Care Home: The Briars

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What the care home does well The home has pre-admission procedures which ensures that the home only admits people whose needs it can meet. People are provided with comprehensive information about the service. One external professional added in their comment card that the home has an `excellent reputation within the community`. All evidence indicates that people`s personal care needs are met. People stated in comment cards that they were happy living at the home and felt that their needs were met. External health and social care professionals commented on the good continuity of care and staff having good knowledge of service users. They also identified that the home did well with `knowledge of service users, attention to detail`, another stating that `staff are very aware of peoples needs and conditions`. Care staff stated that they felt they provided `good person centred care and good end of life care`. The home provides an excellent range of activities, both individual and in groups. Care staff or external professionals provide activities. The home has its own minibus and outings are arranged with consideration of where people would like to go and what they would like to do. People are offered choice and decisions are respected. A person who lives at the home added the comment `the home tries to help residents to join in various activities and interests and holds meetings to get the residents views and ask if there is anything they would like for a change`. An external health professional added the comment that the home `provides the perfect environment for staff and clients to reach their potential in an holistic supportive manner`. People receive a nutritious balanced diet with choice and special diets catered for. The home employs appropriate numbers of care staff that ensure that people`s needs are met. Staff receive the necessary training including NVQ`s and training specific to the needs of the people living at the home. Seventy-four per cent of care staff have an NVQ of at least level 2. Additional comments about what the home does well were added by several staff stating that the home provides good training. The home has an excellent management structure with senior staff having designated management roles and responsibilities. The home has a variety of quality monitoring systems and the views of people who live at the home are regularly sought and their opinions respected and acted upon. What has improved since the last inspection? Although there were no requirements made following the previous inspection in November 2006 some areas that the home could improve were identified in the report. The home has addressed these issues and made further improvements following quality assurance work and consultation with the people who live at the home. The home has a programme of redecoration and replacement of fixtures and fittings and has further plans to improve parts of the homes environment. What the care home could do better: The home continues to be extremely well managed for the benefit of the people who live there with a clear management structure and defined management roles. The home has clear ideas of how it would like to improve the service provided in the future for the continuing benefit of the people who live at the home. There were no requirements or recommendations made following this inspection. Key inspection report Care homes for older people Name: Address: The Briars The Broadway Sandown Isle Of Wight PO36 9BD     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: Janet Ktomi     Date: 1 5 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: The Briars The Broadway Sandown Isle Of Wight PO36 9BD 01983403777 01983407422 briars@greensleeves.org.uk www.greensleeves.org.uk Greensleeves Homes Trust care home 32 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) : 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: 32 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Dementia - DE Date of last inspection Brief description of the care home The Briars is a large detached property located on a prominent corner site in the coastal town of Sandown. There are bus stops located close by and parking available at the home or in streets nearby. The original building has been extended and now provides thirtytwo single bedrooms all with ensuite facilities. The home has appropriate bathing, WC and communal rooms. All parts of the home are accessible via a passenger lift or stair lift. The grounds to the front of the property have been landscaped and the paths provide Care Homes for Older People Page 4 of 31 32 0 Over 65 0 32 Brief description of the care home wheelchair access. The home has aviaries in the rear garden with a range of birds and animals (chipmonks and rabbits) for the benefit of the people who live at the home. The home is owned by Greensleeves Homes Trust and Mrs Fiona Regan is the homes registered manager. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: The home previously had a key inspection in November 2006 and Annual Service Reviews ASR in April 2008 and October 2008. This report contains information gained prior to and during an unannounced visit to the home undertaken on the 15th October 2009. All core standards and a number of additional standards were assessed. The visit to the home was undertaken by one inspector and lasted approximately eight hours commencing at 9.45 am and being completed at 6pm. The inspector was able to spend time with the registered manager and staff on duty. The inspector was provided with free access to all areas of the home, documentation requested and people who live at the home. Prior to the inspection visit the registered manager completed the homes Annual Quality Assurance Assessment AQAA and information from this is included in this report. Information was also gained from the homes service file containing notifications Care Homes for Older People Page 6 of 31 of incidents in the home. Surveys were sent to the home for distribution prior to the inspection visit. Five were received from people who live at the home, four from people who work at the home and four from external health and social care professionals. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? Although there were no requirements made following the previous inspection in November 2006 some areas that the home could improve were identified in the report. The home has addressed these issues and made further improvements following quality assurance work and consultation with the people who live at the home. The home has a programme of redecoration and replacement of fixtures and fittings and has further plans to improve parts of the homes environment. Care Homes for Older People Page 8 of 31 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 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents and their representatives have the information needed to choose a home which will meet their needs. People or their representatives are able to visit the home prior to admission to assess the quality of facilities and suitability of the home. All people are assessed prior to moving into the home to determine that their individual needs can be fully met. Standard 6 is not applicable as the home does not provide intermediate care. Evidence: The registered manager explained the homes admission procedure and the preadmission assessments for two people admitted shortly before the inspection visit were viewed. The inspector discussed admissions with care staff and people who live at the home. Information in surveys received and the homes AQAA are also considered. Care Homes for Older People Page 11 of 31 Evidence: The registered manager stated that if an initial inquiry from either social services or from a persons family indicates that the home would be able to meet the persons needs the registered manager will arrange to visit the person, either at their home or in hospital. A comprehensive pre-admission assessment is completed including where possible members of the persons family and professionals involved in their care. Care manager assessments are obtained when people have a care manager. The prospective service user and their family are provided with information about the home and where practicable are invited to visit the home before making a decision as to whether to move in on an initial trial basis. When the person to be admitted is unable to visit the home a relative is invited to view the available room and facilities at the home. The home uses an assessment tool devised by the provider which includes a standard assessment form with an additional form that can also be used when people have dementia. The assessment tool covers all the relevant areas necessary for the home to decide if it is able to meet a prospective persons needs. The registered manager stated that she will also visit and reassess people who have been admitted to hospital before they are discharged back to the home to ensure that their needs can continue to be met. The homes AQAA stated that the home had admitted two short term/temporary admissions in the year preceeding the inspection. The AQAA also stated that there had been ten admissions and no placement breakdowns during this time. The registered manager showed the inspector the information provided to service users or their families prior to admission. This contained information about the home including the service users guide to the home, information about the provider trust, pricing information and other information that may be helpful to prospective residents including information from existing residents and photographs of the home. On the day of the unannounced inspection visit the registered manager was due to visit a potential new admission and had a pack of information and assessment forms ready to take with her. Surveys were received from five people who live at the home, all stated had received enough information before admission about the home to decide if it was the right place for them. Discusions with people living at the home during the inspection confirmed that people or relatives had visited the home prior to admisison and that they had received written information about the home. Care Homes for Older People Page 12 of 31 Evidence: Discussions with care staff confirmed that they felt that they had enough information about new people admitted to the home and that they had the necessary training to meet peoples needs. Four external health and social care professionals completed surveys and all stated that assessment arrangements ensure that accurate information is gathered and the right service is planned for people. The home provides all people with a copy of the terms and conditions of residency. A blank copy being seen with the service users guide and this provides relevant information about the terms and conditions of occupancy. The home does not provide dedicated accommodation for intermediate care or specialist facilities for rehabilitation. Care Homes for Older People Page 13 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health, personal and social care needs are set out in an individual plan of care that states how individual needs should be met. Medication is correctly stored administered safely and full records are maintained. People are treated with respect and their dignity preserved. Evidence: Four care plans were viewed, two for people admitted to the home shortly before the inspection visit and the others for people who have been living at the home for a longer time. The inspector discussed with staff and people who live at the home how care needs are met. Surveys completed by health and social care professionals, service users and staff are considered as is the homes AQAA. Manual handling practices in communal areas were observed during the inspection visit. People have a detailed plan of care that related to the persons assessment. The care plans are individualised and person centred providing appropriate individual information as to how needs should be met. Care plans contained information about decision making and peoples preferences as to how their care needs should be met Care Homes for Older People Page 14 of 31 Evidence: such as preferred times for getting up and going to bed. Care plans are reviewed on an as needed or monthly basis. Service users or their representatives had signed to confirm their agreement with their care plan and reviews. The home uses a key worker system with the name of the key worker stated on the care plan. Photographs were seen in care plans. Also viewed were records of daily care provided by care staff which indicated that care was being provided as detailed in care plans. The home also maintains additional records of care provided for some people and these were viewed for one person including records of when they had been assisted to change their position and when food and fluids had been offered and how much received. Care plans contained relevant risk assessments and management plans including nutrition, falls, pressure injuries and any individual risks such as those resulting from memory loss. The home monitors peoples weight on a monthly basis with records seen. Staff were also aware of how to monitor peoples weight when scales could not be used. Care staff spoken with said that communication about peoples needs was good with a handover at the start /end of each shift. Care staff also stated that they felt they had sufficient time and training to ensure they were able to meet peoples personal and health needs. Staff appeared to have time to meet peoples needs on the day of the inspection visit. Four health or social care professionals completed surveys. All stated that peoples health and social care needs are properly monitored, reviewed and met and that the home seeks advice and acts on it to meet peoples social and health needs and improve their well being. Five comment cards were received from people who live at the home. Four stated that they always and one usually receive the care and support they need. All stated that the home makes sure they get the medical care they need and one added an additional comment saying I get to see a doctor when I want one. Discussions with people during the inspection visit confirmed that they felt their health and personal care needs were being met. Observation also indicated that health and personal care needs were being met. Care plans viewed contained individual manual handling assessments. Manual handling equipment was viewed in the home and care staff stated that they had received manual handling training and this was recorded on the homes training matrix. During the inspection visit staff were observed using manual handling equipment in communal areas. The procedures observed were appropriate and full Care Homes for Older People Page 15 of 31 Evidence: explanations were given to service users throughout the procedure. Whilst viewing the home equipment to meet the needs of people was seen including manual handling equipment, pressure relieving equipment and falls prevention equipment including infra light movement detectors, pressure mats and tab monitors. The home is an extended property with bedrooms on the ground, first and second floor. Social and health professionals stated in comment cards that they felt that staff treated people who live at the home with dignity and respect. People who live at the home stated that staff are nice and respected their rights to privacy and dignity. Observations of staff interactions indicated that people are treated with respect and their right to dignity maintained. Privacy and dignity are included in the homes induction training. All bedrooms are for single occupation with en suite facilities providing privacy for personal care. Care staff confirmed that they had sufficient time to meet peoples needs and discussions indicated that they had a good understanding of individual peoples needs and how these should be met. Care staff have received training to meet the general and specific needs of people. The registered manager identified in the AQAA the homes plans for improvement over the next year including developing a training plan for Dementia mapping and how the environment could be further improved to reduce risks relating to challenging behviours, risks and falls. The senior staff member responsible for medication explained how this is managed in the home, storage facilities and related records were viewed. Staff also described the procedures used to administer medication to people. These indicated that medication is stored and administered correctly. The home has the necessary storage facilities for medication that must be kept at cooler temperatures and for controlled medications. Medication administration records had been fully completed with no gaps. Care plans contained information as to when individual as required medication should be administered with a copy of this held with the medication administration records. No concerns in respect of medication were raised by health or social care professionals in surveys they completed. Training records and care staff confirmed that they have undertaken medication training. Medication is audited as part of the homes quality monitoring systems. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The routines for daily living and activities are flexible and varied to suit peoples individual needs and wishes providing a range of opportunities for people to have a stimulating and interesting life. Family and friends are able to visit. People receive a balanced diet in pleasing surroundings at times convenient to them. Evidence: The inspector spent time talking with people in the homes lounges and observed part of the lunchtime and teatime meals and afternoon activity organised by activity staff. Information about social activities and preferences was viewed in care plans. Discussions with people who live at the home and staff along with comment cards from service users, staff and external professionals and the AQAA completed by the registered manager are also considered. The routines for daily living and activities made available are flexible and varied to suit peoples individual needs. People living in the home are able to spend their time in the home where they wish, people were seen sitting in all of the homes various communal rooms with some having chosen to remain in their bedrooms. People were also seen moving around the home as they wished. The home has a medium sized pleasant garden which has paved paths and level access from the home. The garden contains Care Homes for Older People Page 17 of 31 Evidence: raised flower beds which some service users had been involved in caring for. The garden also has an aviary with rabbits, chipmunks and birds. People living at the home are encouraged to visit the animals and assist in their care should they wish to do so. Care plans contained individual information such as times people like to get up and go to bed. Some of the people living at The Briars have age related memory loss and care plans contained life history information and recorded peoples likes and dislikes, previous leisure interests and religious needs. People confirmed to the inspector that they are given choice over many aspects of their lives and that staff respect their choices. People were seen eating different meals, sitting in different places and choosing to join in or not with activities. Bedrooms seen contained personal items brought into the home. The inspector observed activities during the day of the unannounced inspection visit. The home has visiting entertainers and its own activity organisers. The home has its own minibus and trips out are arranged. People informed the inspector that they had enjoyed these in the summer and the activities organiser was arranging a trip for the day following the inspection to a local donkey sanctuary. A notice board in the hall listed planned activities and events. Examples of art and craft work completed by people was seen on display around the home as were photographs of activities and outings that had occurred. The registered manager explained that people are encouraged to be active members of the community and that along with the local rotary club the home has raised money to support local charities including sponsoring a Romanian child to visit England. The home also has a fully equipped hair dressing room on the second floor. Information about religious needs is included in care plans and the registered manager stated that she has contact details and would arrange visits from appropriate ministers and clergy if this were requested or identified as a need. The home has a church service every six weeks provided by a local vicar. The home does not have a private room for visitors however the home does have a number of communal areas and a small conservatory off a lounge that could provide a private space for visitors if required. People were observed visiting during the inspection and the visitors book evidenced that people are able to visit at any reasonable time. Care Homes for Older People Page 18 of 31 Evidence: The home has several separate dining areas. Most people were seen to have chosen to have their lunchtime meal at the dining tables with staff observed taking meals to people who had chosen to remain in their bedrooms. People living at the home informed the inspector that they had enjoyed their lunch which had included red cabbage from the homes garden. The inspector was present for the main lunchtime meal and lighter teatime meal. People were seen to be eating the meal and most of the plates emptied. Care staff were seen providing assistance in a non obtrusive manner. Equipment to promote independence such as lipped plates and adapted cutlery was available. Drinks and snacks are also available throughout the day with people confirming this as well as the inspector observing people being given morning and afternoon hot drinks and biscuits. One of the lounge diners has a fridge with transparent front containing a range of cold drinks, juices and snacks which people can help themselves to if they wish. The inspector observed people getting themselves drinks and snacks throughout the day. The registered manager stated that following changes in the homes kitchen staff a cooked breakfast is now provided with breakfast and other snacks now being available from the kitchen at any time throughout the morning. The registered manager stated that the home aims to introduce a higher level of flexibility for the lunch time and evening meals to enable people to have their meals when they want them and not at set times. The need for special diets or supplements as well as peoples likes and dislikes is recorded pre admission. Discussion with the home kitchen staff confirmed that they were aware of special dietary needs and individual likes and dislikes of the people who live at the home. Care Homes for Older People Page 19 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. People are protected from abuse. Evidence: The home has a clear complaints policy and procedure and a copy is in the service users guide and further information on display in the homes entrance hallway. Discussions with staff confirmed they were aware of what to do if a person or their relative complained or raised an issue. The manager identified in the homes AQAA that the home had received six complaints in the past year two of which had been upheld. The homes complaints log was viewed and this evidenced that where appropriate complaints were referred to the local safeguarding team for external investigation. The registered manager stated that as part of the regulation 26 visits to the home by a representative of the provider any complaints investigations are reviewed. All five service users who completed comment cards stated that they knew how to make a complaint and who to talk to if they were unhappy. External health and social care professionals stated in comment cards that the home had responded appropriately if they had raised concerns about the service. Four staff completed comment cards and they stated that they knew what to do if someone had a concern about the home. Care Homes for Older People Page 20 of 31 Evidence: During the visit to the home the inspector spoke with people who live at the home. They stated that they would raise a concern or make a complaint should the need arise. The inspector observed a service user raising an issue when they thought they had ordered a different meal at lunch time. This was appropriately dealt with by the carer who changed the meal. This evidenced that people feel able to raise issues and that peoples views are listened too. The home has a policy and procedure relating to safeguarding adults and ensuring that people are not at risk of abuse. Care staff have safeguarding adults training and related training such as challenging behaviour, mental capacity act and deprivation of liberties. Discussions with care staff indicated they had an understanding of safeguarding and what they should do if they suspected abuse may have occurred. The homes policies and procedures in respect of peoples personal finances should ensure that people are not at risk of financial abuse. Bedrooms viewed had a lockable facility for people to keep valuables. The homes recruitment procedures should also protect people. Care Homes for Older People Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean, safe, well maintained home that meets their individual and collective needs. Evidence: The inspector viewed the home with the registered manager and viewed records related to services such as gas and electric and fire safety equipment. The inspector also discussed the homes environment with care staff and people who live at the home. Service user comment cards and the AQAA completed by the registered manager are also considered. The home is situated in a large older house that has been extended at various times. All bedrooms are for single use and have en suite facilities. Bedrooms seen are well maintained and individually decorated and furnished. The home has a shaft lift and all parts of the home are accessible to people with mobility needs. The home has the necessary moving and handling equipment and baths are fitted with hoists. The registered manager stated in the homes AQAA that following discusion with people who live at the home they now have lounge dining areas rather than one specific room to eat in and the other a lounge. People were observed moving freely about the home with corridors being fitted with grab rails to aid mobility. The home also has a hairdressing room. Care Homes for Older People Page 22 of 31 Evidence: Some bedrooms on the ground floor have been fitted with overhead track hoists to enable staff to provide safer transfers for people with poor mobility. The home has a range of equipment for moving and handling and for detection of movement (infra light detection systems)and tab alarms to alert staff that people assessed as being at risk of falling may be moving around their rooms. Staff maintain contact with each other via walkie talkies eliminating the need to search for other staff if they require assistance to meet a persons needs. All areas are fitted with a call bell system. Communal areas and hallways had been decorated with artwork produced by people who live at the home. The home has pleasant well kept gardens accessible via the lounge/dining areas. This has paved pathways and raised flower beds. People confirmed that they had enjoyed using the garden in the warmer months. The garden houses several aviaries where birds, rabbits and chipmunks live. The home was clean and tidy throughout and there were no unpleasant odors. At the time of the visit the home was comfortably warm throughout. No concerns about the homes environment were raised in any comment cards received from staff, service users or external health or social care professionals. People who live at the home confirmed that the home is always warm and clean. The home employs housekeeping and maintenance staff. The laundry was visited and is appropriate and fit for purpose with machines capable of washing to disinfection standards. The home has an infection control policy and procedure and all staff receive training in infection control. Members of staff spoken with confirmed that they had access to all the necessary equipment to prevent cross infection such as disposable gloves and aprons, supplies of which were seen during the visit to the home. Substances hazardous to health (COSHH) were stored securely. Certificates seen confirmed that the homes services such as gas and electric have been checked and serviced as appropriate. Portable electrical appliances are regularly checked. The records for the checks of fire detection and fighting equipment were viewed and confirmed that the necessary checks are undertaken on all the homes fire equipment. The registered manager stated in the homes AQAA that the homes fire detection system had been improved the previous year providing fire panels on each landing to improve fire evacuation times should the need arise. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home employs appropriate numbers of care staff to ensure that the needs of people living at the home are met. Staff receive the necessary training. The home has thorough recruitment and employment procedures that should ensure that people are safe. Evidence: All comments from people who live at the home, and in surveys received from health and social care professionals were positive about care staff. Additional comments from a person who lives at the home included the staff are very kind and caring to me and another they are always supportive and around when I need them. An external professional adding staff very aware of peoples needs and conditions and another knowledgeable of people who live at the home and have attention to detail. Duty rotas were seen during the visit to the home and a list of who is on duty each day is provided in the entrance hall. These evidenced that five staff are provided throughout the morning and afternoon shifts with three staff at night. The home also employs a cook, kitchen assistant, housekeepers, laundry, administration and maintenance staff. During the inspectors visit staff on duty corresponded to those on the duty rota. One of the four comment cards received from staff stated that they felt that the home needed more staff, the others felt that there were ususally enough staff to meet peoples needs. Care staff spoken with on the day of the inspection visit Care Homes for Older People Page 24 of 31 Evidence: stated that they generally have sufficient time to meet peoples needs and throughout the inspection care staff appeared to have time to meet peoples needs. Comment cards were received from five people who live at the home with four stating always and one usually that staff are available when they need them. They all stated that staff listen and act on what they say. The registered manager described the homes recruitment procedures and the records relating to three new members of care staff were viewed. These evidenced that the home has thorough recruitment procedures and that all the necessary preemployment checks are carried out including at least two references, POVA and CRB checks. The home also has comprehensive induction procedures with staff undertaking shadow shifts until they are felt to be competent. A new member of care staff was due to undertake a shadow night shift on the night following the inspection visit. Discussions with care staff confirmed that new staff undertook induction and shadow shifts. Care staff stated that they felt they had the necessary skills to meet peoples needs and were not expected to undertake activities for which they had not been trained. Care staff stated that they have lots of training. The inspector was shown the homes training matrix which evidenced that staff have received all mandatory training and additional service specific training to give them the skills to meet peoples needs. The registered manager stated on the homes AQAA that the home has been awarded the investors in people status for the second time. One of the senior staff is allocated time each week for training and has completed a learning and development NVQ. The home has its own NVQ assessors with the registered manager stating that the home has seventy-four per cent of care staff with an NVQ many with a level three qualification. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager has the necessary experience and qualifications to manage the home. The management of the home is based on openness and respect. The home has excellent quality assurance systems in place to ensure the quality of the service provided and to ensure the continued development of the service based on the opinions and needs of the people who live there. Evidence: The AQAA completed by registered manager, surveys completed by staff, service users and external professionals are considered along with records viewed during the inspection visit. The registered manager has the required qualifications and experience and is highly competent to run the home and meet it stated aims and objectives. The registered manager stated that she has a HND in social care, Registered Managers Award and is an NVQ assessor and internal verifier. The registered manager stated that she undertakes regular updates of mandatory training with other staff in the home and Care Homes for Older People Page 26 of 31 Evidence: additional training relevant to the needs of the home. Throughout the inspection visit the registered manager demonstrated that she had a good knowledge of the care needs of the individual people who live at the home. The registered manager stated that she has regular meetings with the other managers of homes owned by the provider and this also helps keep her up to date. The home has various meetings with minutes seen for staff meetings, service user meetings and senior staff meetings. The home has made a number of changes following consultation with service users including having lounge/diners as opposed to separate rooms for sitting and eating in and changes to the menus. There are plans to further improve the service increasing the continuity of staff to service users via allocations of floors and in the way that meals are provided. The home has sent questionnaires to stakeholders and the responses collated with action taken where appropriate. The registered manager completed the AQAA to a very good standard identifying where the home could improve and future plans for the home. A representative of the provider undertakes a monthly unannounced visit to the home to assess the quality of the service provided. A report is completed following these visits and were viewed during the inspection. Reports evidenced that the visits are thorough and cover all aspects of the running of the home and include discussions with people who live at the home and staff. The home also has a range of internal audits completed by the registered manager and senior staff such as on medication and care plans. Care plan reviews include either the person whose plan of care it is or their representative. The home does not become the appointee for, or involved in the personal finances of people who live at the home. Any additional expenses such as for hairdressing or chiropody are invoiced to the person responsible for paying the persons bill. The inspector was shown completed invoices and these clearly showed what extra services were being charged for. The AQAA stated that all bedrooms have a secure storage facility and rooms viewed evidenced this. Care staff stated on surveys and to the inspector that they receive regular supervision and that they are able to approach the registered manager at any time if they had need of support or advice. The AQAA stated that senior staff have recently undertaken a supervisory management course and senior staff spoken with during the inspection visit confirmed that they have received training in supervision and that they provided supervision to care staff. Care Homes for Older People Page 27 of 31 Evidence: Various records identified in the relevant outcome group of this report were viewed during the inspectors visit. All records were appropriately stored with access only available to people who should have access. No concerns in respect of health and safety were observed during the unannounced visit to the service. The home ensures that there are weekly checks of the fire detection equipment. Portable Electrical Appliance Tests PAT, electrical wiring and gas certificates were seen. The local environmental health department has awarded the home five stars, the maximum available, for food hygiene. Accident reports were seen in care plan files and these are reviewed during the Regulation 26 visits to the home. The home has equipment to help prevent falls and risk assessments are in place to assess risks to individual people and manage these. The home notifies the commission and local safeguarding team of incidents in the home which require notification. Information would indicate that the home aims to learn from any incidents and where possible prevent recurrence. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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