Care Home: Stocks Hall Nursing Home

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What the care home does well The information gathered before admission was extremely detailed, providing staff with a clear picture of each individual, so that they were confident that the assessed needs of people could be fully met. The plans of care were extremely well written documents, providing staff with clear guidance about how the assessed needs of people living at the home were to be met and how people were to be supported to maintain their privacy and dignity. Residents had been involved in the care planning process and a review of care provided was conducted on a monthly basis to ensure that current needs were accurately reflected in the plan of care. One comment card received from a relative stated, `We have been 100 percent happy with the care that our father has received and the care and attention the staff provide at at all times`. A variety of external professionals had been involved in the care of people living at Stocks Hall Nursing Home to ensure that their health care needs were being appropriately met. A range of risk assessments were in place to ensure that systems were implemented to protect the health and safety of anyone on the premises. Relatives spoken to were happy about how visitors were received into the home and they informed us that the staff were all very respectful, friendly, kind and caring. Sufficient information was provided to people about the use of the local advocacy services to act on their behalf, should they so require and people living at the home were able to have some control over their lives by managing their own finances, should they wish to do so. Activities were provided both in the home and outside, so that people were able to continue their leisure interests whilst living at the home and so that they were able to maintain links with the local community. The routine of the home was fairly flexible and aimed to allow residents their freedom and independence by enabling them to have some control over their lives. Visiting arrangements were in place to suit the needs of individual residents and advocacy services were accessed for those wishing to have an independent person to act on their behalf. Service users were provided with a choice of nutritious and well balanced meals to ensure a good dietary intake. Meals were well presented to promote appetite and to aid in nutrition. Those requiring support with eating their meals were assisted in a discreet manner, whilst others were encouraged to eat independently. Safeguarding policies and procedures were in place, so that people knew what they should do if an allegation of abuse was received by the home. The finances of residents were sufficiently protected by the policies, procedures and practices of the home. The home was tastefully furnished and pleasantly decorated to a good standard and the premises, both internally and externally were well maintained providing those living at Stocks Hall Nursing Home with a safe, clean, comfortable and homely environment in which to live. The home was pleasant smelling and effective infection control measures were in place to ensure that the health and safety of people was well protected. Staffing levels were calculated in accordance with the assessed needs of people to ensure that appropriate care was delivered. Recruitment procedures and financial arrangements were in place at the home, which demonstrated that those living at Stocks Hall Nursing Home were safeguarded from abusive situations. A lot of training had been provided for all staff so that they were kept up to date with current policies, procedures and legislation and so that they were sufficiently trained to meet peoples assessed needs. The registered manager holds relevant qualifications, has a lot of experience and is appropriately trained to manage the care home. Residents, relatives and staff thought highly of her and they all felt supported by the management of the home. Systems were in place to ensure that the quality of service provided was closely monitored so that any shortfalls identified could be promptly addressed. The health, safety and welfare of residents were protected by the policies, procedures and practices of the home so that any hazards, which could pose a potential risk, were minimised or eliminated. The home was well managed by a competent person and a team of skilled senior staff, who together had completed a wide range of training so that they were able to deliver the care required by the individual residents. What has improved since the last inspection? The management of liquidised and pureed meals had improved since our last key inspection, so that different tastes were served seperately in order to aid in nutrition. Some areas of the home had been decorated and floor coverings replaced, showing that the service continues to improve the environmental standards for the people living at the home. Recruitment practices had improved by applications from prospective employees being current. Risk assessments were in place and the issue with the laundry door being unlocked when vacant had been addressed. Strategies had been implemented for when a resident consistently refuses medication. What the care home could do better: The management of medications was in general satisfactory. However, two recommendations have been made to ensure that medication practices are consistently safe. Any hand written entries on the Medication Administration Records could have been signed, witnessed and countersigned to avoid any transcription errors. Written guidance could have been provided for staff so that they were aware of possible triggers which may indicate the administration of `as and when required` medications. The complaints procedure could have contained the current contact details of Social Services, so that people were aware of which authority to refer a complaint to, should they need to do so. It is also suggested that a numbered page record book be implemented for logging complaints, so that the risk of loose leaf pages being lost, mislaid or removed is minimised. Environmental risk assessments could have been reviewed at regular intervals to ensure that they are up to date. Key inspection report Care homes for older people Name: Address: Stocks Hall Nursing Home Stocks Hall 50c Whitemoss Road Skelmersdale Lancashire WN8 8BL     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Vivienne Morris     Date: 0 9 1 2 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 32 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 32 Information about the care home Name of care home: Address: Stocks Hall Nursing Home Stocks Hall 50c Whitemoss Road Skelmersdale Lancashire WN8 8BL 01695555234 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: sueking@stockshall-care.co.uk Stocks Hall Care Homes Limited care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum places - 24) Dementia - Code DE (maximum places - 36) The maximum number of service users who can be accommodated is: 60 Date of last inspection Brief description of the care home Stocks Hall is a purpose built establishment, providing nursing and personal care for up to 60 elderly people, including those whos care needs are associated with Dementia. The home is set in pleasant, well maintained grounds. A patio area with garden furniture is available for those wishing to spend some time outdoors. Private accommodation is located on two levels, the first floor being accessible by passenger lift or stairs. The majority of bedrooms are single with a high percentage having en Care Homes for Older People Page 4 of 32 Over 65 0 24 36 0 Brief description of the care home suite facilities. Two companion rooms are available for partners, friends or those preferring to share accommodation, both having en suite facilities. A number of lounges, quiet rooms and dining areas are available throughout the home, where a variety of activities may take place. The fees at the time of the site visit ranged from £557 - £682 per week. Charges for specialist care can be obtained from the home. Additional charges were being incurred for hairdressing, chiropody, magazines/newspapers and toiletries. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of Stocks Hall Nursing Home took place on 8th March 2007. The quality rating for this service is three star. This means that people who use this service experience excellent quality outcomes. The site visit to Stocks Hall formed part of the inspection process and was conducted over one day in December 2009. It was unannounced, which means that the managers, staff and people living at the home did not know it was going to take place. During the course of the site visit, discussions took place with those living at the home, as well as their relatives, staff and managers. Relevant records and documents were examined and a tour of the premises took place, when a random selection of private accommodation and all communal areas were seen. Comment cards were received from 18 people who were living at the home and one staff member and their feedback is reflected throughout this report. Every year the provider completes a self assessment, known as an AQAA, which gives information to Care Homes for Older People Page 6 of 32 the Commission about how the service is meeting outcomes for the people living at the home and how the quality of service provided is monitored. It also gives us some numerical information about the service. Some of this information from the AQAA is incorporated in this report. We observed the activity within the home and tracked the care of four people during the site visit, not to the exclusion of other people living at Stocks Hall. The total key inspection process focused on the outcomes for people living at the home and involved gathering information about the service over a period of time from a variety of sources. The Care Quality Commission had not received any complaints about this service during the last twelve months. Two safeguarding referrals had been reported to social services by the home. In both cases the home responded well to the information received and acted in the best interest of the people living at Stocks Hall Nursing Home. Care Homes for Older People Page 7 of 32 What the care home does well: The information gathered before admission was extremely detailed, providing staff with a clear picture of each individual, so that they were confident that the assessed needs of people could be fully met. The plans of care were extremely well written documents, providing staff with clear guidance about how the assessed needs of people living at the home were to be met and how people were to be supported to maintain their privacy and dignity. Residents had been involved in the care planning process and a review of care provided was conducted on a monthly basis to ensure that current needs were accurately reflected in the plan of care. One comment card received from a relative stated, We have been 100 percent happy with the care that our father has received and the care and attention the staff provide at at all times. A variety of external professionals had been involved in the care of people living at Stocks Hall Nursing Home to ensure that their health care needs were being appropriately met. A range of risk assessments were in place to ensure that systems were implemented to protect the health and safety of anyone on the premises. Relatives spoken to were happy about how visitors were received into the home and they informed us that the staff were all very respectful, friendly, kind and caring. Sufficient information was provided to people about the use of the local advocacy services to act on their behalf, should they so require and people living at the home were able to have some control over their lives by managing their own finances, should they wish to do so. Activities were provided both in the home and outside, so that people were able to continue their leisure interests whilst living at the home and so that they were able to maintain links with the local community. The routine of the home was fairly flexible and aimed to allow residents their freedom and independence by enabling them to have some control over their lives. Visiting arrangements were in place to suit the needs of individual residents and advocacy services were accessed for those wishing to have an independent person to act on their behalf. Service users were provided with a choice of nutritious and well balanced meals to ensure a good dietary intake. Meals were well presented to promote appetite and to aid in nutrition. Those requiring support with eating their meals were assisted in a discreet manner, whilst others were encouraged to eat independently. Safeguarding policies and procedures were in place, so that people knew what they should do if an allegation of abuse was received by the home. The finances of residents were sufficiently protected by the policies, procedures and practices of the home. The home was tastefully furnished and pleasantly decorated to a good standard and the premises, both internally and externally were well maintained providing those living at Stocks Hall Nursing Home with a safe, clean, comfortable and homely environment in which to live. The home was pleasant smelling and effective infection control Care Homes for Older People Page 8 of 32 measures were in place to ensure that the health and safety of people was well protected. Staffing levels were calculated in accordance with the assessed needs of people to ensure that appropriate care was delivered. Recruitment procedures and financial arrangements were in place at the home, which demonstrated that those living at Stocks Hall Nursing Home were safeguarded from abusive situations. A lot of training had been provided for all staff so that they were kept up to date with current policies, procedures and legislation and so that they were sufficiently trained to meet peoples assessed needs. The registered manager holds relevant qualifications, has a lot of experience and is appropriately trained to manage the care home. Residents, relatives and staff thought highly of her and they all felt supported by the management of the home. Systems were in place to ensure that the quality of service provided was closely monitored so that any shortfalls identified could be promptly addressed. The health, safety and welfare of residents were protected by the policies, procedures and practices of the home so that any hazards, which could pose a potential risk, were minimised or eliminated. The home was well managed by a competent person and a team of skilled senior staff, who together had completed a wide range of training so that they were able to deliver the care required by the individual residents. What has improved since the last inspection? What they could do better: The management of medications was in general satisfactory. However, two recommendations have been made to ensure that medication practices are consistently safe. Any hand written entries on the Medication Administration Records could have been signed, witnessed and countersigned to avoid any transcription errors. Written guidance could have been provided for staff so that they were aware of possible triggers which may indicate the administration of as and when required medications. Care Homes for Older People Page 9 of 32 The complaints procedure could have contained the current contact details of Social Services, so that people were aware of which authority to refer a complaint to, should they need to do so. It is also suggested that a numbered page record book be implemented for logging complaints, so that the risk of loose leaf pages being lost, mislaid or removed is minimised. Environmental risk assessments could have been reviewed at regular intervals to ensure that they are up to date. 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 10 of 32 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 11 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information gathered before admission was extremely detailed, providing staff with a clear picture of each individual, so that they were confident that the assessed needs of people could be accurately met. Evidence: We tracked the care of four people living at Stocks Hall during the key inspection process. The care records seen showed that the needs of people had been very thoroughly assessed before they moved into the home and that a lot of information had been considered prior to the admission process commencing. The detailed assessments had been retained on residents files so that those working at the home were confident that the staff team were able to deliver the care and support required in order meet individual needs. Care Homes for Older People Page 12 of 32 Evidence: The assessed needs of those admitted to the home were consistently recorded within the care plan, providing staff with detailed information as to how peoples needs were to be met. Staff spoken to knew about the needs of people and how to access the care plans, policies and procedures, which showed that they were able to obtain relevant information if they needed it. The manager of the home sent us the Annual Quality Assurance Assessment which was very detailed and told us what the service does well and any areas for development. She wrote, We carry out a very detailed pre admission assessment gathering information about the service user both as they are now and some information about their past life, this is shared with the staff to enable them to have a clear picture of the service user prior to them coming into the home and ensuing we can meet their needs. Written contracts are issued outlining what services are provided and those that can be provided but would have an extra cost. Staff are shown how to access the care files and the relevant policies and procedures to aid their care of the service users. We received 18 comment cards from people using the service, who all told us that they received enough information to help them decide if Stocks Hall was the right place for them, before they moved in. The Statement of Purpose and Service Users Guide were available in peoples bedrooms, providing them with all relevant information about life at Stocks Hall Nursing Home. Care Homes for Older People Page 13 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of people living at the home were being consistently met and their privacy and dignity was always respected. Evidence: We examined the care records of four people living at the home. All four plans of care were very detailed and person centered, providing clear guidance for staff about how peoples assessed needs were to be accurately met. People had been given the opportunity to be involved in the care planning process so that they were able to make some decisions about the care and support they received. Care plans had been reviewed every month or more frequently, if required and changes in needs were reflected well, so that staff were provided with up to date information about the care and support needed by each individual. The registered manager and staff team are to be commended on the consistently high standard of care planning adopted by the home. Care Homes for Older People Page 14 of 32 Evidence: The AQAA and the care records showed that a variety of external professionals were involved in the care of people living at the home to ensure that their health care needs were being appropriately met. Pressure care and nutritional needs were being appropriately met and any specialised equipment was provided as necessary. A wide range of assessments were in place so that the health and safety of people living in the home were protected within a risk management framework. People spoken to were very happy with the care and support provided and they felt that all their needs were being met by the staff team. Comments from them included, I am really looked after very well. The staff are all exceptionally nice, The staff are great. They treat me very well, like a human being , The carers are marvelous both the girls and the boys. They treat me with so much respect and a relative commented, I am more than happy with the care my relative receives. Her every need is attended to without question. The staff are always smiling with a cheerful word. Clear medication records were maintained to ensure that a thorough audit trail was evident and photographs were retained of each resident on their Medication Administration Records for identification purposes. The management of medications was good, although hand written entries on the Medication Administration Reeds had not always been signed, witnessed and countersigned to minimise the potential risk of transcription errors. One recommendation from the previous inspection had not been addressed. Written guidance should be provided for staff so that they are aware of possible triggers which may indicate the administration of as and when required medications. We saw staff speaking to residents in a respectful manner and knocking on bedroom doors before entering to ensure that privacy and dignity was consistently maintained. A written policy was in place and available to staff, which demonstrated that those living at the home were supported to maintain their privacy and dignity at all times. Induction records showed that staff had been instructed to treat service users with respect and care records demonstrated that the wishes of people were respected in relation to maintaining privacy and dignity when giving personal care. Residents spoken to stated that the staff treat them well and respect their privacy and dignity at all times. The manager told us on the self assessment what the home does well and any areas that could be improved. She told us, Care plans are detailed and individualised Care Homes for Older People Page 15 of 32 Evidence: respecting the rights of service users at all times and ensuring they are treated with dignity and respect. The care plan reflects the information gathered prior to their admission. The service user and representative are involved in the care planning and the files are regularly updated. Good risk assessments are in place to ensure the health and safety of the service users We have good communication with outside agencies to aid in the care of the service user. There are robust policies and procedures in place surrounding all aspect of medicine management. We deliver in house mandatory training on customer care. Service users and representatives are offered advocacy services on admission or at any time during their stay with us. Those who returned comment cards and who live at the home told us that, in general, they received the care and support required, including medical care and when asked what the service does well one relative wrote, My mother is well cared for and she has a good rapport with staff. She is mostly content and she trusts the staff and another wrote, The staff look after my husband very well. They are always on hand when we need advise and they are always friendly, providing 100 care. When asked what the home could do better, one relative told us, In our opinion nothing. All our needs are cared for. One staff member returned a comment card, who felt that up to date information was always provided for staff about the needs of the people they supported or cared for. Care Homes for Older People Page 16 of 32 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. The daily routines of the home were flexible and people were encouraged to maintain their leisure interests and activities whilst living there. The management of meals was good and visitors were made welcome to the home. Evidence: Residents spoken to said that the routine of the home was relaxed and that people were able to get up and go to bed when they wanted to do so. Staff were seen offering people a variety of choices in relation to daily living and residents spoken to said that staff were very helpful. Four activity organisers were employed by the home who were responsible for planning a variety of social activities both in the home and within the wider community. Records were retained about peoples leisure interests and hobbies, including religious needs so that staff were aware of individual social care needs, and could therefore plan activities accordingly. Records showed that those who were less able to participate were given the same opportunities as others by the provision of individual activities. A sensory room was available for those requiring periods of relaxation. Care Homes for Older People Page 17 of 32 Evidence: Residents said that outside entertainers visited the home and occasional trips out were arranged, which they enjoyed. A variety of notices were displayed informing people about what activities were available and one relative said that visitors are encouraged to become involved. Information about the provision of activities was included within the statement of purpose and service uses guide, so that people were aware of what activities were provided. At the time of this unannounced visit to the home some people were out on a day trip and we were told that another excursion had been arranged for the following day to allow more people to get out in to the community. Some training had been provided for managers and staff in relation to socialisation. Evidence was available to demonstrate that the home was focusing more on providing individual interaction with the people living at the home. It was pleasing to see the Christmas themed competition arranged for those living on the dementia care unit in order to increase interest and seasonal awareness. Policies were in place in relation to equal opportunities, which included an explanation of the six principals of care, including rights, fulfillment, independence and choice, showing that all those living at the home were given the same opportunities to make decisions and informed choices about their daily lives. The plans of care showed that peoples choices had been taken into consideration and they included information about the leisure interests of residents so that staff were able to provide activities in accordance with peoples preferences. The care plans recorded social histories well so that staff could get a clear picture of each persons life, interests and hobbies. A visiting policy was in place at the home and information relating to visiting was also included in the statement of purpose and service user guide to ensure that all interested parties were aware of the visiting arrangements of the home. Relatives were seen to be visiting people in private and visitors spoken to felt that they were made to feel welcome to the home at any time and that a friendly environment was provided for both residents and visitors. The comment cards received supported this information. Personal possessions adorned individual rooms, where appropriate to create a homely environment and audits of service users belongings had been conducted on admission to protect the safety of personal possessions. People living at the home were able to manage their own finances, if they so wished Care Homes for Older People Page 18 of 32 Evidence: and if they were capable to do so, showing that they were able to have some control over their lives. The four weekly menus were examined and were found to provide a choice of well balanced meals to ensure that those living at the home received a nutritious dietary intake. The menu of the day was clearly displayed, so that people were aware of the choices they had been given for lunch. Staff were seen offering people choices of meals and a number of residents confirmed that there were alternatives to the menu available if required and this was supported by one person being offered a wide range of alternative choices and being served with her selected option. We established that special diets were provided as required. The food served at lunchtime was nutritious and well presented. We saw that specialised utensils were provided to aid in independent eating, but that people were also supported with their meals in a dignified manner as was needed. The catering staff were aware of individual dietary needs, preferences and any special diets required so that people were receiving meals, which fulfilled their expectations. The dining rooms were found to be relaxed areas for people to eat in, with well presented tables and unhurried atmospheres, so that those dining were comfortable and enjoyed having their meals in pleasant surroundings with age appropriate background music playing. The manager told us how the service had improved in this area within the last twelve months, which included, the availability of a minibus seven days a week including evenings. The home had held an afternoon tea with support from Lewy Body society offering support to Families and the personal profile has been developed so it is a continuous tool. Of the 18 people using the service 14 told us that, in general, the home arranged activities which they could take part in and the other four did not answer the question. One person wrote on the comment card, The home regularly organises activities and day trips out for the residents. Healthy meals are provided and regular snacks supplied. When asked what the service could do better one relative wrote on the comment card, To ensure that residents have more drinks at regular intervals throughout the day. One relative told us that she felt very comfortable visiting the home and added, Staff are very friendly and welcoming. Records showed that some people living at the home had utilised an independent person to act on their behalf so that they could Care Homes for Older People Page 19 of 32 Evidence: make some informed decisions about their life and the statement of purpose told people how these services could be accessed. When asked if they liked the meals at the home, 13 people living at Stocks Hall who sent us comment cards told us that, in general, they did, two said that they sometimes did and three did not answer the question. Care Homes for Older People Page 20 of 32 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. Complaints were well managed and people living at the home were safeguarded. Evidence: A complaints procedure was in place at the home, which was displayed prominently and which was included within the service users guide. However, this needed to be updated with the relevant contact details so that people had access to current information. People spoken to at the time of the site visit said that they would know what to do if they were not happy about something at the home. The manager of Stocks Hall told us that complaints policies and procedures are robust and that paper work is in place to document all complaints. Policies and procedures are in place regarding safeguarding vulnerable adults including managing challenging behaviour. Complaints are responded to in a timely fashion and are used in a constructive manor to enhance staff development in a no blame culture. The staff member who sent us a comment card told us that they would know what to do if someone had a complaint about the home and all 18 people living at Stocks Hall who returned comment cards told us that there was someone they could speak to if they were unhappy. Thirteen of these people said that they would know how to make a formal complaint should they need to do so. One person said that they would not know how to complain about the service and four did not answer the question. Care Homes for Older People Page 21 of 32 Evidence: A system was in place at the home so that any complaints received could be recorded and any recurring patterns identified and regularly monitored. However, it is recommended that loose leaf pages be avoided and complaints be logged in a numbered page record book to reduce the risk of information being mislaid, lost or removed. Policies and procedures were in place at the home in relation to safeguarding adults, which were in accordance with Department of Health guidance, so that people were fully aware of the action to take should an allegation of abuse be reported to the home. Staff spoken to confirmed that they had received training in relation to safeguarding adults and the training matrix seen supported this information. Staff were aware of what they should do if they had any concerns about the welfare of anyone in their care to ensure that appropriate action would be taken. Care Homes for Older People Page 22 of 32 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 provided a safe and well maintained environment for people to live in, which was clean, pleasant and hygienic. Evidence: At the time of our visit to this service the first floor unit was closed to visitors because of an outbreak of diarrhea and vomiting. Therefore, the outcome of this section was based on the environmental standards of the ground floor only. A programme of routine maintenance demonstrated that the up keep of the premises, both inside and out was an ongoing process, so that the home was well maintained, providing a safe and pleasant environment for people to live in. The ground floor was well presented, providing a clean, hygienic and safe place for people to live. It was tastefully decorated with good quality furnishings, making the environment comfortable and pleasant for the people living at Stocks Hall. One lady was very eager to show us her bedroom, saying, Isnt this nice and cosy? We saw that personal belongings and photographs adorned peoples bedrooms, making each one individualised and homely. A Jacuzzi, snoozalon and wet room were all available for use on the ground floor. A ramp allowed people easier access to the grounds of the home, which showed that Care Homes for Older People Page 23 of 32 Evidence: those requiring the use of a wheelchair to get about were given the same opportunity as the more mobile to access the pleasant garden areas. The communal lounges and dining rooms were pleasant and comfortable, providing people with a variety of areas to sit and creating a homely environment for those living at Stocks Hall. Policies and procedures were in place in relation to infection control and clinical waste was being disposed of and removed in the correct manner so that the possible risk of cross infection was minimised. Records showed that staff had received infection control training and this was confirmed by people working at the home. The laundry department was suitable for the needs of the residents and it was well organised, providing sufficient equipment, so that laundry was completed in a timely fashion. The manager told us what the service does well. She wrote on the homes selfassessment, We provide a safe and homely environment. We have dedicated maintenance staff who ensure that repairs and decor are maintained to a high standard. The gardens are well maintained. A Good housekeeping team ensure that the home remains clean and odour free. We have a well organised and clean laundry. When asked if the home was fresh and clean, the majority of people who sent us comment cards told us that, in general, it was. Care Homes for Older People Page 24 of 32 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. The number and skill mix of staff met peoples needs and thorough recruitment practices protected those living at the home. Evidence: At the time of our visit to this service there were 56 people living at Stocks Hall Nursing Home. The number of staff on duty was being calculated in accordance with the assessed needs of people living at the home, using a bench marking system and records showed that a good skill mix of people made up the staff team, so that residents needs were being consistently met. We established that additional staff were brought on duty so that one to one supervision could be provided, when necessary. Agency staff were used as required, provided by the companys registered agency so that continuity of care was maintained. Staff spoken to felt that they were not under pressure to complete work as in general there were enough staff on duty to meet the needs of people living in the home. We saw that staff had time to spend with those living at the home, so that individual care and support was regularly provided. Records showed that there was a total of 48 care staff employed at the home, 25 of whom had achieved a recognised qualification in care, giving a total of 55.5 of care staff suitably qualified to provide and oversee appropriate care was being delivered. Care Homes for Older People Page 25 of 32 Evidence: We were told that an additional 15 staff members were in the process of completing this award, so that the staff team as a whole would be better qualified. Formal induction processes had been adopted by the home so that staff understood their role and were able to perform the duties expected of them. The homes self assessment showed that a wide range of training was provided for staff so that people working at the home were competent to look after the people in their care. All staff completed a variety of mandatory core-training courses to ensure that there was a skilled workforce and that people had the necessary knowledge to meet the needs of the people they were caring for. Staff spoken to felt that a lot of training was provided to meet their needs, including training specific to the care of people living in the home and staff training certificates available on files supported this. Three staff files were examined at the time of our site visit. We found that recruitment procedures were being followed in day to day practice and that sufficient checks had been undertaken on staff to ensure that those living at the home were well protected. The manager of the home told us on the self assessment what the home does well and how the service has improved in this area during the last twelve months. When asked if there were staff available when they were needed those people living at the home who returned comment cards told us that, in general, there were. However one relative wrote, On very rare occasions there has not been a member of staff present in the dementia care unit lounge and another commented, The staff are very committed, but seem a little under pressure at times. One person living at the home suggested it would be better if new staff were introduced to the residents. The staff member who sent us a comment card told us that their employer carried out all relevant checks before they started at the home and that their induction covered everything they needed to know to do the job when they started at the home. This person also indicated that they were given training that was relevant to their role, helped them understand and meet the individual needs of people and which keeps them up to date with new ways of working. Care Homes for Older People Page 26 of 32 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 was well managed by a competent person, having effective systems in place for monitoring the quality of service provided. The health, safety and welfare of people living at the home was consistently protected. Evidence: The manager of Stocks Hall Nursing Home has been in post for several years. She has the required qualifications and experience and is competent to run the home. During the time she has been in post she has worked hard to improve and maintain an excellent service by providing an increased quality of life for the people living at the home. She has the skills to operate the home efficiently and effectively for people living there. There was a strong belief of being open and transparent in all areas of running the home so that people were kept informed of matters involving them. The manager had completed a variety of additional training courses and was resident focused. She leads and supports the staff team who have been appropriately recruited, so that those living at the home are adequately protected. Care Homes for Older People Page 27 of 32 Evidence: Residents and staff spoken to were happy with the management of the home and felt that they would be able to approach the manager if they had any concerns or if they wished to discuss any thing. A variety of surveys were being conducted annually so that the views of people living at the home, their relatives and stakeholders in the community were obtained about how the service was performing. The information gathered was put together and produced to show interested parties the strengths and weaknesses of the service. A variety of meetings were held, with minutes kept, so that people were informed of any relevant matters. The home had been accredited with a number of external awards, showing that it was audited on a regular basis by external professional bodies. The registered manager had put in place a variety of regular, detailed checks. This enabled her to identify and address any shortfalls within the systems in place at the home and closely monitor the quality of service provided. The registered person ensured that visits to the service were conducted at least every month, when a full report was made so that the service could be monitored. Systems were in place at the home to ensure that residents finances were sufficiently protected. The relatives of residents were often responsible for the management of their money. Clear records were kept of any money or valuables retained at the home on behalf of people living there so that the possibility of any mishandling was reduced. A wide range of risk assessments had been conducted, which were sufficiently detailed, showing that systems had been put in place in order to reduce the possibility of injury to people living at the home. However, some of these had not been reviewed for quite some time and therefore it is recommended that risk assessments are reviewed to ensure they are current. The homes self assessment showed that all systems and equipment had been appropriately checked so that the health and safety of people living at the home was protected. This was confirmed by examination of a random selection of service certificates. Accidents occurring in the home had been accurately recorded so that the manager was able to audit and monitor the frequency of accidents. The environment was free from any potential hazards, which could pose risks to those living at the home. Fire drills were conducted periodically to ensure that all staff were familiar with the fire procedure and evacuation plan within the home and a record was retained of staff attendance so that the home could ensure that all staff were involved Care Homes for Older People Page 28 of 32 Evidence: in a fire drill at least annually. Policies and procedures were in place at the home in relation to Health and Safety issues, moving and handling, food hygiene and Infection Control practices, so that staff were aware of the importance to ensure that the health, welfare and safety of people living at the home was consistently protected. When asked what the service does well one relative wrote on the comment card, Staff support residents and their families at all times. All the nurses and managers are always available and nothing is too much trouble and another commented, I have observed staff with my relative and all have shown great concern, patience and care towards him and other residents. The staff member who returned a comment card told us that the ways in which information about people living at the home is shared between staff always works well. One staff member told us at the time of our visit, The managers of the home are very flexible and they are very good at allowing a work life balance. Care Homes for Older People Page 29 of 32 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 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 Any hand written entries on the Medication Administration Records should always be signed, witnessed and countersigned to avoid any transcription errors. Written guidance should be provided for staff so that they are aware of possible triggers which may indicate the administration of as and when required medications. The complaints procedure should be up dated with contact details of Social Services, so that people are aware of which authority to refer a complaint to, should they need to do so. It is recommended that a numbered page record book be implemented for logging complaints, so that the risk of loose leaf pages being lost, mislaid or removed is minimised. It is recommended that all environmental risk assessments be reviewed at regular intervals to ensure that they are up to date. 2 9 3 16 4 16 5 38 Care Homes for Older People Page 31 of 32 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. 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