Care Home: St Martin`s Nursing Home

What the care home does well People are provided with information about the service offered to enable them to make an informed decision about whether they would like to live at the home. People who use the service have access to a range of health and social care professionals and this ensures that any healthcare needs are met. There is a range of activities that people can participate in so that they lead an interesting and stimulating lifestyle. A varied menu that reflects individual needs and preferences is offered. The expert by experience said "People who needed more help were served lunch half an hour before the other people. This allows staff to give people who needed help their full attention". People can see their visitors as they choose so that they can continue to have relationships that are important to them. The home creates a friendly and welcoming atmosphere where people can personalise their rooms to reflect preferences and tastes. People are supported by staff who understand how to assist people to meet their needs. Staff treat people with respect and maintain their dignity. People are involved in meetings so that they are involved in decisions about the home. The home make changes as a result of listening to people who live there. People told us: "Nurses look after you well. Care staff that get you up in the mornings are lovely" "Well organised activities" "They offer good care and support" "Appears to offer a home from home for my mother" "Always seem happy to help" "Clean environment, no smells" "There is a lovely family feel. I have no concerns about him living there, the standard is superb" "They show that they care for him rather than just looking after him" "They really put a lot of effort into making him look nice" The report written by the expert by experience was very positive about the home and included: "I observed staff walking with people and chatting with people and visitors. It did not have the appearance of being artificial but seemed to be natural and common practice" "All the people had their hair combed, their clothes were well coordinated and oral hygiene was obviously taken care of" "There were no unpleasant smells, the decoration and furnishings of the home were of a good standard and this provides a pleasant living environment" "The people I spoke to were attentive, curious and are continuing to enjoy their lives in a home in which they feel happy and secure". What has improved since the last inspection? An enhanced GP service has been agreed at the home. A GP surgery is held at the home once a week so that people can see the GP without having to make an appointment. An extension to the home has been completed which consists of eight single ensuite rooms with toilet and hand wash basin. This means that all of the people living at the home can have the choice of having their own room. Some people had chosen to stay in shared rooms. One person who had moved into a single room told the expert by experience "I am very comfortable, warm and cosy and I am over the moon". The garden has been landscaped making it more accessible to the people who live at the home. There has been on going redecoration of the home, including bedrooms and corridors. New carpet has been fitted in the main corridor and lighting in the entrance of the home has been improved. These improvements enhance the environment that people live in. The number of care staff with a National Vocational qualification has improved which means that staff should have the knowledge and skills to care for people. What the care home could do better: The home must ensure that necessary recruitment checks are in place prior to staff starting work at the home so that people are protected from harm. Key inspection report Care homes for older people Name: Address: St Martin`s Nursing Home 51 Vesey Road Sutton Coldfield Birmingham West Midlands B73 5NR     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: Lisa Evitts     Date: 2 5 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 29 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 29 Information about the care home Name of care home: Address: St Martin`s Nursing Home 51 Vesey Road Sutton Coldfield Birmingham West Midlands B73 5NR 01213211789 F/P01213211789 st.martinsnh@btopenworld.com www.stmartins-nursinghome.co.uk Mrs Bernice Ann Underhill care home 24 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) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 24 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 24 Date of last inspection Brief description of the care home St Martins provides nursing care for up to 24 older people who may also have dementia needs. It is a family owned and run organisation. The home is situated in a pleasant suburb of North Birmingham and is within close proximity of public transport and the city centre. There is a train station within 5 minutes walking distance, which provides access to intercity connections. There is off road parking situated at the front of the building that comfortably accommodates five vehicles. The premises have been converted from a private residence. There is a conservatory style extension at the rear of the building, which overlooks a large attractive garden. Care Homes for Older People Page 4 of 29 Over 65 0 24 Brief description of the care home An extension has recently been completed at the home which provides single rooms and means that all 24 people have the option of their own room. Nine of the rooms in the home have ensuite facilities. Bedrooms are situated on both the ground floor and the first floor. The home has ramped access to enable wheelchair users to easily access the building and a passenger lift is available to the first floor. The home has dining room facilities and two lounges. A Harmony Suite is available for people to use and this has soft music and fibre optic lights to encourage relaxation or quiet time. Kitchen and laundry facilities are located within the home. The home has hoists and pressure-relieving equipment available for people who are assessed as needing this equipment. There are assisted bathrooms and shower facilities to meet the needs of the people who live there. A copy of the previous inspection report is available from the home so that people can read this if they want to. Current fee rates are available from the home and are dependent upon individual needs. Additional charges include hairdressing, aroma therapy and chiropody. Care Homes for Older People Page 5 of 29 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 focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. The last visit to the home was on the 19th February 2007. We completed Annual Service Reviews of the home in March and December 2008 and found that the home continued to provide excellent outcomes for the people living there. This visit to the home was undertaken by one inspector over one day. We, the commission were assisted throughout the day by the Registered Manager. The home did not know that we were visiting that day when there were 24 people living there. Information was gathered from case tracking two people who live at the home. Case Care Homes for Older People Page 6 of 29 tracking involves discovering individual experiences of living at the home by meeting or observing them, discussing their care with staff, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. We spoke to two staff and looked at staff files and health and safety records. An expert by experience was present for part of this inspection. An expert by experience is a person who, because of their experience of using services and ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. Experts by experience observe what happens in the home and talk to people who live there to get their views of the home. The expert by experience talked with six people who live at the home, one visitor and two members of staff. The expert by experience provided a report of her findings, parts of which have been included in this report. Prior to our visit we sent out random surveys to ten people who live at the home, ten relatives and five staff. Ten people who live at the home, nine relatives and five staff returned the surveys. Comments were very positive about the home and are included in this report. We were sent an Annual Quality Assurance Assessment (AQAA) by the home. This tells us about what the home think they are doing well and where they need to improve. It also gives us some numerical information about the staff and people who live at the home. Before our visit we reviewed any notifications received about the home, these are reports about things that have happened in the home that they must tell us about. Care Homes for Older People Page 7 of 29 What the care home does well: People are provided with information about the service offered to enable them to make an informed decision about whether they would like to live at the home. People who use the service have access to a range of health and social care professionals and this ensures that any healthcare needs are met. There is a range of activities that people can participate in so that they lead an interesting and stimulating lifestyle. A varied menu that reflects individual needs and preferences is offered. The expert by experience said People who needed more help were served lunch half an hour before the other people. This allows staff to give people who needed help their full attention. People can see their visitors as they choose so that they can continue to have relationships that are important to them. The home creates a friendly and welcoming atmosphere where people can personalise their rooms to reflect preferences and tastes. People are supported by staff who understand how to assist people to meet their needs. Staff treat people with respect and maintain their dignity. People are involved in meetings so that they are involved in decisions about the home. The home make changes as a result of listening to people who live there. People told us: Nurses look after you well. Care staff that get you up in the mornings are lovely Well organised activities They offer good care and support Appears to offer a home from home for my mother Always seem happy to help Clean environment, no smells There is a lovely family feel. I have no concerns about him living there, the standard is superb They show that they care for him rather than just looking after him They really put a lot of effort into making him look nice The report written by the expert by experience was very positive about the home and included: Care Homes for Older People Page 8 of 29 I observed staff walking with people and chatting with people and visitors. It did not have the appearance of being artificial but seemed to be natural and common practice All the people had their hair combed, their clothes were well coordinated and oral hygiene was obviously taken care of There were no unpleasant smells, the decoration and furnishings of the home were of a good standard and this provides a pleasant living environment The people I spoke to were attentive, curious and are continuing to enjoy their lives in a home in which they feel happy and secure. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 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 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements are in place to ensure that people have the information they need and can be confident that their needs will be met if they decide to live at the home. Evidence: The home has a service users guide which had been updated recently to ensure it gives people current information about the home. People are provided with a copy of this document on admission to the home. The document can be made available in alternative formats upon request so that all people can access the information. The fee rates for living at the home were not included in the guide as they are dependent on individual needs. The guide should contain a range of fees so that people know how much they might have to pay to live at the home. In the surveys returned to us seven people said that they had enough information about the home before they moved in, two people said they didnt have enough information and one person wasnt sure. Care Homes for Older People Page 11 of 29 Evidence: A notice is displayed informing people that they can get a copy of the last inspection report from the office, so that they can read this if they choose to. Before anyone comes to live at the home, comprehensive pre admission assessments are undertaken. We looked at two peoples assessments and they contained enough information, so that the person and the home knew that their individual needs could be met before they moved in. The manager verbally confirms that the home can meet peoples needs after the assessment. This should be written confirmation so that people can be confident that their needs can be met. The AQAA told us that people can come and visit the home before they move in to see if they would like to live there. One relative told us When I saw the facilities that the home provides, the layout of the rooms and how pleasant and clean it was, I did not need to look at another home. The home does not offer intermediate care facilities and therefore this standard does not apply. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal care and health needs of the people living there are met so ensuring their well being. Evidence: Each person had a written care plan. This is a plan about the individual. It states what they can do independently and what support staff need to give them to meet their needs. We looked at two peoples care files in detail and partially looked at one other. We found that people had care plans in place which provided staff with most of the information about how to meet peoples needs in a way that they preferred. There were some good details recorded such as preferences for bath or shower and what time people liked to go to bed. One person had a history of depression and there was a plan in place so that staff knew what signs may indicate this illness. One person at the home had been making inappropriate calls to an establishment and a behaviour chart was in place to monitor this. Staff had spoken with the person and their family but a care plan had not been written and this should be in place with the behaviour chart. One person sometimes tried to leave the building and a risk assessment was in Care Homes for Older People Page 13 of 29 Evidence: place to guide staff. Documentation regarding wound care and dressings was very detailed and provided good information for staff. Care plans were updated when changes occurred so that staff had current information. The exception to this was one care plan said that someone could sit out for two hours but position charts showed that the person sat out for longer than this. Staff told us that the person could now sit out for longer following review with the specialist tissue viability nurse but the plan had not been changed to reflect this. Risk assessments are completed each month for nutrition, risk of sore skin, falls and moving and handling. Risk assessments were in place for the use of bed rails. We saw that staff referred to this equipment as cot sides and we discussed the use of the terminology with the manager as this does not promote the dignity of the older people who use this. People are seen by external healthcare professionals such as the GP, community psychiatric nurse (CPN), optician, chiropodist and tissue viability nurse. This means that people receive specialist advice when required. People told the expert by experience that the GP visits once a week and should they need to see a doctor at any time, then medical assistance would be obtained as soon as possible. The expert by experience said A visitor told me that they were extremely happy with the medical care provided for their mother and said that staff kept her up to date with her mothers progress following a fall. We looked at the management of medication. Medication was securely stored and copies of prescriptions were kept so that staff could check that they had received the correct medication into the home. All of the Medication Administration Records (MAR) charts were signed when medication was given. The medication audits were correct which means that people had received their medication as prescribed. The audit trail was not always easy to follow as medication was not always signed in on receipt to the home. The audits had to be completed from the number of tablets on the box and date started. The expert by experience said all the people were well cared for and well presented, they were smartly dressed and have maintained their individual style.Their hair was combed, their clothes were coordinated and oral hygiene was obviously taken care of. In a survey received from a relative they said They show that they care for him rather than just looking after him. An example of this is when they enabled him to Care Homes for Older People Page 14 of 29 Evidence: come to my brothers wedding. They really put a lot of effort into making him look nice. Ive seen them fuss over him just when hes staying in, tucking in his shirt, smoothing his hair etc. Following the recent completion of the extension, people in shared rooms had the option of moving into single rooms with ensuite facilities. Care Homes for Older People Page 15 of 29 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. Activities offered and meal choices mean that people experience a meaningful lifestyle. Evidence: The home does not have a dedicated activity coordinator and staff assist people with activities. There is a weekly and monthly activity rota displayed in the home. There are a wide range of activities on offer such as painting, craft sessions, gentle exercise, puzzles, walking, bingo, pat dog visits (dogs that assist with therapy through touch), videos and nail manicures. A church service is held once a month and two people at the home receive Holy Communion which means that people can follow their religious beliefs when they move into the home. An aroma therapist visits the home and some people choose to have massages at an additional cost. The home also has Harmony room which has sensory lights and music to provide a soothing and relaxing environment. In a survey received a relative commented They have good entertainment, sing a longs and pantos. People told the expert by experience that they had made Easter hats, baked cakes, enjoyed sing a longs and went out to the local park which they thoroughly enjoyed. The expert by experience said I observed staff walking with people and chatting with Care Homes for Older People Page 16 of 29 Evidence: them and visitors. Staff were observed encouraging interaction, physical and mental stimulation. It did not have the appearance of being artificial but seemed to be natural and common practice. There is an open visiting policy, which means that people can see their friends and relatives as they choose and can continue with relationships that are meaningful to them. A relative told us They always make me feel welcome. The home has a four week rotating menu. This showed a choice of hot meal at lunchtime and soup and sandwiches or a lighter hot meal in the evening. People are asked on a daily basis about their choice of food and alternatives are offered. The expert by experience observed the lunch being served and said the people who needed more help were served half an hour before the other people and this allows staff to give people who needed help their full attention. Tables were laid with clean cloths and table mats and condiments and serviettes were available. The expert by experience said I observed staff assist people in a dignified manner, gently encouraging a person to eat at their own pace. We also observed one member of staff wearing gloves while assisting someone with their meal. We discussed this with the manager at the time of our visit as it does not promote peoples dignity. People told the expert by experience that there was a variety of food which was well presented, warm and they described the food as being excellent. People said food and drinks were usually served on time and that fresh fruit was provided. One person said the meals are good and the puddings are excellent. Care Homes for Older People Page 17 of 29 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. Arrangements are in place to listen and act upon people views and to safeguard people from harm. Evidence: The complaints procedure is available in the service users guide which each person has a copy of. This document is available in alternative formats and means that people have access to the procedure if they want to make a complaint. The home had not received any formal complaints in the last twelve months. We received an anonymous complaint about this service in March 2009 regarding staffing levels. Due to an error the home did not receive this complaint and so were unable to investigate it. During our visit we did not identify any concerns regarding the number of staff provided on duty. Feedback from people using the service, visitors and staff were all positive. People told the expert by experience if they had any concerns they knew how to raise it with immediately with staff. One person said they were aware of the formal complaints process but didnt need to use it. A relative commented any concerns I raise are dealt with swiftly and are resolved. This should mean that people can be confident that they are listened to. The home has a safeguarding policy which gave staff good details about what to do if Care Homes for Older People Page 18 of 29 Evidence: they suspected or witnessed abuse. It also gave local contact numbers so that people would know who to call. In addition to this the home had a Deprivation Of Liberty Safeguards (DOLS) procedure which was detailed and gave staff guidance about when and how they should complete a referral. This policy should guide staff to know how to use this in every day practice when peoples freedom may need to be restricted in their best interest. There had been one safeguarding referral at the home which had been investigated and closed. Staff have received training in the protection of vulnerable adults and staff spoken to were able to demonstrate a good understanding of what they should do in the event of an allegation being made. Care Homes for Older People Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a homely, clean, comfortable and pleasant environment in which to live that meets their individual needs. Evidence: The home has two lounges and a Harmony room so that people can choose where they want to spend their time. There is a hairdressing room which can also be used for visitors such as the GP and chiropodist so that people can be seen in private. The home is bright and nicely furnished. The home was clean and fresh with no unpleasant odours and in the surveys we received from people living at the home, nine of them said that the home was always clean and fresh. There are three shower rooms and two bathrooms with meet the needs of the people living at the home. Grab rails and raised toilet seats are provided. Corridors are wide with handrails and enable people to mobilize around the home as they choose to. The home has hoisting equipment to move peoples position and special mattresses to help prevent skin soreness. Since our last visit to the home, a ground floor extension has been completed and was opened in November 2009. This consists of eight single bedrooms which have ensuite toilet and wash hand basin. A walk in shower room has been included in the area. This Care Homes for Older People Page 20 of 29 Evidence: meant that people who were sharing a bedroom had the option of moving into a single room if they wanted to. We saw in the minutes of meetings that this had been discussed with the people living at the home. Some people had moved into the single rooms but three people had chosen to stay in their shared rooms and remain with their friends. The new rooms were completed to a high standard and had matching furniture sets. The heating was under floor and each room can be controlled individually so that people can alter this as they choose to. We saw that people have personalised their rooms with items that were familiar to them and in a way that met their individual needs and choices. Some people had chosen to have their own telephone line in their room so that they could continue to make calls to people and maintain relationships that are important to them. Following a risk assessment people have the option of having their own door key which promotes their independence and dignity. The expert by experience spoke to one person who had moved into one of the new rooms and they said I am very comfortable, warm and cosy and I am over the moon. People described their rooms and communal areas as being excellent. In the surveys received from relatives, they commented: Nice rooms Appears to offer a home from home for my mother Clean environment, no smells I have no concerns about him living there, the standard is superb. The home has made other improvements such as landscaping the garden to make it more accessible to people. Improved the lighting in the reception area, redecorated some rooms and laid new carpet in the main corridor. There is a rolling programme of decoration in place to ensure the home maintains its current standards. Care Homes for Older People Page 21 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living in the home were being cared for by a stable staff team that could meet their needs. Lapses in the recruitment procedure may place people at risk of harm. Evidence: During the daytime there are four carers and one trained nurse on duty. At night there are two carers and one trained nurse. These numbers appeared to meet the needs of the people living at the home on the day of our visit. In addition to the nursing and care staff the home also have domestic, laundry, kitchen and maintenance staff to meet all the needs of the people who live there. There were no staff vacancies. The home maintains a core group of staff and does not use agency which means that people know who will be assisting them to meet their needs. People told the expert by experience that the home does not use agency staff and they felt this was good as it provided them with a continuity of care to a very high standard. Comments received from people living at the home and surveys included: We are just like a family; you see the same staff every day Care Homes for Older People Page 22 of 29 Evidence: Day and night staff are approachable, friendly and kind Nurses look after you well. Care staff that get you up in the mornings are lovely The staff are always interacting with the residents and there is a lovely family feel. The number of staff with a National Vocational Qualification (NVQ) Level 2 in care has increased to 67 . This should ensure that the majority of staff have the knowledge and skills to care for people individually and collectively. Staff spoken to were able to demonstrate a good knowledge about peoples needs and it was clear that they knew the people at the home very well. People told the expert by experience that the staff knew them well and knew their likes and dislikes. We looked at three staff files. All staff had references but two people had started work at the home prior to a Protection of Vulnerable Adults (POVA) first check being completed. This is now known as a Independent Safeguarding Authority (ISA) check. The manager advised that staff came into the home for training and are supervised but this does not ensure that people are safe from harm. A POVA/ISA first check and a risk assessment should be in place until a full Criminal Records Bureau (CRB) check has been received. There was good evidence that gaps in employment history had been explored. Staff complete an induction to the home to ensure that they have a basic knowledge about their role and the home. The AQAA told us that staff receive training on policies and procedures of the home, health and safety, manual handling and equipment operating instructions. We discussed training with the manager who advised that she did the training for moving and handling on induction but did not have a teaching qualification for this. It is recommended that there is a qualified moving and handling trainer in the home. Staff receive annual moving and handling training. Staff told us that they had received training in moving and handling, fire training, infection control, Parkinsons disease and venepuncture. The home has a training plan for the year which identifies training in fire, first aid, moving and handling, food hygiene, physical intervention and restraint training. Training is booked annually and may mean that new employees do not receive training in a timely manner and this should be reviewed. Care Homes for Older People Page 23 of 29 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. The home is run in the best interests of the people who live there. Peoples opinions are sought and acted upon. Evidence: The registered manager has experience of caring for older people and in the managers role. She is a Registered Nurse and has completed a National Vocational Qualification level 4 (NVQ) in management. The manager completes training courses to keep her knowledge up to date. This should ensure that she has the knowledge to support staff and ensure the home is run in the best interests of the people who live there. The home also has a general manager who is responsible for none nursing management. One relative commented in a survey There is a good nurse manager. There are meetings for people who live in the home and their relatives so that they have an opportunity to voice any concerns or raise any ideas about how the home could improve. One person told the expert by experience that she actively got Care Homes for Older People Page 24 of 29 Evidence: involved in the running of the home and attended the residents meetings. The person felt the meetings were effective and that actions agreed from those meetings are acted upon. An example of this was that the porridge was cold and since being discussed at a meeting it was now served warm. The expert by experience said three of the people stated they were aware of what their rights were and are confident that these rights are active and functional. The people I spoke with were attentive, curious and are continuing to enjoy their lives in a home where they feel happy and secure. The home has a system in place to monitor the quality of the service provided by the home. The home has various matrixes in place which show different areas to be audited each month. This ensures that all aspects of the home are covered on a roiling basis. Service users questionnaires are sent out and these are collated into a report which provided positive comments and included actions to address negative comments. We saw that the home acted on peoples comments for example one person had asked for lighting to be better at night and spot lights have been fitted to improve the lighting. One person had suggested fish and chips from the chippy. This had been arranged for one lunchtime. This means that people can be confident that they are listened to and suggestions are acted upon. Prior to the inspection the manager had completed the Annual Quality Assurance Assessment (AQAA). This gave us information about how the home thought they were performing, what they do well and how they could improve. They had identified areas where further improvements could be made and had plans how to achieve this. The home is able to hold small amounts of money for people. We looked at four peoples money and found three of them had correct balances. The manager told us that the incorrect one was a result of when the money had been taken from the safe. The office had been broken into and the money stolen. The home had contacted the police and reimbursed the money to the people living at the home. They had not informed us of this incident which is notifiable and we discussed this during our visit. Staff receive supervision to ensure that they are performing well in their roles and to identify any training needs. The manager completes night spot checks to ensure that staff are performing well in their roles and to ensure that night staff are supported. A sample of records in relation to health and safety and maintenance checks were looked at and we found that checks had been undertaken to ensure that the equipment was safe and in full working order. Care Homes for Older People Page 25 of 29 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 26 of 29 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 Robust systems must be in place for recruitment. To ensure that people are safe from harm. 22/03/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 Information should be available to people about the range of fees so that they know how much they will have to pay to live at the home. People should have written confirmation following pre admission assessments so that they know their needs can be met. Medication should be signed in upon receipt to the home so that a audit trail is easy to follow to ensure that people receive their medication as prescribed. Care plans should be updated when needs change so that people have curent information. Appropriate terminology should be used for equipment that people use to promote their dignity. The practise of wearing gloves when feeding should be reviewed to ensure that peoples dignity is promoted. Page 27 of 29 2 4 3 7 4 5 6 7 7 15 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 7 8 30 35 A qualified moving and handling trainer should be available to provide staff training. We should be notified of any incidents that occur in the home that affect the people who live there. Care Homes for Older People Page 28 of 29 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). 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