Care Home: St Anne`s Nursing Home

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What the care home does well The home has a comprehensive pre-admission procedure, which ensures that the home only admits people whose needs it can meet. All evidence indicates that the home ensures that people`s health and care needs are met. Activities are provided and the home has an activities organiser three days per week with additional external entertainers visiting the home on a regular basis. The home employs appropriate numbers of nursing and care staff that ensure that peoples needs are met. Staff receive the necessary training and good recruitment procedures are in place. The home has a high number of care staff with an NVQ in care. The home is well managed in the best interests of the people who live there. What has improved since the last inspection? One requirement was made following the previous inspection in June 2007. The home was required to ensure that copies of the statement of purpose are made more readily available. This has been met with a copy of the statement of purpose, service users guide and recent inspection reports being available at all times in the homes entrance hall. Since the previous inspection the home has been rebuilt and extended. This has been completed over two phases. Phase one was completed in July 2008 and people living at the home moved from the older building into a purpose built home providing all single ensuite rooms, communal rooms and bathing and WC`s. The original home was then demolished and phase two was built on the site of the old home. This is nearing completion with a date of September 2009 being the target. The home will then be able to accommodate up to fifty-four people in high quality, modern, purpose built accommodation. What the care home could do better: Two requirements are made following this inspection, one in respect of medication and one relating to food and drinks provided to people who live at the home. The home must ensure that correct administration procedures are followed so that people are no placed at risk of receiving the incorrect medication. The home must ensure that it has all the medication a person has been prescribed so that people are able to receive their medication as prescribed by their doctor. Daily maximum and minimum medication fridge temperatures have not been recorded to ensure medications are stored at the correct temperature at all times. The registered person must ensure that people have access to a drink at all times and that alternatives to the main option are offered at all meals. Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Anne`s Nursing Home 1 Lawn Road Portswood Southampton Hampshire SO17 2EX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Janet Ktomi     Date: 1 5 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: St Anne`s Nursing Home 1 Lawn Road Portswood Southampton Hampshire SO17 2EX 02380585032 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Pegmar Ltd care home 22 Number of places (if applicable): Under 65 Over 65 22 0 old age, not falling within any other category physical disability Additional conditions: 0 22 The maximum number of service users to be accommodated is 22 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Physical disability (PD) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home St Annes Nursing Home is a care home providing nursing care for people over 65 years of age. The home is registered to accommodate up to twenty-two service users. The home is registered to provide nursing care to those with physical disabilities who are under the age of sixty-five years. The home is located on the outskirts of Southampton city and is therefore close to all the local amenities and is accessible by public transport. The home is in the process of being completley rebuilt and extended to provide purpose built accommodation for up Care Homes for Older People Page 4 of 34 Brief description of the care home to fifty-four people in single ensuite rooms. The first phase was completed in July 2008 and the second phase is planned for completion in September 2009. A passenger lift is installed to give service users access to all parts of the home. Pegmar Ltd owns the home and it is managed by registered manager Mrs Kathryn Imonikhe. Information about the homes fees is available from the registered manager. Care Homes for Older People Page 5 of 34 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: This report contains information gained prior to and during an unannounced visit to the home undertaken on the 15th May 2009. All core standards and a number of additional standards were assessed. The home was previously inspected in June 2007 and had an Annual Service Review in June 2008. The visit to the home was undertaken by one inspector and lasted approximately seven hours commencing at 10.00am and being completed at 5pm. The inspector was able to spend time with the responsible person, registered manager, Care Homes for Older People Page 6 of 34 staff on duty and was provided with free access to all areas of the home, documentation requested, visitors and people who live at the home. Prior to the visit the registered manager completed an Annual Quality Assurance Questionnaire (AQAA), information from which is included in this report. Information was also gained from the notifications of incidents in the home. During the visit to the home the inspector was able to meet with and talk to people who live at the home and staff on duty. What the care home does well: What has improved since the last inspection? What they could do better: Two requirements are made following this inspection, one in respect of medication and one relating to food and drinks provided to people who live at the home. The home must ensure that correct administration procedures are followed so that people are no placed at risk of receiving the incorrect medication. The home must ensure that it has all the medication a person has been prescribed so that people are able to receive their medication as prescribed by their doctor. Daily maximum and minimum medication fridge temperatures have not been recorded to ensure medications are stored at the correct temperature at all times. The registered person must ensure that people have access to a drink at all times and that alternatives to the main option are offered at all meals. Care Homes for Older People Page 8 of 34 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 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. All people are assessed prior to moving into the home to determine that their individual needs can be fully met. People, or their representatives, are able to visit the home prior to admission to assess the quality, facilities and suitability of the home. Standard 6 is not applicable, as the home does not provide intermediate care. Evidence: The registered manager explained the homes admission procedure and the preadmission assessments for one person admitted shortly before the inspection visit and one person admitted several months before the inspection visit were viewed. The inspector discussed admissions with care staff and with some people who live at the home. The statement of purpose, service users guide and other information available to prospective service users or their relatives was viewed. Care Homes for Older People Page 11 of 34 Evidence: The registered manager stated in the homes AQAA that assessments are only carried out by the manager after potential service users or their relatives have visited the home. The AQAA also stated that the pre-admission form has been updated. The registered manager explained the homes admission procedure and was clear about the level of care needs the home can accommodate. The registered manager stated that if an initial inquiry from either social services, health continuing care or from a person or their family indicates that the home would be able to meet the persons needs the registered manager will invite the persons relatives to visit the home to view the facilities and room available and arrange to visit the person, either at their home or in hospital. A comprehensive pre admission assessment is completed including where appropriate members of the persons family and professionals involved in their care. The person or their relative is provided with information about the home. The pre-admission assessments viewed had been completed by the registered manager and contained information about the persons needs that should enable the home to decide if they are able to meet the persons needs following admission. Following admission the home had completed further assessments including a body map for marks or injuries on admission and relevant risk assessments such as for nutrition, falls and pressure area management. The bedroom of one person whose assessment was viewed was visited and this contained equipment that the assessment had indicated was required (pressure relieving mattress). Discussions with people who live at the home confirmed that people or their relatives have visited the home prior to a person moving in. Six of the seven comment cards received from people who live at the home confirmed that they had received enough information about the home. Discussions with care staff confirmed that they felt they had enough information about new people admitted to the home and that they had the training and time to meet peoples needs. People living at the home tend to be long term, however the home could provide respite or short stay accommodation if a suitable room were available. The same admission procedures would be used for respite or short stay admissions as for longterm admissions. At the time of the previous inspection in June 2007 it was noted that the statement of purpose was not readily available to service users or their representatives. A Care Homes for Older People Page 12 of 34 Evidence: requirement was made that the management must ensure copies of the statement of purpose are readily available. A copy of the statement of purpose was seen in the homes entrance hall along with a copy of the service users guide and previous inspection reports. This requirement has therefore been met. The home does not provide dedicated accommodation for, intermediate care or specialised facilities for rehabilitation. Care Homes for Older People Page 13 of 34 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 and personal care, which a person receives, are based on their individual needs. The handling of medication does not ensure that in all cases people have recieved their medication as prescribed by their medical practioner. Daily maximum and minimum medication fridge temperatures have not been recorded to ensure medications are stored at the correct temperature at all times. People are treated with respect and their dignity and privacy is maintained. Evidence: Three care plans were viewed, one for a person recently admitted to the home and the the others for people who have been living at the home for a longer time. The inspector discussed with staff and people who live at the home how care needs are met. The arrangements for the storage, administration and records relating to medication were viewed. Comments from service users, staff and external professionals comment cards and the homes AQAA are also considered. Care Homes for Older People Page 14 of 34 Evidence: People have a plan of care that related to the persons pre-admission assessment. The care plans follow a comprehensive format and are individualised, written in plain language, providing detailed information as to how needs should be met. Care plans are written by the qualified nurses. One instance where incorrect wording on a risk assessment was noted was discussed with the registered manager. Plans are reviewed on a monthly basis and when needs change. Relatives or service users had signed care plans. Care plans are held within the nurses office which can be locked when not in use. Care plans contained relevant risk assessments and management plans including nutrition, manual handling, falls, bed rails, pressure areas and any individual risks. Risk assessments viewed appeared appropriate to the persons needs and had been reviewed monthly or when risks changed. Where risk assessments in relation to pressure injuries resulted in a high risk being identified, the peoples bedrooms were seen to have been equipped with a pressure relieving mattress. The home undertakes nutritional risk assessments for people and there was evidence in all care plans viewed that people are being weighed monthly. Care staff spoken with said that communication about peoples needs was good and indicated that the qualified nurses and care staff work as a team. Eight comment cards were received from people employed at the home and all stated that they always get up to date information about the needs of people they care for and three stated usually and five always that the systems used to pass on information work well. An additional comment from a person who works at the home was the home provides person centered care and it provides personalised care. We are small and hence provide a high quality service making sure that the service users and their families feel comfortable and safe. The inspector was able to talk with people who live at the home who stated that they felt they received the care and support including medical care they need. Comment cards were received from seven people who live at the home. Four stated that they always receive the care and support they need with three responding usually and one sometimes to the same question. Five people who live at the home state that they always receive the medical support they need with one responding usually and one sometimes to this question. Records were available to demonstrate that people have access to a range of services such as GPs, Dentists and Chiropodists. Records and discussions with people who live at the home confirmed that health professionals are consulted when necessary. Three external health professionals completed comment cards none raised any concerns Care Homes for Older People Page 15 of 34 Evidence: about the home or care people receive. Additional comments included treats residents with respect and provide a good level of care. The external health professionals stated that the home always/usually seeks advice and acts upon it to manage and improve individuals health care needs and that the home always/usually respects peoples privacy and dignity. Care plans contained individual manual handling assessments and information as to how a person should be moved. The home has the necessary moving and handling equipment and aids including hand rails in corridors to promote independence. Care staff and staff training records confirmed that they had undertaken manual handling training. The inspector observed care staff using manual handling equipment appropriately. People stated that they felt that staff always treated everyone who lives at the home with dignity and respect. Observations of staff interactions indicated that people are treated with respect and their right to dignity maintained. All bedrooms are for single occupancy and have en suite facilities. Bedroom doors are all lockable. Care staff confirmed that they had sufficient time to meet peoples needs and discussions indicated that they had a good understanding of individual peoples needs and how these should be met. Observations of care staff indicated that they had sufficient time to meet peoples needs. At the time of the inspection visit nobody was self administering his or her medication. All medication is administered by qualified nurses. The home has a temporary treatment room where medication is being stored until the second phase of the homes rebuild is completed. The home has the necessary storage facilities and recording books for controlled medications. Also seen were destruction kits for controlled medication no longer required by service users. The home has a fridge for the safe storage of medication that must be kept at cool temperatures. This is kept locked. The home records the temperature of the fridge on a daily basis however this is only the temperature at the time it is checked although the home has a maximum/minimum thermometer. The thermometer recorded that the minimum temperature that medication had been stored at was 0 and the maximum had been 12 degrees centigrade, however it was not possible to determine when the thermometer had been reset or when these temperatures had been recorded. The registered manager stated that she would design a new form and that each day the maximum and minimum temperatures would be recorded to demonstrate that medication is being stored at the correct temperature. Care Homes for Older People Page 16 of 34 Evidence: Other medication is stored in the medications trolley. The inspector viewed medication administration records and checked medication available for the people whose care plans were viewed. All medication administration records were fully completed however for one person whose care plan was viewed the home did not have all the medication that had been prescribed for them. The person had not received regular pain relieve medication for two days or their regular night sedation the night prior to the inspection. The inspector was informed that a prescription had been obtained from the persons doctor and that this had been passed to the pharmacy used by the home. Records were seen that confirmed this had occurred days before the inspection however the home had not contacted the pharmacist when medication stocks were low to request the medication be delivered or arrange collection. The manager stated that she would contact the pharmacy to arrange for the medication to be made available and collected. Requirements are made in respect of medication in that the homes administration procedures must be safe and the home must have supplies of all medication prescribed for people. Care Homes for Older People Page 17 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The routines for daily living and activities made available are flexible and varied to suit peoples individual needs. Family and friends are able to visit. People receive a balanced diet in pleasing surroundings at times convenient to them. People must have access to a drink at all times. Evidence: The inspector spent time talking with people and observed part of the lunchtime meal. The inspector discussed activities with people who live at the home and viewed information about activities undertaken in records and related information in care plans and pre-service assessments. People living in the home are able to spend their time in the home where they wish, people were seen sitting in the homes lounge and others chose to spend time in their bedrooms. The home has limited gardens available at the time of the inspection visit due to the building work that is almost completed. The inspector was informed that there are plans to landscape the gardens once these are again available for people to use. Once building work is completed there will be greater choice in respect of communal space for people. Care Homes for Older People Page 18 of 34 Evidence: Care plans viewed contained information about peoples likes and dislikes and the home also seeks life history information from people or their relatives. People confirmed to the inspector that they are given choice over what time they get up and go to bed, as well as choice as to how and where they spend their time. Comment cards from staff had an added comment service users always have choice in all aspects of care provided. Comment cards from service users confirmed that people have choice about activities with one person saying I dont take part in activities. Bedrooms seen contained personal items brought into the home. Care plans and assessments include information about leisure activities, likes and dislikes, catering and religious needs. The home has an activities organiser who works three days per week providing a range of group and individual activities. The home also has visiting entertainment and special events are organised such as a Polish day planned for June and a party to celebrate a persons birthday. Information about planned activities was provided in the entrance hall. The home can arrange for newspapers to be delivered on a daily basis and people confirmed that they receive these. The inspector viewed the records maintained by the activities organiser that showed that group and individual activities are provided and that individual activities are provided to people who either choose to remain in their bedrooms or who must remain in bed due to their health needs. Visitors are able to visit at any time and complete a visitors book on entering the home. The home does not have a private room for visitors although this will be available once the rebuilding work is completed. This did not appear to be an issue for people visiting the home during the unannounced inspection who visited their relatives in the lounge or the persons bedroom. Care plans contained nutritional assessments and information about specific nutritional needs of the people living at the home. The home has a temporary dining room and people were seen to have their lunch time meal in this room or in their bedroom. People living at the home informed the inspector that they enjoyed the food at the home. Comment cards from service users stated that they always/usually liked the meals provided at the home, one added the comment more variety would be nice, another added that she had to have a pureed diet due to her condition which confirmed that special meals are catered for. The menu for the meals on the day of the inspection was displayed in the homes lounge. Only one option was listed, the manager stated that alternatives were available if people requested these. The inspector spoke with people who stated that Care Homes for Older People Page 19 of 34 Evidence: they were happy with the meals. When asked if alternatives were available people did not seem sure. One stated that she was provided with an alternative as the home knew that she did not like a specific meal. The inspector was present for part of the main lunchtime meal. The inspector observed people being given morning and afternoon drinks but people sitting in the lounge in the afternoon did not have access to a drink. For some people this did not seem to be an issue but others stated that they did get thirsty and would like a drink. This was discussed with the manager who stated that when it was hot staff provided frequent cold drinks and that if people asked for a drink a hot or cold drink would be provided. The inspector had asked people if they had ever requested additional drinks, they stated that they had not. The home must ensure that people have access to a drink at all times. The registered manager stated that when the rebuilding of the home is complete that two options will be provided at all meals, until then the home must ensure that alternatives are offered and not wait for people to request an alternative. Care Homes for Older People Page 20 of 34 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 and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. People are protected from abuse. Evidence: Discussions with people who live at the home and staff as well as information in the homes AQAA, comment cards received and records viewed are considered. There was a copy of the homes statement of purpose and service users guide in the hall and this had information within it about the homes complaints procedure. People the inspector spoke with stated that they did not have any concerns or complaints, they stated they would raise any concerns if they had any and that they thought the home would sort things out. Service users who completed comment cards stated that they knew who to talk to if they were not happy and how to make a complaint. Staff comment cards all stated that they knew what to do if a service user or relative raised a concern. Comment cards from external professionals raised no issues re complaints or safeguarding. No complaints have been received about the home at the Commission. The homes AQAA stated that one complaint had been made at the home and this was confirmed by the registered manager at the time of the inspection visit. This was investigated by the home and the complaint was upheld with the home taking action to address the Care Homes for Older People Page 21 of 34 Evidence: issue (re the homes front door) to prevent a reoccurrence of the situation that had led to the complaint. The home has a policy and procedure relating to safeguarding adults and ensuring that people are not at risk of abuse. Care staff have safeguarding adults training as part of their induction. The registered manager and staff confirmed that they had received safeguarding training with training in relation to deprivation of liberties being planned. Staff are provided with copies of the general social care council code of conduct and the homes policies in respect of whistle blowing. People stated to the inspector that they felt safe at the home. The local safeguarding team from Southampton Social Services has investigated a safeguarding concern at the home which was not substantiated. The home does not become directly involved in peoples personal finances and appropriate recruitment procedures are in place. Care Homes for Older People Page 22 of 34 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. People live in a clean, safe, new environment that meets their individual and collective needs. Evidence: The inspector viewed the home with a senior member of staff, viewed certificates related to equipment and discussed the home with the people who live there, staff and the registered manager. The provider is in the process of replacing the original building with a new purpose build nursing home. This has been done in two parts with part one completed approximately one year prior to the inspection visit. People living at the home moved into the new building and then the original home was demolished and part two of the building built on the site of the original home. Part two is nearing completion and should be ready in September 2009. Once completed the two parts will be joined (knocked through) to make one home capable of providing care for up to fifty-four people in single ensuite rooms with all the necessary communal and care support facilities (bathrooms, sluices etc). Prior to the home being registered for increased numbers the Commissions registration team will visit the home to fully assess the facilities and ensure that they are suitable Care Homes for Older People Page 23 of 34 Evidence: for people with nursing care needs. At the time of this inspection the home was found to be clean throughout with no unpleasant odours. The home employs cleaners with two on duty on the day of the unannounced visit. Comment cards from people who live at the home confirmed that the home is always (6) and usually(1) fresh and clean. All bedrooms are for single occupancy with ensuite facilities (although some larger rooms may be available once the building is completed for married couples should they request to share). Bedrooms viewed contained all the necessary furniture and equipment with all beds being of adjustable height and position. The home has a range of pressure relieving equipment should people be assessed as being at risk of pressure injuries. Appropriate bathing facilities are provided with supported baths or showers on each floor and WC located near to the lounge as well as ensuite to all bedrooms. The home has the necessary moving and handling equipment the service records for which were viewed. Accommodation is provided on three floors each accessible via a shaft lift for which the home has a service agreement. Domestic, care and nursing staff confirmed that they have attended infection control training and have access to all the necessary infection control equipment such as disposable gloves and aprons. Care Homes for Older People Page 24 of 34 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 home employs appropriate numbers of staff that ensure that peoples needs are met. Staff receive the necessary training and good recruitment procedures are in place. A high number of care staff have an NVQ of at least level two in care. Evidence: Records relating to recruitment and training were viewed. Discussions with staff and people who live at the home as well as comment cards received are considered as well as information provided by the registered manager in the homes AQAA.. The home has a consistent staff team with the AQAA stating that only two staff have left in the past year. Staff stated that the home is a happy place to work. All comments from people who live at the home were positive about the homes nursing and care staff. Service users stated that they felt there were generally enough staff to meet peoples needs. Professionals stated in comment cards that staff appear to have the necessary skills and experience to meet peoples needs. One adding compassionate staff with terminal care, and good communication with relatives. Duty rotas were seen during the visit to the home. Duty rotas stated that one qualified and three care staff are provided in the morning, one qualified and three care in the Care Homes for Older People Page 25 of 34 Evidence: afternoon/evening and one qualified and two care at night. Cleaners, activities worker, and kitchen staff are also employed. During the inspectors visit staff on duty corresponded to those on the duty rota. This was also the response in comment cards from staff four stating that they always, three usually and one sometimes have enough staff to meet peoples needs. Care staff stated that they generally have sufficient time to meet peoples needs and throughout the inspection care staff appeared to have time to meet peoples needs. Service users stated in comment cards that there are always (2) and usually (5) enough staff available when they needed them. The registered manager provided training and qualification information during the inspection and on the AQAA. The home has eleven care staff, nine of whom have an NVQ in care. Four having this qualification at level 3 and five at level 2. The registered manager stated that the remaining care staff will be undertaking an NVQ in the future. The inspector spoke with one carer who confirmed that she would be doing her nvq and another who confirmed that she had just completed an nvq. The registered manager showed the inspector the training information and confirmed that staff undertake all mandatory training. The registered manager is a train the trainer for manual handling and the home provides some training in house with external trainers providing fire and first aid training. Nursing and care staff stated that they felt they had the necessary skills to meet peoples needs and were not expected to undertake activities for which they had not been trained. All staff who completed comment cards stated that they had training relevant to their role which helped them to understand and meet the needs of the people living at the home. One added a comment that they had completed NVQ3 in adult care and had done courses on dementia, infection control and palliative care. Seven stated that they always and one usually have the right support, experience and knowledge to meet peoples needs. Staff stated in the additional comments section of the comment cards under what the service does well ongoing training, updates and courses, gives staff training and up to date courses. Staff comment cards stated that they felt the home could have regular staff meetings, with one saying that this was planned. When the staff team increases there will be a need to consider how staff are formally kept updated about issues affecting the home and people who live there. The recruitment records for two staff recruited since the previous inspection were viewed. These contained all the required information and confirmed that all staff are fully checked including references, CRB and POVA checks prior to commencing employment at the home. The homes recruitment procedures should ensure that unsuitable people are not employed at the home. The registered manager explained Care Homes for Older People Page 26 of 34 Evidence: the homes induction procedure that includes the Skills for Care induction. Induction workbooks were seen along with certificates for courses staff had attended. New staff also initial shifts as supernumerary as part of their induction. New staff on duty at the time of the inspection confirmed that they had worked extra to numbers for about a week and a half. Care Homes for Older People Page 27 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is appropriately managed and run in the best interests of the people who live there. Peoples financial interests are safeguarded. Staff are supervised. Records are well maintained. The health, safety and welfare of people and staff are promoted however the home must ensure that substances hazardous to health are kept secure at all times. Evidence: The registered manager has managed the home for twenty-two years, is a registered nurse and has a management qualification. The registered manager has also completed training to become a trainer for manual handling and safeguarding and intends attending further training in connection with deprivation of liberties and other relevant training she identifies. Throughout the inspection visit the registered manager demonstrated knowledge of the people who live at the home and the mechanisms by which support can be obtained when necessary. Care Homes for Older People Page 28 of 34 Evidence: The responsible person was at the home during the inspection and people who live at the home confirmed that he is regularly at the home and undertakes a range of management and other tasks. People who live at the home, visitors and staff stated that they felt they could approach the responsible person or the registered manager and that the home was effectively managed. Care staff stated in comment cards that the home is a happy place to work and there has been a very low turnover of staff. The registered manager completed the AQAA to a good standard providing relevant information about the service and returned this to the Commission within the required timescales. The home undertakes a range of quality assurance activity. People who live at the home and their relatives are included in the care planning process and reviews of care plans, signatures of relatives and service users being seen in care plan files viewed. The registered manager showed the inspector completed surveys from people who live at the home which have been completed this year. The registered manager stated that once she feels that all that will be returned have been returned she will collate the information and use this to change the service if indicated. The home does not does not act as appointee or hold valuables for people living at the home. Peoples personal finances are dealt with by the person themselves or their families or solicitors. All bedrooms have a lockable facility to ensure the safekeeping of money or valuables. Should people require services that are not covered by the fees, for example hairdressing or chiropody these are invoiced to the representative responsible for the persons money. Staff confirmed that they felt appropriately supervised. In comment cards seven staff stated that they regularly meet with the manager and one sometimes met with the manager. Various records were viewed during the inspectors visit. All records were appropriately stored with access only available to people who should have access. Records were seen to be well maintained. During the inspection visit the inspector observed that the trolley containing a range of cleaning products hazardous to health was left unattended in a hallway. This was pointed out to the registered manager who agreed that she would purchase a lockable box to go on the trolley in which cleaning substances could be stored securely at all times. A requirement is not made in this respect as the manager stated that this would be resolved shortly after the inspection and the cleaners were reminded about the dangers of leaving items unattended. No other concerns about safety were noted. Care Homes for Older People Page 29 of 34 Evidence: The home is clean and new therefore maintenance is not yet an issue. The home undertakes weekly checks of the fire detection equipment and the records for these were seen. Most of the equipment at the home is new and the home has entered into servicing contracts with the equipment provider. The inspector viewed records of servicing of older equipment. Care Homes for Older People Page 30 of 34 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 31 of 34 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 9 13 The registered person must ensure that safe administration procedures are used at all times. People must receive medication prescribed by their doctor. So that people are safe and do not become ill. 01/06/2009 2 15 16 The registered person must 01/06/2009 ensure that people have access to a drink at all times and that alternatives to the main option are offered at all meals. So that people are not thirsty and have choice at all meals. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 32 of 34 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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