Care Home: St Michael`s Care Home

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What the care home does well The home has a commitment to providing high quality person centred care. Residents are encouraged to maintain their independence, make choices and as far as possible retain control over all aspects of their daily lives. The home held a range of activities and social gatherings and residents have the opportunity to go on regular outings. A resident surveyed said "I love it here it is my home now" and another said "The home is very good and clean". One relative spoken with considered that the home had a "open and professional caring approach". The manager was described as "open and approachable". Staff were described as "very good, caring and helpful". Residents were generally very happy with the variety and quality of meals served. They described both the laundry service and the cleaning as `excellent`. A number of staff surveyed considered that it was the nicest home that they had ever worked in. What has improved since the last inspection? The care documentation has been developed further and made more person centred and improvements have been made in medicines management since the last inspection. The home has a continued programme of refurbishment to improve the environment. There has been redecoration throughout much of the home and furniture has been replaced in the communal areas, making the surroundings very pleasant for people living there. Good staff recruitment practices are maintained and a training and development plan has been implemented and progressed to ensure that all staff, including new staff receive basic care skills as they enter the employment of the care home. A quality assurance and a quality monitoring system are in place to measure success in meeting the aims, objectives and the Statement of Purpose of the home. A feasibility study has been undertaken to look into the possibility of building a new purpose built home on the adjacent plot of St Michael`s Care Home and within the same grounds, as the current home has become expensive to maintain and is generally old throughout. Residents have been informed of the proposals. Planning permission has been sought and granted at the time of this inspection. There are proposals that work will begin in December 2009 and be completed by 2012. Most residents spoken with spoke positively of this change overall with some voicing concerns, however the home has plans to follow a clear consultative process and ensure the CQC is fully informed of the building progress. What the care home could do better: The management team should continue to develop the care plans. Each person should have a comprehensive plan of care which should be person centred and indicate the assistance required to aid the person`s predominant needs such as physical, social and healthcare needs. These should correlate with the daily evaluations to ensure all service users individual care needs are met and that staff are aware of these needs. Transcribed medications should evidence two signatures to ensure service users receive their correct medication. Inspecting for better lives Key inspection report Care homes for older people Name: Address: St Michael`s Care Home Marine Parade East Clacton on Sea Essex CO15 6JW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Helen Laker     Date: 2 3 0 7 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 29 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 29 Information about the care home Name of care home: Address: St Michael`s Care Home Marine Parade East Clacton on Sea Essex CO15 6JW 01255423688 01255423594 stmichaels.care@btconnect.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) : The Sisters of Mercy of the Union of Great Britain care home 35 Number of places (if applicable): Under 65 Over 65 0 35 dementia old age, not falling within any other category Additional conditions: 35 0 The maximum number of service users who can be accommodated is 35 The registered person may provide the following categories 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 Date of last inspection Brief description of the care home St Michaels provides residential care for up to 35 older people. The home is situated on the sea front at Clacton on Sea and is close to local shops and amenities. The building is a large property spread over three floors. There are gardens and terraced areas around the property with views over the sea. There is an attached car park for visitors plus ample roadside parking nearby. St Michaels is owned by the Sisters of Mercy of the Union of Great Britain. There is a convent adjacent to the home. The chapel is shared by the convent and the home and Care Homes for Older People Page 4 of 29 Brief description of the care home is also open to people from the local community. The fees at the time of inspection in July 2009 ranged from 425.00 pounds to 494 pounds weekly. The higher fees being for high dependency, a larger room, or a room with en-suite and sea views. 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this home is two star. This means that people who use this service experience good quality outcomes. This key unannounced inspection looking at the core standards for care of older people took place on a weekday between 10:00 and 16:00. The registered manager, deputy manager and staff were present throughout and assisted with the inspection process by supplying records and information. This report has been compiled using information available prior to the visit such as surveys sent out, evidence found on the day of inspection and the annual quality assurance assessment (AQAA), which is required by law and is a self assessment completed by the service. The AQAA provides an opportunity for the service to tell us what they do well and areas they are looking to improve and/or develop. It is anticipated that some progress be noted as this Care Homes for Older People Page 6 of 29 contributes to the inspection process and indicates the homes understanding of current requirements, legislation changes and own audited compliance. This document will be referred to as the AQAA throughout the report. During the day the care plans and files for four of the residents were seen as well as four staff files, the policy folders, the medication administration records (MAR sheets), some maintenance records and the fire log. The manager also supplied a copy of the duty rota, the menus, and other pertinent documentation which was required. A tour of St Michaels was undertaken and ten residents, six members of staff as well as the manager administrator and domestic staff were spoken with. The home was clean and tidy offering homely accommodation to the residents. The residents seen were relaxed and clearly felt at home in the environment using all areas of the building. All the records and files were generally well maintained and easily accessible. Interactions between staff and residents were friendly and appropriate. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 29 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 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. This judgement has been made using available evidence including a visit to this service. Prospective residents can expect to have an assessment and assurances that their needs can be met prior to entering the home. Evidence: The assessments of three recent admissions to the home since the last inspection were inspected. All of the assessments seen were noted to have been completed prior to the admission date and cover the all areas relating to the health and welfare of individuals. This information was usually supplemented by a social services assessment. Attention to dates, times and signatures was discussed with the registered manager, this must be given more prominence so it is consistently maintained. The registered manager reported that pre-admission assessments were undertaken by her or her deputy at the prospective residents own place of residence, or at hospital depending on the needs Care Homes for Older People Page 11 of 29 Evidence: and circumstances of the individuals at the time. The AQAA states We make individuals feel welcome and we are always being told that the home has a lovely friendly atmosphere. We have areas where visitors can make themselves refreshments and we now have a new home brochure in place. Prospective residents and their families were encouraged to visit and spend time at the home, discussing their needs, before making a decision about admission as part of the initial contact arrangements and respite care may be suggested if required. Residents spoken with reported that they had experienced this approach and found it helpful and reassuring. One service user spoken to stated I enjoyed the first visit I knew I wanted to stay. Care plans are generally reviewed after the first month in consultation with the resident, families, representatives and the registered manager. St Michaels does not provide intermediate care. 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. This judgement has been made using available evidence including a visit to this service. Care planning standards in the home do ensure that the care of residents is monitored and they can be assured that their health care needs are generally met through the management of medication and are supported to access health professionals as needed. Residents receive person centred care and documentation is being developed to reflect this. Medicines management is being reviewed in order to improve the safety for residents. Evidence: The care plans relating to four of the people living at St Michaels were examined at this visit to assess how the service understands the way in which it should plan and meet their needs. The care plans contain a variety of assessments that identified the level of support the individuals require in their daily lives. These included activities of Care Homes for Older People Page 13 of 29 Evidence: daily living, equality and diversity, choice and dementia care. Plans are regularly reviewed and updated to show changes, with clear review notes maintained. Evidence of individuals involvement with developing their own plan of care is available through monthly reviews within the care plans. The majority of residents spoken with and surveyed were very satisfied with the standards of care and said that they received the care and support they needed. It was evident from discussions with residents that staff did try to provide person centred care. They confirmed that staff respected their privacy and dignity whilst providing care. One resident described the care staff as lovely I could not do so much if I was in my own home A relative spoken with said that management and staff met the care needs of their relative well and they received the medical support they required and had no complaints. The health care of people living at the home is monitored through the documents contained in care plans, these also include health professional visits and their outcomes, monitoring sheets for weight and dietary intake etc. The AQAA states We have in place comprehensive care plans are drawn up with the involvement of resident their family and staff, they are updated regularly. The care documentation has been developed and made more person centred and expanded to cover residents abilities and preferences and as well as their physical and psychological health and care needs. Some of the daily care records contained adequate detail others were less informative. For example one care plan did not identify a healthcare need of glaucoma identified in a pre admission assessment and not all dates and signatures were evident on all documentation reviewed. Additionally it was noted that daily evaluations varied depending on who had completed the entries and repetition was noted indicating that specific care needs had not been referred to in the formulated plan and reported on. This was discussed with the manager and the need for consistency to ensure all staff are aware of how to meet residents needs. Aids and equipment are provided to encourage and promote independence for people living at the home and the risk management framework supports individuals to maximise their independence. The support from local GP practices was reported by both staff and residents to be variable. The manager stated it was difficult at times to get GPs to visit residents. Staff reported that they had excellent liaison with the Residential Care Team and Boots the pharmacists, who provided both support and training. Community nurses visited the home every day to see residents who needed nursing input. There was evidence that residents were referred for hospital consultations and treatment when appropriate The service arranges training on healthcare and topics that are relevant to the people they support. Care Homes for Older People Page 14 of 29 Evidence: Medication is administered from trolleys that are stored securely when not in use. The daily administration of medication is generally well recorded however some gaps were evident. Medication Administration Records (MAR) sheets were neat but there were some missing signatures and too many hand written prescriptions without two signatures being evident. A signature audit may be of value to keep this issue in check. Staff need to make better use of the omissions code located on the bottom of the MARS sheet. Items are checked in to the home and returns systems are in place. A number of residents were self medicating and said that they wished to retain their independence for as long as possible. They confirmed that their medicines were kept in a locked drawer in their rooms. Controlled medications were in order and there was evidence of medication being kept under review. People living at St Michaels made many positive comments about the staffs attitude towards them. They felt that their dignity and privacy were respected. Good practice was observed during this site visit for example, staff were seen to knock on doors before entering a room and ensured that doors were closed when attending to residents personal care needs and sensitive assistance was provided at mealtimes. Comments received from the people at the home included They help me very well and they are lovely staff and The staff are wonderful, I dont know what I would do without them Additionally a relative stated, We have no problems with the care it is very good and they are treated with respect. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. Residents benefit from a good varied range of activities and from good links to the local community. Residents enjoy involvement in activities of their choice and their nutritional needs are met. Evidence: A monthly activities programme was available and carers were involved in providing some of the activities. The manager said that she did consider identifying a person to co-ordinate activities in the home and advertised for the post but a suitable candiddate had not been found. The majority of residents surveyed said that there were always activities that they could take part in. The activities included crafts, reminiscence, bingo, quizzes, bowls, music, games, films, a knitting circle on Mondays and social sessions. The home has close links with the convent and many of the residents who were nuns attended the daily services in the chapel. The home has very good links with the local community, a number of whom attended the chapel in the grounds. The convent has a resident priest who provides support to residents when required. The home has considerable support and input into activities and outings from members of Care Homes for Older People Page 16 of 29 Evidence: the local Help the Aged society. Residents who wished to were regularly assisted to access the homes computer. This enables them to keep in touch with friends and family. A session of movement to music is held every week and the manager confirmed that the person leading the session had appropriate training. Regular outings were arranged using the homes mini bus for transport. A monthly and weekly activities programme is in place which every resident receives a copy of, it is on notice board for all to see. DVDs are made of the years activities which are shown to residents and their families, which enables them to see them all enjoying themselves. A compliments book is in place in the main entrance for all to see along with a photo album showing the activities the home provides. The AQAA details We have purchased a mobile easel for staff to do quizzes on with residents. We have taken residents to Dedham, three residents wanted to go out in a rowing boat which they did, we have taken residents ten pin bowling to Colchester and Walton. We have continued to use beach huts in Clacton and Brightlingsea, we have had picnics at Alton Waters, we have ventured further to garden centres in Marks Tey and Stanway, we have visited Jimmys Farm, Beth Chattos gardens plus all the activities we do in house. We have now created a games room for residents with lots of different activities in there for residents and staff to do with residents, there is always a puzzle left out for all to have a go. Relatives surveys confirmed that When time and the weather allows, residents are taken out to local venues Residents said that they had particularly enjoyed recent visits to the beach hut. A record was made of those who had attended in order that all residents were offered a chance to go. Outside entertainments were also arranged periodically. The home had held a strawberry fair and was planning to hold a barbecue on the 15th August 2009. Additionally a garden party had been held at the home of the deputy manager. One resident who loves football was taken to Chelsea Football Club and Wembley Stadiums for guided tours. Residents also visited Tiptree jam factory and the home has also taken residents out to Marks Hall Garden and Arboretum where they were taken down to the walled garden in a golf buggy. A volunteer runs the homes tuck shop with the assistance of the clerk. Items such as toiletries, cards and sweets were stocked. A number of residents were very independent and went on holidays and on day trips from the home. There was evidence that staff respected residents choices and encouraged them to be as independent as possible. One resident described the home as there is lots to do and you can choose., another said I just like to sit and that is ok. Residents surveyed and spoken with were generally very satisfied with the standard of food available. One described it as very good. They confirmed that the home had choices at all mealtimes and offered alternatives if they didnt like what was on the menu. There was evidence from surveys carried out at the home that residents satisfaction with the menu and food served had improved over the past two years. The home has a four week menu and the manager said that this is regularly kept under Care Homes for Older People Page 17 of 29 Evidence: review in line with special diets. The home had purchased a heated trolley with a Bain Marie and this had improved the quality and temperature of meals served. The lunch period had also been extended and residents could start the meal anytime from 12:30 to 13:15 and additional staff had been allocated to assist residents at mealtimes. The manager said that they had also refurbished the ground floor refreshment room. Care Homes for Older People Page 18 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. This judgement has been made using available evidence including a visit to this service. Residents who use the service have access to a clear and understandable complaint procedure that ensures that they are listened to. The home operates good practices to ensure the protection of the people who live there. Evidence: The residents at St Michaels are supported by the homes robust complaints policy and practices. The complaints records included details of any issues raised by residents or their representatives. None were observed to present any risk to residents health and safety however were generally treated with appropriate sensitivity and respect. There was evidence that complaints had been investigated and appropriate action taken when necessary. The AQAA informs us that We have in place a complaints procedure which is on display on the notice board also in a folder in the small lounge, it is also in residents handbook which every resident has in their room. We have a complaints log where all complaints are log and action taken. It also states that five complaints have been received since the last inspection and that one safeguarding referrals has been made. this concurs with the homes complaint records and these were seen to have been dealt with professionally and appropriately. Feedback from one visiting professional indicated that The home is very professional in its approach. Records provided evidence that staff members had attended annual training in the Care Homes for Older People Page 19 of 29 Evidence: Protection of Vulnerable Adults in May 2009. There was evidence that the manager reinforced the training by discussing the types of poor care that could constitute abuse during staff meetings. The manager said that all staff received a copy of the whistle blowing policy and the Essex County Council POVA guidelines. The AQAA informs us that All staff attend yearly POVA training, follow up any allegations or incidents of abuse. CRB and POVA checks are carried out on all staff prior to commencing employment. Staff spoken with were able to demonstrate a good awareness of safeguarding procedures and practice including whistleblowing. Care Homes for Older People Page 20 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is well maintained and encourages their independence. Evidence: A physical tour of the building was undertaken with the proprietor. This tour included all communal areas and bathrooms, the laundry and some residents bedrooms. All areas of the home were clean, fresh, homely and welcoming with no odours. Areas of the home highlighted at the homes last inspection as being in need of redecoration and refurbishment have been addressed. The AQAA informs us We have two passenger lifts which enables residents to access all parts of residents communal and private space. We have had fitted in one of our dependent toilets over head tracking and hoist, which enables staff to hoist residents straight from wheelchair, onto the toilet. All bathrooms, en-suite facilities, and toilets are fitted with grab rails etc which are assessed to meet the needs of residents. We have an assisted bath in one of our bathrooms with an over head hoist and weighing scales fitted, we also have a walk in shower, we have two stand up hoists, three other hoists for the moving of residents unable to mobilise themselves. There is a loop system fitted in the residents dining room, we have storage areas for wheelchairs, frames etc. We have an excellent call alarm system in place in every room including communal areas, for residents who are Care Homes for Older People Page 21 of 29 Evidence: immobile they are given a pendent to wear round their necks. We do only have 6 rooms which are not en-suite, and have no shared bedrooms. Residents comments regarding the environment included It is a lovely place to be and They keep it very nice. The residents rooms seen showed a high level of personalisation. The home was very clean and there were no unpleasant odours. Residents were very complimentary about the quality of cleaning in the home. One resident said Its kept very clean. They also reported that there was an excellent laundry service. There were two through floor passenger lifts providing access to upper floors of the home. The surrounding gardens were attractive and well-maintained and accessible to residents. The AQAA confirmed this stating We provide a homely, comfortable, safe environment for residents with different communal areas in which residents are able to socialise if they wish, most bedrooms have ensuite facilities, comments from residents families and visitors remark on the home having a lovely friendly atmosphere, and always smells nice. Areas are very well maintained and maintenance staff are efficient and active in sorting out any problems quickly and efficiently. We also have a very good laundry system in place which works very efficiently. We also have a chapel on site were daily mass is held. We had not until recently a safe secure area for residents to sit out in, this area is now proving very popular with residents and their families. Relatives spoken with spoke positively of the environment and the services provided. Staff training and annual refresher infection control training is planned as part of the homes ongoing training programme. A feasibility study has been undertaken to look into the possibility of building a new purpose built home on the adjacent plot of St Michaels Care Home and within the same grounds, as the current home has become expensive to maintain and is generally old throughout. Residents have been informed of the proposals. Planning permission has been sought and granted at the time of this inspection. There are proposals that work will begin in December 2009 and be completed by 2012. Most residents spoken with spoke positively of this change overall with some voicing concerns, however the home has plans to follow a clear consultative process and ensure the CQC is fully informed of the building progress. Care Homes for Older People Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. Residents are looked after by a staff team who are aware of their needs and wishes and are subject to a thorough recruitment process. Evidence: The home maintains staffing levels appropriate to the needs and number of people living there. Individuals consulted felt that there are always sufficient staff available when they need them, and relatives consulted felt that staff have the right skills and experience to look after residents properly. Some staff members stated that at busy times it would be beneficial to have extra members of staff on duty at times as it can become busy. Throughout the inspection visit the atmosphere was calm and peaceful. People consulted with also commented that they did not feel rushed at any time of the day, they were given time to get up and did not feel that staff were overly stretched. The staff interacted with residents in a respectful and pleasant manner. People living at the home and their relatives gave very positive feedback about the staff employed to work at the home. One resident stated Staff are helpful and very Care Homes for Older People Page 23 of 29 Evidence: caring and courteous and another commented They know what they are doing and that is what matters. Discussion with the registered manager and scrutiny of records confirmed that the service is proactive in its staffing, recruitment and training, with planning for the potential needs of people who may use the service in the future. Staff files were examined to determine how the service carried out its recruitment process. The documents on the files seen demonstrated a robust approach with checks made on the persons Criminal Records Bureau (CRB) check, and the Department of Health Safeguarding POVA first list, as well as two written references, and proof of the persons identity. These with the completed application form assist the service to determine whether the person is of a suitable background to work with vulnerable people. Staff are provided with relevant training that is targeted on improving outcomes for people living at the home. The registered manager maintains a list to ensure that all staff training/refresher training is delivered promptly. The staff training programme demonstrated that staff undertook a variety of courses pertinent to their work including first aid, medication, infection control, fire safety, food hygiene, moving and handling and POVA. Training needs are documented and staff can identify their own training needs. The majority of care staff had completed National Vocational Qualification (NVQ) at level 2 and ten had achieved NVQ at level 3 or equivalent. The manager was aware of staff training needs and organised training on a regular basis. Evidence was available to confirm that staff meetings and staff supervisions take place regularly where training, activities, new staff and policies and procedures are some of the things discussed, the outcomes of these meetings are cascaded through individual departments/floors to ensure good communication throughout the service. The homes AQAA indicates, the home considers itself capable of keeping abreast of changes in legislation. They analyse results of Quality Assurance questionnaires and compile from that the development of the service. The home believes that they provide a service that meets the needs of the service users in their care. They have a commitment to listening to both staff and service users and regularly making changes to their practice when offered best practice recommendations to promote improvement. Care Homes for Older People Page 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. Residents can be confident that the home is run in their best interests and ensures their safety and welfare. Evidence: The registered manager has considerable management experience. She has been an NVQ assessor and internal verifier and completed the Registered Managers Award (RMA) and had previously been an assessor for the RMA. There was an open and positive atmosphere in the home. The manager provides clear leadership and was promoting resident centred care and services. The manager said that she tried to see all the residents on a regular basis and encouraged them to share any concerns and make suggestions. Residents meeting are held every two months. One resident said You can talk to the manger and they will help you. A relative Care Homes for Older People Page 25 of 29 Evidence: spoken with said that staff at the home were helpful and kind and nothing was too much for them. the AQAA states We have good feed back on how the home is managed, we hold regular resident and staff meetings to ensure this continues, residents, their families and staff know that we have a open door policy and they are welcome to speak with us, or to phone us if they have any problems they wish to discuss with. We feel the ethos in our home is different from other homes because we have the chapel and the sisters from the convent, everyone who visits always remark on the lovely atmosphere at St Michaels and the friendliness of the staff and the Sisters. Residents were surveyed by the home in April 2009 and there was evidence that action had been taken to address any issues raised. The home has a quality assurance programme. Regular surveys were carried out and an analysis was made. The manager said that she was continuing to develop the quality assurance programme with a number of audits to monitor the quality of services and care in the home. An example of this was spot task checks on staff i.e medication administration. A number of residents looked after their own finances. The home looks after the personal monies for about ten residents. Separate records have been set up and their money was kept in separate plastic pockets. All receipts and invoices are kept. The manager audits the monies regularly and signs to indicate that they were correct. The home have systems in place to ensure that all equipment had regular servicing and maintenance. Fire and Control of Substances Hazardous to Health (COSHH) risk assessments had been completed. The manager said that the last fire inspection had not raised any issues of concern and the fire officer had been satisfied with the risk assessment completed. Fire drills and alarm tests had been held and the last fire drill recorded was on the 13/07/2009, and there were systems to ensure the safety of the water. Care Homes for Older People Page 26 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 27 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 7 15 Staff must ensure that 30/10/2009 where possible residents and/or their representatives have input into the care planning system. Staff need to ensure that residents care plans are a clearly documented daily record of the care delivered and be person centred to evidence that staff appreciate the diversity of individual residents So that staff appreciate the diversity of individual residents 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 9 Any transcribed medications must be clearly documented with evidence of two signatures to ensure the risk of medication errors being made are reduced. Care Homes for Older People Page 28 of 29 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. 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