Care Home: Stoke House Care Home

What the care home does well Effective pre admission needs assessment are performed prior to people moving into the home to ensure their needs can be identified and met. Medication is managed appropriately. Service users are afforded appropriate levels of privacy and dignity. Recreational activities are provided within the home and opportunities are available for service users to interact within the broader community. Service users expressed satisfaction with the quality and variety of meals provided at the home. Service users said they feel safe at the home and are able to express their views and concerns to a receptive management team. Service users benefit from a well-maintained environment, which is comfortable, clean and safe throughout. A staff training programme is in place to ensure staff are competent in meeting the needs of service users and staff recruitment practices are robust. The management structure is effective in supporting staff to promote the health and wellbeing of service users. What has improved since the last inspection? This is the first unannounced inspection since the home was re registered in September 2009. What the care home could do better: The registered person should ensure that the refurbishment of the bathing facilities is undertaken. The registered person should ensure that mobility aids such as wheelchairs are maintained and in good working order Key inspection report Care homes for older people Name: Address: Stoke House Care Home 24-26 Stoke Lane Gedling Nottingham Notts NG4 2QP     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: Steve Keeling     Date: 2 4 1 1 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 28 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 28 Information about the care home Name of care home: Address: Stoke House Care Home 24-26 Stoke Lane Gedling Nottingham Notts NG4 2QP 01159400635 01159400634 cnr@stokehouse.com www.stokehouse.co.uk Stoke House Care Home Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Deirdre Margaret Gibbs Type of registration: Number of places registered: care home 46 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 people of the following gender either, whose primary needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP Dementia not falling within any other category Code DE The maximum number of people who can be accommodated is 46 Date of last inspection Brief description of the care home Stoke House Nursing Home is a large home set in its own grounds located in a residential area. There are car-parking facilities in the grounds and the gardens are attractive and well maintained. Service users are accommodated on the ground and Care Homes for Older People Page 4 of 28 Over 65 46 46 46 0 Brief description of the care home the first floor. Some rooms have en-suite facilities and the home offers both nursing and residential care services. The home is adapted for ease of access throughout for service users with mobility difficulties. There is an activities organiser and service users are enabled to use local community amenities. Information about the service is available via Stoke House web site www.stokehouse.com, statement of purpose and service user guide. The current weekly fees range is £392 - £455. Additional charges and made for hairdressing, chiropody services and newspapers. Care Homes for Older People Page 5 of 28 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 the inspection undertaken by the Quality Care Commission is upon outcomes for people who use the service (service users) and their views on the service provided. The process considers the providers capacity to meet regulatory requirements, minimum standards of practice, and focuses on aspects of service provision that needs further development. Two regulation inspectors conducted the unannounced visit. The main method of inspection used is called case tracking which involves selecting service users and looking at the quality of care they receive by speaking to them, observation, reading their records and asking staff about their needs. The registerd manager and two members of staff were spoken with as part of the visit, records relating to medication management was also inspected to form an opinion Care Homes for Older People Page 6 of 28 about the quality of care provided. A partial tour of the building was undertaken which included service user bedrooms and communal areas they frequent to make sure that the environment is homely and safe. A review of all the information we have received about the home since it was reregistered on the 08.09.2009 was considered in planning this visit which included the Annual Quality Assurance Assessment which was provided by the registered manager. Six responses we have received from the ten Have Your Say Pre inspection service users questionnaires and the four responces to the five staff surveys which were distributed to service users at the home prior to the inspection process. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking 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 8 of 28 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 9 of 28 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. Effective pre admission needs assessments are performed prior to people moving into the home to ensure their needs can be identified and met. Evidence: The Have your say pre inspection questionnaire asked people Did you receive enough information to help you decide if this home was the right place for you, before you moved in. Five respondents stated Yes and one respondent stated No. Information provided by the registered manager in the Annual Quality Assurance Assessment states A significant amount of time and effort is expended in planning to ensure that admission to the home is personal and well managed. It is of paramount importance that at all times service users and relatives are treated with the utmost respect and dignity and information shared and gathered is exchanged between all the relevant parties together with reassurance and support. Each service user has an individualised pre-admission assessment. Information is obtained from the relevant Care Homes for Older People Page 10 of 28 Evidence: professionals, relatives and service user, to ensure that the care home can meet their needs. We positively encourage service users to be involved in the assessment process. The assessment process is undertaken by the Manager or Deputy Manager and is carried out with skill and sensitivity. The assessment focuses on achieving positive outcomes for service users and gender, age, sexual orientation, race, religion and disability are incorporated in to the planning process. We looked at the records of the two case tracked service users, each had an assessment of their needs in place. The assessment process was effective in providing the opportunity to identify service users holistic needs, in relation to promoting their health and wellbeing. It was also shown that the assessment process uses information provided by other agencies, such as Adult Social Care and Health,when available. Intermediate care is not provided at Stoke house. Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The healthcare needs of service users are recorded and met. Medication is managed appropriately and service users are afforded appropriate levels of privacy and dignity. Evidence: Information provided by the registered manager in the Annual Quality Assurance Assessment states Each service user is supported to make their own decisions with regard to health and personal care. This is carefully planned and monitored with both the service user and their relatives and support is given based on the rights of dignity, equality, fairness, autonomy and respect. We have comprehensive care plans and risk assessments, incorporating the terms of the Mental Capacity and Deprivation of Liberty Acts, which cover all areas of concern and these are monitored and evaluated on a regular basis. Nutritional screening is undertaken upon admission and is regularly evaluated within the care plan. Care plans contain information with regard to end of life care and advance wishes and feelings of the service user/relatives are recorded. The service user can use a G.P of their choice and have access to the services of a dentist, optician, chiropodist, pharmacist, audiologist, and any other health care professional that is appropriate to their health care needs. We maintain a record of Care Homes for Older People Page 12 of 28 Evidence: visits from professionals. The Have your Say pre inspection questionnaire asked service users Does the home make sure you get the medical support you need, five respondents stated Always and one respondent stated Usually. On the day of the inspection we asked service users if they felt their needs were being fully met at the home, responses included I am very happy here, the staff are great, it is very nice and Yes we are well looked after, I am very happy and feel safe. Records showed and service users confirmed on the day of the inspection that they have access to external professionals such as Doctors, Social Workers, Community Dietitians, Tissue Viability Nurses,Dentists, Opticians and Chiropodists. Service users also confirmed that a doctors visits are arranged by the care staff if they are feeling unwell and doctors attend to the home on a regular basis. On the day of the inspection we spoke to a General Practitioner who stated that she had every confidence in the quality of service provision and praised the manager and staff in providing A very good consistent service. On the day of the inspection we were provided with a copy of the most resent community pharmacy inspection report dated 10.10.09 which concluded The standards of medication management are very high, excellent. Medication is only administered by the qualified nurses. We observed a medication round and it was evident that medication was administered appropriately by the qualified nurse. Medication administration records were mostly filled out correctly although we were informed by the manager and a senior member of the nursing staff that through internal auditing procedures it had been identified that on one occasion a Bank Nurse did not follow the homes medication procedure. Through conversations with the manager and the nursing agency who supplied the bank nurse it was established that appropriate actions were being taken the address the concern. We asked service users if they get their medication on time. The responses were Yes, always and All the time Information provided by the registered manager in the Annual Quality Assurance Assessment states We have a detailed guidance in our staff training folder, which contains information with regard to the six areas of equality, sex and gender, religion or belief, disability, sexual orientation, age and race. In addition, there is guidance Care Homes for Older People Page 13 of 28 Evidence: with regard to diversity and information why equality and diversity are important. The training folder contains several resource material documents and a complete guide to equality and diversity guidance for Managers. Staff training plays great emphasis on service users preferences and respecting service users privacy and dignity. Service users are given choices with regard to choosing what to wear, when to get up and when to retire to bed. All staff knock on service users bedroom doors prior to entering their room. On the day of the inspection we asked service users if their respect and dignity is promoted, comments included I cannot fault them [staff], very respectful and They are lovely, I have no concerns at all. We observed interactions between staff and service users throughout the day and at meal times, service users were being assisted to have their meals in a kind, considerate and un-rushed manner, offering appropriate assistance when required. All observed interactions promoted service users respect and dignity. Care Homes for Older People Page 14 of 28 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. Recreational activities are provided within the home and opportunities are available for service users to interact within the broader community. Service users expressed satisfaction with the quality and variety of meals provided. Evidence: Information provided by the registered manager in the Annual Quality Assurance Assessment states We believe that the individual right for each service user to have a full, stimulating and meaningful life in our Home and the local community, is of paramount importance. We therefore endeavour to seek the views of the service users with regard to their individual interests when we plan the daily routines and activities. Our routines are therefore very flexible and service users are supported with regard to their choices. We have been established for nineteen years and have therefore have strong links with the local community. Service users are able to readily access local activities and can be involved in the homes activities. We recognise the importance of service users personal and social relationships and staff are extremely respectful of service users privacy and dignity. We employ an activity organiser who works with the management to ensure that we have a regular programme in place, with a wide variety of different activities available for service users to participate if they so wish. The management and the activities organiser actively encourage service users Care Homes for Older People Page 15 of 28 Evidence: participation in the activity programme but are mindful of each individual capability and willingness to be involved. The Have your Say pre inspection questionnaire asked service users Does the home arrange activities that you can take part in if you wish, three respondents stated Always and three respondents stated Usually. We discussed the social activities provision with service users who confirmed they were satisfied with the social activities which include board games, guest entertainers, religious interventions, and trips out. Special events such as Christmas and Easter are celebrated. Service users also stated that staff respect their wishes if we dont wish to participate. Information provided by the registered manager in the Annual Quality Assurance Assessment relating to the provision of meals states We take great pride in the standard, quality, appearance and portion size of our meals served to our service users. We recognise that meals are of paramount importance to service users and to us, the Management. Our main cook is qualified to NVQ level 2 and is responsible for the overall running of the kitchen staff, planning menus, kitchen hygiene and health and safety. She has recently completed a level 3 qualification in Supervising Food Safety in Catering accredited by the Chartered Institute of Environmental Health. All other kitchen staff have NVQ level 2. All staff have received training in food hygiene. Menus are changed on a 5 weekly cycle as required by Nottinghamshire County Council Care Home Auditors and regular consultations with regard to menu preferences are undertaken. Our daily menus are written up on a white board on the dining room wall and on laminated menus on the dining tables. The Have your Say pre inspection questionnaire asked service users Do you like the meals provided, three respondents stated Always and three respondents stated Usually. On the day of the inspection service users commented that The food is very good, plenty of choice and Yes its lovely. Care Homes for Older People Page 16 of 28 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. Service users feel safe at the home and feel confident in expressing their views and concerns. Evidence: Information provided by the registered manager in the Annual Quality Assurance Assessment states We welcome complaints, comments and suggestions in a positive way and use them to continually evaluate the standard of service we deliver. Nottinghamshire County Council Adult Care and Health Department have introduced a new complaints procedure with effect from 01/04/2009 and we have this new procedure in to a folder which is located on our information table located in the entrance foyer. In addition, we have displayed the new complaints procedure in newly purchased picture frames on the wall next to the lift in the entrance foyer. This guidance gives the reader clear instructions with regard to the procedure to follow. The new complaints procedure has been documented within our Statement of Purpose. Prospective new service users and their relatives are made aware of the complaints procedure and the location of the documents. It is available in large print on request. We have an open house policy where persons are supported and given reassurance in issues that may relate to protection and safety. We are mindful of the fact that elderly persons do not like to complain and therefore it is of paramount importance that they are supported at all times. All complaints and comments are recorded and are fully investigated and the complainant is kept informed of the progress of the investigation. Complaints are referred to the Customer Relations Care Homes for Older People Page 17 of 28 Evidence: Service at Nottinghamshire County Council in accordance with new policy. All staff know the importance of listening to service users with regard to any concerns and complaints they may have and these are reported to the qualified nurse in charge who will deal with them appropriately. All staff receive training in Protecting Vulnerable Adults and the Safeguarding of vulnerable adults. We have policies and procedures with regard to all aspects of adult abuse and the monitoring and supervision of staff ensure that they are strictly adhered to. The Have your Say pre inspection questionnaire asked service users Is there someone you can speak to informally if you are not happy, and Do you know how to make a complaint, all six respondents stated Yes. The Care Quality Commission has not received any concerns or complaints since the home was re registered on the 8th September 2009. We examined the homes complaints book, which showed that complaints are documented effectively with outcomes and actions following the complaint. We asked service users if they felt confident in highlighting any concerns or complaints, responses included I have no complaints, they [staff] are kind and I feel very safe and I have no worries at all. Service users confirmed that they had every confidence that the registered manager would address any issues of concern in a professional and efficient manner. Records showed, and staff confirmed, that training in Safeguarding Adults has been provided. We spoke to a member staff to determine her level of understanding in this area. The member of staff demonstrated a good level knowledge of Safeguarding Adults procedures. In addition the member of staff said that the revised Nottinghamshire Safeguarding Adults policy is available at the home if further guidance is required. Care Homes for Older People Page 18 of 28 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. Service users benefit from a well-maintained environment, which is safe, comfortable, clean and fresh throughout although shortfalls were identified in relation to the quality of bathing facilities. Evidence: Information provided by the registered manager in the Annual Quality Assurance Assessment states We ensure that the environment is accessible, homely, clean, safe, comfortable and well maintained and has been designed to meet our service users individual and collective needs in accordance with relevant guidance and regulation. Our home is well maintained. We have a programme of routine maintenance with a maintenance schedule to ensure that the building is safe and well maintained. We take great pride in the beautiful gardens that surround the home. The home faces south-west and the gardens enjoy the sunshine for most of the day. The lounges and dining areas have been especially designed to overlook the private rear gardens and patio areas, which are well stocked with a profusion of shrubs, plants and flowers. We also have a large pond and rockery which provide a home for several species of local wildlife. The Have your Say pre inspection questionnaire asked service users Is the home fresh and clean, three respondents stated Always and three responds stated Usually. We asked service users if they are satisfied with the standard cleanliness in Care Homes for Older People Page 19 of 28 Evidence: the home, they said they were and confirmed that their bedrooms are cleaned on a regular basis, as are the communal areas in the home. We did a partial tour of the building, which included service users bedrooms and communal areas. The majority of areas were safe, well maintained, clean, fresh and warm. Service users bedrooms were homely, safe and personalised. Some bathroom facilities were in a poor state of repair. It was confirmed by the registered manager that the issue is currently being addressed, new baths have been recently purchased with an expectation that all the bathroom facilities will be upgraded as part of the ongoing refurbishment plan within six months. It was also noted on the day of the inspection that care staff were mobilising a service user in a wheelchair which was observed to be faulty. We discussed this matter with the registered manager who stated that she was in the process of replacing the faulty wheelchairs. Staff said that gloves and aprons are worn at all times when providing personal care to promote infection control; we observed that gloves and aprons were available and staff were using them appropriately. To further promote infection control within the home a hand sanitiser is placed in the foyer and all visitors are encouraged to use the sanitiser, which is good practise. Care Homes for Older People Page 20 of 28 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. Staffing levels are sufficient in meeting the needs of service users. A staff training programme is in place to ensure staff are competent in meeting the needs of the service users and recruitment practises are robust in protecting service users from those that may be unsuitable to work with vulnerable adults. Evidence: Information provided by the registered manager in the Annual Quality Assurance Assessment states The home is staffed in order to meet the assessed needs of the service users and the size and layout of the home at all times. The skill mix of staff takes in to account the assessed needs of the service users and particularly those with dementia and complex health care needs, who may require additional support and supervision. Staff understand the importance of giving support to service users to enable them to address their needs and wishes in an individualised and person centred way and promote independence. A staffing rota is completed by the Manager and additional staff are employed at peak times of the day, for example we endeavour to have at least one member of staff in the main lounge at all times to observe and ensure that service users are safe and their needs are being met. Qualified nurses are registered with the UKCC and checks are made to ensure that their registration is renewed every three years. The key worker system is operated to ensure that each service user is the responsibility of a specific member of staff. The Manager undertakes a very thorough interview process, assessing the suitability of candidates, Care Homes for Older People Page 21 of 28 Evidence: exploring any gaps in employment and discrepancies in information supplied by the candidate. Before any offer of employment is made, two written references and CRB/POVA checks are obtained, together with the relevant checks on work permits if appropriate. Staff are employed in accordance with the code of conduct and practise set by the GSCC and are given copies of the code. All staff receive a statement of terms and conditions of employment which they sign and a copy is retained within their personal records. All staff receive a job description and a copy of the relevant health and safety policy for the job they do. A second copy of this is signed by the employee and is kept in their personal file. All aspects of the recruitment process are documented by the Manager and no appointment is confirmed until all the necessary paperwork is completed and received. All appointments are subject to a satisfactory three month trial period, during which time performance and capability is monitored. At the end of the trial period the Manager conducts an interview with the staff member to discuss performance and whether this has met or exceeded the targets expected. The staff contract is not renewed if we are not satisfied with the staff members performance. The training of staff is of paramount importance to us. Training exceeds the National Training Organisation standards and ensures that staff understand the aims of the home and the importance of meeting the changing needs of service users. All staff receive at least three paid training days per year. The Manager personally undertakes a three monthly appraisal of individual staff performance and the employee is given full opportunity to discuss any concerns or problems that they may have experienced. The Manager is able to discuss any shortcomings that the employee may have and further training is arranged if appropriate. Newly recruited staff have to complete a satisfactory three month probation period. Notes are taken of the meeting and issues discussed and any action plan agreed is signed by both parties. In the event of the trial period not being to a satisfactory standard, the contract of employment is not renewed. The Have your Say pre inspection questionnaire asked service users Are staff available when you need them, three respondents stated Always and three respondents stated Usually. We asked service users if staff are available when needed, responses included Yes, we have lots of staff here, sometimes they dont come immediately but they always come and We have lovely staff here, cannot fault them. Staff files examined on the day of the inspection contained Protection of Vulnerable Adult checks, Criminal Record Bureau Checks, an application form, two written references, proof of identity and supervision notes. The staff files were well organised and effectively managed. Staff spoken with on the day of the inspection confirmed Care Homes for Older People Page 22 of 28 Evidence: that an induction process is provided when they commence employment and an extensive training programme is also provided. One member of staff stated A great deal of emphasis is placed on training and development, we are always doing some sort of training, it very good. We asked a General Practitioner if she thought the registered manager and care staff were confident and competent in performing their duties, her response was Yes I have every confidence in this service and would recommend it to anyone. Care Homes for Older People Page 23 of 28 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 management structure is effective in supporting staff to promote the health and wellbeing of service users. Evidence: Information provided by the registered manager in the Annual Quality Assurance Assessment states The Registered Manager is a first level registered nurse who has been qualified since 1979. She has had extensive experience of working within the NHS and Nursing Homes and has been in a senior management position for the last eight years. She was appointed to the position of Deputy Manager at Stoke House in 2004 and was further promoted to the position of Manager in August 2005. She has a commitment to professional development and has attended numerous training courses relevant to her role. In addition, she has completed the Registered Managers Award and NVQ 2 and NVQ 3 in administration. The home has a comprehensive quality assurance and monitoring system, which covers all aspects of the home such as activities, care, staffing, facilities and the environment. The Manager regularly audits performance against procedures to ensure that best practice is maintained. In Care Homes for Older People Page 24 of 28 Evidence: addition, there are regular staff meetings to encourage input with regard to improving practice. A significant amount of time is spent ensuring the views of service users/relatives are obtained. Service users are supported in completing the satisfaction questionnaires and if they are unable to do so, their relatives are approached to provide assistance. Service users receive feedback on the views they have expressed. The views of service users/relatives and staff are listened to and acted upon. The Have your Say pre inspection questionnaire asked service users What do you think the home does well, comments included The matron runs the home brilliantly and she creates a relaxed atmosphere, one that you can relax in and its very obvious that the manager and all the staff do their best for all the residents and They look after us, I feel safe here, I feel well looked after. I can bring my ornaments and all my pictures, I have a laugh with all the staff. The Have your Say pre inspection questionnaire asked staff What does the home do well comments included We provide excellent care and listen and respect service users wishes, We provide high standards of living accommodation. Any training needs are identified quickly and staff are given appropriate courses to attend. Matron is extremely approachable and deals with any issues/concerns as soon as she is available to do so and We meet all the needs of service users we are caring and committed in all aspects. On the day of the inspection service users and staff employed at the home praised the registered manager and felt confident in her abilities in providing and safe and efficiently run service. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 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 19 23 The registered person must 30/06/2010 ensure that the planned refurbishment of the bathing facilities is undertaken. To ensure the bathing facilities are well maintained. 2 22 23 The registered person must ensure that equipment provided at the care home for use by service users is maintained in good working order To promote the health and wellbeing of service users. 26/02/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 27 of 28 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). 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. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!