10 of 30 Evidence: each file contained a contract and this reflected whether the placement was being made on a long term or short term basis. The contracts were clear, detailed and informative. Contracts are signed by the resident. Originally the care home provided a service to retired nurses although now retired nurses account for approximately half of all admissions. We discussed the pre-admission procedure with the manager who confirmed that an assessment of need was carried out prior to admission. Although this had been carried out by the home in respect of both of the residents a record was only kept on the file of the resident that was self-funding. The manager and deputy manager had visited the resident who had been referred on an emergency basis while the person was in hospital. Prior to this visit they had received information from the local authority, which included a multi-disciplinary health needs assessment. They also had access to the records kept at the hospital and were able to speak to the hospital staff providing care. On the basis of the information received from the local authority and the hospital and from their own observations the manager confirmed that the home was able to provide a service to meet the needs of the resident and a placement was offered. A capacity assessment has been incorporated into the pre-admission procedure and paperwork. When we spoke with residents one person told us that the manager had visited her while she was in hospital, prior to being admitted to the home. The manager said that most of the residents are self-funding and that the care home is recommended to the prospective resident by a family member or by a friend that has visited the home and picked up a brochure. If the enquiry comes from someone who does not live locally a copy of the last inspection report, the Service User Guide and the Statement of Purpose are enclosed in the envelope with a brochure. When a referral is made the prospective resident is encouraged to visit and perhaps spend a weekend in the home on a respite care basis. We discussed the role of the key worker in the admission process. Normally a key worker is allocated to the new resident according to the room number that the resident will occupy and the manager tries to ensure that this person is on duty when the resident is admitted. This enables the key worker to ensure that the new resident is comfortable and at ease. If a resident needs to change their room in the future, due to increasing dependency, they may keep their key worker for reasons of continuity and good practice. When we spoke with residents they were pleased with the choice of care home and said that it had met their expectations. The home does not provide an intermediate care service. Care Homes for Older People Page 11 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that their care plans are written in a way that guides care staff in how best to meet their needs and they can be assured that they receive good health care. Medication is safely stored and administered to protect residents wellbeing and staff treat them with courtesy and respect. Residents wishes for terminal care to be provided in the home are respected and carried out with sensitivity and dignity. Evidence: We selected 3 residents to case track and looked at their case files. We noted that files contained a comprehensive care plan that addressed the individual needs of the resident so they contained both core needs and specific needs. The format of care plans has recently changed so that they include a capacity assessment. Care plans have also been updated to include end of life care as part of the preparation for the Gold Standards Framework. Plans included a skin assessment form, a manual handling risk assessment, a falls risk assessment, a dependency assessment, a personal risk assessment and a room risk Care Homes for Older People Page 12 of 30 Evidence: assessment. There were regular evaluations of planned care and evidence of 6 monthly reviews being held. Care plans and review meeting minutes had been signed and dated by the resident, where possible. Case files also gave evidence of access to health care services in the community and the support provided to the resident in the home. A record is kept on the residents file of professional visitors, including the GP. There is a pressure care risk assessment and we discussed the care of a resident that had been discharged from hospital with a pressure ulcer into the care of the District Nurse (DN). Although this person no longer needs support from the DN a pressure mattress, soft cushion and a programme of visits to dress the ulcer had been in place. Files contained an assessment for mouth care, where the need for assistance with oral hygiene can be identified. The need for regular dental checks by the dentist are incorporated in the oral care assessment. Care plans also identify a need for foot care and there was a record of visits by the chiropodist. When we spoke with residents a resident told us that she had regular appointments with the dentist, optician and the chiropodist and that when she visits her GP a carer is available to go with her as an escort. The home has a medication policy and procedures. Senior staff administer medication and are provided with training. The manager is arranging for the seniors to receive refresher training. The manager carries out an assessment of competence for each person administering medication and then carries out periodic spot checks. The spot checks are not recorded. MARs sheets are audited on a weekly basis. The home uses a blister pack system for administering medication to residents. We examined the medication records and noted that the records were up to date and complete. A record is also kept of the verification at handover that the administration and documentation over the past 24 hours is correct. Individual records included an agreement by the GP for the use of certain homely remedies. Allergies were noted in the records and on the MARs sheets. Where residents self-medicate a risk assessment has been completed and placed on file. The manager told us that the GP is only involved in this assessment if the home has concerns about the residents ability to carry out the task. We discussed the areas of privacy and dignity with the residents, some of whom have assistance with personal care tasks. One resident said that some members of staff are more sensitive to the feelings of residents than others. Another resident said that her dignity was respected and that she never felt embarrassed. Another resident said that when she had a bath the hoist was used and that she felt safe when this was used and that her dignity and privacy were respected. The care home has enrolled with Barnet PCT on the Gold Standards Framework Care Homes for Older People Page 13 of 30 Evidence: programme. This scheme is designed to enhance the care of elderly people in care homes, particularly focusing on end of life care through advanced care planning. After a period of training and assessment, homes will receive accreditation from the PCT. Training has already commenced. The home already provides terminal care for those people who wish to spend their last days in the home and accommodation is provided for relatives who wish to stay overnight. Tributes from relatives about the high quality of care provided by the staff at this time have been received. Care Homes for Older People Page 14 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home enjoy an excellent quality of life that reflects their interests. Residents are able to exercise choice about their lives and the activities provided are stimulating and prevent boredom. The food and catering facilities are excellent. Evidence: When people are admitted to the home, their life history is recorded in their file, including their hobbies and interests. The home offers a range of activities and details of these are posted on the residents notice board. Activities include arts and crafts, simple cooking and keep fit to music sessions. The home employs an activities coordinator, who works 15 hours per week, which can include weekends. Activities depend on the persons mobility and their individual needs and preferences. Residents confirmed that the activities coordinator asked them what they wanted to do and confirmed that the coordinator attended residents meetings to discuss activities. Activities also take place outside the home and may include attending luncheon clubs, Monday club, going out for walks and shopping. Residents told us that within the home they took part in playing cards and games and in cooking. They told us about quizzes being held and an outside person coming to talk about different decades. Care Homes for Older People Page 15 of 30 Evidence: Flower arranging was mentioned by several residents and is obviously popular. We were told that residents had prepared canapes. Residents confirmed that entertainers visit the home and a resident told us about people playing the piano and singing. Film nights were mentioned. They said they were happy in the home and could choose to join in or opt out of activities. Any activity undertaken is recorded in individual daily logs. Birthdays are always celebrated. Residents are assisted with meeting their spiritual needs. A monthly church service is held within the home and a member of the Catholic church visits to give communion to residents. Some residents receive visits from the minister of the church they attended prior to admission to the home. Other residents are helped to attend church by volunteers, who act as escorts. The home has an open policy for visits and the manager said that if visitors arrive at mealtimes the Sun Lounge could be used so that the resident and their visitor(s) can sit down together and have a meal. If residents prefer to have privacy when visited they may entertain residents in their rooms if they wish. Residents have a right to refuse to see a visitor if the person is not welcome by them and where a resident has been placed in the home as a safe guarding measure there could be photographs of people that are not allowed access to the resident. We saw residents having opportunities to exercise choice in their daily lives. Some residents choose to spend time in their rooms during the day and others choose to enjoy company when sitting in the communal lounges. Residents told us that they were able to choose when to go to bed and to get up in the morning. We saw trays being prepared at lunchtime for those residents who preferred to eat their meal in their room. We were told that the majority of residents have asked to have a breakfast tray in their room each morning. Residents said that they chose what activities they wanted to take part in and we were told that they were asked for their suggestions for the content of the activities programme. Residents confirmed that choice was available at mealtimes and that alternatives were served. The residents right to privacy in their own room was respected and rooms showed evidence that the resident had been able to bring some of their personal items with them. We saw that some residents handled their own finances while others were supported by a family member. Residents meetings are held and residents are able to comment on the service provided and make suggestions for any changes or improvements that they would like to happen. The dining room is very pleasant and provides a relaxed atmosphere for eating. The dining tables were very attractive with tablecloths, napkins and flowers. Etiquette is Care Homes for Older People Page 16 of 30 Evidence: part of the staff training programme and this includes how to lay a table properly and how to plate meals attractively. This is good practice and we commend the home for this initiative. There was a notice board in the dining room showing the menu for the day but when we visited the dining room before lunch time we noted that the menu on display was for the previous day. The residents said that the meals were very nice and a resident said that she particularly enjoyed the roast dinners. The meal served during the inspection consisted of liver and bacon or breaded chicken. Potatoes, broccoli and carrots accompanied this. The dessert was Christmas pudding with custard or cream. When we spoke with residents in the afternoon a resident told us that the liver was nicely cooked and that the portion sizes were good. Another resident told us that there was variety on the menu and that the meals consisted of good quality food. We saw that in the afternoon residents are asked about their choice of meals for the next day and that a record is kept of this. The record is then used by the chef the next day when preparing the meals. Sufficient food is cooked so that a resident can change their mind at the table. Records are kept of what residents actually ate each day, which showed their chosen alternatives to the planned menu. The menu ensured that the people who live in the home have a diet that is nutritious and wholesome and we noted that fresh fruit was on offer. Some residents also were provided with a bottle of Yakult each day. We observed staff supporting residents who needed assistance when eating. This was done in an unhurried and dignified manner. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home can be confident that any concerns will be taken seriously and addressed by the manager. There are good systems in place to safeguard residents and staff are trained in the detection and prevention of abuse. Evidence: A copy of the complaints procedure was on display in the home. It was clearly written and included information about the different stages of the process and about the timescales for each stage. The contact details for the CQC (the regulatory authority) were correct. There is also a comments/complaints book that is kept in the entrance hall. No complaints have been recorded since the last key inspection and none have been made directly to the CQC. When we spoke with residents they each said that they knew who to talk with if there was something that they were not satisfied with. They were confident that if they raised any matters they would be listened to and taken seriously. One resident referred to a matter in the past and confirmed that the manager had dealt with this appropriately and that it had been resolved to the residents satisfaction. Residents were complimentary about the manager and her staff and about the service received. We saw several written compliments. One referred to the kindness, care and support to the mother of the person writing to the home. Another said that the resident had always spoken very highly of the staff and the care received. There are opportunities for residents to raise matters of concern before they become complaints during residents meetings and we saw evidence that these are held on a regular basis. Residents and staff meetings are held to ensure that Care Homes for Older People Page 18 of 30 Evidence: suggestions for improvements can be made and then acted on. The home has not made any safe guarding referrals to the local authority since the last key inspection. The manager is an accredited trainer in adult protection procedures and has run in house training sessions for members of staff. She also had confirmation from the local authority that 2 members of staff had been allocated places on an external training course to be held in February. Two other members of staff had attended an external training course in January. On the previous key inspection members of staff have been able to demonstrate a good knowledge of abuse issues and their responsibilities regarding reporting suspected abuse. When we looked at staff records we saw that they had been properly screened before starting work in the home. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident of living in a home that is well maintained, comfortable, clean and attractive. Residents bedrooms are comfortable and they are able to bring their personal possessions with them when they move in. There is specialist equipment available so that people can be supported safely in their personal care. Evidence: There have been plans for several years for the estate to be sold for development and for the current home to be rebuilt within the grounds. The area manager from Friends of the Elderly previously informed us that the plans had been submitted to the local authority and that they were waiting for planning permission. A tour of the premises was carried out during the inspection and several residents kindly showed us their bedrooms. They were satisfied with the size of the room and with the furniture and furnishings. When a bedroom becomes vacant, we were informed that it is refurbished for the next occupant and we saw 2 vacant rooms. The size of the bedrooms varies and they all have an individual character. All of the bedrooms we visited were attractively decorated. They were bright, clean and comfortably furnished. We noted that residents had brought some small personal possessions with them to make their rooms more homely. We saw that although bedrooms are not en suite there are toilet and bathing facilities close by. There are mechanical hoists and special baths available to assist people with their personal care. Care Homes for Older People Page 20 of 30 Evidence: The inspection was carried out during a particularly cold spell and we noted that in the care home it was warm throughout. A resident told us that they had been warm during the recent periods of bad weather and snowfalls. Communal areas were comfortable and there were pictures and items of furniture that were part of the history of the building. (It had been the residence of Sir Thomas Lipton). Residents appreciated the history of the building and the manner in which it was decorated and furnished. Although some of the rooms on the ground floor had lofty ceilings the home maintained a homely atmosphere. Since the last key inspection some refurbishment of the home has taken place. New furniture and carpet has been provided for the main lounge, a new washing machine with a sluicing cycle has been purchased for the laundry, guards have been fitted to radiators throughout the home, part of the ground floor has been rewired, the driveway has been resurfaced and a first floor bathroom has been redecorated. The home employs a maintenance person who is responsible for the general upkeep of the building, gardens and minor repairs. The gardens were well maintained and residents spoke of their enjoyment both of using the gardens and of the gardens as a view from the windows. One resident described the garden as beautifully kept. We noted during the site visit that the home was clean and tidy and free from offensive odours. Domestics are employed to keep up standards of cleanliness. Staff are provided with disposable gloves and aprons and have been trained in respect of infection control procedures. Residents commented on the cleanliness of the accommodation. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient numbers of staff available to meet the residents needs and residents can be confident that the staff are well trained to meet their needs. All staff are properly screened before starting employment to protect the best interests and welfare of the residents. Evidence: We looked at staffing levels in the home. The manager is assisted by a deputy manager. There are senior carers and carers. During the early shift and on the late shift 1 senior and 2 carers are on duty. A third carer may also be on duty on either the early or the late shift if needed. At night there is 1 senior and 1 staff on waking night duty. The manager and the deputy manager provide an on call back up service in case of an emergency occurring when they are off duty. Residents confirmed that there are mostly enough staff. When residents have used the call alarm system they confirmed that response times were good. The manager said that gaps on the rota are covered by bank staff and that the home doesnt often use agency staff. We discussed the proportion of qualified staff among the staff team. Thirteen carers have successfully completed their NVQ level 2 qualification and 3 members of staff have completed their NVQ level 3 qualifications. A further member of staff is currently working towards their level 3 qualification. Therefore the home has met the target of having a minimum of 50 of its carers having an NVQ level 2 qualification. Care Homes for Older People Page 22 of 30 Evidence: We looked at the personnel file for 3 members of staff. Two had been recently recruited and 1 person had worked in the care home for a while. We noted that each file contained an application form that had a section for giving full details of the applicants employment history. It also contained a declaration regarding any cautions or convictions. Files contained 2 references and evidence of a satisfactory CRB disclosure being obtained, or applied for. We also saw an ISA confirmation that the applicant was not known to be unsuitable for working with vulnerable adults. There was proof of identity on file (passport details) and evidence that the applicant had been asked to demonstrate their right to reside and to work in the UK, where required. Staff have received training in respect of end of life care as part of the homes preparation for the Gold Standards Framework application. The manager said that a number of topics of training are supported now by e learning although an independent person gives health and safety training and training on using hoists. Members of staff also have safeguarding training through an external source in addition to e learning or in house sessions. E learning covers fire awareness, first aid, infection control, COSHH and induction. E learning is either undertaken when a person is on duty or during additional paid hours. The manager said that she is looking to review training records in view of the importance of e learning. We saw that training records related to individual training profiles and to an overview of the staff teams training needs. There was evidence that training in respect of safe working practices e.g. manual handling is refreshed at recommended intervals. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be assured that the home is well run and they are consulted about the service they receive. There are good systems in place to safeguard the health and safety of residents, staff and visitors to the home and staff receive regular supervision to support them in their roles as carers. Evidence: The manager has successfully completed the RMA and the NVQ Assessors Award. She also has completed the train the trainer qualification in respect of protection of vulnerable adults procedures. Prior to taking up the managers post in the home she worked in the home as the deputy manager for 3 years. She has many years experience working with elderly persons, in a residential care setting, and has also worked in a day care setting, for adults with sensory impairments. There is evidence that she attends short training courses and sessions to update her skills and knowledge. Recently this has included workshops for the Gold Standards Framework and Deprivation of Liberty Safeguards. She has also attended refresher training for health and safety, risk assessments and safeguarding adults. Care Homes for Older People Page 24 of 30 Evidence: Residents told us that the manager and deputy manager are approachable and we noted during the inspection that residents were comfortable in coming to the office to speak with the managers. During the inspection a member of the local authority had come to the home to carry out 3 review meetings. There were also other people visiting the home during the day. The person from the local authority commented that although their visit had been during a busy day for the managers she had received full assistance from everyone on duty in a calm and professional manner. We discussed quality assurance systems in place in the home. A quality assurance questionnaire is distributed on an annual basis to residents. The response to the 2009 survey was poor with only 3 completed questionnaires being returned out of a total of 24. The manager said that the survey took place at a time where there were other requests for feedback and she thought that the annual survey had suffered because of this. However, the 2010 survey will go ahead. Within the home both residents and staff meetings are held. We saw the minutes of the last residents meeting that took place on the 12th January 2010, where 11 of the residents took part. When we spoke with residents they confirmed that meetings were held although 1 resident said that she preferred not to attend. However, she told us that she was provided with a copy of the minutes of the meeting by the manager. We saw from the minutes that residents were informed of things that were happening in the home e.g. building works and that they were asked for their feedback in respect of meals and activities. A resident confirmed that the chef and the activities co-ordinator attended these meetings. We were told that during staff meetings members of staff had an opportunity to put forward ideas for improvement. We were given the example of the provision of a trolley to serve teas and coffees after the meal rather than using a cabinet in front of the hatch between the dining room and the kitchen. This new system has proved a success. We checked the copies of Regulation 26 visit reports that were available in the home and noted that there were gaps in the period between June and October and that the date on the last available report was the 11th November 2009. Residents receive their own personal allowance and some residents manage their finances independently while others are assisted by a family member etc. No one connected with the running of the home acts as an appointee for any resident. Residents (or someone acting on their behalf) are encouraged to make a small amount of money available for everyday purchases and they receive an invoice for settlement of purchases or items of expenditure made on the residents behalf. Care Homes for Older People Page 25 of 30 Evidence: Records are kept of all transactions, which include a running total and signatures are obtained, where possible. The accounts are checked by the manager and they are audited on a random basis through Regulation 26 visits and on a yearly basis. Records were satisfactory. Members of staff receive 1:1 supervision approximately 4 times per year in addition to support on a day to day basis. An annual appraisal of the member of staffs performance is carried out on the anniversary of their appointment although the manager said that they will be moving towards grouping these together in a block as this would be a more efficient system. Members of staff are also supported through staff meetings that take place every 2 to 3 months. The folder containing maintenance and servicing documents was made available. We noted that at the front was a list of all the contact details of firms providing a service to the home. We saw that there was a letter dated the 15/6/09 from the LFEPA confirming that the systems in place were found to be satisfactory. There were valid certificates for the servicing of the fire extinguishers, and the fire precautionary systems in the home. We also saw valid certificates for the testing of the portable electrical appliances, the electrical installation, the gas supply and the lifts. The fire alarms are tested on a regular basis and fire drill are held. The most recent fire drill took place in November 2009. The home was displaying a 4 stars (very good) score on the door from the environmental health department. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 33 26 Regulation 26 visits must take place on a monthly basis and a copy of the report of the visit must be available in the home. This will assure residents that the quality of the service provided is subject to an independent system of monitoring and review. 01/04/2010 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 3 That when the manager carries out an assessment visit for a resident who is funded by the local authority, and placed on an emergency basis, a record is kept. That a record is made and kept of when a member of staffs competence to administer medication is spot checked. That when a risk assessment is carried out in respect of a resident self-medicating the views of the GP are sought and recorded. 2 10 3 10 Care Homes for Older People Page 28 of 30 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 4 5 15 27 That the daily menu board in the dining room is updated each morning. That staffing levels and dependency levels of residents are kept under regular review to check that they match so that adjustments can be made if discrepancies are identified. That 1:1 supervision sessions for members of staff take place at least 6 times per year so that the care practice of the member of staff is kept under regular review. That staff meetings take place on a monthly basis so that members of staff are aware of and act on new information. 6 36 7 36 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!