Care Home: The Chace

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What the care home does well The Chace ensures it could meet peoples` needs before they move in. The manager meets possible residents to assess their needs and they can visit and stay at the home to check it suits them. This also helps staff get to know them and the care they need. Residents` relatives surveys show they are happy with the home. Three comment that `a warm, caring and friendly service is given` and `each client is treated with respect` and staff have `care, compassion and patience with clients and their families`. Three care professionals are also positive about the home. One commenting in their survey that `The Chace is a pleasure to visit. There is always a happy atmosphere and it maintains the sense of a small, friendly, family type home`. Each resident has a plan showing their needs, likes and dislikes and possible risks to their health and safety. Plans help staff know and give people the support they need. Residents receive good personal care. Staff also ensure they have good health care support, promote healthy lifestyles and manage their medicines safely for them. Residents are given opportunities to take part in a range of activities in the home and to socialise and go out in the community. They also have healthy meals they enjoy. The Chace has a lovely village setting and garden. The home is well kept, furnished and decorated and offers a pleasant, comfortable, safe and clean home to residents. Staff have training about how to keep people safe. The home also takes up necessary checks on new staff to help make sure they are suitable to work caring for people. The home has ways of checking it is doing things right and that good quality care is being given to residents. Plans are also made to continually improve the service. What has improved since the last inspection? Since the last inspection of The Chace, which was carried out on the 30th of April 2007, the following improvements to the service have been made:The home assesses the needs of possible new residents more fully. This helps the manager decide if the home would be able to give people the support they need. Better assessments are made about the potential risk of residents developing pressure sores and of their appetite and diet having an adverse affect on their health. The range of leisure and therapeutic activities in the home has been developed and new recreational and IT equipment bourght for residents to use. A record is kept of complaints to show how they were investigated and dealt with. New carpets and flooring have been fitted in some communal parts of the home and some bedroom shave been refurbished. This makes the home nicer for residents.The ways service quality is reviewed includes residents` and other peoples` views. This helps them plan how to improve the home as residents want and/or for their benefit. What the care home could do better: When residents` plans are `person centred` and focus on their wishes and goals they should have support needed to meet them and benefit from a more individual lifestyle. Provide clear plans for staff about identified risk areas for residents so they know how to manage them. Records should also detail incidents and how they were looked at and dealt with so that plans can be reviewed and updated better. Give staff instruction and make sure they would know how to report any incidence or suspicion of abuse or neglect outside the home, for the protection of residents. The home should find out more information from people wanting to work at the home in one aspect. This is part of the way that helps care services ensure staff are suitable. Arrange more training for staff related to care practice and residents` special needs. This would help staff understand and be able to offer them support in a better way. If staff have regular individual supervision from managers it would better ensure they are doing their job well, have the training they need and develop their skills. Ensure all staff take part in a fire drill when they are new and then at least once a year. This should help them deal better with a fire in the home to keep people safe. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Chace Chase Road Upper Welland Malvern Worcestershire WR14 4JY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Christina Lavelle     Date: 2 9 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: The Chace Chase Road Upper Welland Malvern Worcestershire WR14 4JY 01684561813 Telephone number: Fax number: Email address: Provider web address: enquiries@thechase.com www.thechace.com Name of registered provider(s): Name of registered manager (if applicable) Chace Rest Home Limited Type of registration: Number of places registered: care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 34 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 34, Old age, not falling within any other category (OP) 34, Physical disability (PD) 26 Date of last inspection 34 0 26 Over 65 0 34 0 Care Homes for Older People Page 4 of 30 Brief description of the care home The registered provider is Chace Rest Home Limited and the owner is Mr Anthony Reeley. The Chace can provide accommodation with personal care for up to 34 people who must be over the age of 65. The home can provide care for older people who require care because of physical disabilities and/or dementia. The number of places available for people with physical disabilies is limited to 26. Respite care and a day care service are also provided. The home is situated in the village of Upper Welland, which is near the town of Malvern. There is a rural bus service close to the home. The property consisits of an original building, formerly a country manor house, and a large extension with a lovely garden. The accommodation is available on two levels in both parts of the building. The home offers 14 bedrooms on the ground floor, 12 of which have ensuite facilities. There are 18 bedrooms on the first floor, 17 with ensuite facilities. There are four bathrooms, three of which are adapted for people with physical disabilities plus a shower room that is also adapted for people with disabilities. Hand rails are provided in corridors and a shaft lift is available for access between floors. Information about the service is provided in a statement of purpose and service users guide, available from the home. Fee levels are agreed between the home and people using the service (and their funding authority if applicable) depending on their assessed needs. Up to date information about fees should be obtained from the home. Additional charges include such as hairdressing, chiropody, personal toiletries, extra continence aids, newspapers, magazines, holidays and transport for hospital visits. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This is a key inspection of the service provided by The Chace care home. This means all the standards that can be most important to people who use care services are assessed. As part of this inspection we, the commission, spent eight and a half hours at the home. Our visit was made without telling staff or anyone using the service beforehand. People who are living or staying at the home are called residents by staff and it was agreed to refer to them as residents in our report. We use a range of evidence to make judgments about the quality of the service, focusing on how well outcomes are being met for people by the home. The way the home is run and plans to improve the service were discussed with the owner and the new manager Mrs Lynn Burton. We also spoke with other staff, including two senior carers, two care workers, the cook and activities organiser. We spent time with residents in their sitting areas, speaking to three people privately in their bedroom. Care Homes for Older People Page 6 of 30 We had a tour round parts of the building. We also checked some records that care homes are required to keep. They include residents care records and others about staffing, the premises and health and safety. An annual quality assurance (AQAA) was completed before our visit, as required. The AQAA asks managers to say what their home does well, could do better and about their plans to improve the service. It gives us some numerical information about residents, staff and other aspects of the service. All other information we had received about the home since the last inspection is considered. This includes events that had affected the health, safety and welfare of residents (these are called notifications). Two complaints were made to us about the service alleging poor practice and neglect of residents. These matters were referred under multi-agency safeguarding procedures and investigated by the provider. Health care professionals were also involved and appropriate action was taken by the home to monitor and review the issues. Steps were taken to increase management support and to ensure good communication and working relationships with health care professionals so that residents health needs are identified and dealt with proactively. What the care home does well: What has improved since the last inspection? Since the last inspection of The Chace, which was carried out on the 30th of April 2007, the following improvements to the service have been made:The home assesses the needs of possible new residents more fully. This helps the manager decide if the home would be able to give people the support they need. Better assessments are made about the potential risk of residents developing pressure sores and of their appetite and diet having an adverse affect on their health. The range of leisure and therapeutic activities in the home has been developed and new recreational and IT equipment bourght for residents to use. A record is kept of complaints to show how they were investigated and dealt with. New carpets and flooring have been fitted in some communal parts of the home and some bedroom shave been refurbished. This makes the home nicer for residents. Care Homes for Older People Page 8 of 30 The ways service quality is reviewed includes residents and other peoples views. This helps them plan how to improve the home as residents want and/or for their benefit. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may wish to live or stay at The Chace can be confident the home could support them. This is because a full assessment is made of their needs, which they and people close to them are involved in. This tells staff about them and the support they will need. The home does not provide an intermediate care service. Evidence: The previous inspection and AQAA confirm that the home provides the required information documents, which are a statement of purpose and service users guide. The guide can be provided in a different format if anyone needs this. Both are included in a welcome pack with photographs of the home and a monthly newsletter, available from the home. Four peoples relatives confirm in their surveys they were given enough information when considering The Chace as a home for their family member. We discussed the processes for the assessment and admission of potential residents with the manager and staff, which confirms how they describe them in their AQAA. We Care Homes for Older People Page 11 of 30 Evidence: also looked at the care records of two people who had recently moved into the home and discussed their admission experience with several of the residents . The manager meets people at their current residence, having obtained information from any existing assessments made by their social worker or hospital staff. The home now uses a pre-assessment tool, which the manager completes detailing peoples needs and preferences, if they are not already known to them. This forms the basis of their initial care plan. Three care professionals confirm in their surveys the homes assessment arrangements usually ensure that accurate information is gathered and the right service planned. Introductory visits are then arranged to the home, which can be for the day or for a short stay, followed by the offer of a trial stay of four to six weeks. Residents confirm that they were given the opportunity to visit, one saying they were happy for their relative to check out the home for them and another who had stayed for a weekend. The home allocates a senior staff member to people when they are having a trial stay to welcome them and help them settle in They also involve their family and relevant professionals in reviewing and making the decision about whether the home could meet their needs and if living at the home will suit them. A contract is then agreed between all relevant parties covering fee level and any additional charges. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents personal and health needs are being met. If their care plans involved them more they could better reflect their wishes and goals and how staff could help them to meet and/or achieve them. Peoples medicines are managed safely in the home by staff who also provide support in a way that respects their privacy and dignity. Evidence: We looked at four residents care records and discussed care provided by the home with staff and residents during our visit. Each resident has a care plan based on a needs assessment showing support staff should give them. Plans cover relevant areas such as mobility, food and drink, physical, social and emotional and care. They include some background details, peoples food likes and dislikes and preferred routines. It is clear that the home has a person centred approach to care, which means that staff treat residents as individuals. The new manager has recognised however that the homes care planning system needs development so there is more focus on peoples wishes and goals, instead of mostly on their needs and how staff should meet them. They have started to help residents make up life books with pictures and information Care Homes for Older People Page 13 of 30 Evidence: about their family, history and interests as part of developing person centred planning. Residents should also be as involved as they can be in drawing up their own plans and regularly reviewing them. Their relatives or advocates could also have more input, especially when people whose frailty or condition limits their ability to express their views and preferences. Some of the plans we saw also needed to be reviewed and updated so they reflect peoples changing and current needs. Care staff should have an active role in care planning and reviews, as they work most directly with residents. It is good that the manager plans to develop a keyworker system, whereby care staff are allocated to particular residents. They should have time to offer these people more personal support on a one to one basis and so can get to know them better and ensure their plans reflect their wishes and goals. In respect of residents personal and health care their plans show the support they each require from staff. Four residents say they always receive the personal care they need and one of their family comments my relative is always dressed nicely. Health care advice and input is appropriately sought by the home from GPs, nurses and specialists and we observed senior staff are proactive in doing so. Three health care professionals confirm this, one saying that communication between them and the home has improved recently and is very good. Two indicate the home always acts on their advice to improve health and wellbeing and one usually. Records are kept of health care input, treatment and appointments attended by each resident. When necessary physical checks are made by staff such as weight, with records kept. Risk assessments are made in relation to each residents dependency, nutrition and risk of pressure sore development. There are also general risk assessment checklists covering possible hazards in the home environment and when people go out. Some residents have specific risk assessments due for example to falls, dietary needs and behaviours arising from dementia. Although staff we spoke to know about and how to deal with these risks there should be clearer management plans in place. The home should also ensure staff fully record all incidents in respect of these identified risk areas with actions that have been taken and outcomes so they can monitor and analyse them to show that risks are being reduced and managed appropriately. Regarding residents medication the last inspection found people were receiving their prescribed medication safely. The AQAA confirms that the home has a policy and procedures for managing medicines and residents ability to self administer is appropriately risk assessed. A NHS pharmacist carried out an audit of the homes Care Homes for Older People Page 14 of 30 Evidence: medication system recently that was satisfactory with only a few advice points made. We found during our visit that medicines are stored securely in the home and that suitable arrangements are in place for storing and dealing with controlled drugs. It is considered good practice however that internal and external medicines are stored separately. We saw that records of medication prescribed to residents, kept in the home and administered by staff are maintained appropriately. This includes for all medicines received by the home so that there can be an audit trail. There is a list kept of all staff who are designated to administer medication and they have all been through a formal training process for the safe handling of medicines. We observed that staff offered residents support and interacted with them in a caring and respectful way. Residents told us staff always knock on their doors to afford them privacy and respect their chosen routines, food preferences etc. They can have their own telephone, their mail is given to them unopened and they can receive visitors in their bedrooms when they wish. Whilst this is all positive when care plans are reviewed and updated it should be ensured that comments seen in one persons needs assessment such as they are incontinent due to laziness are reconsidered because they are judgmental and do not reflect an understanding or respectful attitude. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Chace provides a range of activities for residents to take part in and to socialise and go out in the community. Their independence is encouraged and they can make choices about their lifestyle. Staff support residents relationships with their family and friends and make people welcome in the home. Food provided by the home is varied and healthy and residents have the diet they need and meals they enjoy. Evidence: The home employs a specific staff member on four weekdays whose remit is residents welfare and occupation and as the AQAA says to help them exercise choice and control over their lives. This person (called the OT/Welfare manager) arranges various activity sessions, entertainment and outings to offer stimulation and opportunities for residents to join in activities, socialise within the home and be part of the community. Music workshops and exercise sessions take place in the home weekly. The OT meets new residents to discuss their interests and social needs so that the home can try and meet them. Notes are kept of the outings and activities that each person has participated in with comments about if they enjoyed them or not. This information should be incorporated in their care records, as they show how the home is meeting individuals social needs and what they are doing in their daily lives. Care Homes for Older People Page 16 of 30 Evidence: It is good that the OTs role and hours have been extended and there is commitment to offering more leisure and therapeutic opportunities. The OT has also completed training to help residents with their postural stability for falls prevention as well as therapeutic activities for people with dementia. The OT would like to involve care staff more in the activity and therapy sessions. Staff we taled to understand their role in providing social stimulation as well as personal care and say they make efforts in the afternoons to sit and spend social time with residents. Residents have the opportunity to attend church services and local clergy regularly visit. The home has a vehicle and staff aim to take small groups out twice a week for drives, to tea shops, garden centres etc. It was a nice sunny day on our visit and a group went out for a drive to look at the bluebells. Some residents are supported to go to the village shop and a local pub and/or to do their personal shopping on request. Regular meetings are held with residents and staff when leisure activities, events in the home and community, menus, daily living routines and religious observance are discussed. A resident has recently agreed to chair these meetings in future and will also seek the views of residents individually. The home produces a monthly newsletter to keep people informed of changes, the coming months programme of events, activities, outings and to involve them in the day-to-day running of the home. A board in the home shows the day, date and activities being held and could include the menu. Since the last inspection new equipment has been provided for activities and more regular entertainment arranged. Residents can have IT access if they wish and the AQAA says they plan to install digital TV in all rooms, have interactive CDs and DVDs, book more entertainment and hold coffee mornings inviting the local community. Residents confirm their independence is encouraged. They can have drink making facilities and take their meals in their bedroom if they wish. The AQAA states the home allows flexible routines that are service user focused and more able residents say they make choices in their daily lives and routines and staff fit in with them. We found staff to be very welcoming and helpful and saw them taking time to talk with and offer reassurance to confused residents. The AQAA says vistors are made welcome by the home at any time and residents confirm this and that their relatives and friends are offered drinks etc. One relative comments that the home generates a warm, friendly atmosphere to both residents and visitors. Regarding food provided by the home we saw that the kitchen was clean, tidy and Care Homes for Older People Page 17 of 30 Evidence: suitably equipped. The cook we spoke with clearly understands the importance of nutritious meals and how to meet special dietary needs. She knows residents likes and dislikes well although it would be better if she had the opportunity to discuss them directly with new residents rather than obtaining this information through care staff. Menus are set for a four week period show a variety of well balanced meals. Whilst there is not an actual choice of the lunch time main meal alternatives are made if needed or requested and yoghurts or cheese and biscuits are always available instead of the pudding. A cooked dish such as soup, omelette, baked potato and macaroni cheese is also provided at tea time. We saw that food stocks included healthy options such as fresh fruit and vegetables. The cook says that most of the meals, cakes and soups are home made and that very few convenience foods are bought. We saw todays lunch being served out, with trays laid for people who were eating in their bedroom. The meal comprised of gammon, mashed potato, cauliflower, courgette and carrots with home made parsley sauce and looked very tasty. The cook and care staff presented the meals well and know peoples preferred portion size and when for example meat needs to be cut up for them. Staff were available to discretely assist people who needed support. Residents praise the quality of the food and confirm that their meal preferences are taken into account. One care professional thinks that the food is excellent and says residents always comment on their lovely meals. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concerns about the home or their care they know how to complain. Concerns are looked into and action taken to put things right. The home takes action to follow up any allegations and safeguards residents from abuse and neglect. Evidence: The Chace provides an appropriate complaints procedure, which is included in the homes information documents and given to all residents and/or their families and representatives in the welcome pack. The home now has a complaints log to complete when concerns are raised detailing the issues, action taken and outcome. Residents told us they know how to make a complaint. They feel confident to discuss worries with staff, one saying they are always dealt with properly. Staff confirm they would know how to respond if concerns are raised with them. We observed there is an open atmosphere in the home and feedback we received shows people are happy with the home. People are given opportunities to express their views of the service through residents meetings and questionnaires sent to relatives. The AQAA says the home plans to work with external advocates, which would be a positive development. Since the last inspection the commission received two complaints about the home. Allegations were made about poor staff practices and the adverse effects on this on the personal and health care of some residents. These matters were referred under multi- agency safeguarding procedures and the provider was asked to investigate. Care Homes for Older People Page 19 of 30 Evidence: A detailed response was made following aspects of staff practice being monitored and the needs and care of particular residents reviewed. Whilst there was no evidence to substantiate most issues raised it is positive that steps were taken to provide greater management and senior support at the home. District nurses were also involved to check possible risks to some residents and confirm they are satisfied with the care provided. In addition one nurse says communication with the home is now very good and specialist equipment is provided for pressure relief for residents who need them. Policies and procedures are provided by the home on abuse, whistle blowing and for the protection of vulnerable adults (POVA). Management and staff clearly understand their responsibility for residents safety and welfare. The AQAA and staff confirm that new staff receive instruction as part of their induction and staff have had further POVA training. The home should ensure however that all staff are aware of the local multiagency safeguarding procedures to ensure they would know how to report any incidence or suspicion of abuse or neglect oustide the home if they ever needed to. The home carries out necessary checks before new staff start working at the home, including a police Criminal Records Bureau (CRB) check. This helps to make sure that only suitable people are employed to support people using this care service. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Chace provides a comfortable, pleasant and safe environment for residents. The home is kept clean and appropriate steps taken to promote good infection control. Evidence: The Chace is located in the village of Upper Welland, which is about two miles from the town of Malvern. The home has a local shop, Church, village hall and public house and is close to a rural bus route. The home has a lovely setting and private gardens. The AQAA says it is planned to develop a sensory garden, which will be of benefit especially to residents with dementia or visual impairments. The property comprises of an original building, which was a country manor house, and a large modern extension. Accommodation for residents is available on two levels in both parts of the building. Aids and adaptations, such as hand rails, are provided with a shaft lift for access between floors. Some bedrooms have to be reached by a a short stairway and so would not be suitable for people with very limited mobility. The home has two sitting rooms, a separate dining room and other communal areas for residents and visitors. There are four bathrooms and a shower room for everyone to use and all but one bathroom are adapted to assist people with physical disabilities. Each resident has their own bedroom, most having ensuite facilities and the three without a bathroom close by for their sole use. We looked at several bedrooms and Care Homes for Older People Page 21 of 30 Evidence: they are all well personalised. Residents say they like their bedrooms very much and were encouraged to bring their own furniture and possessions. The overall impression of the home is well kept, furnished and decorated and very pleasant and comfortable. The AQAA confirms they have a refurbishment programme and residents are consulted about redecoration of their bedroom and communal areas. We saw that bedrooms are upgraded when they are empty. All areas of the home we visited were found to be clean, tidy and fresh. One family survey says my relatives room is always spotless and residents surveys indicate that the home is always clean and fresh. The previous inspection and AQAA confirm that there are policies and procedures on infection control for staff to follow. Staff receive training on infection control, in fact a group of staff were having a training session at the home today. The home provides staff with personal protective equipment such as aprons and gloves. The laundry has suitable facilities and equipment and there are arrangements in place for the disposal of soiled waste. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has enough staff to provide safe support and to meet the personal and health care needs of residents. People can have confidence in staff because checks are done that help to make sure they are suitable to work in a care service. Staff receive training to keep people safe but more individual support and training on care practice and residents special needs could help them understand and support people better. Evidence: The evidence obtained from our inspection shows that the home has a well motivated management and staff team who offer caring support to residents. One staff says in their survey we try really hard to listen to each resident and meet their requests . The main aims of the service are to promote an open and pleasant environment and individualise care. One resident comments that staff have got the right idea to be as helpful as they can and others also praise the staff. One care professional comments that staff are always cheerful and approachable and know the residents well. Staff feedback confirms that there are sufficient staff on duty at all times to meet residents personal needs. The managers plan to review staffing rotas to make staffing more flexible is good however, as staff say they too busy in the mornings to be able to spend any social time with residents. There has been quite a high staff turnover in the last 12 months and two relatives say that more consistency would be good. Staffing does seem to have stabilised because agency staff are not being Care Homes for Older People Page 23 of 30 Evidence: deployed and there is only one staff vacancy currently. Regarding staff recruitment we talked to a new member of staff and looked at the records of the two newest staff. This confirms that the home had taken up necessary references and checks (including a CRB police check) before they started work at the home. Although they had written all their previous jobs on their applications any gaps in their employment should also be explored with an explanation recorded. New care staff appropriately work shadow shifts and have to work a six month probationary period before their appointment is confirmed and a contract of employment agreed. Just over half care staff team have achieved a National Vocational Qualification (NVQ) in social care and more staff are working towards NVQ. The same ratio completed induction training that meets with approved specifications. The managers plan to set up a mentorship scheme and for senior staff to have training on supervision would be positive developments. Some staff have received training on dementia but more training on this and other relevant topics such as conditions associated with age related frailty, person centred planning and communication could help them to do their job, understand residents needs and be able to support them better. The AQAA says care staff have supervision sessions but this seems to have lapsed. The managers plan to build on training and development should include regular formal individual supervision. Each staff member should also have a training and development assessment and profile based on an assessment of their work performance and training needs. Their plan to introduce annual appraisals is positive. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Chace is led and managed in an appropriate way that meets residents needs. There are systems in place to review practice and the quality of the service to ensure it continually improves, as residents want and/or for their benefit. The environment is kept safe for people because staff follow relevant health and safety procedures. Evidence: There has not been a registered manager at the home since January 2009. However the provider Mr Reeley, who was previously registered as manager for 15 years, has been working at the home full time since then. A new manager Lynn Burton was recently appointed and will be applying for registration. Ms Burton is suitably qualified and has extensive experience in residential care and management. The home has three senior managers and three senior carers who share management tasks. We saw and feedback received indicates that management is open and approachable. Staff feel that communication between them has improved and one comments we are looking forward to a positive and forward thinking management structure. The Care Homes for Older People Page 25 of 30 Evidence: evidence obtained from this inspection confirms that the staff team are clear about the aims and objectives of the service and are well motivated to provide good quality care. The AQAA includes clear, detailed information about what the home does well and how this results in good outcomes for residents. It shows improvements that have been made in the last 12 months and includes their plans to make further improvements and develop the service to benefit residents and in line with currently accepted good practice. The home operates a quality monitoring and assurance (QA) system as required to review how the service is operating. This includes the views of residents and their relatives, who are sent questionnaires, the results of which have been analysed and made public. Their plan to work with external advocates will extend this. The Chace has achieved awards through external QA organisations Investors in People and Classic Homes. Regarding health and safety the previous inspection and AQAA confirm that the home has required policies and procedures in place. Risk assessments related to the environment and substances hazardous to health (COSHH) are carried out and/or in place. Staff have training in all mandatory health and safety topics, although some staff had not taken part in a fire drill as part of their induction or at least once a year as they should. The information in the AQAA confirms that regular servicing and maintenance of the electrical and fire safety systems, heating and gas appliances and the lift and hoists continue to be arranged at the expected intervals. There were no safety hazards observed in the home environment during our visit. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 The home should progress with their plan to implement more person centred care planning. This means focusing more on identifying residents wishes and goals and the support they need to meet or achieve them, which will also help to individualise the care they receive. Residents plans should include clear guidelines on how staff should manage identified risk areas. Records should also detail all related incidents and how they have been investigated, reviewed and any actions taken. All staff should receive specific instruction on local multiagency safeguarding procedures that is regularly reinforced with them through training, staff meetings and supervision. This is to make sure that all staff would know where to refer and report any incidence or suspicion of abuse or neglect of outside the home, for residents protection. A system should be put in place so that before new staff are appointed any gaps in their employment record are explored and an explanation obtained and recorded. This is part of the process that helps to make sure they are suitable people to work in a care service. 2 7 3 18 4 29 Care Homes for Older People Page 28 of 30 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 5 30 The home should arrange more staff training relevant to care practice and the special needs resident. Care staff should also receive regular individual supervsion and each have a training and delopment assesment and profile. This would help them understand residents needs and how to support them better and ensure their work performance is monitored and their training and development needs are met. Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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