Care Home: Tewkesbury Care Home

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What the care home does well Information is available about what can be provided to help people and their families to make decisions about their future care needs. People can visit to help with these decisions. Tewkesbury Care Home is comfortable and homely. The premises are clean and well furnished. The service makes sure that residents are provided with the support they need. We saw that on the day of the inspection all residents were clean and well dressed. Residents and their relatives are encouraged to be involved in their planning of care. Residents are actively supported and encouraged to maintain family contact, friendships and relationships. Residents are treated with dignity and respect. Residents are helped with their medical appointments and staff work well with other professionals and agencies to provide the health support they need. Medication is well managed, stored properly and given to residents as prescribed by the doctor. Tewkesbury Care Home makes sure that suitable staff are employed and that all checks are made to keep people safe. Residents can choose what they want to eat from the menu. Alternative options to the main menu are provided, and people can have snacks and drinks at all times. There are procedures in place to make sure that where money is managed for residents, it is kept safe. The service is well managed by a competent and qualified management team. People say they are `approachable` and `always listen`. What has improved since the last inspection? This is the first inspection of the service since it re-opened. What the care home could do better: The care plans to continue with the further development that has started. Key inspection report Care homes for older people Name: Address: Tewkesbury Care Home The Oxhey Bushley Tewkesbury Glos GL206HP     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Dianne Thompson     Date: 1 5 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Tewkesbury Care Home The Oxhey Bushley Tewkesbury Glos GL206HP 01684850311 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): tewkesbury@majesticare.co.uk Ross Healthcare Ltd Name of registered manager (if applicable) Mrs Jenifer Lesley King Type of registration: Number of places registered: care home 74 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Tewkesbury Care Home stands in a pleasant, landscaped garden providing seating for residents and relatives to sit outside when the weather permits. The home is conveniently situated within the boundary of the town of Tewkesbury. There is ample parking at the home for visitors. The service provides a vehicle for transportation of residents, which is suitable for people with a physical disability. The registered provider is Ross Healthcare Ltd and the registered manager is Mrs Jennifer King. Care Homes for Older People Page 4 of 28 Over 65 74 0 0 74 Brief description of the care home Tewkesbury Care Home is registered to provide nursing care and accommodation for a maximum of 74 residents with a physical disability or frailty due to old age. The home has been extensively refurbished and extended following the floods of 2007. There is good access to the home and accomodation is provided on the ground floor. Up to date information relating to the fees charged for the service is available from the home. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection to see what the service was like for the residents of Tewkesbury Care Home. A key inspection looks at all essential aspects of operating a care home. This type of inspection looks for evidence that shows continued safety and positive outcomes for people who use a service. This was the first inspection since the home has re-opened following the floods of 2007. The inspection took place during one day and the manager was present during part of the inspection. The manager, the deputy manager, and members of the staff team provided assistance during the inspection. The manager completed an Annual Quality Assurance Assessment (AQAA) and sent this to Care Quality Commission. The AQAA is where the manager tells us about the service provided at Tewkesbury Care Home and how they plan to develop the service. Care Homes for Older People Page 6 of 28 Three residents were identified for close examination by reading their care plans, risk assessments, daily records and other relevant information. This is part of a process known as case tracking where evidence of the care provided is matched to what life is like for residents living at Tewkesbury Care Home. Time was spent talking with residents, visiting relatives and some staff. We looked to see if residents were being kept safe and how the service listens to residents views about their life at the home. We saw how staff spoke to and supported residents, and we looked round the home to see what the standard of accommodation was like. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Tewkesbury Care Home gives people information about their service that helps them make a decision about whether their needs can be met. People can be confident that they will be looked after by the staff because detailed assessments are completed to make sure their needs can be met before a service is offered. Evidence: There is detailed information about the home available to prospective residents to help them make a decision on whether they would like to stay. We saw copies of the Statement of Purpose that gives information about their policies and procedures, and an information pack that is sent to people enquiring about the home. The service makes sure information is accessible to everyone. The statement of purpose and information about the home are available in alternative formats such as audio. Care Homes for Older People Page 10 of 28 Evidence: The manager said in the services Annual Quality Assurance Assessment (AQAA) that we have a comprehensive brochure pack sent out when the first enquiry is made. The manager carries out the pre-admission assessments which now includes a mental capacity assessment. We spoke to people living in Tewkesbury Care Home and looked at their care records. We saw that each person had a pre-admission assessment completed by the manager or the deputy manager of the service prior to their admission. All documents are completed with involvement of prospective residents, their relatives, advocates and any other interested parties. Pre-admission assessments include details of likes and dislikes, mobility, medication, personal safety and risk. The assessment procedures makes sure that people are fully involved in their assessment and that visits to other interested parties take place to help with gathering information. We saw copies of Community Care assessments received from local authorities. Information from these are used in assessment and subsequent care planning. People using the service told us that the staff are very helpful, staff are excellent here, nothing is too much trouble and all staff speak to you. A visitor spoken to confirm they had been given information about the home and that the manager had spent some time with them showing them around. They said they are always made to feel very welcome. Staff confirmed they had been given information to make sure they can give people the support they need. Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Tewkesbury Care Home keeps care plans up to date to make sure that people can be confident they will receive support for their specific care needs. The management of peoples health and medicines makes sure that people are kept well and safe. Evidence: People living in the home looked well cared for and were clean, their hair had been groomed and nails were trimmed and clean. All residents were well presented and wore clothes reflective of their choice and time of year. Care records for three people were identified for close examination by reading their care plans, risk assessments, daily records and other relevant information. This is part of a process known as case tracking where evidence of the care provided is matched to outcomes for residents. Information obtained from a care needs assessment is used to develop a care plan. A care plan tells staff about the persons care and social needs, and the level of support they need to maintain their well-being. Care plans were available for the identified Care Homes for Older People Page 12 of 28 Evidence: needs for each person as stated on their initial assessment. For example, there was a section on mobility in the care plan stating that support was needed from 2 staff to enable a person to get out of their chair. Staff confirmed they were aware of this. One resident explained how staff supported them during the morning by coming to wake them up at the time they had requested and then bringing breakfast to them in their room. Later, they would then come back and help them to get dressed. One resident said they like to have a lie in some mornings and that they can go to bed when they want to. People living at the home and their relatives confirmed that they had access to their care plan, and that they receive the support as shown in these care plans. The manager said in the services Annual Quality Assurance Assessment (AQAA) that service Users are encouraged to make their own decisions about how they live and that care plans are detailed to reflect person centred care. The manager said that all care plans are currently being revised to the new, updated format. We saw care plans where this had been completed. The manager said they are working to complete this work as soon as possible so that everyone is working to a consistent format. All resident care files contained risk assessments relating to mobility, falls and nutrition as well as other assessments linked to the environment such as hot water. We saw records to show how a consistent weight had been reached for one person through careful monitoring and nutritional support. The manager said she is completing a deprivation of liberty check list for each resident to identify if any care practices within the home would deprive them of their liberty whilst residing at the home. No residents have been identified to require an assessment at this time. From the care plans we could see that regular reviews of individual care needs are being carried out and that further three monthly care plan reviews with people who use the service and their relatives are undertaken. Staff confirmed that they are informed when there are any changes to care plans and that they are fully aware of how people want their personal support provided to maintain each persons dignity and right to privacy. We spoke to people who confirmed they are always given personal care with dignity and respect. They always knock and ask me what I want to do, staff are always polite, they never rush me and always give me plenty of time. Staff were observed talking to residents and Care Homes for Older People Page 13 of 28 Evidence: visitors throughout the day, their manner was always polite, cheerful and respectful. Tewkesbury Care Home has suitable medication policies and procedures in place. Information about each persons health needs are detailed in their care plan. Information includes prescribed medication and possible side effects. For example one record showed that carbamazole tabs, to observe for headaches, nausea, gastro intestinal disturbances, or rashes. We checked the storage and administration of medication in the home. We saw that all medication was stored correctly in a locked medication trolley. All medication was available as prescribed and records show that medication is administered as instructed by the doctor. Photographs of each person for whom medication was prescribed and a signature list of all staff who administer medication was seen. The manager tells us in the AQAA that registered nurses have current PIN number and keep their practice updated with relevant training. Time was spent with the deputy manager who administered medication during the inspection visit. The deputy manager confirmed that nursing staff are regularly supervised and are supported to keep up to date with their training. Medication records show that regular medication audits are completed. The manager said in the AQAA that monthly audits to include accident, complaints, medication, pressure sores, weights, waterlows, maintenance, fire are completed. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Tewkesbury Care Home are supported to take part in social and leisure activities and to maintain contact with their families and friends so that they have a meaningful lifestyle. People are able to choose from a varied, wholesome and appealing menu to help them maintain their health and well being. Evidence: Social activities are provided regularly and there is a daily social activity schedule on display showing planned activities. Staff confirmed these take place on most days. Activities include trips out, walks around the garden and locally, and regular hair dresser appointments. The home has a salon that the visiting hair dresser uses. The manager said in the services Annual Quality Assurance Assessment (AQAA) that we have links with local community, input from the church and entertainment visits the home. We provide activities five days a week. Recent events held at the home are: Balloon Race, Morris Dancers, School singers, Thai Tasting, Strawberry Fayre, Masked Buffet, Charity coffee mornings, Clothes show. We have a trolley shop for Service Users to purchase from. Service Users privacy is respected they have private phone lines and areas to meet their visitors. Regular Service Users meetings. Care Homes for Older People Page 15 of 28 Evidence: On the day of the inspection a group of people from the British Legion were visiting for a themed activity, a 40s war time theme with cakes, food, songs and memorabilia of the time. This was a very well received activity and supported by many of the residents who seemed to be having a very good time. Staff said they held a BBQ the previous Saturday with friends, visitors, families and prospective residents invited. Time was spent talking with staff responsible for coordinating activities who said singing sessions are always very popular so we plan these regularly. The home has landscaped gardens with attractive open and courtyard areas with ample seating arrangements. Staff talked about gardening activities and said they recently had a sunflower growing competition and grew tomatoes in raised beds in the courtyard. People can choose to take their meals in their rooms or eat in the dining areas off each of the lounge areas. We saw that people could choose from a wide range of breakfast options that included cereals, yogurts and fruit, a full English breakfast, or any preferred combination. All meals are buffet style and people can help themselves or be served as they prefer. All tables are laid with table cloths, napkins and glasses available on each table together with a copy of the menu card for the day. Meals are prepared in the main kitchen, and transferred to dining rooms. Meals are served from a portable hotplate and staff said they like to make sure all food is served hot. On the day of the inspection the main meal was a choice of pork escallop with mashed potatoes and vegetables, or omelette. Staff confirmed there is usually a choice of 2 main meals but other options such as salad, or baked potatoes are provided if preferred. Some people need help with feeding. Where people need to have their food liquidised, the food is presented in individual portions not as one combined mix. We were told by one resident that they like their sherry, and staff confirmed that this is available before lunch if people want it, or any other time if they wish. Residents are encouraged to give feedback on the meals at any time and during their regular monthly meetings. Residents we spoke to said the food is very good here and the meals are very varied - its like being in a hotel, I like the meals we get here. Residents confirmed that the chef speaks to everyone each afternoon for their menu choices for the next day. Visitors can help themselves to refreshments in the Care Homes for Older People Page 16 of 28 Evidence: communal mini kitchen that has been especially built. Visitors are also welcome to have meals. Afternoon tea and cake is served from a trolley, with a light evening meal such as quiche, salad, scrambled eggs served at tea time. All residents have their own fridges in their rooms so they can store their own food, snacks and drinks for when they want them. Staff offered cakes from the trolley to people who were not joining in the 40s activity session of the afternoon. Cakes had been made as 40s style for the occasion. Visitors are welcome at all times. We spoke with people visiting at the time of the inspection who confirmed they can come and go as they wish, made very welcome by all staff staff are very helpful and make sure all their relatives needs are met. One person was celebrating their birthday on the day of the inspection. Visitors commented its lovely here its like a hotel. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Tewkesbury Care Home feel confident their concerns will be listened to and acted upon. Systems are in place to protect residents from abuse to ensure their safety and well being. Evidence: Tewkesbury Care Home has a complaints policy and procedure in place. A copy of the complaints procedure was seen on display in the main entrance to the home. No complaints or allegations of abuse have been received by Care Quality Commission (CQC). All comments from residents whether they are good, bad or just requests are recorded appropriately. The complaints log shows that 8 complaints have been logged, with 1 complaint having been referred to Adult Protection currently being investigated. Reasons for complaints varies from issues about recent fee increases, lost property, bell responses to one complaint about the food. All complaints, process and outcomes have been clearly documented, with planned actions in place where complaints had been upheld. Discussions with residents in the home confirmed that they feel at ease with staff and feel they can openly make comments about daily matters in the home without any fear of reprisals. People we spoke to confirmed they know who to talk to if they have a concern or a complaint. Care Homes for Older People Page 18 of 28 Evidence: We saw the compliments folder in which there are many letters and cards thanking the manager and staff for care given to relatives, for the events they are invited to and for birthday celebrations arranged for residents. A visitor to the home said that the staff are brilliant at communicating with them, and they had no complaints whatso-ever about the home. There is a policy in place in the home on adult protection with the procedure for reporting abuse on display on the notice board. Staff have also attended training on how to recognise abuse and when questioned were able to state what they would do if this was witnessed or reported to them, this included reporting it to the manager or deputy manager. Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience 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 pleasant and comfortable environment which is clean and well maintained to ensure residents can be cared for safely. Evidence: Tewkesbury Care Home is set in the countryside just outside the town of Tewkesbury. It has been totally refurbished and an extension to the main building has been built following the floods of 2007. The building has been designed so that all bedrooms have views of the gardens. There are separate lounges with dining areas, a library area, lounge areas for quiet times and a main lounge for larger social gatherings. One lounge has a flat screen TV that is used for playing DVDs. Seating in the lounge areas is arranged so that people can interact if they wish in small groups. There are landscaped gardens and courtyard areas where people are able to walk, and various seating areas where people can sit and enjoy the garden safely. There are many flower filled hanging baskets and planted tubs throughout the gardens. A feature of all the garden areas are the bird tables which provide continual interest for the residents. These bird tables attract a wide variety of birds as observed throughout the inspection. The home is beautifully furnished with good quality furnishings and added touches which are evident throughout the home, such as the tissues in all lounge areas in Care Homes for Older People Page 20 of 28 Evidence: coordinating tissue storage containers. Welcome packs for prospective residents were seen on the beds in the vacant rooms. There is a lovely atmosphere throughout the home. It is clean and tidy and there were no unpleasant odours noted. It was evident that there were disposable aprons and gloves available to staff as well as liquid soap and paper towels at all hand wash basins to wash their hands. Staff were busy but not intrusive, and engaged well with residents and visitors. It was noticed that all staff spoke to everyone including all visitors to the home. Visitors commented its like a hotel. Bedrooms are spacious and pleasantly decorated. It was evident that residents had been encouraged to personalise their rooms to make them more homely. Each room has a lockable storage facility so residents can lock away any personal possessions and there is a call bell facility to all rooms. The manager said in the services Annual Quality Assurance Assessment (AQAA) that the home is well maintained with plenty of day space for Service Users. We have extra bath and shower facilities. The environment is warm and homely. Maintenance records are kept up to date. Staff have received infection control training. We have adapted equipment for Service Users with limited mobility, e.g. hoists, Zimmer frames, grab rails throughout the home and in bathrooms. We provide a comfortable and safe environment for our residents. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents feel that their needs are being met by the skill mix and numbers of staff. Suitable recruitment procedures are in place to safeguard residents. Evidence: Staff within the home were observed to be friendly, caring and supportive to residents. Residents we spoke to were happy with the staff and comments include they always listen and do their best for me, and there are always enough staff. Time was spent talking with a visiting health professional, who evaluates service provision on a regular basis for those residents who are receiving nursing funded care. Comments included this is one of the top nursing homes in Worcestershire, have never had any problems here, staff are responsive to all situations and changing care needs. Any requests made of staff are always done, we never have to chase up , check or remind staff about anything, staff are always helpful, there is a good rapport, they are proactive and manage care for people with complex needs. The manager said the staff rotas are created to reflect the skill mix and continuity of care. The service employs registered nurses, care staff and ancillary staff. The service does not use agency staff. Staff have access to appropriate training. We saw training records to show that the majority of staff are up to date with this, or that training is planned to bring them up Care Homes for Older People Page 22 of 28 Evidence: to date. This includes training in health and safety, fire, manual handling of residents, food hygiene and the protection of vulnerable adults. Additional training courses include continence care, dementia awareness, NVQ, palliative care, and ethics, morals and confidentiality. Pressure sore training is completed by all nursing staff. New staff complete induction training. The manager confirmed that 60 of staff have NVQ Level 2 in Care and another 16 are working towards the qualification to help them provide more effective care to the residents. The manager said in the services Annual Quality Assurance Assessment (AQAA) we have our Investors in People award. Registered Nurses have current PIN number and keep their practice updated with relevant training. Induction programmes are completed for all new staff members. A Compliance Manager has been appointed to make random visits to the service to monitor all staff files. New staff files were viewed to confirm appropriate recruitment procedures had been carried out. New staff had the required Protection of Vulnerable Adults (POVA) checks, criminal records checks and two written references had been obtained as required. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by an experienced and qualified manager who manages Tewkesbury Care Home in the best interests of the residents. Evidence: Tewkesbury Care Home provides residential care for older people and nursing care. The registered manager Jennifer King is a qualified nurse who has many years experience working in health and social care. She has been in her management role for 8 years and has completed her Registered Managers Award (RMA). The manager confirms that she keeps up to date with best practices and changes in legislation. This has included working to the new requirements around deprivation of liberty which could impact on residents in the home. The manager is devising ways to determine if residents need to have a formal assessment in relation to this. The manager and deputy manager demonstrated a good level of knowledge about the home and the residents care needs. Residents spoke highly of the managers and confirmed that they felt able to talk to them and that they would be listened to. Care Homes for Older People Page 24 of 28 Evidence: Visitors confirmed that the management team are approachable and always make time for you. Quality monitoring is carried out in various ways. Surveys are given out to residents on a regular basis to obtain feedback. Residents and staff meetings are held regularly and notes are kept. One of the residents meetings included a discussion on menus, the garden furniture being uncomfortable and social activities. New cushions for the garden furniture were purchased as a result of this feedback. We saw that all documentation in the home is audited on a monthly basis and records of these are kept. The manager said in the services Annual Quality Assurance Assessment (AQAA) the Quality Assurance Audit has been done this year and we are working through the action plan. The service also completes regular audits to maintain their Investors In People award. Policies and procedures are in place to support people with their finances should this become necessary. The manager said in the AQAA that all monies are kept in the safe and records are regularly audited. Health and Safety is being well managed and there are good operational systems in place. We saw records that show that regular safety checks are carried out. Staff complete mandatory training in areas such as areas of fire safety, first aid, food hygiene and infection control, moving and handling training. Staff supervision makes sure that people are clear about their roles and responsibilities. Staff confirmed that regular supervision takes place. The service has a signature sheet in place for staff to sign to confirm they have read the policies and procedures. These procedures are in place to help staff maintain and promote the safety of people within the home environment. Risk assessments are completed for areas such as fire safety, water systems, equipment and regular maintenance and servicing of equipment. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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