Care Home: St Saviours Care Home

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What the care home does well People are given the information and support to help them decide if the home is able to meet their assessed needs. They have the opportunity to look around the home and meet staff who will welcome them when they move in. Detailed assessments are carried out with the input of each person and their relatives. Assessment documentation now includes details relating to religious and cultural background, as well as significant relationships. People receive care that is tailored to their individual needs. The home has positive working relationships with a range of professionals, such as social workers, occupational therapists, community psychiatric nurses, district nurses and family doctors. People receive medical help when they need it. One person said, "Very pleased" and "Doctors and nurses visit when needed, quick response to medical issues." People are supported to maintain contact with family and friends and links with the community. They are consulted on the meals served in the home. Menus are stored in racks and then placed on tables when they are set. These have been produced and laminated in an attractive and accessible, large print format. In addition menu boards with magnetic frames are displayed on the dining room wall. This helps people to choose what they prefer to eat. People are confident in the home`s response to complaints and they feel safe and protected from abuse. Very positive feedback has been received at the home in respect of the service people receive. One relative said, "I would like to express my sincere thanks for everything you did for my father during his last difficult weeks." Another relative said, "I will never forget the kindness and empathy that you have shown to us and my father during this difficult time." The home provides clean, well maintained and comfortable accommodation for the people who live there, and has benefited from ongoing decoration, new carpets being laid, the installation of a new telephone system, improved office space and a nursing station on the upper floor. In addition new equipment has been obtained, such as new hoists, kitchen equipment, washing machines, tumble dryers and outside seating. Adequate staffing levels are maintained at the home and increases in staff hours have been implemented. Recruitment practices are in line with the policy in place. Staff have the training that is relevant to their work and the home benefits from having a Training Co-ordinator. The manager and the provider are experienced and well qualified and the home is run in the best interests of the people who live there. One staff member said, "It`s the best job I`ve ever had." Another told us that the management are "Very helpful and lovely to work for." The relatives of a person living at the home said that the owner and the manager are approachable, "There`s always an open door, he`s always around and very approachable. The manager is very efficient in her own quiet way." What has improved since the last inspection? Care plans are now regularly updated to ensure that staff are aware of the care and support each person needs. The home`s complaints procedure is promoted within the home to ensure that people know how to raise concerns and a suggestion box is in the reception area of the home to encourage feedback on the service. There is now a system for people to have their views known on the way in which the home is run. Survey forms are placed in magazine racks in the bedroom of every person. The manager and the provider actively seek feedback on the service from people living at the home, as well as from relatives, visitors and outside professionals. A Quarterly Newsletter is being planned, to be circulated to all stakeholders involved in the home, including family doctors, district nurses and other outside professionals. Meetings with people living at the home are taking place and the minutes are recorded in a book. What the care home could do better: Activities within the home need to continue to be further developed to ensure that people have meaningful daytime occupation. Arrangements should continue to be made to ensure that there are sufficient staff to engage people in activities within and outside the home. The manager must make an application to be registered with the commission. Key inspection report Care homes for older people Name: Address: St Saviours Care Home 5 Lidget Lane Retford Nottinghamshire DN22 6QW     The quality rating for this care home is:   two star good 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: Frances Shillito     Date: 1 7 0 3 2 0 0 9 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 31 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 31 Information about the care home Name of care home: Address: St Saviours Care Home 5 Lidget Lane Retford Nottinghamshire DN22 6QW 01777703040 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): darren@stsaviourscarehome.com St Saviours Care Homes Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 40. The registered persons may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission are within the following category: Old age, not falling within any other category - Code OP. Date of last inspection Brief description of the care home St Saviours is a care home providing personal care and accommodation for 40 older people. The home provides short and long care and will accept emergency admissions. The home is owned by St Saviours Care Home Limited which is run as a family business. The home is located in a residential area of Retford, close to shops, pubs, the post office and other amenities. The home was opened in August 1995, with the most Care Homes for Older People Page 4 of 31 Over 65 40 0 Brief description of the care home recent change of ownership in September 2007 and consists of a purpose built building. All of the home?s bedrooms are single, and 15 of the bedrooms have en-suite facilities. Bedrooms are located on 2 floors and there is a passenger lift. The home has 3 enclosed garden areas that are well maintained and easily accessible. There is ample car parking available. The provider confirmed that the fees for the service are £394 per week, depending on dependency needs. There are additional charges for hairdressing and chiropody. Further information about the home is available from the provider, the manager or the website: www.fbccarehomes.com Care Homes for Older People Page 5 of 31 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 focus of inspections carried out by CSCI (Commission for Social Care Inspection) is on the experiences and outcomes for people using a service, and their views on the service provided. This process assesses how well the service provider is able to meet regulations and minimum standards of practice. Our inspections also look at aspects of service provision which need further development or improvement. This was our first visit to St Saviours since February 21 2008. This inspection visit involved one inspector, it was unannounced and took place in the daytime. Before the visit an analysis of the home was carried out from information gathered over the last year, including that from the Annual Quality Assurance Assessment completed by the manager. We also sent out survey forms called Have Your Say About... to people living at the home and six were completed and returned to us. Care Homes for Older People Page 6 of 31 The main method of gathering information followed is known as case tracking. This involves looking at the quality of the care received by a number of people living at the home. We also use evidence from our observations during the visit, we speak with people living at the home and their relatives, about their experience of the service. We look at records and talk with staff about their understanding of the needs of the people they care for. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? Care Homes for Older People Page 8 of 31 Care plans are now regularly updated to ensure that staff are aware of the care and support each person needs. The homes complaints procedure is promoted within the home to ensure that people know how to raise concerns and a suggestion box is in the reception area of the home to encourage feedback on the service. There is now a system for people to have their views known on the way in which the home is run. Survey forms are placed in magazine racks in the bedroom of every person. The manager and the provider actively seek feedback on the service from people living at the home, as well as from relatives, visitors and outside professionals. A Quarterly Newsletter is being planned, to be circulated to all stakeholders involved in the home, including family doctors, district nurses and other outside professionals. Meetings with people living at the home are taking place and the minutes are recorded in a book. 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 31 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 31 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. People are given the information and support needed to help them decide if the home is able to meet their assessed needs. Evidence: The home has an information booklet which was seen in the reception of the home and in the magazine racks in peoples rooms. It contains lots of information about the service provided and the running of the home. We noted that the contact details of CSCI (Commission for Social Care Inspection) need to be updated to reflect a recent change of address. The information booklet explains how to make a complaint and there is also a copy of the previous CSCI key inspection report available for people to read, to find out about the home. The manager explained that improvements are planned to produce the information booklet and the statement of purpose in large print, to make it more accessible and easier for people to read. She said that there are also plans to review both these Care Homes for Older People Page 11 of 31 Evidence: documents to take account of principles of equality and diversity, person centred care and the Dignity Challenge. This will help to ensure that people have as much information as they need about the service provided. The manager had told us in the AQAA (Annual Quality Assurance Assessment), the paperwork completed before the inspection, that We always encourage people enquiring to come and visit the home prior to any admission taking place. During the visit a full tour of the home is given. People living at the home confirmed this by saying that arrangements were made for them to have a look around the home before they moved in, to ensure that they were making the right decision. They confirmed that they were shown around by a staff member who helped them to settle in when they moved in. During the inspection relatives of people living at the home said that they had made the right decision in choosing the home, This is what impressed us. I picked a number of homes and the owner here said, Have a look at it, make your own mind up. They made it like her own room, really personalised. Now shes really settled. We also received six Have Your Say... survey forms, which were filled in by people living at the home. They all told us that they had received enough information about the home before they moved in and they all confirmed that they had received a contract on admission to the home. During the inspection visit we looked at the care records of three people. This is known as case tracking and is a method of gathering evidence on the experiences of people using the service. At the last inspection we saw that the assessment information did not include details relating to cultural origin and background. Also it only included marital or single status, and not any other significant relationships. During the inspection we saw that for each person there was a detailed assessment which was carried out before they moved into the home. It was also noted that an Ethnic and Gender Monitoring Form had been completed for each person, detailing their religious and cultural origin, as well as their family background and significant relationships. Staff said that this helps the home to be confident that a persons needs can be met there. One person had been recently admitted to the home. We saw from the records made by staff that a thorough assessment had been made by the social worker, to guide staff on how to care for this person, and to develop a care plan going forward. Care planning paperwork was also seen, showing us that staff had planned develop a plan as soon as possible. Staff confirmed that they would be involving the person concerned and their relatives. Care Homes for Older People Page 12 of 31 Evidence: The home does not provide intermediate care. Care Homes for Older People Page 13 of 31 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. People receive care that is tailored to their individual needs. Evidence: At the last key inspection we saw that care plans were not person centred and did not reflect all areas of an individuals life. Some care plans seen that were too vague and had not been kept updated. During this key inspection the manager and staff told us that each person and their family are very much involved in the development of their care plan, which is reviewed every month. In addition many of the forms used at the home in the care planning process have been updated to demonstrate the care which is provided to each person, making it easy for staff to follow. The case files of three people were seen during the inspection visit and we saw that these were well organised with a contents list at the front of the file, making records easily accessible. For one person there was a holistic, individualised and person centred care plan in place, which created a clear picture of them and how they should be cared for. It Care Homes for Older People Page 14 of 31 Evidence: included instructions and guidance in respect of arrangements for dying and death. These had been completed with the person and their familys input and were signed by them. We saw that this person had a review of the care plan in recent weeks. The care plan of a second person seen had also been developed in a holistic and person centered way. It was individualised, detailed and easy to follow. Risk assessments were seen which had been reviewed within appropriate timescales. The care plan of another person was seen, who had been admitted in urgent circumstances just before the inspection visit. Staff had not yet had the opportunity to complete the care planning process, yet the documentation was on file, ready to begin as soon as possible. This would be informed by the assessment that had been completed by the social worker, prior to admission. Staff also showed good knowledge of this persons needs during discussion. During discussion people said that staff ensure that they have access to health care services, such as the GP, optometrists, the dentist and the chiropodist. This was confirmed by what staff said and the records they had made on file on an ongoing basis. The manager confirmed that the home has positive working relationships with a range of professionals and works in collaboration with them. During the inspection a Healthcare Assistant who supports the District Nurse team said that she visits the home regularly, The home is lovely and the residents are happy. In addition the relatives of a person living at the home described the home as excellent and fantastic, adding, We come at different times and days. Shes always immaculate. Shes well cared for, comfortable and happy. We are really pleased, any problems, they let us know. Another relative told us, Absolutely everyone of them displayed what I can only describe as superb professionalism, with a warm heart, and went far beyond the call of duty on so many occasions. During the inspection visit the records and stocks of medication was examined and found to be in good order. The manager and the staff confirmed that only trained staff administer medication and make appropriate records, and this was observed. She also explained that a medication audit had taken place just before the inspection visit, with a positive outcome. There had been a reminder for staff to record the reasons for medication being returned by the pharmacy. The manager said that plans are being made for staff to attend Safe Handling of Medication training as soon as possible. Care Homes for Older People Page 15 of 31 Evidence: We saw that the AQAA reflected that management promotes the Dignity Challenge within the home. People spoken with said that staff are friendly and respectful to them and that their privacy and dignity is safeguarded within the home. Observations made during the inspection visit and discussions with staff and people living at the home confirmed this. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to maintain contact with family and friends and links with the community. Activities within the home are being developed to ensure that people have meaningful daytime occupation. Evidence: At the last inspection both management and staff conceded that the activities provision was an area for improvement. This was echoed by people who live at and visit the home. The manager confirmed in the AQAA that an activities programme is being developed and there are plans to appoint an Activities Co-ordinator. A clergyman visits the home to support people and more outings are being planned in the community. During the inspection visit the manager told us that some relatives of people living at the home run a Dominoes Club, and people engage in activities and afternoons out at the local church, once a week. She explained that people living at the home enjoy playing bingo, and that MECCA, an organisation involved in bingo, had sent a kit which would enable staff at the home to facilitate regular games. During the inspection visit notice boards depicting activities people are involved in and Care Homes for Older People Page 17 of 31 Evidence: the birthdays that have been celebrated. This included bingo, Connect 4, arts and crafts and trips out into the community. The manager added that they also encourage staff to spend time on a one to one basis, engaging in conversation with people in the dining room. They added that the home would be celebrating its first birthday in September 2009, with a party. A Summer Fayre and an Easter Fayre would also be organisaed. This would include the input and involvement of relatives and friends, who would run stalls. The manager and staff also told us that regular meetings are held with people living at the home, to find out about the activities they most enjoy.. Staff said that meetings take place as often as possible, but that people do not always want to be consulted as a group, so they are spoken with individually. The minutes of meetings attended by staff and people living at the home were seen. People living at the home filled in some Have Your Say About..... survey forms. One person said, Possibly more activities could be added. Another person said, There could be more activities. During the inspection we saw people in the lounge playing a large game of Connect 4 which was very animated and clearly enjoyable. People exclaimed who the winner was. People spoken with during the inspection visit said that staff encourage them to maintain contact with their family and friends. They said that they are supported to live the lifestyle of their choice as far as this is possible. Two people said that they enjoy going out for walks and were setting off for a stroll together. The manager informed us in the AQAA that people are consulted on choice of meals, that catering staff welcome people on admission, show them sample menus, and identify their individual food preferences. Catering staff and people living at the home who were spoken with confirmed this. During the inspection visit staff said that two dishes are always offered to ensure that there is something for everyone. If not staff said that a snack can be prepared for people who want an alternative. We saw that fruit is always available for people to eat if they are hungry and staff said that yoghurts are also. During the inspection visit people were observed having lunch. The meals served was Shepherds pie, which looked tasty and where needed, staff were offering support to people whilst they were eating. We also saw that menus were stored in racks and then placed on tables when they are set. They had been produced and laminated in an attractive and accessible, large print format. In addition menu boards with magnetic Care Homes for Older People Page 18 of 31 Evidence: frames were displayed on the wall. This helps people to choose what they prefer to eat. Of the six Have Your Say About... survey forms we received in November 2008, four people said that they usually like the food, with one person saying they sometimes like it. One person said, Better quality meat would be more acceptable. People spoken with during the inspection visit said that the food has improved, that they enjoy the food and that there is always a choice. They said that if they prefer something different they can tell staff, who will sort it out for them. One relative told us, The cooks a brick. They dont have to have what they dont want. One morning they made her toast as she was asleep when breakfast was served. Care Homes for Older People Page 19 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are confident in the homes response to complaints and they feel safe and protected from abuse. Evidence: At the previous inspection we saw that the complaints procedure needed to be promoted so that the process to make a complaint is known by staff and people, and that a record of all complaints is made. The manager confirmed to us in the AQAA that the complaints procedure is explained to people when they move into the home, and that the complaints procedure is available in the reception of the home, as well as in each persons bedroom. During the inspection this was confirmed. The manager said that she intends to produce this an a more accessible format, with information in Large Print. She added that people have access to independent advocacy and information was seen in the home which is available to people living there. Six people who filled in the Have Your Say About... surveys forms, told us that they know how to make a complaint. Five people said that they always know who to speak to if they are unhappy about something. One person said, I can talk to senior staff. People spoken with during the inspection visit said that they know how to complain, and are confident that if they are not happy about something, this will be resolved by staff. Care Homes for Older People Page 20 of 31 Evidence: During the inspection visit the record of complaints was seen to be appropriately kept. Discussion took place with the manager in relation to one concern raised, which had been responded to promptly and both parties were satisfied with the outcome. The manager explained that the records and outcomes of complaints area also held on the individuals file. The manager told us before the inspection that a suggestion box is in place at the reception of the home, to encourage feedback from anyone with an interest in the home, so that these views can inform the planning of services provided there. She also said that, the manager and provider are always available at any time to listen to any concerns. Relatives spoken with during the inspection visit confirmed this. A compliments book was also seen in which positive feedback on the service is recorded. In addition the home maintains a Messages of Appreciation file, in which thirteen letters were seen expressing very positive feedback in respect of the service people receive. One relative said, I would like to express my sincere thanks for everything you did for my father during his last difficult weeks. Another relative said, I will never forget the kindness and empathy that you have shown to us and my father during this difficult time. The manager told us in the AQAA that a safeguarding procedure is in place, and that staff at the home have received safeguarding training. During discussion with the manager she said that she had attended training facilitated by Nottinghamshire County Council Adult Social Care Service. Policies and procedures were seen in place, including the Nottinghamshire County Council Safeguarding Adults, Policy, Procedure and Guidance for Alerters - October 2007. The manager and the provider also told us that when interviewing people questions are asked to establish their awareness of safeguarding. Staff spoken with during the inspection confirmed that they had received training and they demonstrated that they understand their responsibilities in relation to making a safeguarding alert if they suspected abuse. All staff spoken with said that they would approach management first and then the Safeguarding Team. People living at the home said they feel safe and comfortable. One person said, Im very happy and I feel safe. Care Homes for Older People Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides clean, well maintained and comfortable accommodation for the people who live there. Evidence: During the key inspection visit it was noted that the accommodation is purpose built. The home is well maintained, comfortably furnished and attractively decorated. A tour of the home was provided by the manager, and we saw that the environment was clean, tidy and in good order. Pleasant flower arrangements were seen in a number of communal areas. We saw that the home provides ample communal space so that people can choose whether they want to sit in one of the lounges, the conservatory, or in one of the dining rooms. Six people told us in the Have Your Say About... surveys, that the home is always kept fresh and clean and well maintained. During the inspection visit people said that staff keep the home clean and fresh. The manager told us in the AQAA that there are two cleaners on duty every day, with a programme in place which enables one bedroom to be spring cleaned every day. A gardener is also employed to maintain the garden areas for the enjoyment of the people living at the home. In addition the home has benefited from ongoing decoration, new carpets being laid, the installation of a new telephone system, Care Homes for Older People Page 22 of 31 Evidence: improved office space and a nursing station on the upper floor. In addition she said that new equipment has been obtained, such as new hoists, kitchen equipment, washing machines, tumble dryers and outside seating. During discussion the manager also explained that a maintenance person works at the home. Staff confirmed that they record any repairs in a book, which are signed off once they have been promptly completed. Before the inspection the manager informed us that people are encouraged to personalise their bedrooms, and that some bedrooms have now been fully refurbished and redecorated with new carpets. In addition all the lounges and some of the corridors and bathrooms have been redecorated and re-carpeted. This was seen during the tour of the building. A number of peoples bedrooms were seen. They were very personalised with personal belongings and an array of photographs of family and friends on the walls. The manager told us in the AQAA that staff receive training in infection control, health and safety and fire safety. Staff spoken with during the inspection confirmed this. Evidence was seen that the homes infection control policies and procedures and related risk assessments are in place to be followed by staff. Care Homes for Older People Page 23 of 31 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. Adequate staffing levels are maintained at the home. Recruitment practices are in line with the policy in place. Staff receive the training that is relevant to their work. Evidence: At the last key inspection staff said that there are enough staff to meet the needs of people at the home, but not enough time to organise any activities or outings. A requirement was made that there should be sufficient staff on duty to enable peoples social and recreational needs to be met. During the inspection the manager and the provider explained that staff now spend more individual time engaging with people, as well as undertaking group activities and trips out into the community. They added that there are also plans to employ an Activities Co-ordinator from April 2009, which will enhance the activities programme at the home. During discussion at the inspection the manager and the provider also said that in terms of staffing levels, there has been an increase in staff to 37. The manager explained that there used to be 3 staff on duty at night, but that this has now been increased to 4, to ensure that there are escort facilities, in the event that a person needs to be accompanied to the hospital overnight. In addition they said that the cleaners hours have been increased to ensure that the home is clean, tidy and pleasant. Care Homes for Older People Page 24 of 31 Evidence: During the inspection visit the staffing rotas were seen. This included rotas for care staff, kitchen, laundry and maintenance. Staffing levels were noted as satisfactory. Staff spoken with said that there are enough staff on duty to provide care, spend time with people and undertake case recording. The manager reflected in the AQAA that, Prior to any employment potential staff must complete an application form providing details of previous employment, two sets of satisfactory references, a POVA (Protection of Vulnerable Adults) check and CRB (Criminal Records Bureau) check. Any discrepancies are investigated and a conclusion arrived at before employment commences. Two staff files were examined and the recruitment records seen were kept in god order. They contained all the necessary paperwork, including proof of identity, satisfactory references and a CRB (Criminal Records Bureau) Enhanced Disclosure. We also saw that there was evidence that staff had an induction soon after starting work. The manager expressed her commitment to staff training and personal development. It was confirmed that out of 30 staff, 5 had achieved an NVQ (National Vocational Qualification) Level 2, a further 5 staff had achieved an NVQ Level 3, with the remaining staff at varying stages of completing this training. She added that the home is keen to improve on this to have as many care staff qualified as possible. The manager and staff said that staff are due to attend training in the Safe Handling of Medication as soon as possible. In addition the manager told us that she had recently attended Deprivation of Liberty training and will be cascading this training to the staff team. She also told us that she had also recently attended Mental Capacity Act training and had obtained a Train the Trainer Resource Pack. In addition some staff had recently undergone Dementia Awareness training and that this is ongoing, to allow for all staff to receive it. Staff are also due to attend Safeguarding Training facilitated by Nottinghamshire County Council Adult Social Care. Finally medication training is also being planned for staff. The training records at the home were seen. We found that generally staff have received the mandatory and specialist training which is relevant to their work. During discussion with the manager and provider, they said that updates to training in fire safety, food hygiene, infection control, first aid and moving and handling were being planned with the Training Co-ordinator, who also told us during the inspection that she is carrying out an audit of staff training, to help in the development of a training plan. This training will help staff to provide the best possible care to people living at the home. In the AQAA the manager shared her commitment to the regular and effective Care Homes for Older People Page 25 of 31 Evidence: support and supervision of staff. All staff spoken with said that they receive regular supervision, and that their training needs are raised in these meetings. They also told us that team meetings are held regularly and that minutes are produced for them to read. We saw that the last team meeting took place just before the inspection visit. Staff said that they are a good team and that they work well together. They said that they have seen many changes and improvements at the home and that the managers are approachable. One staff member said, Its the best job Ive ever had. Another told us that the management are Very helpful and lovely to work for. Care Homes for Older People Page 26 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and it is run in the best interests of the people who live there. Evidence: It was noted at the point of inspection that the manager is well qualified and experienced. She confirmed that she has been in the position of a registered manager in the past and will be making an application for registration with the commission again in the near future. In addition the provider takes care of the administrative function of the home and is also a qualified RGN (Registered General Nurse) and an RMN (Registered Mental Health Nurse). The manager and provider work in partnership in the day to day running of the service. At the previous inspection we found that a formal system for people to express their own views on the running of the home was needed. A requirement was made for this to be achieved. During the inspection the manager and the provider explained that they have an open style of management, and make themselves available to receive Care Homes for Older People Page 27 of 31 Evidence: feedback from anyone with an interest in the home, particularly the people who live there. The relatives of a person living there were spoken with. They said that the owner and the manager are approachable, Theres always an open door, hes always around and very approachable. The manager is very efficient in her own quiet way. During the inspection survey forms were seen in magazine racks in the bedroom of every person. The manager and the provider explained that they actively seek feedback on the service from people living at the home, relatives, visitors and outside professionals. Once all the surveys have been completed the provider intends to pull all the information together, analyse it and produce a report to give people to read. They also told us that a Quarterly Newsletter is being planned, to be circulated to all stakeholders involved in the home, including family doctors, district nurses and other outside professionals. They added that meetings with people living at the home are taking place and the minutes are recorded in a book. They stated that people are consulted on the running of the home. The manager said, The cook discusses with people their likes and dislikes and keeps this information in a list. Staff and people living at the home said that the manager is approachable and encourages their views on the direction and running of the home. The minutes of some of the meetings attended by them were seen. There was evidence that people are consulted and kept informed of matters relating to the running of the home. The paperwork known as the AQAA was completed and returned to us by the manager within the required timescale. It contained all the information we had asked for. Discussion with the manager and the provider, and information shared with us in the AQAA, showed us that they are aware of any changes that need to be made and are committed to making improvements within the service. Notifications of significant incidents or occurrences at the home have been made to us without delay. During the inspection we saw that there are appropriate policies and procedures in place to promote the health and safety of people living at the home. The manager said that all the necessary health and safety checks are carried out regularly, and that there are service contracts in place in respect of all the homes equipment. A range of records seen during the inspection confirmed this. Care Homes for Older People Page 28 of 31 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 29 of 31 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 31 9 The manager must make an application to become registered with the commission. This will ensure that management arrangements at the home are made formal, which will assist in the running of the home. 30/11/2009 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 12 The development of the activities programme should continue, to ensure that people living at the home have meaningful daytime occupation. Care Homes for Older People Page 30 of 31 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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