Care Home: St Christophers Care Home

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What the care home does well The staff work hard to ensure that residents` needs are appropriately assessed and that their care is planned to ensure that these needs are met, whilst encouraging and enabling residents to maintain their independence where possible. Each of the three residents surveyed said that the staff always listen and act on what they say. Residents spoken with expressed their satisfaction with their quality of life at the home. One resident spoken with commented `I am very well looked after, nothing is too much trouble` and another `I have everything I need`. Comments received from relatives on survey forms included: `Very caring, pleasant staff`, `I`ve found St Christophers to be a very good caring team and work hard at making the home friendly. I cannot fault the service at St Christophers` and `Standard of care is very high. All staff seem very genuine and treat residents with respect. We are very satisfied with St Christophers.` Additional comments made by social and health care professionals on their survey forms included: `Excellent, well supported, confident and competent staff` and `I have always found staff protect resident`s privacy and dignity. I always get positive comments from residents about their care at St Christophers.` If residents 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. All interactions observed between the management, staff and residents evidenced that the home has a close and caring staff team. Residents benefit from the clear management approach at the home providing an open, positive and inclusive atmosphere and can have confidence in the care home because it is led and managed appropriately. The home has an effective quality assurance and monitoring system in place and residents can be confident that their views are listened to and valued. What has improved since the last inspection? Two recommendations were made at the last inspection, one recommended that each care issue be allocated a separate page and the other recommended that nutritional screening be carried out for each resident on admission. Both these recommendations have been met. The ongoing maintenance, redecoration and refurbishment programme provides residents with a comfortable and homely environment in which to live. We were advised that improvements since the last inspection have included: the painting of all exterior woodwork; extending and refurbishing one of the smaller rooms to allow more spacious surroundings; refurbishing rooms to contemporary living style as they have become vacant; refurbishing a 1st floor bathroom to accommodate a disabled shower and a bath and recruiting an interior designer to assist in the decor of the home. In the AQAA, to demonstrate improvements made since the last inspection, the manager stated that they have: `Achieved our Investors in People award. Achieved the Catering for Health award. Achieved the Infection control award Cleaner safer Care Home Scheme. Achieved the five stars in the Scores on the Doors environmental health (incorporating food nutrition) award.` What the care home could do better: A requirement has been made regarding improving future staff recruitment procedures so that residents and their relatives or representatives can be confident that all required checks have been done on the staff to make sure that they are suitable to work with them. It has been recommended that the home review their adapted recording methods to ensure that they demonstrate coverage and sign off of all Skills for Care Common Induction Standards and the associated outcomes. Key inspection report Care homes for older people Name: Address: St Christophers Care Home St Christophers Care Home Ascot Priory Priory Road Ascot Berkshire SL5 8RS     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Denise Debieux     Date: 2 2 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: St Christophers Care Home St Christophers Care Home Ascot Priory Priory Road Ascot Berkshire SL5 8RS 01344884079 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ascot Residential Homes Ltd Name of registered manager (if applicable) Mrs Gillian Sian Gwyther Type of registration: Number of places registered: care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home St. Christophers is a period property located within the extensive grounds of Ascot Priory. The home provides care for older people who can no longer live independently at home, or choose not to. Accommodation is provided mostly in single rooms and is sited over two floors with a lift providing access to the upper floor for those with mobility problems. As well as the grounds of the priory, the home has its own garden area providing outdoor seating and activities in the warmer weather. Ample parking is provided to the front of the home with local bus routes running a short walk away from the home. Fees range from £650 to £850 per week. This information was provided on 22 January 2010. Care Homes for Older People Page 4 of 30 Over 65 25 0 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This unannounced visit formed part of a key inspection and was carried out on 22 January 2010 starting at 10 am. Mrs Gill Gwyther, registered manager, was present as the representative for the establishment. It was a thorough look at how well the service is doing. It took into account detailed information provided by the manager and any information that CQC/CSCI has received about the service since the last inspection on 01 May 2007. The people who live at this home prefer to be referred to as residents. For clarity and consistency this term will be used throughout this report. On the day of this visit eleven of the residents were involved in the inspection and information was gained from four on duty staff. Prior to the inspection, survey forms were sent to ten residents, ten relatives, ten social and health care professionals and Care Homes for Older People Page 5 of 30 to ten members of staff employed at the home. Survey forms were returned by three residents, nine relatives, eight social and health care professionals and seven members of staff. These survey forms were correlated and the results were shared with the manager during the inspection. Comments made on the survey forms, both positive and negative, were included in the correlation. Care was taken to exclude any comments that could identify the writer. The manager demonstrated a pro active attitude to the results of our survey and plans to explore any items raised further as part of the homes quality assurance process. Some of the comments made to us on the day of this visit and made on the survey forms are quoted in this report. The home sent us their annual quality assurance assessment (AQAA) when we asked for it. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. The AQAA was well written and gave us all the information we asked for. Residents care plans, staff recruitment and training records, menus, health and safety check lists, activity records, policies, procedures, medication records and storage were all sampled on the day of this visit. We looked at how well the service was meeting the standards set by the government and have in this report made judgements about the standard of the service. We would like to thank the residents and staff for their time, assistance and hospitality during this visit and the residents, their relatives, social and health care professionals and staff who provided additional information and participated in the surveys. Care Homes for Older People Page 6 of 30 What the care home does well: What has improved since the last inspection? Two recommendations were made at the last inspection, one recommended that each care issue be allocated a separate page and the other recommended that nutritional screening be carried out for each resident on admission. Both these recommendations have been met. The ongoing maintenance, redecoration and refurbishment programme provides residents with a comfortable and homely environment in which to live. We were advised that improvements since the last inspection have included: the painting of all exterior woodwork; extending and refurbishing one of the smaller rooms to allow more spacious surroundings; refurbishing rooms to contemporary living style as they have become vacant; refurbishing a 1st floor bathroom to accommodate a disabled shower and a bath and recruiting an interior designer to assist in the decor of the home. In the AQAA, to demonstrate improvements made since the last inspection, the manager stated that they have: Achieved our Investors in People award. Achieved the Catering for Health award. Achieved the Infection control award Cleaner safer Care Home Scheme. Achieved the five stars in the Scores on the Doors environmental health (incorporating food nutrition) award. Care Homes for Older People Page 7 of 30 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 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be 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. The home does not offer intermediate care. Evidence: We were advised that, on the first enquiry from a prospective resident or their representative, the resident or their representative will be invited to visit the home. Following the initial visit to the home, and if the resident wishes to continue, the manager will visit the resident and carry out a pre admission assessment to ensure that the home can meet the residents needs and wishes. In the AQAA, to demonstrate what the home does well, the manager stated: Thorough information about us, what we do and how we do it, prior to, on and after Care Homes for Older People Page 10 of 30 Evidence: admission in an easy to read and understand format is given to all residents and their families. Assessments prior to admission are very thorough and involve where possible, the client, competent trained and experienced staff, relatives and other stakeholders e.g. GP, district nurse etc. Two members of staff attend assessments to aid discussion and decision making as to our ability to meet the individuals needs. Discuss possible new residents within the team regarding meeting needs and impact on home. Where ever possible short term visits and/or stays as often as required, are encouraged. Invite resident and family for lunch/dinner and/or to spend the day with us before they make their decision. Wherever possible the same staff who assess the individual and have met the family also admit the person and introduce them to the house, staff and other residents. This statement was supported by the findings of this inspection. Two care plans for people who have recently moved to the home were sampled during this visit. In each case comprehensive pre admission assessments had been carried out to ensure that the home could meet the residents identified needs. Of the eight social and health care professionals who returned survey forms, six felt that the homes assessment arrangements always ensure that accurate information is gathered and that the right service is planned for people and two answered usually. Residents surveyed all felt they had received enough information prior to moving to the home. Care Homes for Older People Page 11 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health and personal care needs are met. The home has a plan of care that the resident, 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. Residents rights to privacy are respected and the support they get from staff is given in a way that maintains their dignity. Evidence: The home has a small and close care team and the staff demonstrate an in depth knowledge of each individual residents needs, abilities and preferences in how they wish their care to be delivered, resulting in all residents stating that they receive the care and support they need. One resident spoken with commented I am very well looked after, nothing is too much trouble and another I have everything I need. In the AQAA, to demonstrate what the home does well, the manager stated that: Care plans are kept in residents individual rooms wherever possible, and the individual and their family are encouraged to have and use this as a working Care Homes for Older People Page 12 of 30 Evidence: document for smooth communication and awareness with all stakeholders. Wherever the individual is able, they are involved in and contribute to the writing of their plan of care. This statement is supported by the findings on the day of this inspection. Two recommendations were made at the last inspection, one recommended that each care issue be allocated a separate page and the other recommended that nutritional screening be carried out for each resident on admission. Both these recommendations have been met. The care plans sampled during this visit were all based on pre admission assessments, had been drawn up shortly after each residents admission to the home and clearly set out the actions which staff need to take to meet the health and personal care needs of the residents. Residents preferences in how they would like their care delivered had also been included. Comprehensive risk assessments had been carried out and actions staff need to take to minimise any identified risks were included. Care plans are reviewed on a monthly basis and daily notes are kept that reflect the care given. These daily notes demonstrated that any changes or new concerns are promptly acted upon. The care plans had been signed by residents, or their representatives, to demonstrate their involvement and agreement to the content. Each of the nine relatives who returned survey forms stated that the home always meets the needs of their relative. Part of the lunchtime medication round was observed and the medication administration records, medication storage, policies and procedures were all sampled and found to be in order. We were advised that all staff receive training in the handling of medication and their competency is assessed by the manager prior to the staff members being allowed to administer medications to residents. On the day of this visit staff were observed to always knock before entering the residents bedrooms and all interactions observed between staff and residents were seen to be caring and respectful. All residents spoken with felt their privacy and dignity was always respected, as did all social and healthcare professionals who returned survey forms. One professional commented: I have always found staff protect residents privacy and dignity. I always get positive comments from residents about their care at St Christophers. Comments received on survey forms from relatives included: Standard of care is very high. All staff seem very genuine and treat residents with respect. We are very satisfied with St Christophers. Data provided in the homes AQAA does not identify any residents with specific religious, racial or cultural needs at this time. However, from the evidence seen and Care Homes for Older People Page 13 of 30 Evidence: comments received, we consider that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. Care Homes for Older People Page 14 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each resident is treated as an individual and the care home is responsive to his or her individual needs. They are part of their local community and are supported to follow personal interests and activities. Residents 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. Meals are well balanced and varied with individual choices and preferences catered for. Evidence: The routines of daily living are arranged to suit individual residents preferences and choices. This was confirmed by residents spoken with on the day of our visit. The home have an activity organiser who currently works twenty four hours a week, dividing that time equally between St Christophers and the sister home on the same site. In the AQAA, to demonstrate what the home does well, the manager stated that: Residents are encouraged to continue and maintain contact with family, friends and the local community by going out as much as possible. Our enthusiastic activities Care Homes for Older People Page 15 of 30 Evidence: organiser takes a great interest and pride in her work. In house entertainment and trips out arranged and receive positive feedback. Mobile library to visit. PAT dog visits regularly. Volunteer Ascot Services assist with transport and this link to the community has enhanced residents lives and well being. Installed a computer with internet access for residents and families to use easily in the conservatory. Currently awaiting printer as requested. Improved home shopping trolley, taking into account residents wishes. This statement is supported by the findings on the day of this inspection. Two of the three residents who returned survey forms stated that there were always activities they could participate in, with one answering usually. Some comments received on survey forms from relatives indicated that they felt the home need to further develop the activities provided, particularly for those with short term memory loss or signs of dementia. However, this is an area for improvement that the home has already identified and is taking steps to improve. We were advised that the activity organiser has begun a training course provided by the National Association for Providers of Activities for older people; is visiting local homes providing care to people with dementia to gain information and ideas on different activities to improve on what they provide and relate them to residents with short term memory loss as well as in their activities programme; is starting to provide training to all care staff in the provision of activities and has started meeting with other activity organisers in the local area. In their AQAA the manager described what they could do better and set out their plans for improvement over the next twelve months: Continue to improve activities and motivation for people with short term memory loss. More 1:1 activities for people who do not want to or are unable to join with others. Continue to get the activities coordinator involved in staff training. Improve activities training/awareness with all staff, not just the activities person. Continue to take more photographs of everyday life in the home and use these to inform training of new staff and old. To increase our sensory based activities. Review quality assurance systems including food and activities. Install a new loop system for people with hearing aids. Menus sampled showed that the home offers a varied and well balanced menu, with residents able to choose alternatives if they do not want the dish that is on the menu on the day. The lunchtime meal was taking place during this visit, the food was well presented, the atmosphere in the dining room was pleasant and relaxed and there were ample staff available to offer help and assistance as needed. All residents spoken with said they were enjoying their lunch and all residents who returned survey forms said that they always liked the meals at the home. Care Homes for Older People Page 16 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If residents 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 residents from abuse and neglect and takes action to follow up any allegations. Evidence: In the AQAA, to demonstrate what the home does well, the manager stated: Listen and respond immediately to any/all complaints and concerns seriously, however major or minor and regardless of the source. Maintain the highest understanding and input, that safeguarding in all aspects of peoples lives is our most fundamental role and goal. Safeguarding training bi-monthly highlighting on dignity, privacy and reporting/disclosure. Ensure residents and visitors are aware and comfortable to make us aware of any concerns at any time and the procedures to follow in doing so, by giving them information and asking the question. This statement was supported by the findings of this inspection. The home has a complaints procedure in place that is available to all residents and their relatives and is also included in the residents guide. All residents surveyed said that they knew who to talk to if they were not happy and that they knew how to make a formal complaint. Of the eight social and health care professionals who returned survey forms, five said that the management responds appropriately if concerns are raised, the remaining three answered not applicable. Care Homes for Older People Page 17 of 30 Evidence: There is a whistle blowing policy in place and the home have a copy of the latest Berkshire Safeguarding Adults Policy and Procedure. Training in safeguarding adults is included in the homes staff induction and all staff receive regular updates on any changes to the local safeguarding procedures. The manager has a good understanding of the requirements of the new Mental Capacity Act and related Deprivations of Liberty Safeguards and all staff surveyed stated that they knew what to do if anyone raised concerns about the home. All residents spoken with said that they felt safe at the home with one resident adding always and another commenting The staff make sure we are safe. Care Homes for Older People Page 18 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The location and layout of the home and gardens are suitable for their stated purpose. Residents live in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. Their room feels like their own, it is comfortable and they feel safe when they use it. An ongoing maintenance and redecoration programme provides the residents with clean, pleasant and homely surroundings in which to live. Evidence: Residents spoken with expressed their satisfaction with the accommodation provided at the home. Residents surveyed all said that the home was always fresh and clean. On the day of this visit we saw all areas of the home and grounds. The furniture and furnishings were seen to be of a good quality and personal bedrooms were all seen to be personalised to the individual residents wishes. The maintenance and redecoration programme for the home was seen to be ongoing. Since the last inspection there have been many improvements to the communal and individual areas of the home. We were advised that these improvements included the painting of all exterior woodwork; extending and refurbishing one of the smaller rooms to allow more spacious surroundings; refurbishing rooms to contemporary living style as they have become vacant; refurbishing a 1st floor bathroom to accommodate a disabled shower and a bath; recruiting an interior designer to assist in the decor of the home and employing Care Homes for Older People Page 19 of 30 Evidence: contract maintenance staff to assist in catching up on the back log of maintenance work created by the unexpected change of management last year. Laundry facilities are sited on the ground floor with washing machines suitable for the needs of the residents at the home. In the AQAA, to demonstrate what the home does well, the manager stated that they have: Nominated an infection control lead and achieved infection control award and trained all staff. Achieved the infection control award Cleaner Safer Care Home Scheme. On the day of this visit the home was found to be warm and bright with a homely atmosphere and a high standard of housekeeping apparent. Care Homes for Older People Page 20 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have safe and appropriate support as there are enough competent staff on duty at all times. The home has a staff recruitment procedure in place but the registered manager needs to ensure that all required checks have been carried out before allowing new staff to begin working at the home. Residents needs are met and they are cared for by staff who get the relevant training and support from their managers. Evidence: At present the care staff team consists of the registered manager, two home coordinators, three senior carers and eight care assistants. The staff rota evidenced that staff are provided in sufficient numbers to meet the needs of the current residents at the home. The morning (8am to 2pm) shift is covered by three care workers, two care workers cover the afternoon/evening shift (2pm to 8pm) and two care workers cover the night shift. Any care staff left in charge of the home have received additional training in running a shift and a member of management is always on call and available if needed. Of the three residents surveyed, two stated that staff are always available when needed and one answered usually. One resident commented that the staff: Take care of me. Comments received from relatives on survey forms included: Very caring, pleasant staff and Ive found St Christophers to be a very good caring team and work Care Homes for Older People Page 21 of 30 Evidence: hard at making the home friendly. I cannot fault the service at St Christophers. Of the eleven care staff, nine hold a National Vocational Qualification (NVQ) level 2 or above in care, exceeding the 50 required by the national minimum standards. Since the last inspection the home have only had three staff vacancies, and the recruitment files for these three people were sampled. All files were seen to contain a completed application form, proof of identity, two references and a full employment history. For two of the people enhanced Criminal Record Bureau (CRB) and Protection of Vulnerable Adult (POVA) list checks had been obtained as required. However, for one person a CRB and POVA list (now ISA - Independent Safeguarding Authority list) check had not been carried out, due to staff involved in recruitment misunderstanding the Department of Health POVA guidance as to who should be checked. It was noted that the staff member does not work directly with residents. The home were also unaware of new regulations that came into force in July 2004 and were not aware that they should be verifying applicants reasons for leaving previous employment with vulnerable adults, when applicable, or that full employment histories are now required with a written explanation of any gaps. The amended recruitment requirements and Schedule 2 of The Care Homes Regulations 2001 were reviewed with the manager and a copy of the CQC guidance, explaining the changes, was left with the home for their reference. It is positive to note that the management took immediate action and, following this inspection, we were advised by the manager that all staff files had been checked against the new regulations and that all recruitment information was in place as required. With reference to the person without a CRB or POVA list check, we were advised that they have applied for a CRB for this person, that the person will not have contact with residents and will be chaperoned until the CRB is returned. A risk assessment has also been carried out. Staff induction is in line with the new, mandatory Skills for Care common induction standards and we were advised that staff are supervised until they have completed their induction. The home have adapted the Skills for Care induction recording log book for their own use, so that all information is included on one sheet, however, it has been recommended that they review their adapted recording methods to ensure that they demonstrate coverage and sign off of all Skills for Care Common Induction Standards and the associated outcomes. Care Homes for Older People Page 22 of 30 Evidence: Mandatory health and safety training is included in the staff induction and the staff training log demonstrated that staff are booked on additional training and updates when needed or indicated by the needs of the residents they support. For example, recent training has included training in dementia and diversional techniques. In the AQAA, to demonstrate what the home does well, the manager stated that they: Promote innovative, individual and group training to ensure quality. Use every opportunity to learn and improve, and encourage staff to do the same. Promote qualifications and learning as a means to achievement and development internally and externally, e.g. by encouraging staff to achieve NVQ and then do their nurse training and return as qualified staff. Maintain skill mix per shift team to senior/junior, experienced/less experienced, part time/full time wherever scheduling allows, to continuously improve learning and development opportunities, skills and attitudes, as well as consistency in care and high standards. All staff surveyed confirmed that they are given training which is relevant to their role and keeps them up to date with new ways of working. One member of staff commented that there is: good support from management as they care for residents and staff constantly strive for improvement and another that: training is always offered to all staff. Each of the three residents surveyed said that the staff always listen and act on what they say. Additional comments made by social and health care professionals included: Excellent, well supported, confident and competent staff. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from the clear management approach at the home providing an open, positive and inclusive atmosphere and can have confidence in the care home because it is led and managed appropriately. The home has an effective quality assurance and monitoring system in place and residents can be confident that their views are listened to and valued. Residents, or someone close to them, control their own money and choose how they spend it. The environment is safe for residents and staff because appropriate health and safety practices are carried out. Evidence: The manager is qualified as a registered nurse and holds her Registered Managers Award qualification. Her management style is inclusive and the residents benefit from the ethos, leadership and management approach of the home, which is open and transparent. The detailed information provided in the AQAA was supported by the findings on the day of this inspection and demonstrated that the manager has a clear Care Homes for Older People Page 24 of 30 Evidence: understanding of areas they wish to improve, with plans already underway to achieve the identified improvements. The home has an effective quality assurance and monitoring system in place that is based on seeking the views of the residents and their relatives. We were advised that the home carry out bi-monthly quality assurance questionnaires with each resident, undertaken by a member of staff who is not their key worker and including anyone who may be visiting at the time. The provider also carries out yearly resident and relative surveys, correlates the responses and then formulates an action plan to address any issues that are raised. There is a key worker system in place and there are regular residents meetings, quarterly Friends of St Christophers meetings involving residents, relatives and visitors and there is a monthly newsletter where thoughts and opinions are sought. For example, we saw a copy of the homes January newsletter. One article discussed a recent television programme which had related to care provided for people with dementia in care homes. The newsletter article stated: We found the programmes both upsetting and thought provoking. We have taken on board some of the ideas raised in the programmes, in particular improving our carers knowledge of our clients past history and in involving clients in more day to day activities around the homes. We have left feedback forms around the home to ask if our clients or their families have other ideas which will help us to improve the lives of the people in our care. In their AQAA to demonstrate changes made as a result of listening to the residents, the manager stated: Ordered a printer for the communal use internet access computer; continued with our annual garden party; continue to change day to day routines/rooms/needs as per individual request and/or need; offer aperitif drinks before main meals; maintained outdoor activities including more outings; introduced more room/bed based activities to include less able clients in the activities programme; recommenced and restyled the company newsletter; changed/adjusted the interview process formally for new staff to incorporate residents views if they are unable to participate in staff interviews for any reason; redecoration of rooms as per residents preferences and entirely refurbished a 1st floor bathroom to accommodate a disabled shower and a bath. Policies and procedures are in place to protect residents financial interests. The manager stated that the home does not handle the financial affairs for residents. Health and safety monitoring check sheets were sampled and found to be well maintained and up to date. All staff have received required safe working practice training and updates and staff were observed to be following appropriate health and Care Homes for Older People Page 25 of 30 Evidence: safety practices as they went about their work. In the AQAA, to demonstrate improvements made since the last inspection, the manager stated that they have: Achieved our Investors in People award. Achieved the Catering for Health award. Achieved the Infection control award Cleaner safer Care Home Scheme. Achieved the five stars in the Scores on the Doors environmental health (incorporating food nutrition) award. A total of seven staff survey forms were returned to us prior to the inspection. From observations made on the day and from comments made on the staff surveys, it is clear that the home have a close and happy staff team. When asked what the home does well, staff comments on the survey forms included: Involve families, staff and other groups involved in the care for any decisions. Residents wishes are paramount and always come first; Staff have good relationships with residents and relatives that is continuous and long standing. Tries to keep ahead of all new developments and keep staff informed. Wonderful home to work in and The staff are all committed to take care of the residents. I am very proud to be working in such a lovely environment with lovely staff and residents. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 19 The registered person must ensure that no person is employed to work at the home without first making sure that all the required checks and documentation have been obtained and must ensure that all staff involved in recruitment are fully aware of, and adhere to, the requirements of the Care Homes Regulations 2001 and related amendments. So that residents and their relatives or representatives can be confident that all required checks have been done on the staff to make sure that they are suitable to work with them. 22/02/2010 Care Homes for Older People Page 28 of 30 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 30 It is recommended that the registered person review the homes induction recording methods to ensure that they demonstrate coverage and sign off of the Skills for Care Common Induction Standards and the associated outcomes. Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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