Care Home: Snaith Hall Nursing And Residential Home

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What the care home does well People in the home are provided with a warm, safe and comfortable place to live that welcomes visitors and makes them feel at home. The home is clean and staff work hard to make sure the building is odour free. The home is welcoming and has a relaxed atmosphere. People living there said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home. People being cared for have good access to professional medical staff and are able to access external services such as dentists, opticians, physiotherapists, chiropody and dieticians, so their health is looked after and they are kept well. What has improved since the last inspection? The home continues to update its buildings and improve care practises so people can enjoy a good quality of life in safe and comfortable surroundings. What the care home could do better: During this visit some areas where changes should be made were identified, and recommendations of good practice have been made which can be found at the end of this report. These include care plans becoming more person centred and developing the staff training to include formal equality and diversity sessions and safeguarding of adults. We would like to thank everyone who completed a questionnaire and/or took the time to talk to us during this visit. Your comments and input have been a valuable source of information, which has helped create this report. Key inspection report Care homes for older people Name: Address: Snaith Hall Nursing And Residential Home Pontefract Road Snaith Goole East Yorkshire DN14 9JR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Eileen Engelmann     Date: 1 4 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 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 28 Information about the care home Name of care home: Address: Snaith Hall Nursing And Residential Home Pontefract Road Snaith Goole East Yorkshire DN14 9JR 01405862191 01405869817 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.snaithhallcarehome.co.uk Mrs Adrienne Elizabeth McEnroe,James Patrick McEnroe care home 47 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 47 The registered person may provide the following category of service only: Care home with nursing - Code N To service users of the following gender: Either Whose primare care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places 47 Dementia Code DE, maximum number of places47 Physical disability - Code PD, maximum number of places 47 Date of last inspection Brief description of the care home Snaith Hall is a Regency historical grade two listed building in the village of Snaith, near Goole in East Yorkshire. It is close to the village shops and amenities. It is registered as a care home with nursing for up to 47 people. Care Homes for Older People Page 4 of 28 47 0 47 Over 65 0 47 0 Brief description of the care home Over time extensions have been added to the hall that are in keeping with its age and character. The home is in three parts; up to twelve people are accommodated within the Hall, the Garden Wing accommodates twenty-four people and the Flower Wing twelve. Forty of the bedrooms have en suite facilities and eighteen of these include showers. The Hall and the Garden Wing both have passenger lifts provided to first floor rooms. Other areas of the home have had ramps and grab rails installed to make sure people can access all areas. There are two lounges, two quiet areas and two dining rooms in the and a large conservatory adjoining the Hall. Covered walkways join the Hall to the Garden and Flower Wings. A well-maintained and attractively planed large, private, enclosed garden is available for people to enjoy. Information about services provided by the home is available in the Statement of Purpose and Service User Guide. Copies are available in the home and can be posted out on request. Information given to us by the manager on 14 July 2009 indicates that fees range from 362.04 GBP to 536.30 GBP depending on the room facilities chosen by the person and the care needs of the individual. There may be a top up fee depending on the funding source and these are discussed on a one to one basis with the manager. 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Information has been gathered from a number of different sources over the past 23 months since the service had its last key inspection visit (14 August 2007), this has been analysed and used with information from this visit to reach the outcomes of this report. We completed an Annual Service Review (ASR) for Snaith Hall on 16 July 2008. We only do an annual service review for good or excellent services that have not had a key inspection in the last year. An ASR is part of our regulatory activity and is an assessment of our current knowledge of a service rather than an inspection. The published review is a result of the assessment and does not come from our power to enter and inspect a service. This unannounced visit was carried out with the manager, staff and people using the service. The visit took place over 1 day and included a tour of the premises, Care Homes for Older People Page 6 of 28 examination of staff and peoples files, and records relating to the service. Questionnaires were sent out to a selection of people living in the home and staff. Their written response to these was good. We received 6 back from staff (60 ) and 9 from people using the service (90 ). Informal chats with a number of people living in the home took place during this visit and comments from the questionnaires and face to face conversations have been put into this report. The manager completed an Annual Quality Assurance Assessment and returned this to us within the given timescale. We have received one formal complaint in the last 12 months, this was passed onto the Social Services team to investigate and was resolved quickly. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 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 9 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. People wanting to use the service undergo a needs assessment and are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met. Evidence: Four peoples care and records were looked at as part of this visit, they each have been provided with a statement of terms and conditions/contract on admission and these are signed by the person or their representative. Each person has his or her own individual file and the funding authority or the home, before a placement is offered to the individual, completes a need assessment. The home develops a care plan from the assessments, identifying the individuals problems, needs and abilities using the information gathered from the person and their family. Those people living at the home who receive nursing care undergo an assessment by a registered nurse from the local Primary Care Trust, to determine the Care Homes for Older People Page 10 of 28 Evidence: level of nursing input required by each individual. Discussion with the manager indicated he goes out to assess individuals who have expressed an interest in coming into the home, and each person is given information about the service and life in the home. Staff members on duty were knowledgeable about the needs of each person they looked after and had a good understanding of the care given on a daily basis. Comments from three people showed that they were satisfied with the care they receive and have a good relationship with the staff. One relative told us The staff are caring and patient with my relative, who is totally helpless with very limited communication and two people said that the home does everything well, I have no complaints and the home has good carers who help me. Information from the Annual Quality Assurance Assessment and discussion with the manager and people living in the home indicates that all of the people using the service are of White/British nationality. The home does accept people with specific cultural or diverse needs and everyone is assessed on an individual basis. Discussion with the manager indicated that the home looks after a number of people from the local community, although placements are open to individuals from all areas. Information from the Annual Quality Assurance Assessment and observation of the service showed that the home employs one care staff from overseas. The home is able to offer a very limited choice of staff gender to people who express preferences about care delivery, as the manager is the only male care staff within the home. The manager told us he would discuss the lack of male care staff with future service users as part of the needs assessment process. Information from the training files and training matrix indicates that the majority of staff are up to date with their basic mandatory safe working practice training, or they are booked onto training in 2009. The home is registered with us to accept placements for people with dementia, and information given to us by the manager indicates that ten staff have completed a distance learning package around dementia awareness. More staff are due to complete this as part of the rolling programme of training. Staff who completed our surveys said that their training was good and that they felt they provided a high quality of care, which promoted peoples rights to individuality, privacy and dignity. The home does not have any intermediate care beds and therefore standard six does not apply to this service. Care Homes for Older People Page 11 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. The health, personal and social care needs of people using the service are being met by the service and staff. Evidence: Information given to us in peoples surveys, and during discussions on this visit with people using the service, indicates that individuals are satisfied with the care they receive and enjoy life in the home. Nine people said that staff listen to us and take action when needed, and three people commented that Staff give good care and attention, I receive excellent care from lovely staff and I get regular showers and clothes are kept clean, medication is given regularly and I am unable to find fault with the staff or the service. We looked at four care plans as part of our visit, the format of the care plans covers most areas of care needs, but the information recorded by the staff was not person centred and lacked detail about each persons wishes and choices regarding care. The documents seen were pre printed and staff add names and additional details or cross out sections that do not apply. We gave examples to the manager of where the plans Care Homes for Older People Page 12 of 28 Evidence: were vague and discussed how these could be improved. In one plan the staff have written they must maintain levels of independence, but do not indicate what these levels are, what the person is capable of doing for themselves or if there any specific wishes or decisions made by the person regarding their independence. Another plan says staff should give analgesia for pain, but does not say where the person has pain, what causes it or what type of analgesia is used. The recording of activities attended by each person is poor and there is little information about family and friends within the plans. It was very clear from talking to staff and observations made during the visit that staff had a good understanding of peoples needs. Care staff clearly described what they did to help different people and it was evident they treated them as individuals. We spoke to the manager about the need to ensure the person-centred information that the staff are carrying in their heads, is transferred onto the care plans. People said that they have good access to their GPs, chiropody, dentist and optician services, with records of their visits being written into their care plans. They all have access to outpatient appointments at the hospital and records show that they have an escort from the home if wished. Comments from the people using the service indicate they are satisfied with the level of medical support given to them. One person told us that speaking on a personal level the home meets my needs, I feel fortunate to live here. Each of the four care plans we looked at have risk assessments around pressure area care and nutrition completed for the individual. Care needs are assessed based on the risk assessments and any specialist beds or equipment to meet these needs are in place. The staff ask for input from a dietician if they have specific concerns about a persons nutritional welfare. We found that peoples weights were not always being recorded on a regular basis in the care plans, discussion with the manager indicated these should be done at least monthly and he assured us that staff would bring the weight charts up to date immediately. Where a person has specialist healthcare needs but is not funded for nursing care, then the Community District Nurses are involved in their care. Discussion with the nurses in the home indicated there is a good working relationship with the community healthcare professionals and they are confident about asking for outside help and advice when needed. Information from the Annual quality assurance assessment (19/6/09) and discussion with the manager indicates that there have been no people admitted with pressure sores to the home in the past twelve months. We looked at one example of the homes wound care charts, this was located in the persons care plan. The information on the chart was not indepth and there was no visual/written evidence other than the chart to show how the Care Homes for Older People Page 13 of 28 Evidence: wound was progressing. Staff were able to tell us what wound care was being given to the person, how things were progressing and what advice had been received from the Tissue Viability Nurse. There was no indications that wound care was not effective in the home, just that it was not being documented as thoroughly as it could be. Most people living in the home who are on regular medication are helped by nurses and care staff. The qualified nurses will look after medications for the nursing individuals and senior care staff can give medications to residential individuals. The senior care staff have received certificated training around the administration of medications. Discussion with the deputy manager indicated she is responsible for checking the repeat prescriptions and medication stock in and out of the home. There are disposal of waste medication books in place and appropriate containers for normal and hazardous substances. Discussion with the nurses indicated that three people in the home like to self medicate and one person arranges their own repeat medications. Self medication risk assessments are completed for all three individuals, but the information about each persons wishes and choices (in the care plans) is not detailed or person centred so new staff may not know how to meet this specific need. We advised the nurses to look on our website for Pharmacy guidance/informaton around self medication and its documentation in care plans. Checking of the system showed that there is no positive identification (photographs) of the people who are receiving medication. This could make it difficult for new staff to identify individuals and could lead to errors being made. The manager assured us that he would put photographs into the system as a priority. Staff are maintaining accurate records of medications within the home, including controlled drugs and fridge medication. We looked at the suction machines within the home, these are kept clean and ready for use. However, the nurses could not say when they were last checked to ensure they were working okay or if they received annual maintenance. The manager should make sure the suction machines are fit for purpose and keep records of any checks/maintenance carried out. Chats with people revealed that they are happy with the way in which personal care is given at the home, and they feel that the staff respect their wishes and choices regarding privacy and dignity. Comments from the surveys indicate that people feel there is a good rapport between the staff and people using the service. One person told us that I am very satisfied. If anything is needed I just ask and it is done. Care Homes for Older People Page 14 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are provided with choice and diversity in the activities and meals provided by the home. Individual wishes and needs are catered for and people have the option of where, when and how they participate in both eating and leisure activities. Evidence: Activities within the home are fairly low key, but six people who completed our surveys say that there is always something for them to do. The manager told us that an activities person works two hours a week and organises a variety of sessions including craft work, quizzes, weekly armchair exercise classes and other group and individual events. The home has strong links to the community and encourages visits from local school children and various church groups. There are notices within the home telling people about forthcoming events and activities on offer. One person we spoke to said I like to spend time in my room, but I enjoy going into the dining room for meals and a member of staff takes me outside in my wheelchair whenever I ask. People and visitors were seen sat out in the gardens of the home, which have a number of shady/sheltered areas ideal for quiet or private conversations. Information in the Annual Quality Assurance Assessment completed by the manager Care Homes for Older People Page 15 of 28 Evidence: on 19/6/09, says that the service is aware of the changing needs of the people in the home and over the next twelve months the recreational activities are to be reviewed and the outcomes acted upon. Discussion with the people living in the home indicates that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family. Visitors told us that they can come into the home when they like and that they are always made welcome. People spoken to were well aware of their rights and said that they had family members who acted on their behalf and took care of their finances. There is some information and advice on advocacy and this is on display in the home. Information from the Annual Quality Assurance Assessment indicates that the home holds meetings for relatives and people using the service were they can discuss any issues around care or the service. The manager informed us that he is looking into accessing training around equality and diversity, the Mental Capacity Act and Deprivation of Liberty for the staff. This type of training ensures that staff have sufficient knowledge about human rights legislation, so they understand individual rights within the care home and out in the community. Observation of the midday meal showed it to be well prepared and presented, and people were offered a choice of foods to eat. Staff were organised when serving the meal and a number of individuals were seen to offer assistance to people who need help with eating and drinking. People and relatives are pleased with the quality and quantity of the meals served, saying the food is very good and I enjoy what I am given. The home has a three weekly menu and a selection of daily alternatives if people want a change to the meal on offer. Snacks and drinks are available day and night and people told us that staff were very good at getting them what they wanted. Care Homes for Older People Page 16 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. The home has a satisfactory complaints system with some evidence that people feel that their views are listened to and acted upon. Visitors and people using the service are confident about reporting any concerns and the manager acts quickly on any issues raised. Evidence: The home has a complaints policy and procedure that is found within the statement of purpose and service user guide. We discussed with the manager, the need to ensure that the policy/procedure is on display in the home and available for anyone to read. It would also be good practise to ensure the document is available in a number of different formats to meet the individual needs of people living in the home, such as large print, easy read and audio versions. Peoples survey responses showed individuals have a clear understanding about how to make their views and opinions heard and those people spoken to said the manager listens to any issues and takes action when needed to sort them out. There is no evidence of how the manager deals with niggles and grumbles on a daily basis, and it was recommended that he start to document these and show how they are resolved. Information from the Annual Quality Assurance Assessment (19/6/09) and checks of the complaints record showed that there has been 1 complaint made to the home in the past 12 months. This was investigated and resolved by Social Services without any Care Homes for Older People Page 17 of 28 Evidence: further action needed from the home. We recommended that as a good practise measure the manager completes audits of the number and type of complaints received, as part of the quality assurance system within the home. The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of peoples money and financial affairs. People told us in our surveys that The home makes me feel safe and at home. The staff on duty displayed a good understanding of the safeguarding of adults procedure. They are confident about reporting any concerns and certain that any allegations would be followed up promptly and the correct action taken. Discussion with the manager indicated that he has attended Safeguarding of Adults from Abuse training and this information has been cascaded down to the staff. The manager recognises the need for staff to attend formal training around safeguarding and is in the process of sourcing this type of training. He assured us that it would form part of the rolling programme of staff development. Care Homes for Older People Page 18 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 provides an extremely high standard of environment, which offers people a safe, comfortable and attractive place to live. Evidence: Snaith Hall consists of the Hall, a Regency historical listed building, with the Flower Wing (a purpose built extension) accommodating 23 people and the Garden wing also purpose built, which accommodates 24 people. We walked around the building and found it satisfactory and suitable to meet the needs of the people using the service. The home has an ongoing maintenance and refurbishment programme and the manager was able to show us the work that has been completed in the past 12 months and discuss work that is planned for this year. The home is warm and welcoming and offers people a safe, comfortable and homely place to live. Individuals commented that the home is always fresh and clean and that there are no odours. People have easy access to a number of outdoor areas, including a secure garden area, covered verandas, shady patio areas, lawns and planted beds. Inside the home people are provided with a variety of communal spaces made up of two lounges, two quiet rooms and two dining rooms. A conservatory is sited between the Hall and Garden Wing and offers people access to the gardens. The home has 40 en-suite bedrooms and 18 of these have en-suite shower facilities Care Homes for Older People Page 19 of 28 Evidence: and 1 bedroom has an en-suite bathroom. Both the Hall and Garden Wing are provided with passenger lifts, giving people access to the first floor. People we met were happy to show us around their bedrooms, these are nicely decorated and furnished with a mixture of the homes furniture or peoples own. Discussions during this visit indicated that people using the service are satisfied with the laundry service provided by the home. Infection control policies and procedures are in place, and staff have access to good supplies of aprons and gloves for use in personal care. Well equipped sluice rooms have been provided in each wing and help to promote good infection control practices. The staffing matrix supplied to us on 14/7/09 indicates that infection control training is part of the rolling programme of training and that 17 staff are booked to attend a refresher session in August 2009. Care Homes for Older People Page 20 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff induction, training and recruitment practices are good, resulting in an enthusiastic workforce that works positively with people to improve their whole quality of life. Evidence: Checks of the staffing rotas and observation of the service showed that the home employs one member of staff from overseas. Discussion with the manager indicated that the home is an equal opportunities employer and this was promoted during recruitment of staff. There are a number of staff who have been at the home for some years, individuals told us that they have a good working environment and enjoy their jobs. Staff members told us that they work as a team and this includes covering shifts when others are on leave or sick. Staff feel that their induction and training helps them meet the needs of people who use the service. We spoke to two people who use the service during this visit, and they were satisfied with the care they receive and said that they did not have to wait too long for staff to come when they needed assistance. Individuals told us that staff are friendly, helpful and supportive. At the time of this visit there were 33 people in the home, the home has seperate staffing levels for flower wing/hall and the Garden Wing. Overall in the home the Care Homes for Older People Page 21 of 28 Evidence: staffing levels were as follows, in a morning from 8am to 4pm there are two nurses and seven care assistants, in an afternoon from 4pm to 10pm there is one nurse on duty and six care assistants and at night from 10pm to 8am there is one nurse and three care assistants. Information from the annual quality assurance assessment about the number of staffing hours provided, and information gathered during the visit about the dependency levels of the people using the service, was used with the Residential Staffing Forum Guidance and showed that the home is exceeding the minimum hours asked for in the recommended guidelines. 56 of care staff at the home have an NVQ 2 or above in care and all new starters have to complete an induction which meets Skills for Care criteria. Staff have access to a mandatory training programme, as well as other specialist subjects which reflect the diverse needs of the people using the service. Nurses are supported in maintaining their own professional portfolio of practice in order to keep their Personal Identification Number (PIN) from the Nursing and Midwifery Council (NMC) up to date. The home has a recruitment policy and procedure that the manager understands and uses when taking on new members of staff. Checks of three staff files showed that police (CRB) checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. Nurses at the home undergo regular registration audits with the Nursing and Midwifery Council to ensure they are able to practice. Care Homes for Older People Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is satisfactory overall and the home regularly reviews aspects of its performance through a good programme of audits and consultations, which includes seeking the views of people using the service, staff and relatives. Evidence: The home has been owned and managed by the provider and family since it was first registered over fifteen years ago. The manager is a registered general nurse and is hoping to complete a management qualification equivalent to NVQ level 4 by the end of December 2010. This has been delayed in the last two years due to ill health. The home has achieved the local councils quality award (QDS) parts one and two. Continuous monitoring and assessment of the home and its practice/service by the Councils Quality Assurance Team is an essential part of the process leading to the awards being reaffirmed year after year. Feedback is sought from the people living in the home and relatives through regular Care Homes for Older People Page 23 of 28 Evidence: satisfaction questionnaires, and the manager has produced an annual development report as part of this process to highlight where the service is going and/or indicate how the management team is addressing any shortfalls in the service. Meetings for people using the service are held every two weeks before the church services and minutes are circulated to people living in the home. Staff have meetings with the manager and everyone is encouraged to join in with discussions and voice their opinions. People and staff agreed that the open door policy used by the manager is effective and encourages individuals to feel confident about talking about issues and the service in general. Policies and procedures within the home have been reviewed and updated to meet current legislation and good practice advice from the Department of Health, local/health authorities and specialist/professional organisations. The manager completes in-house audits of the home and its service on a monthly basis and although the provider still has a strong interest in the home, he has been unable to complete regulation 26 visits due to ill health. The manager told us this would be resolved within the next two months. The home will look after peoples personal allowances if asked to do so. Handwritten records are maintained and only the manager has access to the monies. Each person has their own wallet and receipts are kept for any purchases or payment of bills such as hairdressing and chiropody. We checked one persons files and accounts and these were up to date and accurate. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. The most recent reports from the local Fire Officer and Environmental Health Agency were seen and these were satisfactory. Staff have received training in safe working practices and the manager has completed generic risk assessments for a safe environment within the home. Risk assessments were seen regarding fire, moving and handling, bed rails and daily activities of living. Care Homes for Older People Page 24 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 25 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 7 The manager should consider how staff can improve the details and information in the care plans to show how they are giving person centred care which revolves around each persons wishes, choices, needs and abilities. The manager should review the wound care charts in the home and ensure the information within them is detailed and documents how wounds are progressing. The manager should ensure that staff are recording peoples weights on a regular basis. The manager should ensure that there is a photograph of each person receiving medication in the medication charts, to ensure that staff can clearly identify people and reduce the risk of errors occurring. The manager should ensure that information in the care plans around self medication (were appropriate) is detailed and robust enough to ensure staff are able to meet each persons needs effectively. The manager should ensure that the suction machines in use in the home are checked on a regular basis to ensure they are in working order, and keep a record of all checks Page 26 of 28 2 8 3 4 8 9 5 9 6 9 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations and maintenance carried out on the machines. 7 14 The manager should ensure that staff receive training around equality and diversity, the mental capacity act, deprivation of liberty and other disability discrimination legislation. The manager should complete audits of the number and type of complaints received, as part of the quality assurance system within the home. The manager should keep a record of any niggles and grumbles dealt with on a day to day basis and show how these have been investigated and resolved. The manager should ensure that the complaints policy and procedure is out on display within the home and made available in different formats to meet the needs of people using the service. The manager should ensure that staff receive formal training around safeguarding of adults from abuse and make this part of the rolling programme of staff development. The manager should complete an NVQ 4 in management or equivalent by the end of December 2010. 8 16 9 16 10 16 11 18 12 31 Care Homes for Older People Page 27 of 28 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. 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