Care Home: Sunrise Operations of Winchester Limited

What the care home does well Some comments from the residents and their relatives with respect to `what the home does well`, included, `Decor and cleanliness are outstanding`, `a good range of activities are provided`, `the building is new and like a good hotel. We have our own bathroom and small kitchen`, `there are constant activites during the day, and they look after individual`s needs,` `a friendly, relaxed atmosphere`, `Sunrise`s success is due to its selection of staff, they are wonderful personalities, so helpful and provide loving care`, and `the staff are very kind and always ready to talk and listen to any ideas, comments and difficulties`. The home provides excellent accommodation and supports the residents to retain their independence by providing them with domestic facilites, to enable them to continue to be self-suffient for as long as they are able. The main meals are provided restaurantstyle in very pleasant surroundings, and support is given sensitively to residents, when required. Snacks and drinks are available twenty-four hours per day in the Bistro. The Reminisence unit is well-equipped with a sensory room, and activities are designed to promote reminisence. The home has a minibus to support residents to access the community and residents are encourage to maintain relationships and interests they had established, prior to being admitted to the home. Pets are welcomed, taking away the strain of emotional loss from the residents of being parted from treasured companions, and residents are supported in their care. The home has a resident cat, offering unconditional affection to all. No expense has been spared in providing an excellent, safe, homely, comfortable and interesting environment for the residents. What has improved since the last inspection? This was the first inspection of a new service. What the care home could do better: More consistency in the leadership of the health and social care aspects of the service would inspire more confidence in these outcome areas for the residents Key inspection report Care homes for older people Name: Address: Sunrise Operations of Winchester Limited Sunrise Of Winchester Stockbridge Road Winchester Hants SO22 5JH     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: Christine Bowman     Date: 2 6 0 5 2 0 1 0 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 27 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Sunrise Operations of Winchester Limited Sunrise Of Winchester Stockbridge Road Winchester Hants SO22 5JH 01962814400 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): winchestered@sunriseseniorliving.com www.sunrise-care.co.uk Sunrise Operations of Winchester Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 103 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is : 103 The registered person may provide the following category/ies of service only: Care home with nursing (N) to service users of the following gender: Either whose primary care need on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE) Date of last inspection Brief description of the care home Sunrise Operations of Winchester is a large nursing home, located on the outskirts of Winchester, and within easy reach of public services and facilities. It is provided by an American care provider, Sunrise Senior Living, and can accommodation up to 103 older Care Homes for Older People Page 4 of 27 Over 65 0 103 103 0 Brief description of the care home people, who may require nursing care and/or have dementia. The home is purposebuilt to a high specification, has Assisted Living Neighbourhoods for older people on the first and second floors and a Reminiscence Neighbourhood, specifically designed for people with dementia, on the third floor. Although fully registered as a nursing home, the aim is to provide nursing care for up to 25 residents at any one time. The focus for residents accommodated in the Assisted Living Neighbourhoods is to maintain independent living skills, and personal and social care can be purchased by the hour to support them. The home has the ambiance of a hotel, and car parking facilities are provided to the front of the home, and there is a large garden to the rear of the building for the enjoyment of the residents. Care Homes for Older People Page 5 of 27 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 was the first unannounced key inspection of a newly registered service. Before we visited the nursing home, we looked the information gathered about the service since it was registered six months ago. The appointed manager sent us the Annual Quality Assurance Assessment (AQAA), when we asked for it. This document gives us up to date factual evidence about the running of the home, informs us of what they think they are doing well, how they had improved the service over the previous six months, and of their plans for further improvements. Unfortunately, the appointed manager, who was in the process of applying to be the registered manager of the home, had since left, and the newly appointed manager, was not available to be interviewed. The site visit was carried out on 26th May 2010, over six hours and we met the general manager, who assisted with the inspection process by making residents and staff files and other records available to be sampled. We looked at the communal accommodation and two residents suites. We observed and spoke with a number of residents and staff throughout the day, as they went about their daily lives. We looked Care Homes for Older People Page 6 of 27 at the statement of purpose, residents assessments and care plans, risk assessments, medication records, staff personnel files, policies and procedures and other records. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can decide if this care home is able to meet their support and accommodation needs because detailed information about the home is available to them. They can be confident the home is able to support them because a full assessment of their support needs is carried out before a placement is offered. Evidence: The statement of purpose contained all the required information a prospective resident and their representatives would need to decide if the home could meet their needs. The philosophy of care promised residents that, their individuality would be celebrated, their independence and safety promoted, their privacy and dignity respected and that, their spirit would be nurtured. The Statement of Purpose was available in alternative languages on request, on tape or in large print for those with visual impairment. Care Homes for Older People Page 10 of 27 Evidence: The assessment documentation of four residents, admitted since the service was registered in October 2009, were sampled. Personal information was recorded including family background, education and occupation, social activities, hobbies, and religion to enable the care plan to meet the individuals equality and diversity needs. Health background and health care professionals, such as General Practitioner (GP), already providing a service to the resident were recorded, to ensure continuity. Full nursing assessments had been completed for residents requiring nursing care. Personal care needs had also been assessed, and goals and plans were in place for meeting these needs. The AQAA recorded that, a full assessments of prospective residents needs is carried out by a senior nurse before admission and that families are involved where possible. A General Practitioners report was also sought as the residents were all privately funded. Intermediate care was not provided. Care Homes for Older People Page 11 of 27 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. Care plans address the residents health, personal and social care needs and safe arrangements are in place for the safe handling of medication to protect them. The residents right to privacy is upheld and their dignity maintained. Evidence: As part of the inspection process the care plans (Individual Service Plans) of four residents were sampled. Each file contained a colour photograph of the resident for easy identification, and personal information, including the involvement of health care professionals. Religious, psychological and social needs and interests were recorded to promote an individual approach. Nutritional, falls risk and waterlow risk assessment had been completed for residents with nursing needs. Care plans set out the residents needs and objectives under personal care, mobility, communication, eating and drinking, nutritional needs, skin integrity, breathing, safe environment, social activities, spiritual needs, pain management, and psychological needs. Care plans recorded the action care staff (care managers) were required to take to support the residents to meet their objectives in retaining their independence Care Homes for Older People Page 12 of 27 Evidence: in daily living skills. Residents or their representatives had signed the care plans and the risk assessments viewed on the residents files. Moving and handling risk assessments had also been completed, where required, and the equipment used to support the individual residents with their mobility needs was recorded with instructions to the staff with respect to the support required. External healthcare was accessed with respect to physiotherapists, chiropodists, dentists and opticians, as required by the residents, and a wellness nurse carries out a health monthly check, as recorded in care plans viewed. Residents had been allocated two or three key workers to provide them with consistency and continuity of care. The names of key workers were recorded in residents suites. Although the AQAA had not confirmed the home had a policy for the control, safe storage, disposal, and recording of the administration of medication, a full and detailed policy was available on the day of the site visit, containing clear guidance to the staff. Records inspected had been completed in a satisfactory manner, showing that residents had received the required dosage of their prescribed medication, as set out by their medical practitioners, and there were no unexplained gaps in the recordings. Individual residents records contained a photograph to identify them and most of the residents medication was blister packed at the pharmacy for safety and convenience. The AQAA recorded that regular weekly audits are now carried out to ensure all drugs are accounted for. A check of two residents controlled drug stock, confirmed that the controlled drug register was correct. Records were kept of medication received and disposed of, to ensure it was all accounted for and suitable storage, including a refrigerator, was available to ensure the drugs were safely stored and available to the residents at the correct temperature. The AQAA recorded that residents are asked to bring with them one months supply of medication, when they move into the home, to ensure there would be no delay in receiving it. Observations of the staff throughout the day, confirmed that they were respectful and polite in their interactions with the residents, who appeared to be relaxed and happy in their home. The AQAA confirmed that all new staff had completed the Skills for Care common induction standards, which provide an introduction to the caring role and promote the residents rights to be treated as an individual, with respect for their privacy and dignity. Residents were accommodated single bedrooms, except where couples had chosen to share a bedroom, to enable private consultations with health and social care professionals and privacy with respect to personal care. Care Homes for Older People Page 13 of 27 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: An activities coordinator was employed to arrange the clubs, social occasions, entertainment and meetings, and to coordinate the daily and monthly calendar events and activities. Trips, hairdressing, beauty therapy and chiropody could be booked with the concierge who is on duty from 8.00 am to 8.00pm everyday. The home had its own hairdressing salon, but some residents prefer to use the hairdressing salons in town. The home also had a minibus, and the general manager stated that regular trips were provided two or three times each week to places of the residents choice, such as garden centres, coffee shops, and places of local interest. Clubs included bridge, musical appreciation and gardening. The daily schedule on the day of the site visit, displayed in the Reminiscence Neighbourhood, included baking in the morning, tea and chat in the afternoon and a Care Homes for Older People Page 14 of 27 Evidence: stroll in the garden, followed by a BBC nature video in the evening. A display of photographs in the lobby showed happy residents having their nails painted, baking cakes, and enjoying the sunshine and socialising. The creative frames surrounding the photographs had been designed by the residents, and clay models, resulting from residents creative endeavours, were also displayed. The Reminiscence Neighbourhood was well-equipped with special interest stations, serving as reminders to residents with dementia of important phases of their lives, or of roles they may have played. There was a baby station with a doll in a cot and all the items needed for looking after a baby, a wedding station with wedding dress, and dressing table with jewellery, a desk with stationary, and a dressing-up station with a variety of outfits. The sensory room was equipped with bubble-tubes, colour projector, tactile surfaces, aromatherapy scents and recordings of bird songs. The lights could be dimmed in this room, which provided a relaxing and calming space for residents to enjoy. Residents also had memory boxes at the entrance to their suites, containing familiar items to remind them of where their own front door was located. The wide corridors, with areas of seating areas, provided space to walk around, and finger food was available in the kitchen area at all times. The Assisted Living Neighbourhood, located on the first floor, had an activity lounge supplied with two internet stations, a juke box with a supply of records, a WII console, games, videos, DVDs and a large widescreen television. Large widescreen televisions were provided in lounges throughout the home, as were books, story tapes and selections of compact discs and DVDS. Large print books were also available for residents with visual impairment. The garden had walkways and comfortable seating areas with brollies, to provide shade to the residents when relaxing on hot days, and raised beds to enable the residents to participate in gardening projects. A resident cat provided residents, who might have enjoyed sharing their homes with pets in the past, with a source of unconditional affection and acceptance. This home enabled residents to retain their pets, with support from the staff as required, saving them from the stress and emotional upset of having to part with a best friend, and small dogs were observed entering and leaving the home with their owners, friends and relatives. Visitors were welcomed at any time and residents were able to book a private room to entertain their guests for a meal free of charge. Residents care plans sampled, confirmed attendance at religious services according to their choice. A full list of residents dietary needs and preferences was displayed in the kitchen to Care Homes for Older People Page 15 of 27 Evidence: keep the staff informed, and this information was also recorded in care plans viewed. The dining experience was restaurant-style, with the menu prominently displayed in large print. The two main meal choices for lunch were presented on plates beside the menu, to show residents what to expect. In the Reminiscence Neighbourhood the plates were taken to the tables to help the residents to decide which they would prefer, the general manager stated. In addition to the main choices, other options were available to cater for all tastes. The dining experience was elegant, the dining room light and airy, furnished with comfortable chairs, with supporting arms and casters on the front for easy manoeuvrability, beautifully laid tables with linen table cloths and wine glasses, and pleasant views, through the French windows, of the patio area and gardens. Residents, who needed support, received this inconspicuously from staff sitting beside them. A bistro on the ground floor, located by the entrance of the home, provided snacks and hot and cold drinks twenty four hour per day for the convenience of the residents. Care Homes for Older People Page 16 of 27 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. A satisfactory procedure is in place to deal with complaints, should they arise, and there is a willingness to learn and improve the service to the residents as a direct response to complaints. The recruitment of staff protects the residents, and access to safeguarding training promotes their ability to protect them. Evidence: The complaints and compliments policy and procedure, included in the Statement of Purpose, promised that complaints would be investigated promptly, and that outcomes would be reported back to the complainant within twenty eight days. The Care Quality Commission (CQC) details were included, should anyone wish to make contact. The AQAA, which had been completed in February 2010, recorded that there had been one complaint, which had been fully resolved within twenty-eight working days. Two anonymous complaints, one with respect to insufficient staffing numbers, and another with individual concerns for a resident, had been received by the CQC in February and March, and passed to the Local Authority to investigate as safeguarding issues. Both investigations are now closed to safeguarding, and action plans had resulted in improvements in recording, staff training, and procedures around medication. Procedures with respect to call bells had also improved, with two located in bathroom areas, one in every toilet, one in all bedrooms, and residents had been supplied with call pendants, as required. The staff had pagers and carried communication aids to Care Homes for Older People Page 17 of 27 Evidence: enable them to ensure call bells were answered promptly. The general manager had completed the Residential Forum, which is a tool to enable the home to decide if the right number of people was employed with respect to the needs of the individuals using the service, and she confirmed that the staff numbers are sufficient. She stated that this tool was used on an on-going basis and that staffing numbers would be adjusted as more residents with higher needs were admitted. The home held a copy of the Local Authority Safeguarding Adults Policy and Procedure and a flow chart was available to the staff to inform them of who to contact should an incident arise. The Induction programme includes the Protection of Vulnerable Adults training, and staff files sampled, confirmed that safe recruitment procedures were in place to protect the residents. Care Homes for Older People Page 18 of 27 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 excellent 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 homely, comfortable, safe and well-maintained home, which fulfils their needs and is clean, fresh and odour free. Evidence: The home is a newly constructed and purpose-built property of character, located on the outskirts of Winchester city. A car parking area is provided to the front of the building and to the rear is a large landscaped garden with walkways and sitting areas, flower beds, rose arches, specimen trees, and herbs for use in the kitchen. The entrance hall is impressive with chandeliers, a grand piano, large vases of fresh flowers, framed pictures on the walls, and a concierge on duty at reception, giving the home the ambiance of a high class hotel. The ground and first floor known as the Assisted Living Neighbourhood, provide accommodation for older people, who may require some support from the staff and the third floor is for older people with dementia and is known as the Reminiscence Neighbourhood. The accommodation is of a very high standard, and a variety of living spaces are provided on all floors including sitting rooms or parlours, sun lounges, bistro, activity rooms, sensory room, hairdressing salon, smoking room, and dining rooms on all floors, furnished with good quality domestic-style furnishings providing a homely feel. Domestic-style kitchens and laundry rooms are provided to promote independence, in Care Homes for Older People Page 19 of 27 Evidence: addition to the commercial kitchen and laundry. There are two lifts for accessing all floors and ten assisted spa baths were provided over the three floors. Hoists were available and bathrooms were fitted with grab rails and assisted toilets to suit those with mobility needs. Residents suites viewed were spacious, and contained furniture and personal items brought with them to make the rooms familiar and homely. Photographs were displayed of family members, and it was evident that residents had been encouraged to personalise and make the suites their own home. Suites were provided with kitchenettes and spacious en-suites with walk-in showers, toilets and hand basins of good quality. Fitted wardrobes were provided, but there was sufficient space for residents to bring items of their own furniture. The home was beautifully clean and fresh throughout, and systems were in place to ensure this situation was on-going. The AQAA confirmed that residents laundry was washed separately, and that a system was in place for dealing with soiled laundry. The commercial laundry contained suitable equipment to meet the needs of a large home, and separate domestic laundry facilities were available on each floor to enable residents to wash their own clothes, should they wish to do so. An infection control policy was in place, infection control training provided for staff in induction, and protective clothing was provided to protect the residents and the staff from the spread of infection. Care Homes for Older People Page 20 of 27 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. Efforts are being made to ensure that there are always sufficient, safely recruited, suitably inducted and trained staff to meet the assessed needs of the residents. Evidence: The general manager stated that staffing levels had improved since the AQQA was completed in February, and that there are now sixty-three staff with contractual hours, and sixteen bank staff to cater for the individual needs of the seventy-one residents currently living at the home. The AQAA recorded thirty three care and nursing staff, and twenty-five staff employed in other roles, such as catering, maintenance, housekeeping and administration. The usage of agency staff had decreased since that time, resulting in improved continuity and consistency of support to the residents. We had received some feedback from four residents and four staff, who completed a surveys in March. Two of the staff thought there were usually enough staff to meet the individual needs of the residents, one thought there sometimes were, and one that there never were. Comments from residents with respect what the service could do better included, the home is always under-staffed, we need more staff and higher management need to come up with a solution to staffing issues. The general manager confirmed that a recent recruitment drive had been successful and that by the end of May, the home would have a full complement of its own staff and would no longer need to rely on agency staff. Care Homes for Older People Page 21 of 27 Evidence: Currently, there are only three residents with nursing needs, living at the home, and of the fifty-four residents living in the Assisted Living neighbourhood, eight had no care support requirements. The staff rotas were displayed in the Reminiscence neighbourhood with photographs to inform the residents when the staff would be on duty. Each shift had a team leader and there were five care managers (care staff) working in the mornings, and four in the afternoons. Overnight two waking night staff were on duty in this area. The AQAA recorded that only three of the thirty three care staff, working at the home at the time, 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. The general manager stated that currently fifty-five percent of the staff had either achieved or were working towards an NVQ. The files of two staff were sampled and they confirmed that all the necessary preemployment checks had been carried out for the protection of the residents, including two written references, the Protection of Vulnerable Adults First, and Criminal Record Bureau checks. The staff personnel files were well-organised, had an audit sheet containing important information including, the dates the recruitment checks had been returned, and the date the employee took up employment. The application forms contained a full employment history and required that gaps in employment be explained. Reasons for leaving previous employment were also explained, and a declaration of no criminal convictions had been signed, to ensure that only suitable people would be employed. The staff induction programme was based on the Skills for Care Common Induction Standards, which is an introduction to the caring role, which promotes the residents rights to be treated as an individual, and have their equality and diversity needs respected. Stages of completion of the full induction programme had been signed off by the employee and their supervisor to confirm competence in the staff files sampled. Initial induction consists of three weeks mandatory training and then shadowing shifts with experienced staff, which were recorded in the staff files sampled. All new staff are provided with a handbook giving them important information about the organisation. Care Homes for Older People Page 22 of 27 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 home, which is generally well managed, and in which their opinions are sought and acted upon for the improvement and development of the service. More consistency in the leadership of the health and social care aspects of the service would inspire more confidence in these outcome areas for the residents. Effective systems are in place to promote the residents health, safety and welfare creating a safe environment for them to live in. Evidence: In the relatively short time the service had been registered with the Care Quality Commission, the original Responsible Individual had been replaced, the registered manager had left the organisations employment, a second manager had applied to be considered as the registered manager for the home, but has now tendered her resignation, and a new manager has been recruited. She is a registered nurse, but was not in post on the day of the site visit. The home has a general manager, who takes responsibility for the business aspects of the management of the home, and provides consistency of leadership, ensuring that a suitably qualified nurse is always Care Homes for Older People Page 23 of 27 Evidence: on duty, and that the manager post with responsibility for managing the health and welfare of the residents, is promptly filled. The management structure includes the general manager, the registered manager, and two care coordinators, each taking responsibility for the nursing and care needs of the residents in either the Assisted Living or the Reminiscence neighbourhoods. Monthly visits had been conducted on behalf of the provider, and action plans produced with respect to improving the service. Regular meetings are conducted with families to gain feedback on the quality of the service, and a system was in place to send out annual quality assurance questionnaires, but the home had been open for only six months, and therefore this had not taken place at the time of the site visit. The AQQA recorded that residents handle their own money or it is handled by relatives on their behalf. Small amounts of money can be held by the administrator for residents and this money is safely stored in the home safe and appropriate records kept. On the day of the site visit, training in the Control of Substances Hazardous to Health (COSHH) was taking place with an external provider. Staff records confirmed that at induction new staff received training in fire, Infection control, food hygiene, moving and handling, and health and safety to promote the health, safety and welfare of the residents. The general manager confirmed that all the senior staff had completed a four-day First Aid course and that there were always two first aiders on duty. Certificates confirmed that equipment had been serviced or tested as recommended by the manufacturer or other regulatory body prior to registration. A full independent fire risk assessment had been carried out, and sprinkler systems were in place. Regular fire alarm tests take place weekly and fire drills monthly. Care Homes for Older People Page 24 of 27 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 25 of 27 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 26 of 27 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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