Care Home: The Dower House Nursing Home

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What the care home does well There is a relaxed and homely atmosphere. The accommodation is presented to a very high standard indeed. People say that the nurses and care workers are very kind and attentive. They also say that they receive all the nursing care and support they need. People are helped to stay in good health. This includes keeping an eye on how everyone is and then calling doctors as soon as they are needed. It also involves doing various nursing procedures. People`s medicines are handled safely so that they take them in the right way at the right time. Sensible things are done to help prevent people having accidents. People are served with good quality meals. What has improved since the last inspection? The calendar of social activities has been extended. This means that there is a greater variety of social things that people can do if they wish. Special lower fat alternatives have been introduced to the menu. Various items of new equipment have been provided. For example, this includes an additional walk in bath and there is some new laundry equipment. Nurses and care workers have completed various relevant training courses. What the care home could do better: There are several improvements that now need to be made. The Matron has assured us that each of them will be completed. She says that she wants to get them done as soon as possible and well within the timescales that we will tell you about later in the Report. One part of the recruitment system needs to be strengthened. This is so that the Registered Provider can be sure that it has obtained all of the references it needs for new nurses and care workers. There are some gaps in the training records. This means that the Registered Provider might not be clear that all members of staff have done the training that is intended for them. The quality assurance system doesn`t fully involve all of the people who live in the Service. This is important because they`re the experts on what it is like to live in The Dower House Nursing Home. They need to have a direct say in how things are going.Also, they need to be told what is going to be done to respond to any improvements they may come up with. There are some shortfalls in the fire safety regime. These might reduce the level of protection available in the Service. The Registered Provider has not been able to demonstrate to us that the electrical wiring installation meets the required standard. Key inspection report Care homes for older people Name: Address: The Dower House Nursing Home LLP The Dower House Nursing Home LLP Springvale Road Headbourne Worthy Winchester Hampshire SO23 7LD 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: Mark Hemmings Date: 3 1 0 3 2 0 0 9 This report is a review of the 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 stars – excellent  2 stars – good  1 star – adequate  0 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. things that people have said are important to them: 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 They reflect the Care Homes for Older People Page 2 of 32 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. Care Homes for Older People Page 3 of 32 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 4 of 32 Information about the care home Name of care home: Address: The Dower House Nursing Home LLP The Dower House Nursing Home LLP Springvale Road Headbourne Worthy Winchester Hampshire SO23 7LD 01962882848 01962883222 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Dower House Nursing Home LLP Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration Category(ies): old age, not falling within any other category physical disability Number of places (if applicable): Under 65 0 43 Over 65 43 0 care home 43 Additional conditions: The maximum number of service users to be accommodated is 43. The registered person may provide the following category of service only: Care Home with nursing (N) 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) Physical disability -(PD). Date of Date of last inspection: Brief description of the care home: Up to 43 older people can make their home in The Dower House Nursing Home (the Service). The people who live in the Service can receive nursing care as well as personal support. The property is a purpose built nursing home, to which extensions Care Homes for Older People Page 5 of 32 have been added. The accommodation is on the ground and the first floor. There are two passenger lifts and a stair lift that gives step-free access around the place. Everyone has their own bedroom. Each bedroom has got a private wash hand basin and toilet. All but four of them also have a private bath. All of the bedrooms have television points. There are four short stay rooms. These are provided with a television. All of the bedrooms have a private telephone. There is also a call bell system. There are call points in all of the bedrooms and in their private bathrooms. There are also call points in all of the other bathrooms, toilets and communal areas. There are call pendants for use in the grounds. This means that people can ring for assistance. The Service is set in five and a half acres of grounds and is in a semi-rural area. It is about three miles or so from Winchester. There is a pond and bog garden. There is also an internal courtyard that has got seats and a small fountain. There is a local farm shop within easy walking distance. There are plenty of parking areas provided. The Service does not have its own car. The Registered Provider has recently become a Limited Liability Partnership. The Responsible Individual is a legal term for someone who represents the company to us. The Responsible Individual for The Dower House Nursing Home was previously the Registered Provider for the Service. She has been running the Service for many years. The fee for living in the Service runs from £1015 to £1125 per week. Care Homes for Older People Page 6 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: three star excellent service Our judgement for each outcome: How we did our inspection: The quality rating for this Service is 3 Star. This means that the people who use this Service experience excellent quality outcomes. Since 1 April 2006, we have developed the way we do our inspection of nursing and care services. This inspection of the Service was Key Inspection. We arrived at the Service at about ten past eight in the morning and we were there for about seven and a half hours. It was a thorough look at how well things are going. We took into account information provided by the Registered Provider in its self assessment. This is called the Annual Quality Assurance Assessment (the Assessment). Further, we considered Care Homes for Older People Page 7 of 32 any information that we have received about the Service since the last inspection. During the inspection, we spoke with five of the people who live in the Service. We also spoke with the Registered Manager. In our report we refer to her as being the Matron. We also spoke with the Deputy Manager who is a qualified nurse, one nurse, two care workers, the chef, two laundry workers, the Finance Administrator, the maintenance man and the Matrons secretary. We walked around parts of the accommodation and we looked at a selection of key records and documents. Before we called to the Service, we asked ten of the people who live there and 10 members of staff to fill out a questionnaire for us. We wanted them to tell us what they think of The Dower House Nursing Home. Everyone kindly sent them back to us. Later on in our report, well tell you what people are saying in these questionnaires. The Registered Provider has done its own questionnaires. These have asked the people who live in the Service what they think about different aspects of how things are going. More recently, professional visitors to the Service such as doctors and nurses have also been asked to give their views. Well tell you what people are saying in their answers to the Registered Providers questionnaires as we go through our report. Care Homes for Older People Page 8 of 32 What the care home does well: What has improved since the last inspection? What they could do better: There are several improvements that now need to be made. The Matron has assured us that each of them will be completed. She says that she wants to get them done as soon as possible and well within the timescales that we will tell you about later in the Report. One part of the recruitment system needs to be strengthened. This is so that the Registered Provider can be sure that it has obtained all of the references it needs for new nurses and care workers. There are some gaps in the training records. This means that the Registered Provider might not be clear that all members of staff have done the training that is intended for them. The quality assurance system doesnt fully involve all of the people who live in the Service. This is important because theyre the experts on what it is like to live in The Dower House Nursing Home. They need to have a direct say in how things are going. Care Homes for Older People Page 9 of 32 Also, they need to be told what is going to be done to respond to any improvements they may come up with. There are some shortfalls in the fire safety regime. These might reduce the level of protection available in the Service. The Registered Provider has not been able to demonstrate to us that the electrical wiring installation meets the required standard. 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 10 of 32 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 11 of 32 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. People who are thinking of moving in are asked about what support they need and how they want this to be done. People who want to stay for shorter periods will be helped to go back home. Evidence: The Matron asks people who are thinking of moving in about what support they need and want. This is done so that everyone can be confident that moving in to The Dower House Nursing Home is the right thing for them. She also talks with family members and with medical staff. All of this information is collected so that the Matron can build up a really good picture of how the persons nursing and other everyday needs can best be met. After shes got all of this information, she can then decide if the Service can support the person in a way thats right for them. We looked at the information that has been collected for one person who has recently moved into the Service. We wanted to see what sorts of things are being considered. There is lots of useful information. This includes things such as the way they need to be helped to manage their continence at night. There is also information about how they like to be helped to get about. The Matron says that when she gets the information she shares it with nurses and with the care workers. This is done so that they know in advance about what nursing care and support they will need to provide. We asked two nurses and two care workers about how all of this works out in practice. They say that they are indeed told Care Homes for Older People Page 12 of 32 about people who are about to move in. They say that as a team they discuss how best to help the person in the first few days, while they get to know them better. The Matron recognises that moving into a residential setting is a big step for anyone to take. She says that she wants to do everything possible to put the persons mind at rest. We agree that this is really important. She says that as part of the introduction process, people are invited whenever possible to visit The Dower House Nursing Home. This is so that they can see what the place is like first hand. During these visits, people can ask any questions they want. There are also some written documents that say about the Service in quite a lot of detail. These are called the Service Users Guide and the Statement of Purpose. People can ask to see these if they want. The Matron is quite happy for them to take away a copy if they want to have a look at them at their leisure. In our questionnaire we ask people who live in the Service, did you receive enough information about this home before you moved in so you could decide if it was the right place for you? Everyone says that yes they did. We asked one person about this when we were in the Service. They say, I came to look around and everyone was so kind to me and helped me know how things go. I was shown where my room would be and I was told about things like dining arrangements and the support I would get once I moved in. I have been more than pleased with how Ive been cared for since and Im very glad that this place is here. It really is quite wonderful. One care worker says, we take a lot of care when someone moves in because its such a big thing to go somewhere new and naturally people have misgivings. We want to make people feel welcomed from the start so that they arent worried. We make sure that theyre shown round and that theyre gradually introduced to how things go each day. We dont want them to feel overwhelmed by it all. Most of the people who move into the Service do so with the intention of making it their longer term home. However, there is provision for people to stay for shorter periods. This might be so that someone who cares for them at home can have some time to themselves. Or, someone might move in because theyve been in hospital and arent quite ready to go home yet. When someone moves into a residential setting theres always the risk that their stay might become longer than is necessary. The Matron is aware of this. She says that people are helped to make any arrangements that are necessary for them to leave as planned. This has recently been done for one person who moved into the Service so that they could recuperate after an operation. The Matron has liaised with the persons doctor about the arrangements that will need to be made to support the person at home. She has also contacted a specialist nurse who will help the person continue to get over their operation. Care Homes for Older People Page 13 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with the personal and health care they need. Medicines are handled safely. People are treated with kindness and respect. Evidence: The people who live in the Service say that the nurses and the care workers offer them all the assistance they need. There is a written individual plan of nursing care and personal support for each person. These are important because they are one of the ways that people can say what assistance they want to have and how they want it to be done. Also, the plans give information to nurses and care workers so that they know what to do. We looked at three of these plans. They give a clear account of who needs to do what and why. For example, there is useful information about things such as health care, helping people in the bathroom and about keeping people safe. In more detail, one person needs to be cared for in bed. Someone else needs to be supported to keep their skin healthy. We asked two nurses and two care workers about some of these things. We wanted to know what all of this written information means in practice. They know all about it. In our questionnaire for people who live in the Service we ask, do you receive the care and support you need? Everyone says that yes they do. One person adds, I cannot praise the staff enough, for their support and for their efficiency. They have become friends. Our Matron is first class and leads from the front. The Registered Providers questionnaire for people who live in the Service asks, are you satisfied with the way that staff try to help and look after you? Everyone says that its very good. One person adds, yes, very and they are always so cheerful. Another says, the staff are excellent. The nursing and care plans are kept up to date so that they are accurate. This involves nurses and care workers making daily notes about how things are going. Care Homes for Older People Page 14 of 32 There are then monthly reviews. This is when the Matron and the nurses check out with the person concerned, with their relatives and with the care workers how things are going and what might need to be changed. In our questionnaire for people who live in the Service we ask, do staff listen and act on what you say? Everyone says that yes they do. Sensible steps are taken to ensure that people do not have any avoidable accidents. For example, some people are a bit unsteady on their feet. They are accompanied by a nurse or a care worker so that they dont lose their balance. There are special rails fitted to some of the beds. This has been done so that people dont have to worry about rolling out of bed. The Matron and the nurses have carefully checked the use of these bed rails. This has been done to make sure that theyre the most helpful thing to use for each of the people concerned. People are helped to keep healthy. Recently, new lower fat alternatives have been added to the menu. This has been done to make it easier for people to watch their weight so that they can promote their good health. Nurses and care workers keep a tactful eye open so that a doctor can be called if someone is becoming unwell. Since our last inspection, people have seen their doctors as and when necessary. There have also been contacts with specialist hospital based medical staff. We looked at some of the records about how quickly doctors are being called after the need for medical attention is first noted. Its being done straightaway. In our questionnaire for people who live in the Service we ask, do you receive the medical support you need? Nine people reply that they always do and one person says usually. This latter person doesnt say any more about their answer. The Registered Providers questionnaire asks, are you satisfied with the medical and nursing care you receive? Everyone says that its very good. One person adds, very much so, excellent. One of the professionals who completed the Registered Providers questionnaire says the Service is, a model of excellence. At the moment, none of the people who live in the Service manages their own medication. Theyve asked the nurses to do it for them. The Matron says that people will be helped to do their own medication in the future, if they are able and if this is what they want. There is a system to check that the correct medicines are received from the chemist. Once in the Service, they are stored securely. There is a system to make sure things like eye drops dont go beyond their use by date. Also, there are special security arrangements for some medicines. Only the nurses give out medication. There is a procedure for administering medicines. This is designed to double check that the right medicines are given to the right people at the right time. There is a record kept each time a medicine is given out. We examined two sets of these records for a period of several recent days. They are being correctly completed each time a medicine is given. We looked at two medicines in more detail. This was done to see if the remaining stock matches what should be there. Again, we found things to be in order. People say that the nurses and care workers are courteous and attentive. When we were in the Service we talked with people a lot about this. They are very positive about the nurses and care workers. Several people summarise the general mood in their comments to us. One says, the staff are very kind indeed and theyre always willing to help. They make the place really. I never feel anything but wanted and I know that I can trust staff. When youre having a glum day they always seem to Care Homes for Older People Page 15 of 32 encourage you somehow and I have the greatest respect for all of them. Another person says, the staff are kindness itself. They are quite wonderful and theyre always around to help whenever theyre needed. Nothing is ever too much trouble for them. I often have a chat with Matron and with the others. Theyre more like family and Im so grateful that Im here. A third person observes, the staff are very kind indeed and theyre always willing to help. They make the place really and you never feel that youre being a nuisance. Nurses and care workers are relaxed and informal in how they are. Things are orderly without being too much so. Peoples privacy is respected. If they need help in the bathroom the door is closed first. Members of staff knock and wait before going into peoples bedrooms. People are helped to wear neat and clean clothes so that they can present themselves how they want. They are given their post promptly. Also, they are helped to deal with it if something is difficult for them. People can use their private telephones whenever they want. When we were in the Service we asked nurses and care workers about how things are done in practice. One person summarises the general mood when they say, Matron always says that nothing is more important than taking time with residents. So if were helping someone in the bath we take our time and dont rush. If it takes a long time then thats how it is and no one questions you. Here the residents really do come first and this is how things should be. Care Homes for Older People Page 16 of 32 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. There are some interesting things for people to do. People are free to receive visitors and to spend the day as they wish. Good quality meals are served. Evidence: The Matron says that the plan is that several times a week there is a social thing that people can do. In recent months the range of things that people can do has been extended. She says that each week someone comes in to lead gentle exercises. There are also outside entertainers who come in to play music and to give talks. In addition to this, the care workers organise things like film shows. At Christmas, the chef and the care workers helped people to make their own Christmas cakes. When we were in the Service, the chef was in the middle of making some chocolate fancies for the forthcoming Easter party. In our questionnaire for people who live in the Service we ask, are there activities arranged by the home that you can take part in? Nine people say that there always are and one person answers usually. One of the former people then adds, my attention is drawn to activities going on for the benefit of the residents and the staff are willing to assist me in getting to them should I wish to do so. The Registered Provider also deals with this subject in its questionnaire for people who live in the Service. When people are asked their views about the type of social activities, about their frequency and their duration everyone answers yes they are satisfied with them. When we were in the Service we kept our eyes open to see what people were doing. Most were enjoying the privacy of their bedrooms where they were doing things such as reading and watching the television. We asked them about the sorts of social things that they can do. People are generally positive. One person summarises the general mood when they say, we have things to do now and then, theyre not too often, I Care Homes for Older People Page 17 of 32 dont think that if things were held every day they would be well attended. We dont want things like bingo and being jollied along. Well I dont anyway. Im quite happy with how things are thank you. As weve already mentioned, the Service doesnt have its own transport. This means that a vehicle has to be hired if there is to be a trip out. Some people might quite like to be able to go out to local places of interest in the summer time. We understand that there hasnt been a trip out for some years. People are helped to keep in touch with members of their families, if this is necessary and if this is what they want. Family members and friends are welcome to call to the Service at any reasonable time. The Matron keeps in touch with family members so that they know how things are going. For example, if someone is not well or if they are admitted to hospital. The Registered Provider doesnt get involved in handling peoples financial affairs. For example, running bank accounts or signing for things in someones name. Its a good idea not to get involved in this way. This is because it avoids conflicts of interests. Instead, most people get help from members of their family. People are encouraged to make their bedrooms their own private space. They are asked to bring in things for their own homes so that they can have personal items around them. We saw lots of examples of this. Some of the people have their own small pieces of furniture. One person has some clocks that theyve known from their childhood. People also have their own photographs and ornaments so that their bedrooms feel more like being home. People say that they receive good quality meals and that they have enough to eat. They consider meal times to be a relaxed and pleasant affair. Some people choose to dine in the privacy of their bedrooms. One of the questions we ask in our questionnaire for people who live in the Service is, do you like the meals? Nine people say always and one person says usually. One of the former people just says delicious and another person says, the meals are truly exceptional. Beautifully presented and they look as good as they taste. I am able to ask for an alternative if for whatever reason a certain dish does not appeal. The menu is varied and interesting. When we were in the Service people chatted with us about the catering arrangements and they were very complimentary. One person says, one thing that everyone can agree on is that the meals are excellent. Theyre really to restaurant standard and we get a really good selection of things. When the meals are served everything is always spotless. You can see your face in the knives and forks and the plates are shiney. It gives you confidence that the food is good. And it certainly is. Another person says, the other day I didnt want anything too much for tea because I had had a large lunch. I spoke with (the chef) and asked for a poached egg and lo and behold there it was for me at tea time. The Registered Providers questionnaire for people who live in the Service asks about meals too. All of the comments are very positive. One person writes, I like the variety of vegetables offered and the originality of your meals. Thank you. I am very impressed by the high standards maintained. The main meal of the day is lunch. This is normally a set meal. However, if someone doesnt want it the chef will prepare an alternative. There is a cooked tea and there are always two choices at this meal time. We looked at the records of the meals provided over a two day period. We wanted to see if different people are actually Care Homes for Older People Page 18 of 32 having different things. They are. We also looked at the variety of meals provided over a period of two or three days. There is a reasonable balance. The lunch time dishes include things like minced beef pancakes, liver and bacon and sausages and onions. The tea time dishes are things like watercress soup and grilled plaice fillets. The sweets include things like rhubarb crumble and lemon butter shortbread. Nurses and care workers say that people can have drinks and snacks throughout the night. This is important. Otherwise, it can be a long time for some people between the late evening milky drink and breakfast the next day. Care Homes for Older People Page 19 of 32 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. There is a complaints procedure. There are arrangements to make sure that complaints are dealt with properly. There are arrangements in place to safeguard people. Evidence: There is a written complaints procedure. This explains how to go about making a complaint or raising a concern about something. The Registered Provider hasnt received any complaints since our last inspection and we havent either. We asked several people about making complaints. They say and show by their relaxed manner they would feel quite okay about raising a complaint should they need to. One person summarises the general mood when they say, Ive never even come close to making a complaint because theres nothing to complain about here. If I want to raise something, I just speak with Matron and it gets sorted out. Ive not heard of anyone making a complaint about anything and if they did Im sure that Matron and (the Responsible Individual) would be straight onto it. In our questionnaire for people who live in the Service we ask, do you know how to make a complaint? Everyone says that yes they do. Its very important that people are confident that theyre safe from being taken advantage of. The Assessment commits the Registered Provider to guarding against this. We asked some nurses and care workers about this matter. They know what to look out for. None of them have any concerns about how things are going. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The accommodation is very comfortable and pleasant. There is a modern fire safety system. The kitchen is well equipped. There is a suitable laundry. Evidence: The building is very well maintained on the outside. The gardens are neat, attractive and well kept. On the inside, the accommodation is very well decorated and furnished. There are lots of little touches that make the place feel lived in, such as interesting pictures and displays of flowers. We were told that the Responsible Individual is very particular about points of detail. For example, she insists that things such as hoists are put away when theyre not being used. This is so that they dont clutter up the place and take away from its homely and relaxed feeling. In our questionnaire we ask people who live in the Service, is the home fresh and clean? Everyone says that it always is. The building is fitted with an automatic fire detection system. This provides a high level of fire safety protection. We understand that the fire brigade people say that the system meets the national standard. The Registered Provider has a system of doing regular fire safety risk assessments. This is where an outside consultant goes around the place to check out that everything is still working in the right way. We looked at the record of the most recent one and it says that everything is still okay with the system. The Matron is now going to send a copy of the assessment to the fire brigade people. This is so that they can then check that its detailed enough. Shes going to do this by 1 June 2009. The people from the local Department of Environmental Health called to look at the kitchen earlier this year. Their report says that the food management arrangements in the Service are, excellent. We looked in the kitchen. Its well equipped, clean and very well organised. The chef does sensible things to ensure good food hygiene. She makes sure that the fridges and freezers are cold enough to store food safely. She also makes sure that hot foods are cooked through thoroughly. Theres a stock management system. This means that individual foods dont go beyond their use-by Care Homes for Older People Page 21 of 32 date. People who need it are helped to get about. There are five special baths. These have sides that go down so that you can step into them. Each of the baths has a shower attachment too. There are four mobile hoists. These can be used in the lounges and in the bedrooms. They might be needed if someone cant manage to stand at all. At key places there are assistance poles. These are fitted to the wall and they are there for people to hold onto for extra support. There are frames near to the toilets. People find these very helpful when they are getting down and getting back up again. There are other less obvious things to help people get about. For example, there are special belts that can be used to give people that extra bit of help they might need when getting up from a chair. Also, there are special sheets that can be used to help people change position in bed. When someone moves into the Service, the Matron makes a special note of what assistance they need to get about. She looks at things such as the help someone needs in the bedroom and in the bathroom. We asked nurses and care workers about this. They know what theyre doing. We saw one person being helped into their wheelchair by two members of staff who were using one of the mobile hoists. They werent rushing the person and they were using the hoist in the right way. Once the person was seated in the wheelchair, one of the members of staff helped them get comfortable. We asked people how warm the accommodation is kept. They say that they are always comfortable even during the coldest weather. When we arrived in the Service the central heating was on and it was on when we left. The radiators are fitted with guards. This has been done to reduce the chance that someone will be burnt if they fall against them. The hot water taps that are used by the people who live in the Service are temperature controlled. This means that they wont get hot enough to scald someone. We tested a few taps and the temperature seems alright to us. The laundry has three commercial grade washing machines. These have an extra cycle for items that need an especially hot wash. There are also four separate sluices. These are useful if something needs to be rinsed off before its put in the wash. There are two large tumble driers. We looked in the laundry. Its well organised and clean. New rules have been introduced to help make sure that used water doesnt leak back from things like washing machines into the drinking water supply. It looks like the Service already meets these rules. However, just to be on the safe side the Matron is going to contact the local water supply company to find out. Shes going to do this by 1 June 2009. The Matron says that everyones clothes are marked so that theres less chance of them getting lost or mixed up with other peoples things. This is very important because its a really basic thing to wear only your own clothes. We checked this out for three garments. We found each of them to be marked with the name of the owner. We asked people about this. They say that they do nearly always get their own clothes back from the laundry. One person says, Ive never really had a problem with the laundry. Very occasionally something will go missing but then as soon as you say about it the thing will be found quickly. The staff take care with things so they dont Care Homes for Older People Page 22 of 32 come back stretched or shrunk. No Ive not had any problems in that department. Care Homes for Older People Page 23 of 32 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. There are enough nurses and care workers around. A part of the recruitment arrangements needs to be strengthened. Nurses and care workers know what theyre doing. However, parts of the training arrangements arent clear. Evidence: During the day and the evening, there are always two qualified nurses on duty. In the morning, there are also nine care workers on duty. This number reduces to five in the afternoon and evening. At night, there is a qualified nurse on waking duty and she is assisted by four care workers. There are special security arrangements at night. During the day, there are other members of staff on duty. They variously work in the kitchen, in the laundry and do the housekeeping. In our questionnaire we ask people who live in the Service, are the staff available when you need them? Eight people say that there always are and two people say usually. One of the former people adds, one has to remember that you are not the only person needing help and be prepared to wait a bit sometimes. But they are very good and helpful. In our questionnaire for members of staff we ask, are there enough staff to meet the individual needs of all the people who use the Service? Eight people reply always and two people say usually. When we were in the Service we asked members of staff about this. One person sums up the tone of what was said when they observe, we have enough staff on duty at all times. We have the time we need to do things and not to rush. I have never felt that we needed more people around and Ive not heard anyone else say that either. When we were in the Service we kept a look out for things that might give us a clue about how well the place is being staffed. We noticed that two people who asked to be helped to use the toilet were assisted straight away. Another thing we looked at was the time taken to answer the call bells. We looked at two occasions when it went off. On both times it was answered in about a minute. The Matron says that all of the shifts are being reliably filled. We looked at the written Care Homes for Older People Page 24 of 32 roster. It confirms what the Matron is saying. Its very important that only honest and trustworthy people are employed as nurses and care workers. With this in mind, the Registered Provider completes a number of security checks on new nurses and care workers. These include things such as confirming their identity, taking up references and doing a police check. We looked at the records for one nurse and one care worker. Most of the checks that we need to see have been done. However, the account they both have given of their past jobs isnt detailed enough. This means that the Registered Provider cant be certain that its got all of the references that it needs. We do know that in the case of one of them an additional reference is needed. The Matron is now going to audit the personnel files of all nurses and care workers appointed in the course of the past year. This is so that she can be sure that shes got all the references she needs. She says that this will be done as soon as possible, with the whole exercise being completed by 1 August 2009 at the latest. The Matron says that new nurses and care workers have introductory training before they work on their own. In our questionnaire we ask about this. We say to members of staff, did your introductory training cover everything you needed to know to do the job when you started? Everyone says that it met their needs very well. One person adds, everything is covered in great detail. There is a checklist of the subjects that new nurses and care workers are told about. We looked at one of these checklists that has recently been completed for a care worker. It shows that important things are being covered. For example, they are told about the individual nursing and support plans that we spoke about earlier. They are also shown how to help people get about safely. We asked care workers about this when we were in the Service. One person says, when I first came I was shown around and asked to read lots of things such as about what each person needs and the care plans. I was told about how to safely move people and I had the chance to ask lots of questions. I wasnt rushed and I only started doing things on my own when I was confident that I knew how to do so. I was very supported throughout and it was a really good introduction. Theres a lot to learn and you have to do it gradually. The Matron says that this initial training is just to get nurses and care workers started. Theres a lot for care workers in particular to learn after that. She says that all nurses and care workers are expected to do initial and then regular refresher training in important subjects. For example, in how to safely support people move about, in basic first aid, in food hygiene, in keeping people safe and in infection control. In our questionnaire for members of staff we ask, are you being given training which helps you understand and meet the individual needs of service users and that keeps you up to date with new ways of working? Everyone says that yes they are. We looked at the records of who has done what courses so far. In general, they show that quite a lot of training is being done. However, there are some gaps. Were not sure if its just that the records are not up to date or if some nurses and care workers have missed individual bits of training. The Matron recognises that she now needs to double-check the records. This is so that she can see if there is any additional training that particular members of staff need to do. Again, she has assured us that she wants this done as soon as possible and by 1 August 2009 at the latest. Theres a total of 23 care workers employed in the Service. Nearly all of them have completed a National Care Homes for Older People Page 25 of 32 Vocational Qualification (NVQ) at Level 2 or 3 in health and personal care. This qualification is a very good idea. This is because it helps care workers to deliver high quality residential care services. The Matron says that all new care workers will be encouraged to study for the award. We spoke with two nurses and with two care workers to find out what they know about particular bits of the support they will need to give people. As we have said earlier in this Report, they know a lot about how each of the people who live in the Service likes to be supported. More generally, they know about things such as how to help people to express themselves. They also know about how to respectfully help people who need assistance to manage their continence. Care Homes for Older People Page 26 of 32 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. Things are well managed. People are asked what they think, but this needs to be a bit more organised. People are helped to buy what they want. There are some limited gaps in the health and safety arrangements. Evidence: The Matron has a good knowledge of how things are going. She is a qualified nurse. She also holds a particular management qualification. This qualification is important. This is because its designed to help managers ensure that high quality residential support is reliably provided. The nurses and the care workers say that there is good team work between them. There are handover meetings at the beginning and end of each shift. These are held so that nurses and care workers can be kept up to date with developments. In our questionnaire for members of staff we ask, are you given up to date information about the needs of the people you support or care for? Everyone answers always. One person adds that, we have a very full handover period before the start of every shift and care plans are to hand and updated immediately. There are team meetings about every six months or so. We looked at the records of the sorts of things that were discussed at the last one for the care workers. Theyre practical and relevant. For example, care workers talked about how to practice good infection control techniques. They also talked about housekeeping things such as the need to keep coloured items and whites separate when being washed. In our questionnaire we ask members of staff, do the ways you pass information about Care Homes for Older People Page 27 of 32 people who use the Service between staff (including the manager) work well? Everyone says that they always do. When we were in the Service one care worker spoke about this and says, there is no us and them with the nurses, we all pull together as one team theres nothing like that here, its not that sort of place. The matron is really supportive and helpful we can always talk to her. Shes a genuinely kind person. Someone youd be happy to know outside of work. Its really important that the people who live in the Service have a direct say on how things are going. Theyre the experts because they live there. The Assessment says that people who live in the Service are regularly asked what they think about their home as part of everyday life. As we have already noted, each year the Registered Provider also asks the people who live in the Service to fill in the questionnaires that we have quoted from. In general, we think that this is a very useful thing to do. However, there are some further improvements that can be made. Not everyone is completing the questionnaires. Those who choose not to do so may prefer to be asked their views in a different way. Also, theres no organised way to tell people who live in the Service whats been said and about what is going to be done to respond to any improvements that may have been suggested. The Matron recognises the importance of addressing these issues. She is going to look into this matter further to see what can be done. The Responsible Individual calls to the Service regularly to see how things are going. Members of staff say that she has a detailed knowledge of whats going on and that she sets and maintains high standards. This might be something small like a picture being moved a few inches to the left or right. Or, it might be arranging for the large plasma television in the lounge to be covered with a curtain when its not in use. This is so that the screen is not intrusive for people who want to sit quietly in this area. There is a system to help people buy goods and services without having to handle too much money. This involves the Registered Provider paying for things such as seeing the hairdresser and having a newspaper. The sums spent are then invoiced to the person who can then settle the bill as part of their ongoing monthly payment for living in the Service. We looked in some detail at some of the various transactions involved. We found everything to be in order. What is being charged on the invoices is supported by a receipt that shows the Registered Provider has indeed spent the money in question. The Registered Provider is required to do regular checks to make sure that the fire safety equipment remains in good working order. We looked at the records. Most of the checks are up to date. However, there are quite a lot of gaps in what should be the weekly test of the fire alarm bells. The Matron recognises the importance that has to be attached to fire safety matters. She emphasised to us that the required weekly checks will be put in place immediately. There are regular fire drills. There is also a programme of fire training that aims to give instruction to every member of staff twice year. The way that this is organised at the moment means that very occasionally an individual member of staff may miss one or even both of the training events each year. We looked at the records for two care workers and indeed one of them had missed one of the sessions in question. Its very important that people dont go overdue on this training. This is because the level of fire safety protection in the Care Homes for Older People Page 28 of 32 Service largely depends on members of staff doing the right thing at the right time. The Matron says that she is now going to change parts of the current system. This is so that she can make sure that everyone is up to date with this training. She says that she wants to get this done as quickly as she can and by 1 June 2009. There are up to date reports from engineers about the gas appliances, the mobile hoists and the passenger lifts. They say that everything is in good working order. The most recent report on the electrical wiring installation says that there are a number of things that need to be put right. The maintenance man thinks that most of these have already been done. However, the situation is not quite clear and there are no records to help us sort this out. The Matron says that she will look into this matter. This is so that any improvements that remain to be done will be completed. Again, she wants the matter sorted out quickly and by 1 July 2009 at the latest. We looked at the record of accidents that have occurred in the Service over the past few months. There hasnt been that many. Most have been minor bumps and bruises. The Matron keeps an eye on who has had an accident and what has happened. This is done so that she can do something if there is a particular problem thats causing the accidents. We dont think that theres anything obvious that needs to be sorted out at the moment. The maintenance man regularly checks things to do with the building. He also looks at the condition of equipment such as the wheelchairs. He does this so that if something is broken it can be repaired quickly. Hes also looking for hazards that might result in someone having an accident. He says that he hasnt found any. We kept our eyes open when we were walking around. We didnt notice any particular hazards either. Care Homes for Older People Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes No √ 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 30 of 32 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 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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