Care Home: Stonehill House

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What the care home does well The process of assessing the needs of prospective users of the service is good and aims to ensure that the home will be able to meet the needs of those who accept the offer of a place. Arrangements for meeting the health care needs of users are good and are provided by staff who have the necessary skills, experience and supervision. Where required these are provided in liaison with GPs and other health care professionals. The home is in a convenient location for the amenities of Haddenham village and surrounding areas. The home has good links with the local community and users are able to utilise local amenities as they wish. The Haddenham Abbeyfield Society maintains a close relationship with the home providing support to individual users, supporting people on outings, and supporting good management through monthly monitoring visits by the chairman and other members of the committee. The staff team are experienced, well trained and well supported. Arrangements for the induction of new staff and for maintaining and developing the skills of all staff are good. Users benefit from a good level of stability at management level which supports the ongoing development of the service in line with the changing needs of both current and prospective users of the service. What has improved since the last inspection? The introduction of a questionnaire used in the review of the trial period of residence for new users has supported action to ensure the service can meet the person`s needs. Staff have attended training in infection control which has led to a review of some procedures and improvements in practice. This should help to reduce the risk of users acquiring infection while living in the home. Staff have attended training in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. This training aims to ensure that managers and staff understand their roles and responsibilities under the Act and protect the interests of users. Some changes have been made to an area of the garden in order to permit more light in to the home and improve security. The home has been awarded five stars by Aylesbury Vale environmental health department for maintaing good standards of practice in hygiene. All permanent care staff have now acquired the NVQ in care. What the care home could do better: The record of medicines on admission which is filed in care plans should be dated. The home`s policy and practice on resuscitation should be reviewed in the context of current good practice guidance and be reviewed periodically by the Registered Manager and Haddenham Abbeyfield Society. The home should consider reviewing its homely remedies policy and guidance and draw up a protocol which includes a limit on the amount of medication to be administered before seeking medical advice. The home should seek the advice of the environmental health department on good practice in labelling and storing perishable products in the fridge. Key inspection report Care homes for older people Name: Address: Stonehill House 106 Churchway Haddenham Bucks HP17 8DT     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: Mike Murphy     Date: 1 0 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Stonehill House 106 Churchway Haddenham Bucks HP17 8DT 01844290028 01844299319 abbeyfield.haddenhamsocietyltd@btinternet.co m Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: The Abbeyfield (Haddenham) Society Limited care home 11 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 11 The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Stonehill House is a residential care home, which is owned and managed by the Haddenham Abbeyfield Society, a charitable organisation that is part of the National Abbeyfield Society. The home is registered to provide residential care for up to 11 elderly people over 60 years of age. The home is situated in a residential area in the village of Haddenham and is close to local amenities, which include shops, a library, pharmacy dental practice and health centre. Transport links are available to the towns of Aylesbury and Thame, as well as Oxford City. Stonehill House offers accommodation Care Homes for Older People Page 4 of 31 Over 65 11 0 Brief description of the care home within a converted and extended home similar in style to nearby properties. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection was carried out by one inspector in July 2009. The process included an unannounced visit to the home on Friday 10 July between 10.00 am and 6.00 pm. The registered manager sent us the services Annual Quality Assurance Assessment (AQAA). It was clear and gave us the information we asked for. The inspection included consideration of the information in the AQAA. It also included discussion with residents, staff and the registered manager. Documents, including care records, staff records, the homes statement of purpose, its service users guide, and other records, were examined. The visit included viewing parts of the home including shared accommodation (living room and dining room), two bedrooms (with the residents permission), the laundry, kitchen, offices, and the garden. The inspection also included considering the responses in 12 survey forms which were completed and returned by the date this report was drafted. Care Homes for Older People Page 6 of 31 Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 31 The record of medicines on admission which is filed in care plans should be dated. The homes policy and practice on resuscitation should be reviewed in the context of current good practice guidance and be reviewed periodically by the Registered Manager and Haddenham Abbeyfield Society. The home should consider reviewing its homely remedies policy and guidance and draw up a protocol which includes a limit on the amount of medication to be administered before seeking medical advice. The home should seek the advice of the environmental health department on good practice in labelling and storing perishable products in the fridge. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective users of this service can be assured that the home will provide them with the information they need at the point of enquiry and that it has procedures in place to ensure that it can meet the needs of those who accept the offer of admission. Evidence: The statement of purpose was revised in May 2009. The services users guide was revised in March 2008. The service users guide outlines the aims of the home. It describes the accommodation and services provided. It lists the registered managers qualifications and experience. It describes the admissions process. It outlines the complaints procedure. In addition the guide also outlines the amenities of the area, the homes staffing arrangements, there is a reference to the fees and licence agreement, to the Care Homes for Older People Page 11 of 31 Evidence: arrangements for providing medical care, and notes for sponsors (including various forms connected with the admission of a person to the home). The statement of purpose includes much of the same information as the service users guide but also includes details of fees (which vary according to whether en-suite facilities are provided) and updated information on the Care Quality Commission (CQC). Both documents will need further updating with regard to current contact information for CQC. There have been two admissions to the home over the past year. The admissions process is straightforward. On receipt of an enquiry the registered manager checks whether the prospective resident meets the criteria for admission. If they do, and there is a vacancy, then the enquiry is carried forward. The person and their sponsor are supplied with a copy of the statement of purpose, an application form and other relevant paperwork. If the person lives in the area then the manager may visit the person at home. Arrangements are then made for the person and a member of his or her family to to visit the home, view its facilities, talk to the manager, and have lunch with residents. During the course of the visit the manager meets with the person and completes the homes assessment form. A decision is then made on whether the home can meet the persons needs and an offer of a place is made. Should the person accept the offer then arrangements are made for admission. The home offers a two month trial period. This allows both parties to decide if they feel that the home can continue to meet the persons needs and the person to decide if they wish to continue living there. The home does not offer intermediate care, therefore standard six does not apply to this home. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health care needs of users are met through the homes arrangements for care planning and liaison with GPs and other agencies as required. These are generally sound but the detail of some elements of practice would benefit from review to ensure that they take account of current good practice. Evidence: A service user plan, a care plan, is drawn up for each resident. The care plans of four people were examined during the inspection visit. The care plans were in good order and comprehensive. They included a photograph of the person, basic information, and correspondence with the persons sponsor. Residents expressed a high level of satisfaction with their care. One said They are absolutely wonderful here, really wonderful. I can eat a lot more now than Ive ever been able to eat. It is a homely place. theyve helped me get my confidence back. Care plans included a good assessment of needs included a falls risk assessment and tissue viability risk assessment. A list of medicines taken by the person at the time of Care Homes for Older People Page 13 of 31 Evidence: the assessment was also included. These lists were not dated and it would be advisable to do so and to make it clear that it is simply a record of the medicines taken by the person at the time the form was completed. Care plans included reference to the care and support needs of the person under the broad headings of Physical, Mental and Social (needs). Then, in more detail, under the headings of Hygiene, Mobility, Memory, Hearing, Sight, Elimination, Hobbies, Communication, and Eating and Drinking. Care plans also included reference to individual medical conditions and related care needs. It was noted that all of the care plans examined included a form on whether the person was to be resuscitated. This was accompanied by a letter to the persons sponsor outlining the background to the form. In some cases the form was signed by the persons GP. The form was introduced some years ago on the advice of paramedics following an event in the home. The intention we believe is to assist decision making in an emergency, to avoid unnecessary intervention, and to comply with the expressed wishes of the person. This is a complex area and it would be advisable to ensure that such a practice is guided by a clear policy. The policy should be based on current good practice and be reviewed periodically. Guidance on good practice may be found in the literature on end of life care and on resuscitation (such as that published jointly by the BMA and RCN in October 2007). This would assist in the formulation of a policy.The local primary care trust should also be able to advise. All residents are registered with a local GP group practice. Access to other NHS services is usually through that practice. Healthcare professionals who responded to our survey were positive in their view of the home. One wrote I think Stonehill House does a marvellous job and by the comments of the people who live there, so do they - and their opinion is to my mind the most important Medicines are prescribed by the persons GP and are dispensed by a pharmacy attached to the local GP practice. Most medicines are dispensed in a monitored dosage system once a month. Medicines required at other times are collected by staff. Systems are in place for checking and recording medicines on delivery. Surplus and unused medicines are returned to the pharmacy and records retained. The administration of medicines is recorded in the persons medicines administration record (MAR sheet). Three residents were administering their own medicines at the Care Homes for Older People Page 14 of 31 Evidence: time of this inspection. A Resident Self-Medication Assessment is completed by the manager before a resident manages their own medicines. Copies of completed assessments were noted on the residents files. Medicines are stored either in the persons own room (if self administering) or in a locked metal cabinet in the kitchen. The location of medicines in a cupboard in the kitchen is not ideal since medicines can degrade in warm and humid conditions. The registered manager said that it is difficult to find a suitable alternative location and that the present position of the cupboard is in an area which is well ventilated and which does not get unduly warm. Medicines are stored there for a relatively short period. Liquid and other stock medicines are stored in the larder - a separate room. Medicines requiring cool storage are stored in a lockable box in the kitchen fridge. Staff practice is governed by the homes policy on medicines administration. This was reviewed in 2005. It is a concise two page policy. The main reference text available to staff is a 2009 British National Formularly (BNF). It was good to see an up to date BNF available. The manager said that she had downloaded the guidelines on medicines in social care published in November 2007 by the Royal Pharmaceutical Society of Great britain. These are also available in booklet form. The manager said that she would consider whether a general reference text (such as the guide to medicines published by the BMA in 2007) and our guidance on medicines published in September 2007 would be useful resources for staff and residents. Staff are trained in medicines administration through a distance learning course run by Oxford/Cherwell college. Staff competence is assessed by the registered manager. The manager said that the home is aiming to carry out annual updates for care staff staff on medicines administration. This would be a good practice. The homes arrangements are checked twice a year by a pharmacist. A copy of the report of the most recent inspection carried out in March 2009 was provided for this inspection. It is noted that all was found to be satisfactory at that time. On this inspection the arrangements were generally satisfactory. Record keeping is good. The home retains copies of prescriptions. It was noted that items other than medicines were stored in the medicines cupboard in the kitchen. It was also noted that the homes Homely Remedies policy did not include an upper limit of a medicine to be administered within a 24 hour period. The manager said the home maintained good contact with the local GPs and that staff were likely to seek medical advice early. They Care Homes for Older People Page 15 of 31 Evidence: would not continue administration under the homely remedies policy if they had concerns about the resident. Arrangements for maintaining the privacy and dignity of residents are good. there are no shared rooms. Staff have worked in the home for a number of years and have a good knowledge of the wishes and preferences of residents. A relative who responded to our survey appreciated the Fresh food, flowers, friendly, particularly good manager. Another wrote that the home did well in Care and attention to health issues. assistance with dressing when necessary. The catering. The garden.. Another respondent praised the home for The same, friendly staff. Independence not having to sit in one room. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive the support they need to maintain their independence, personal interests, social contact and contact with the wider community. The homes catering arrangements provide meals which take account of the dietery needs and preferences of residents. Evidence: A resident said It is a very good home. It has an excellent reputation in the local area. I feel very much at home here. I was reluctant to leave my own home but the staff were super. I have contact with the WI and the church. Another wrote .....like most people - I didnt want to leave my home and independence. I have never had a moments regret. From day one I have felt completely at home. Those who care for us are so patient - and have a great sense of humour...I dont think there could be a better home than Stonehill. this is not flattery. It really is a happy place in which to live!. The home is well located for the amenities of Haddenham village and the surrounding area. Most residents have connections with the village, having either lived there or Care Homes for Older People Page 17 of 31 Evidence: having moved to the home to be close to family living in the area. Residents frequently attend social activities in the village organised by such organisations as the Womens Institute, the local Darby and Joan club, and at the village hall. Some residents have attended line dancing events held in the village a couple of times a year. The West Bucks Villages WEA have held a series of talks in the home in May (A Trans-Siberian Railway Journey), June (Medieval London), and July (Birds of Coast and Ocean). Another series is planned for the autumn season. Residents may attend services and other occasions at the local church if they wish. Communion is offered to residents in the home who wish to receive it. The home organises exercise sessions on Mondays and Fridays and bingo and cards on Thursdays. Regular outings are organised to garden centres in Haddenham or Chinnor. Volunteers with the Haddenham Abbeyfield Society provide support to residents and staff on outings. The society also arranges for a member of the committee to visit each resident once a month. Brief notes are filed in the residents care plan.There were numerous copies of correspondence in residents files relating to outings. A resident respondent to our survey wrote that the home Provides a lot of activity to join e.g. keep fit, lectures, services and outings e.g. to garden centre. Residents may have visitors at any time and the manager said that family members can have lunch and join outings if they wish. As mentioned elsewhere in this report residents privacy is respected and they are free to see their visitors where they wish. By arrangement with the manager they may also bring personal possessions into the home. They may also redecorate their room to their liking if they wish. Breakfast is taken in the residents own room between 6.30 am and 10.00 am. Morning coffee is served at 10.30. Lunch is served in the dining room at 12.30. Lunch is the main meal of the day and consists of a main course and dessert. Residents are offered a choice of main course and dessert. Afternoon tea is served at 3.00 pm. High Tea is served, again in the dining room, at 5.30 pm. High Tea consists of a lighter meal such as as poached eggs, sandwiches or fish cakes. Evening drinks (hot beverages) are served as required. Lunch was taken with residents during the inspection visit. It was a Friday and in keeping with tradition Fish, Chips and Vegetables formed the main course, followed by dessert. Fruit squash or water was available to drink as required. It was a pleasant social occasion. Residents expressed satisfaction with the lunch and with the food in the home more generally. However one respondent to our survey thought that the Service at meal times could be slightly Care Homes for Older People Page 18 of 31 Evidence: quicker. Staff provide support to residents as required. Food can be pureed if necessary. The advice of a dietitian is obtained through the local GP practice. The current cook also works as a care worker in the home on a couple of occasions a week and therefore has a good knowledge of the needs and preferences of residents. One respondent to our survey said that carers could more actively encourage (relationship) and others into the garden and get involved. They dont seem to all recognise difference in culture across generations - older people often wont ask. Care Homes for Older People Page 19 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Users living in this home can be confident that any complaint they report will be properly looked into by managers. The home has good arrangements in place to ensure that the users well-being and interests are safeguarded. Evidence: The complaints procedure is outlined under the heading Concerns in the service users guide and statement of purpose. A person dissatisfied with the service is asked to communicate their concerns to the House Manager (the Registered Manager) in the first instance. If the person remains dissatisfied then the person may refer their complaint to the Chairman of the Haddenham Abbeyfield Society Management Committee. The documents also include reference to the persons right to refer their complaint to us. Contact details for CQC will need updating when the documents are revised. The home has received one complaint since the last key inspection. Correspondence relating to this was examined during the inspection visit. The complaint was managed satisfactorily. The registered manager said that the names of all users living in the home are included on the electoral register and many exercise their right to vote at elections. Care Homes for Older People Page 20 of 31 Evidence: The home has a policy on safeguarding vulnerable adults. A copy is included in the staff handbook. This was last revised in October 2008. A copy of the current Buckinghamshire joint agency policy was available in the managers office. Staff receive training on the subject of safeguarding adults through the Buckinghamshire local cluster staff training arrangement. Through this arrangement training is provided to staff in this and a group of four or five other registered homes over the course of the year. Staff seen during the visit had knowledge of reporting arrangements. They expressed confidence in the manager and the management committee to investigate any concerns reported under the safeguarding policy. The staff handbook includes guidance to staff on responding to challenging behaviour. The subject is also included in the cluster staff training arrangements. The home does not manage any monies on behalf of users. This is considered a matter for the user and their sponsor. Care Homes for Older People Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Users live in a comfortable and safe home which is conveniently located for the amenities of Haddenham Village and surrounding areas. Evidence: The home is located in a quiet residential area, a short distance from the centre village centre. Haddenham is under nine miles from Aylesbury and around two miles from Thame. The village is served by Chiltern Line trains at Haddenham and Thame Parkway station and by regular bus services between Aylesbury, Thame and Oxford. The home is conveniently situated for the amenities of the village. The home is a detached property set in its own grounds. There is limited parking to the front of the building but plenty of parking in nearby streets. There is a pleasant secluded garden with lawn, shrubs and a summer house to the rear of the house. There are mature trees to the front. The registered manager was in communication with the local authority on the maintenance of these. The authority has placed some of these trees in a category which limits the amount of work the home can do on them. Apart from any aesthetic considerations the home has to take account of the effect of these trees on the amount of light which some rooms receive and on the view from those rooms. Care Homes for Older People Page 22 of 31 Evidence: This may have prompted one resident respondent to our survey to write Could you please ask (name) the gardener to always keep the plants (e.g. laurel) etc. below the sill as it makes my room lighter, having a brick wall on one side. The garden is maintained by a local gardener on contract. Entry to the home is controlled by staff. The accommodation is over two floors linked by stairs and a passenger lift. The ground floor accommodation includes the entrance hall, dining room, living room, kitchen, laundry, WC, bathroom, and eight bedrooms five of which have en-suite facilities. Three rooms lead directly on to the garden. The accommodation on the first floor includes three bedrooms - all of which have ensuite facilities, WC, and the staff office. The home has a homely and comfortable feel and is suitably furnished and equipped for current needs. Since the last inspection the home has acquired new equipment for the laundry, a new gas oven and water boiler. Two residents were happy to talk about the home in their rooms. The rooms varied in size but both were clean, bright, well furnished and had been personalised by the residents.The residents were satisfied with their accommodation. All areas seen during the course of this inspection were in good order, clean and tidy. COSHH materials and data sheets were safely locked in the cleaners cupboard when not in use. The laundry was in very good order. The kitchen was generally in good order although some perishable products had not been labelled and dated when opened. The home was awarded five stars by the environmental health department on its last visit in November 2008. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Users of this service are supported by staff who have been appropriately checked prior to employment and who have the necessary personal qualities, skills and experience to meet users needs. Evidence: There are two care staff on duty between 8:00 am and 10:00 pm. In addition there is a part-time cook and part-time domestic on duty between 8:00 am and 2 pm. At night, between 10:00 pm and 8:00 am, staffing consists of one waking and one sleep over care workers. These figures exclude the registered manager. Staff turnover is low and the home benefits from having an experienced group of care staff. No new staff had been appointed since the last key inspection but one application was being processed. Applicants are required to complete an application form, provide an employment history, supply two references, attend for a personal interview, provide evidence of fitness for the position, and have Enhanced Criminal records Bureau (CRB) check. It was noted that the homes application form does not require an applicant to provide precise dates of previous employment. Assessment by an interview panel of a candidates continuity in previous employment, or exploration of any gaps in employment, would be facilitated by requiring applicants to provide the full dates of Care Homes for Older People Page 24 of 31 Evidence: starting an leaving previous jobs. The registered manager aims to ensure that all care staff have a CRB check every three years. While this is not currently a requirement it does reflect a thorough approach to staff management. The induction of new staff is co-ordinated by an external consultancy Total Training. The new employee receives guidance and support from a consultant in completing the common induction standards over 12 weeks. This is supplemented by a four day block induction. The registered manager co-ordinates the induction of new staff within the home. Staff have access to a comprehensive staff training programme. Most training is now provided through the Buckinghamshire County Council cluster group arrangement in which five or six homes are grouped together for training events. Training may also be provided by other providers. These include an external training consultancy (for Induction - see above), Oxford/Cherwell college (for Dementia Care and the Administration of Medicines) and events offered by Buckinghamshire Council outside of the cluster arrangement. Staff seen during the course of the visit expressed a good level of satisfaction with their work. They described the standards of care as high, said that the home was well run and that the managers were fine. Staff confirmed that the home provides good access to training and that they have individual supervision every few months. A staff respondent to or survey said that the home provides a Caring environment from staff. Staff have the best interests of service users in mind and said that the home ..seems very well run. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Users live in a home which is well managed, comfortable and safe, and which is run with their interests in mind. Evidence: The registered manager has worked in the home for 24 years. The registered holds both the Registered Managers Award and the NVQ4 in Care. The deputy manager has been in post for 18 months. A number of respondents to our survey were positive in their comments on the manager e.g. ...a lovely lady in charge... and ..(a) good, friendly manager... The registered manager is accountable to the Haddenham Abbeyfield Society through its Chairman and attends meetings of the committee. The registed manager told us that she keeps up to date by going on the same courses as her staff. These include events organised by the cluster training group, those organised by Buckinghamshire County Council and occasional external training events. Care Homes for Older People Page 26 of 31 Evidence: There are two key activities in terms of assessing the quality of the service. The review of a persons care which is held after a person has been resident in the home for two months provides an opportunity to assess whether the home is meeting the persons needs and whether anything further is required. The second key event is the annual stakeholder survey - the last of which took place in November 2008. This provides users, sponsors, and health and social care professionals with an opportunity to comment on the quality of the service. A sample of completed questionnaires of the 2008 survey were seen during the inspection visit. A copy of the report of the survey which goes to the Haddenham Abbeyfield Society Committee was not available at the time of this inspection visit. Reports of visits by managers under Regulation 26 were examined. These visits are carried out monthly and are almost always carried out by the Chairman of the committee. Management practice and systems also contribute towards assessing the quality of the service. These include; day to day encounters with visitors and staff, monthly meetings between members of the Abbeyfield Society Committee and individual residents (one of which took place during the inspection visit) - of which brief summary records are made, two monthly checks of the environment, periodic health and safety audits, and management and staff practice in record keeping. The home does not deal with residents monies. Individual staff supervision is in place. The home has made progress on this since the last key inspection. Meetings take place around four times a year. Meetings are confidential and notes are taken. Staff meetings are also held. Arrangements for ensuring the health and safety of residents, staff and visitors are generally satisfactory. A number of policies govern health and safety matters in the home. Policies were reviewed in 2008 and 2009. Arrangements are in place for checking technical equipment including: electrical circuits, portable electrical equipment, the lift, hoists, fire safety equipment (alarms, fire fighting appliances and emergency lighting), gas appliances, and heating systems. The dates of the most recent checks were provided by the registered manager in the pre-inspection AQAA and were updated at the inspection visit. Staff training in health and safety matters is mainly provided through the local cluster arrangement. Care Homes for Older People Page 27 of 31 Evidence: The home was examined by the Aylesbury Vale Council environmental health department in October and was awarded five stars. Standards of cleanliness in areas of the home visited on this inspection were good. However, it was noted that some perishable products (sauces) in the fridge had not been labelled when opened. On some occasions it appeared that staff had omitted to record the temperature of hot foods served. The registered manager is advised to seek the advice of the local environmental health department on these matters. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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