Care Home: St Gregory`s House

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What the care home does well St Gregory`s House was particularly good in admitting and helping new people settle into the home. Significant time and effort was spent in assessing a new persons` needs and judging whether their needs could be met, and whether they would fit in with other people living in the home. Review meetings were held after the first few weeks of stay to make sure that everything was working well and to make any necessary changes to the care plan. Care plans were individual and included good evidence of peoples choices and wishes. The delivery of care was good, with people saying they were very satisfied and felt well looked after. The staff worked well with visiting health professionals and made sure people got the attention they needed. One visitor commented on how quickly staff called the doctor when her mother seemed unwell. The use of personal histories helped staff to know and understand the needs of those people with dementia. We saw that peoples` privacy and dignity was upheld and staff worked in a friendly and positive way. People were encouraged to make choices and decisions and staff respected these. Staff were aware of people`s cultural and religious needs, and there was a range of activities provided to keep people occupied and entertained. The provision of meals was good and staff paid attention to what people had to eat and drink to make sure they were getting enough. St Gregory`s House had a stable staff team who had been provided with very good training opportunities. All staff completed an annual training programme and had done a six part dementia awareness course. Staff were also supported to gain National Vocational Qualifications relevant to their job role. Staff recruitment procedures were thorough to make sure that only suitable people were employed to work in the care home. The service was well managed and there was evidence of good leadership throughout the management structure. There was a focus on listening to people and meeting their needs. Any complaints were listened to and the manager worked hard to find resolutions and put things right. People we spoke to had confidence in the manager and staff. The care home provided a safe, clean and comfortable environment for people to live in, and there was some on going refurbishment work to provide further improvements. What has improved since the last inspection? A lot of upgrading work had taken place to improve the environment. New carpets, new bedroom furniture and new armchairs had been purchased, as well as 12 profiling beds. Walls had been decorated and the woodwork painted. Some new windows had been fitted and an additional car park and outdoor space provided. External security cameras had been installed. Work was in progress to provide a wet room shower and a sluice room. There are plans to replace the existing conservatory and provide new living areas and a new bathroom, this is dependant on planning permission. Shift times had been altered slightly to suit the needs of people currently living in thehome, and closer work with the local mental health team had been developed. Protected meal times had been introduced to provide a more peaceful atmosphere for those who were easily distracted from eating their meal. People had been consulted on this and the system was flexible. What the care home could do better: There were no requirements or recommendations made as a result of this inspection. The manager and owners continue to provide a very good service to people. Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Gregory`s House St Gregory`s House Preston Patrick Kendal Cumbria LA7 7NY     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jenny Donnelly     Date: 2 8 0 4 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 27 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 27 Information about the care home Name of care home: Address: St Gregory`s House St Gregory`s House Preston Patrick Kendal Cumbria LA7 7NY 01539567543 01539567112 tb.stgregorys@btinternet.com 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) : St Gregory`s House Ltd care home 29 Number of places (if applicable): Under 65 Over 65 0 29 dementia old age, not falling within any other category Additional conditions: 29 0 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is: 29 Date of last inspection Brief description of the care home The home is a large detached three storey Victorian house, which was formerly the local vicarage. It is situated in beautiful open countryside on the edge of Preston Patrick, a small village between Kendal and Kirkby Lonsdale. Modern extensions have been added to provide bedrooms, communal living spaces and an office. The house has a passenger lift to provide easy access to all floors including the basement, and there are assisted bathing facilities. There are two twin bedded rooms, with the remainder being for single occupancy. Two bedrooms have en-suite facilities. The home has its own attractive grounds with secure seating areas and car parking. Care Homes for Older People Page 4 of 27 Brief description of the care home The home is registered to provide personal care and accommodation to 29 older people, including people with dementia. The homes fees as provided on the date of inspection, ranged between £487.00 and £539.00 per week, depending on the level of care required. The homes statement of purpose, service user guide and last inspection report, could be seen at the home, or a copies requested from the manager. Care Homes for Older People Page 5 of 27 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: This was the main or key inspection for the year. The lead inspector Jenny Donnelly asked the manager to fill out a form called the Annual Quality Assurance Audit (the AQAA). This asks for details of what has improved in the home since the the last inspection and for the plans for the coming year. This was fully completed and returned to us by the date we asked. Jenny Donnelly made an unannounced visit to the care home on 28th April between the hours of 09.45 and 15.45. During this visit we (the Care Quality Commission) toured the building, spent time in the lounges, and dining room where we watched lunch being served. We spoke with people living in the care home, their visitors and with the community nurse. We also spoke with the manager and the staff on duty. We Care Homes for Older People Page 6 of 27 looked at files and documents that backed up what we were told and what we saw. Since the last key inspection in May 2006, we have completed two Annual Service Reviews, one in 2007 and another in 2008. An annual service review is where we look at all the information we have gathered about a service in the last year, including the managers Annual Quality Assurance Audit and surveys that we send to people who live in the home. From this we make a judgement about whether the home is continuing to provide a good service to people, or whether we need to inspect sooner than planned. We received positive feedback on St Gregorys House at each annual service review, and did not alter our inspection plan. St Gregorys House was also selected for a national thematic inspection which took place on 13th September 2007. This was one of a large number of short focused inspections across the country designed to look in detail at the quality of care provided for people with dementia, with special attention on how their privacy and dignity was being upheld. This inspection showed that St Gregorys House was providing very good outcomes for people in these areas. Copies of all these reports are available on request from us, or from the care home. What the care home does well: What has improved since the last inspection? A lot of upgrading work had taken place to improve the environment. New carpets, new bedroom furniture and new armchairs had been purchased, as well as 12 profiling beds. Walls had been decorated and the woodwork painted. Some new windows had been fitted and an additional car park and outdoor space provided. External security cameras had been installed. Work was in progress to provide a wet room shower and a sluice room. There are plans to replace the existing conservatory and provide new living areas and a new bathroom, this is dependant on planning permission. Shift times had been altered slightly to suit the needs of people currently living in the Care Homes for Older People Page 8 of 27 home, and closer work with the local mental health team had been developed. Protected meal times had been introduced to provide a more peaceful atmosphere for those who were easily distracted from eating their meal. People had been consulted on this and the system was flexible. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 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 27 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. Arrangements for new people moving into the home are very good, and help people to settle in quickly and receive the care they need. Evidence: St Gregorys House has produced a Service User Guide that provides good written information about the services and facilities provided. A copy of this is issued to new people, and we saw a copy on display in the home. We looked the arrangements for new people to be admitted to the care home and found these to be very good. To assess this, we looked in detail at the records of three people new to the service, and we spoke with them and some of their relatives. We found that the manager or her deputy and gone to visit each person to complete a detailed assessment of their care needs. In agreeing to accept a new person into the home, the manager considered the needs of the other people in the home, to be sure Care Homes for Older People Page 11 of 27 Evidence: that staff can meet everyones needs fairly. The assessment was used to judge whether St Gregorys House would be suitable to meet the persons needs, and from this information an initial plan of care was drawn up. This meant staff knew about people before they arrived in the home, and were able to be prepared to greet them, and have ready any equipment they needed. In some cases the manager had also received a copy of the assessment by the persons social worker, along with relevant information from the hospital or other professionals involved in the persons care. In the case of an emergency admission, the manager still tried to go out and see the person first in their home setting, which is very good practice. We found by talking with people and their relatives that staff put significant time and effort into helping new people to settle into the home. Several relatives told us they had researched a number of care homes in the area and made a definite choice to come to St Gregorys House. People said, We knew this home as we had a relative here before, so this is where we wanted mum to be, and We checked the inspection reports on the website to make a shortlist, then visited some homes and liked this one the best. The first weeks of stay are considered a trial period and we saw evidence of post admission reviews taking place, either with the persons social worker, or their family. These reviews were used to make sure that peoples care needs were being fully met and to discuss any new issues. One persons review included plans to bring some items of furniture from home and to arrange for her to have reflexology. The manager said she has been trying to promote pre-admission visits, where a new person would come for a meal or an overnight stay before choosing to move in. This again is very good practice. St Gregorys House is registered to care for people with dementia, and as such all staff have completed an in house dementia awareness training course, comprising of six modules, completed over a number of weeks. The manager and staff have good contacts and work closely with the local mental health team, community psychiatric nurses and consultant, to ensure they are meeting peoples mental health needs. Care Homes for Older People Page 12 of 27 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. People were cared for very individually in way that was acceptable to them, and respected their choices and wishes. Health needs were recognised and attended to promptly, and medicines were safely managed. Evidence: Peoples health, personal and social care needs were set out in individual care plans. We studied the plans for three people with very different needs. One person was new to the home, one was fairly independent and the other was very poorly and being cared for in bed. Each plan followed a set pattern of general background information, risk assessments and detailed instructions for the daily care people required. There were also daily notes and records of any visits by health professionals. We could see that people had been offered regular baths and had their weight checked. The person who was poorly and being cared for in bed, was receiving regular attention from staff, and having frequent mouth care, to keep them comfortable. All of the files we looked at contained a personal history, as supplied by relatives. This is very helpful for staff caring for people with dementia, as it tells them about peoples interests and Care Homes for Older People Page 13 of 27 Evidence: achievements in life. This information was also used to help plan activities and entertainment. We saw that the care plans had been updated at least monthly, or more often if changes had occurred. Care plans were individual and person centred, so contained information about peoples personal choices and wishes, on how they wanted to be cared for. This also included any specific cultural or religious needs. Many people in the home suffer from dementia, and there were good instructions for staff on supporting those people with more challenging behaviour, and how best to approach situations. There was evidence of good liaison with health professionals, and one visitor stated, staff called the doctor very promptly when they thought mum was a bit chesty. We saw the community nurse visiting the home and understood from staff that she was currently visiting two people twice a week. The nurse told us, staff communicated well with her and her team, and followed their advice. The home was well equipped with hoists, specialist beds and pressure reducing mattresses. We saw that people looked well cared for and comfortable. Staff spoke confidently about how they cared for people as individuals and what they did to protect peoples privacy and dignity. We found that the importance of maintaining peoples privacy and dignity was built into all staff training sessions and was firmly embedded into the culture of the home. People told us they were well looked after, and the visitors we spoke with all praised the level of care provided for their relatives at St Gregorys House. We inspected the management of medicines in the home, and found this to be safe. Medicines were safely stored, and records showed that each medicine received into the home was accounted for, either by being administered to the person as prescribed, or being wasted and destroyed. Medicines records were clear and well maintained. Some people received certain medicines at odd intervals, such as alternate days, or once a week, and these were being safely managed. We asked staff about high risk medicines, such as blood thinning drugs, and they were aware of the precautions needed when administering these. There were arrangements for people to manage their own medicines if they wished, within a risk assessment framework. Some medicines were prescribed to be used as required and we saw instructions on the medicines chart or in the persons care plan, explaining what these medicines were for, and when they were to be used. This reduces inappropriate administration of these medicines and is good practice. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were able to spend their days as they liked and could join in with a range of activities and entertainment if they wanted to. Families and friends were encouraged to visit and take part in the life of the home and people told us they enjoyed their food. Evidence: We saw through observation and from discussions, that people living at St Gregorys House are able to make choices about how to spend their days. Staff knew who liked to get up early and who liked to stay in bed late in the morning. Peoples preferred bed time was recorded in their care plan, although staff said this was flexible if people changed their mind. We saw that people were able to spend their time in the lounge areas or in their bedroom as they preferred. We also saw that people were free to walk about the building as they chose, and go out onto the patio. There was an annual programme of activities and events, some of which were run jointly with another care home, and consisted of tea dances, a bonfire party and trips to local places of interest. There were visiting entertainers twice a month, and these included singers, story tellers and drama groups. The manager said the home used Care Homes for Older People Page 15 of 27 Evidence: about six different entertainers and people we spoke with said they had enjoyed a musical event the previous day. Visitors confirmed they had seen adverts for these events, and had been invited to join in. There was no dedicated activities organiser in the home, and care staff ran the in house activities such as crafts, bingo and exercise sessions. Two care staff were qualified to run the exercise sessions and another had completed memory therapy training. We saw records of each activity and who had taken part. Two people continued to attend day centres, which is unusual for people living in a care home, but was proving very beneficial to them. There were religious services held regularly in the home and staff knew who liked to attend these. We saw a large number of visitors in the home throughout the day, and they told us they were always made welcome and offered refreshments. St Gregorys House is a secure care home so visitors have to ring the doorbell to gain access. One person said they sometimes had to wait a while which was a problem if it was raining. The manager told us there were plans to change the entrance arrangements as part of the ongoing building works. There were no rules as such about visiting times, but the manager said she did ask people to avoid mealtimes if possible, as they were trying to provide protected mealtimes, to encourage people to eat by reducing distractions. We did see evidence however, that in some circumstances people were welcome to visit at mealtimes and have a meal with their relative if they wished to. We thought this was a sensible approach. We saw lunch being served in the dining room, looked at the records of meals served and spoke with the chef about peoples dietary needs. We saw that people who required a special diet, such as soft food, vegetarian or people who would only eat a very limited range of food, were well provided for. Lunch was the main meal of the day and we saw recent meals included gammon, lasagne, fish and chips and full English breakfast. Tea time was a lighter meal of things like scrambled eggs, pie, soup and sandwiches. There was good home cooking and plenty of fresh fruit and vegetables in stock. There was no set rotating menu, the chef planned meals one week in advance, and these were advertised daily on a blackboard. People told us they enjoyed the food and said the chef was very good. One person made a comment about chipped crockery, but the manager told us some new crockery had been purchased and she would ask staff to check that no chipped items were still in use. Staff monitored peoples weight, and gave gentle encouragement, to make sure people were getting enough food and drink. Care Homes for Older People Page 16 of 27 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 said that the manager and staff listened to them and would act on any concerns they raised. The safeguarding procedures in the home worked well to protect people from harm. Evidence: The home has a clear complaints procedure in place, a copy of which is given to people as part of the information pack. We did not see a copy on display to inform other visitors how to complain, and the manager agreed to rectify this. People we spoke with said they would speak with the manager or senior care staff if they had any problems. Some people told us they see the home owners sometimes and could speak to them if they needed to. A number of visitors confirmed that they would raise any issues with staff, and felt confident things would be sorted out. Some people were aware that they could contact outside agencies, such as their social worker. The manager kept a complaint file and this showed one complaint had been made in the last year. We had been informed of this at the time and the manager had copied us into her correspondence about this. We thought the manager dealt with the complaint in a positive way and sought to put things right for the person concerned. Staff had completed customer care training and knew they should refer any complaints made to them onto the manager or her deputy. There were polices and procedures in place to safeguard vulnerable people from harm, Care Homes for Older People Page 17 of 27 Evidence: and staff attended annual training about how to protect people and on how to raise concerns. Staff we spoke with understood the homes polices and procedures for recognising and reporting concerns, and knew how to contact outside agencies such as ourselves or social services. One staff member had recently used the whistle blowing policy to report an incident to the manager, who in turn reported it to the local safeguarding team. At the time of this inspection an investigation was in progress. We judged that the manager and her staff understood their responsibilities to safeguard people, and had acted correctly in referring this allegation to the appropriate authorities for investigation. Care Homes for Older People Page 18 of 27 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. There had been some major investment into St Gregorys House over the last two years, providing people with a safe, pleasant and comfortable home to live in. Evidence: St Gregorys House is a large detached three storey Victorian property, which was formerly a vicarage. Extensions have been added to provide dining and lounge space, additional bedrooms and offices. At the time of this inspection, workmen were on site undertaking work to provide a wet room shower and a sluice room. There were further plans to replace the conservatory which were dependant on planning permission. The home has a quiet lounge, main lounge, conservatory and a dining room. There were three bathrooms with hoists and plenty of toilets. There was a passenger lift and a stair lift to help people access the upper floors, and mobile hoists and other equipment for safe movement of people. There were two twin bedrooms, the remainder being for single use. One bedroom had a full en suite bathroom, and another had an en suite toilet. Bedrooms varied in size and shape due to the nature of the original building. Over the last two years a lot of refurbishment work had been done to improve the home. New carpets had been provided and the walls decorated. There was new seating Care Homes for Older People Page 19 of 27 Evidence: and twelve new profiling beds. There were new wardrobes and chests of drawers in most of the bedrooms, and some old built in cupboards had been removed to allow more flexibility with the space. A number of windows had been replaced, the car park extended and an additional secure patio provided. External security cameras had been installed. There were plans for a new medicines store and a new bathroom. One visitor stated she chose this home because the care was good, but she was pleased the environment was being upgraded to match. The home was fresh and clean throughout, and was tidy and safe for people to walk about. We saw the housekeeper going about her work and taking a pride in keeping the home clean. The maintenance man was touching up paintwork damaged by wheelchairs. We saw that the laundry was well organised and people told us their clothes were nicely laundered. Staff had received training in infection control. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were cared for by a well trained and committed team of staff who were being properly supported to do their jobs well. Evidence: The manager had recently altered the shift patterns in the home to better suit peoples care needs, and this seemed to be working well. On duty at the time of the inspection for 28 people were seven care staff, the manager, administrator, chef, housekeeper and the maintenance man. Care staff numbers reduced to five after 3.30 pm and to three staff after 9.30 pm. We saw that peoples needs were being met and no-one was left waiting to receive attention. Staff had time to sit with people for a chat and to take people outside to smoke as they wanted. There were two care staff vacancies coming up, one to cover a carer who was leaving and one to provide additional holiday cover. The manager had advertised these posts and had a number of people to interview over the week. New care staff completed an induction with the manager that covered all the basic health and safety information, and worked three shadow shifts with experienced staff, before joining in with the annual staff training programme. We saw the training records for the previous year and the training plan for this year. Care Homes for Older People Page 21 of 27 Evidence: Staff had attended training in safe moving and handling, fire safety, care of the dying, personal care, prevention of falls, safeguarding, infection control and equality and diversity. There was also a six module dementia awareness programme for all new staff. There were plans for long term staff to repeat this training programme as some of them first completed it five years ago. We believe this is good practice. We saw that a lot of the 2009 training programme had already been completed, and staff were able to tell us about the training days they had attended. Training was provided by qualified people either within, or external from the care home. The manager supported staff to gain National Vocational Qualifications (NVQ) and 63 of care staff had an NVQ in care which is very good. The chef was also completing an NVQ in pastries, and the administrator was completing one in business administration. We looked at the recruitment records of a new staff member and saw that the manger had completed all necessary checks on the person to make sure they were suitable to work with vulnerable older people before they started work in the home. People and visitors we spoke with told us the staff group were very good, very caring and attentive. People knew staff by their first names. We saw that staff interacted well with people, and were kind and patient. We received some completed surveys from the staff group which were very positive about their experience of working at St Gregorys House. Care Homes for Older People Page 22 of 27 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. St Gregorys House has a strong management team who demonstrate clear leadership skills and focus on listening to people who use the service, and providing positive outcomes for them. Evidence: The registered manager, Mrs Tracey Bindloss is suitably experienced and qualified to manage a care home. She is well supported by the home owners, an administrator and a deputy manager. People living in the home and visitors knew the manager by name and told us they could speak with her if they needed to. The manager values the opinions of people who use the service and their relatives. Satisfaction surveys are used to gather feedback and ideas from people about how the service is run. The most recent survey the manager undertook was about admission procedures and the homes environment. These topics were chosen because a number of new people had been admitted to the home recently, and there is some ongoing Care Homes for Older People Page 23 of 27 Evidence: building and decorating work in progress. Some surveys said it was sometimes difficult for visitors to gain entry to the home, and the manager told us a new door system will be included in the building works. The manager uses a number of audit tools to help her measure the quality of service being delivered, and these include quality checks on the medicines, care plans, and accidents. Accident records are a good example of how the manager uses information to help improve the service for people. The location of accidents is recorded, and showed an accident hot spot in one of the corridors, where the provision of a ramp has given safer access for wheelchairs and equipment. The times of accidents have enabled the manager to change the times that staff attend to certain people, to reduce the number of falls. Using information in this way is helping to reduce accidents and is good practice. The manager also meets monthly with the chef, maintenance man and housekeeper, to review and plan their workloads, to ensure the home runs smoothly. Some petty cash is held in the homes safe on behalf of a number of people. We saw the records for this and found that all transactions were properly recorded and the books audited periodically. People were able to access their money and see their records if they wanted to. There was clear evidence of ongoing investment by the home owners into improving the building and maintaining the quality of service provided. There was a system for staff supervision, where all staff received bi-monthly supervision from the manager or her deputy. We spoke to staff who confirmed they had received this, and we saw some of the supervision records, which showed care practices and training needs were discussed. Some supervisions took place over the telephone. The manager had a system for checking that everyones supervision and training and was up to date. We saw records showing that the homes facilities and equipment had been checked and serviced regularly. This included the fire systems, lifting equipment and heating and water supplies. The kitchen was awarded 5 stars for food safety by the environmental health officer in June 2008. All staff received health and safety training and there were policies and procedures in place to promote the health, safety and welfare of people living, working and visiting the home. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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