Care Home: Stroud House

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What the care home does well This home is good at providing specialist aids to support the residents in retaining their independence and in making sure they remain safe whilst doing so. A wide range of activities is provided to fulfil the residents` recreational and social needs and the home employs staff specifically for this purpose. The home provides transport to enable the residents to access the local community, take trips to local garden centres, enjoy pub lunches, cream teas, and the theatre, visit beauty spots on the Downs to see the bluebells and newly-born lambs, and to take shopping trips for their enjoyment. A relative commented, `there is always a friendly atmosphere when you walk in and visitors are welcome whatever time you turn up,` and a resident`s friend stated, `as an occasional visitor, I feel that my friend is very well looked after and that all her needs are taken care of. I think the service received is first class.` Another relative wrote on the survey they had supported their relative to complete, `all the residents are treated as individuals, whatever their needs. All the residents are treated with dignity and kindness, and there is a range of activities on offer to suit all abilities, and outings in the minibus every week.` What has improved since the last inspection? All the staff, who take responsibility for the administration of medication, had recently undertaken formal training over a eight to ten week period, via a local college, and had been individually assessed for competency. A number of new activity providers had been introduced to the home to provide a more varied range of entertainment for the enjoyment of the residents. Environmental improvements included the replacement of carpets in the three lounges, up the stairs and along the upstairs passageway, and new curtains had been fitted in these areas over the previous twelve months. The majority of armchairs had also been replaced, due to wear and tear, for the comfort and enjoyment of the residents. Other improvements included the refurbishment of two bathrooms, the installation of a new shower and a new boiler to improve the efficiency of the home`s hot water and central heating system and the purchase of special equipment to support residents with mobility needs, to transfer from and to their wheelchairs with the maximum of dignity. Quality assurance questionnaires had been completed and the collated results had been used to contribute to the development of the home in the best interests of the residents. What the care home could do better: A medication audit carried out by a pharmacist, had identified that the controlled drugs cabinet was in need of a more secure locking device, and the home was in the process of attending to this to ensure the safe storage of the residents` medication. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Stroud House Rothercombe Lane Stroud Petersfield Hampshire GU32 3PQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: User doesnt belongs to any group     Date: 0 3 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Stroud House Rothercombe Lane Stroud Petersfield Hampshire GU32 3PQ 01730262657 01730261276 stroudhouse@tiscali.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Western Health Care Limited care home 25 Number of places (if applicable): Under 65 Over 65 0 0 25 0 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: 25 25 0 25 The maximum number of service users to be accommodated is 25 The registered person may provide the following category 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 category: Physical disability (PD) Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Stroud House is a large care home situated along the main road to Winchester, through the village of Stroud, and approximately three miles from the market town of Petersfield. The home is a family run business, and registered to accommodate up to Care Homes for Older People Page 4 of 30 Brief description of the care home twenty-five older people, some of who may have dementia, mental disorders or physical disabilities. Fifteen single and five double bedrooms are provided, fourteen of which, are on the ground floor and are suitable for residents with mobility needs. The communal areas include a large lounge with dining area, a smaller quiet lounge and a television lounge. Secure and attractive gardens with footpaths, lawns and a terraced area are accessible by the residents. The fees for the home range from 385 to 575 pounds, according to the assessed needs of the residents. Care Homes for Older People Page 5 of 30 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 inspection report includes information gathered about the service since the previous site visit on 24th April 2007 under the Commissions Inspecting for Better Lives (ILB) process. The responsible individual, Mr Paul Rodgers, completed an Annual Quality Assurance Assessment (AQAA) giving up-to-date factual evidence about the running of the home and informing us of what they think they are doing well, how they have improved the service and of their plans for further improvements. Two residents completed service user surveys giving their views on the running of the home, two staff members and two healthcare professionals also completed surveys, giving their views on the care and support given to the residents. An unannounced site visit was conducted on 3rd April 2009 by Ms Christine Bowman (Regulation Inspector), to assess the outcomes of the key inspection standards for older people with respect to the Care Homes for Older People Page 6 of 30 residents living at the home. The registered manager, Mrs Irene Morton, was interviewed and provided support for the inspection process by making residents and staff files and other documents available to be sampled. A tour of the premises was undertaken and communal areas and some of the residents bedrooms were viewed. A number of staff and residents were spoken with throughout the day and observations were made of the residents and of staff as they carried out their duties. Residents and staff records, maintenance certificates and complaints and compliments records were sampled and the Statement of Purpose, the Service User Guide and some policies and procedures were viewed. What the care home does well: What has improved since the last inspection? What they could do better: A medication audit carried out by a pharmacist, had identified that the controlled drugs cabinet was in need of a more secure locking device, and the home was in the process of attending to this to ensure the safe storage of the residents medication. Care Homes for Older People Page 8 of 30 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 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 30 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 residents are supplied with all the information they need to make an informed decision about moving to the home, and the home ensures that prospective residents individual needs are fully assessed so that a plan of care can be drawn up to show how their needs will be met. Evidence: The home had recently published a new brochure containing colourful photographs of the home and showing residents enjoying the garden and the beautiful views of the South Downs, on a boat and a farm trip, and of the staff working with the residents. The information promised an environment where quality care and fulfilling lifestyles go hand in hand, and gave prospective residents sufficient details about the services provided to enable them to make a decision about the ability of the home to meet their care needs. Two residents, who completed surveys, confirmed that they had received sufficient information about this home before they moved in so they could Care Homes for Older People Page 11 of 30 Evidence: decide if it was the right place for them and a resident spoken with on the day of the site visit stated they had visited before deciding to move into the home. When no bed was immediately available, a list of local alternatives were given, and when a single room was required, the manager stated, that sometimes residents were prepared to take a shared room and wait for a single vacancy to arise. However, the same was not true for those clients commissioned by the local authority, for unless a top up fee was paid by the clients family, there would be no move to a single room, which the client might prefer, as the local authority would not pay the extra costs, the manager stated. However she also stated that some clients preferred to share bedrooms and were very happy with the situation, and the AQAA recorded that, careful consideration is given to the compatibility of the residents in these rooms to ensure good relationships are developed and maintained. The manager explained the admissions process and stated that, Usually the relatives of prospective residents make telephone enquiries and an enquiry form is completed and a welcome pack, which includes the Service User Guide, is sent at this point. If the initial enquiry confirms that the home may be suitable for the prospective resident, a visit is arranged. Sometimes, an assessment will be carried out in hospital or in the prospective residents home, the manager stated, where there are relatives, they are always involved in the assessment, and the care management assessment and care plan are always sought when the local authority are involved in the commissioning of the placement. Residents files sampled confirmed, this and also that the home carried out a full assessment of the prospective residents needs including communication, medication, breathing, personal care needs, skin problems, physical well-being, dietary needs, continence, mobility, family involvement and behavioural problems. Risk assessments were included with respect to self-medication and allergies, swallowing, falls, moving and handling and the environment and the support required to minimise risks was recorded. The special needs of residents with diabetes and those requiring pureed and soft food were also recorded to enable a full plan of care to be drawn up. Sleep patterns, orientation, memory, literacy, financial skills, life skills, leisure interests, hobbies, religious needs, sociability, sexuality were also taken into consideration when looking into the individual needs of prospective residents. A drawing up of the emotional, physical and social needs of the prospective resident and any environmental considerations was made at the end of the assessment and signed by assessor and resident or their representative to confirm their agreement. Care Homes for Older People Page 12 of 30 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. Residents are treated as individuals, whose care plans address their health, personal and social care needs. Safe arrangements are in place for the handling of medication to protect the residents and the staff and the residents right to privacy is upheld and their dignity maintained. Evidence: Care plans sampled, corresponded to the assessment documentation, and were comprehensive. They identified the support required to assist residents with their personal care, whilst enabling them to remain as independent as possible. Risk assessments recorded identified hazards, who was likely to be harmed, the level of risk, and actions to reduce risks to the residents and the staff in completing the care plan. Care plans had been regularly monitored and reviewed to ensure the residents needs continue to be met. The AQAA recorded that, intermediate care plans are often developed to enable staff to provide the appropriate care when dealing with a shortterm illness or a temporary condition. Observation charts had been developed in order to monitor the specific needs of any residents who may be experiencing poor health or Care Homes for Older People Page 13 of 30 Evidence: who are undergoing a specific health check as determined by their GP. Prompt cards for the staff clarified the actions they were required to take at different times of the day and informed them of residents preferences. Daily records, completed three times each day, and signed by the care staff, provided up to date information on each resident. One staff member, who completed a survey, confirmed that they were always given up to date information about the people they support, and a second recorded that they usually were. Two residents, who completed surveys with support from relatives, recorded that they always received the care and support they needed. Over the previous twelve months, a number of adjustable beds had been installed for residents who were becoming more dependent, and this also benefited the staff, when assisting these residents, by reducing the risks associated with bending. Bed sensors had also been purchased to alert the staff when residents, at risk from falling, get out of bed. Information in residents files sampled included health contacts for General Practitioners (GP), chiropodist, optician, dentists and the community nurses. The psychological well-being of the residents was considered in care planning and involvement with the Community Psychiatric Nurse (CPN) was recorded in a care plan sampled. The manager stated that, where possible residents continued to be registered with their own GP, and that the services of a total of five GPs from two surgeries were utilised by the residents. A full audit of medication had been recently undertaken by a pharmacist, confirming safe policy and practice with respect to the administration of medication. As a result of the audit, the home was in the process of looking into the purchase of a new controlled drugs (CD) cabinet, for although the CD cabinet was metal and suitably secured to a wall, the locking device had a keypad, which meant that anyone with the code could access the contents of the storage facility. The AQAA recorded that an improvement over the previous twelve months was that, all staff, who take responsibility for the administration of medication, have recently undertaken formal training over a eight to ten week period, via a local college, and all have been individually assessed for competency. Certificates held on staff files sampled, confirmed this. A sample of residents medication held, agreed with the total recorded in the medication administration record, and a returns book recorded medication returned to the pharmacy and had been appropriately signed to confirm this. Throughout the day of the site visit, staff working with residents were observed doing so in a respectful and polite manner, and residents spoken with were very satisfied with the care provided. New staff had completed the Skills for Care common induction standards, which provide an introduction to the caring role and promote the residents Care Homes for Older People Page 14 of 30 Evidence: rights to be treated as an individual, with respect for their privacy and dignity. Shared bedrooms had been provided with screens and a private room was available for confidential meetings. Two health professional, who returned surveys, recorded that, the care service always respects individuals privacy and dignity. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are treated as individuals, who are supported to follow their personal interests, enjoy stimulating activities, both within the home and in the community, and to retain as much of their independence as possible. Contact with important people in their lives is promoted and nutritious and attractive meals are provided. Evidence: The home employed a diversional therapist, who explained that this form of therapy had originated in America, and included adjusting activities to fit the client and a lot of reminiscence work. She explained that in all activities, individuals work to their own level, enabling them all to have the opportunity to achieve and gain from the experience. Creativity was employed in providing the range of materials and ideas required to cater for the diverse needs of the residents. The RNIB (Royal National institute for the Blind) website had provided useful information in the design of bingo cards for residents with visual impairment, she stated. When taking part in the Knit and Natter activity, she explained that, it didnt matter if an individual was not able to knit because they might enjoy unpicking fibres and materials or sorting things out. This activity helped the residents to maintain dexterity and encouraged socialisation. The diversional therapist, who had received training in dementia, was a member of Care Homes for Older People Page 16 of 30 Evidence: NAPPA (an organisation promoting activities for older people), and stated that she took advice from an occupational therapist and worked closely with the care staff in meeting the recreational and social needs of the residents. The AQAA recorded that, the residents are able to enjoy a variety of activities, which provide stimulation, encourage communication and enable them to maintain their social skills. The activities schedule was posted on a notice board for all to view. Some of the activities offered over a two-week period included, manicures, video, arts and crafts, hairdressing, bingo, Church of England Communion Service, gentle exercises to music, library service, knit and natter, quiz, musical afternoon with singing, board games, fun and laughter, a birthday celebration and four trips out. Other activities provided, included armchair hockey, playing the African hand drums, dancing, flower arranging, armchair yoga and a monthly visit from a PAT dog. Variety and choice was offered, not only in the activities provided, but also in those providing the activities, and the AQAA recorded that, the daily routines of the home are varied and flexible and the staff assist the residents to make choices regarding their social, religious, cultural and recreational needs. The provision of two buses enabled the residents to access the local community, take trips to local garden centres, enjoy pub lunches, cream teas, and the theatre, visit beauty spots on the Downs to see the bluebells and newly-born lambs, and to take shopping trips. The AQAA recorded that improvements had been made over the previous twelve months, including the introduction of new activities providers, offering a more varied range of entertainment. This included a keyboard player, a 50s, 60s singing duo, a theatrical group presenting singing and dancing from the Blitz era, and a singing group known as Nostalgia, which performs numerous songs reminiscent of the residents former years. A qualified beauty therapist had also recently joined the company and was able to provide an extensive range of treatments designed to pamper and enhance the residents well being. Records were kept of the participation of residents in activities to evaluate the sessions. On the day of the site visit, visitors, who came and went throughout the day, were made welcome, and the happy, relaxed and friendly atmosphere contributed to people feeling at ease. When completing a tour of the premises in the afternoon, some residents were enjoying a trip out in the bus, others were reading newspapers and some were relaxing. Books, which were available in large print from the mobile library, were provided for those with visual impairment. One resident had just returned from having lunch out with their relatives and commented, there is always a friendly atmosphere when you walk in and visitors are welcome whatever time you turn up. Care Homes for Older People Page 17 of 30 Evidence: There was a private room where residents could meet with their visitors should they wish to do so. The AQAA recorded, Residents are encouraged to maintain relationships with family and friends and to develop new relationships with the other residents. The dining room was set out with small tables for up to four residents. Tables were attractively laid with tablecloths and tablemats. Flower arrangements, put together by the residents themselves, and domestic lighting created a pleasant ambiance for socialising and for the enjoyment of the partaking of meals by the residents. Menus included fresh fruit and vegetables and the Good Friday and Easter Sunday menus were already displayed on the notice boards, decorated with colourful borders and promising some special Easter treats. The manager stated that the cook produced home made cakes. Two residents, who completed surveys, recorded that they always enjoyed the meals provided at the home. Care Homes for Older People Page 18 of 30 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. Residents know how to complain and are confident they will be listened to, taken seriously and that their concerns will be acted upon. The home protects its residents from abuse by raising staff awareness and by taking appropriate action to safeguard them. Evidence: The home had a clear procedure for making complaints, copies of which were available in the residents welcome pack and on notice boards throughout the home. The complaints log was viewed and it showed that minor concerns had been recorded and there had been no formal complaints, however the procedure gave a timescale for responding to complainants. There was also a suggestions book available for anyone to record their views for the improvement of the service. The home had a positive attitude to complaints and concerns and viewed them as a means of ensuring the service continues to improve. Two residents, who competed surveys recorded that they always knew who to speak to if they were not happy and that they knew how to make a complaint. There had been no safeguarding referrals over the previous twelve months. The home had a copy of the local authority safeguarding policy and procedure to inform the staff of how to make a referral and the protection of vulnerable adults training had been accessed by the staff whose files were sampled. Care Homes for Older People Page 19 of 30 Care Homes for Older People Page 20 of 30 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. Residents benefit from living in a home that is well maintained, clean, pleasant, homely and hygienic and provides them with sufficient space and facilities to lead the life they choose. Evidence: The home was situated in the village of Stroud, just outside the market town of Petersfield and on a main route to Winchester. It was also close to the main A3 connection from London to Portsmouth and the South Coast. There was a lane to the side of the home, leading to a car park and the main entrance, which was at the rear of the building. The home was located on the edge of the South Downs and residents were able to enjoy pleasant views of the hills in the distance. A welcoming vase of freshly cut flowers just inside the door and a small well-behaved dog were the first indications of the quality of life offered at this home. The operations manager explained that, a resident, who was in the process of reassessment, owned the small dog. She stated that they would continue to offer the dog a home even if the owners needs could no longer be met at the home and if they were unable to take the pet to a new placement. There was sufficient communal space for the residents including two lounges, a dining room and a separate quiet room, which could be made available for residents visitors, Care Homes for Older People Page 21 of 30 Evidence: should they wish to meet in private. It was also available for those residents accommodated in the five shared bedrooms, for any meetings of a confidential nature. The rooms were pleasant, comfortable and domestic. There were potted plants and art and craftwork, which the residents had created, on display in the living rooms. Entertainment in the form of televisions, radios, DVDs, music centres and CDs were available for the residents. The AQAA recorded that carpets had been replaced in the three lounges, up the stairs and along the upstairs passageway over the previous twelve months and that the majority of armchairs had been replaced due to wear and tear. New curtains had been fitted in the lounges and passageways for the comfort and enjoyment of the residents. Other improvements completed included the refurbishment of two bathrooms, the installation of a new shower and a new boiler to improve the efficiency of the homes hot water and central heating system. Special equipment was available to support residents with mobility needs to transfer from and to their wheelchairs with the maximum of dignity. From the large windows in the two lounges adjacent to the dining room, there were views of the garden, which was secure and accessible by people with mobility needs. There was a bird table to entertain the residents in the winter months, and tables, chairs, parasols and a barbeque for use throughout the summer. Residents bedrooms sampled had been personalised with photographs and pictures and residents had brought small items of furniture and personal effects to make their rooms homely. All the residents had a lockable cupboard or drawer in their bedrooms and some beds had been provided with bed sensors to alert the staff when a resident at risk of falls was getting out of bed. Call bells were easily accessible to residents to enable them to call the staff should they need to do so. Shared rooms had been provided with screens and all had en-suite toilets and washbasins. Shared bathrooms and the wet room contained all the necessary equipment to facilitate personal care and a stair lift was provided for residents to assess the first floor. Infection control was good, with disposable paper towels and liquid soap available for hand washing in all the toilets viewed and in the kitchen and laundry room. Bins also had foot pedals to decrease the risk of spreading infection. The laundry room, despite being very small, contained all the equipment necessary for the laundering of residents clothes and bedding. The manager stated that some residents liked to get involved with their own laundry and this was encouraged. The AQAA recorded that the fifteen permanent care staff had all received infection control training. Care Homes for Older People Page 22 of 30 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. A stable, committed and trained staff team, which have been safely recruited to ensure the residents protection, provide their care. Evidence: The AQAA recorded that the retention of staff was good, providing consistency and continuity for the residents, and that in addition to the sixteen permanent care staff, they employed six other staff to fulfil the domestic, maintenance and minibus driving roles within the home. The home invested staff time in catering for the social and recreational needs of the residents in addition to supporting their personal care needs. The manager stated that, rotas are carefully planned to ensure that staffing levels meet the assessed needs of the residents, and additional staff are available at peak times of the day. Observations on the day of the site visit, confirmed that sufficient staff were available when the residents needed them, and two residents, who completed surveys, recorded that the staff were always available when they needed them and that they listen and act on what they say. The residents commented that they were, well looked after always, and completely satisfied with all the care given. Seventy five percent of the permanent care staff care staff had completed a National Vocational Qualification (NVQ) in Care or Health and Social Care at level 2 or above to support them in their role and that the other twenty five percent were in the process Care Homes for Older People Page 23 of 30 Evidence: of working towards an NVQ award, the AQAA recorded. The two staff, who completed surveys, confirmed that they were being given training, which is relevant to their role, helps them to understand and meet the individual needs of the residents with respect to equality and diversity issues, and keeps them up-to-date with new ways of working. The training programme included Health and Safety, Fire Safety, Infection Control, Moving and Handling, Abuse Awareness, Dementia Care, Food Hygiene and First Aid. Staff files sampled, contained certificates to confirm the staff had received mandatory training in a timely fashion and also included certificates for the Administration of Medication. The files of two staff, recruited since the previous site visit, were sampled and they confirmed that all the necessary pre-employment checks had been carried out for the protection of the residents, including two written references, the Protection of Vulnerable AdultsFirst and Criminal Record Bureau checks. The two staff, who returned surveys, recorded that their employer had carried out checks, such as Criminal Record Bureau and references, before they started work. In the last twelve months a new induction programme, which meets with the Skills for Care Common Induction standards, had been implemented, and new staff have been encouraged to work towards achieving an NVQ in Care at an appropriate level, following their induction, the manager stated. The AQAA recorded that the dementia care course, which a number of the staff had completed, provided for a deeper understanding of the changes in the residents moods, behaviour and wellbeing, and that the staff had recently benefited from additional training from the local funeral director. This included the procedures for natural burial and cremation and had enabled them to gain a deeper understanding of what happens after death, which in turn, had enabled them to feel more confident in assisting grieving families. Care Homes for Older People Page 24 of 30 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. Residents live in a well managed home, in which their opinions are sought and acted upon for the improvement and development of the service. Effective systems are in place to promote the residents health, safety and welfare creating a safe environment for them to live in. Evidence: The registered manager, Mrs Irene Morton, was well qualified for the position, having achieved a National Vocational Award at level 4 in care, and obtained a management qualification. She had many years of experience of managing the home and kept herself up to date on relevant issues. She had recently undertaken bereavement and palliative care training and, had the Mental Capacity Act and the Deprivation of Liberty training, scheduled. The provider wrote in the AQAA, the manager has a clear understanding of the aims and objectives of the home, provides an excellent role model for other staff, and the residents respond well to her caring nature. Observations on the day of the site visit confirmed the manager was approachable, Care Homes for Older People Page 25 of 30 Evidence: patient, calm and a good listener to the residents, staff, visiting professionals and relatives, giving her full attention and responding in a considered and caring way. The business and financial arrangements for the home were taken care of by the responsible individual for the company, Mr Paul Rodgers, who introduced himself and offered his support with the inspection process. He stated that the company, which includes Downs House (situated close by), continued to be family run, and that they pride themselves on the personal and individually tailored care that residents receive. The collated results of the most recent quality assurance questionnaires, sent out on a bi-annual basis, recorded high levels of satisfaction with the attitude of the staff. Results confirmed they were always welcoming to visitors and polite and helpful at all times, and comments of, excellent staff, were included. All those who completed the survey thought the food was presented in an appetising manner, and 92 of the respondents thought the meals were tasty and of the appropriate temperature. High levels of satisfaction with the safety and security of the home, and the provision of suitable and sufficient activities and events for the benefit of the residents, were also recorded. Helpful suggestions for improvements were sought and these were included in the development plan for the service over the next twelve months. The AQAA recorded that, residents meetings are no longer held due to the short attention span of the residents, but the manager regularly consults with the residents individually to ensure they remain content. Small amounts of money were held in safekeeping for residents and full accounts were kept of all transactions undertaken, including the retention of receipts. Residents cash was stored in a secure storage facility for protection. The health, safety and welfare of the residents were promoted by regular staff training in moving and handling, fire safety, first aid, food hygiene and infection control. Certificates were viewed on staff personnel files to confirm this. The Annual Quality Assurance Assessment, completed by the responsible individual, confirmed that policies and procedures with respect to health and safety were in place to keep the staff informed, and that the essential maintenance of equipment had been carried out according to manufacturers recommendations to ensure it was safe to use. A sample of certificates were seen on the day of the site visit confirming that maintenance checks had been carried out in a timely fashion. The AQAA recorded that improvements over the previous twelve months included, reviewing and updating risk assessments under the Control of Substances Hazardous to Health (COSHH), reviewing and updating risk assessments to comply with the Health and Safety at Work Act. A recent audit from the Hampshire Fire Safety Officer confirmed the homes compliance with the Regulatory Reform (Fire Safety) Order 2005 and the detailed Fire Risk Assessments for both the building and the residents were approved. Care Homes for Older People Page 26 of 30 Care Homes for Older People Page 27 of 30 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 28 of 30 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 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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