Care Home: The Garden House

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What the care home does well The information that is available about the home provides clear details of the service and its facilities and placement in the home is only offered after a robust pre-admission assessment. This means people can be assured that their specific care needs can be met. Care planning processes ensure that people`s nursing care needs will be identified and met in the way that they want. The monitoring of people`s health status is good and medical care is arranged as and when necessary. Medication procedures are safe and follow good practice guidelines. There are opportunities for the people who live in The Garden House to participate in a full range of social activities. Family and friends are encouraged to visit and welcomed to participate in home activities. The standard of catering is high and people will be provided with well balanced and nutritious meals. The home has a clear complaints procedure and any complaints people may have will be listened to and acted upon. Staff awareness of safeguarding issues will ensure that people are protected from being harmed. The Garden House Nursing Home is an extremely comfortable and well equipped care home, that is furnished and fitted out to the highest standards. It is kept clean and fresh. Each bedroom has en-suite facilities and all communal areas are well furnished. The people who live in The Garden House will be cared for by staff who are skilled and competent and able to meet their specific care needs. Recruitment of staff is in line with safe procedures, which means that only suitable staff will be employed to work in the home. The Garden House is a well managed care home, run in the best interests of the people who live there. Peoples views will be sought to ensure that they receive the care and support that meets their expectations. People`s health and safety will be promoted because of safe working practices. What has improved since the last inspection? No requirements or recommendations were made following the last key inspection. What the care home could do better: We have not issued any requirements as a result of this inspection but we have made four good practice recommendations 1. Care plans should be rewritten when too many amendments have been made to make them unclear. 2. Amend details about the Care Quality Commission on the Complaints Procedure. 3. Continue towards achieving a 50% ratio of care staff with an NVQ 2 qualification. 4. The Fire Risk Assessment is due to be reviewed. Key inspection report Care homes for older people Name: Address: The Garden House Cote Lane Westbury on Trym Bristol BS9 3UN     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: Vanessa Carter     Date: 2 3 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: The Garden House Cote Lane Westbury on Trym Bristol BS9 3UN 01179494000 01179494040 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: St. Monica Trust care home 76 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: May accommodate in `The Oaks` and `The Cedars` up to 64 people aged 65 years and over who require nursing care. May accommodate in `The Sundials` up to 12 people with dementia aged 65 years and over who require personal care only. The manager must be registered on parts 1 or 12 of the Nursing & Midwifery Council Register. Date of last inspection Brief description of the care home The Garden House is operated by St Monicas Trust, a charitable organisation, and is registered to provide personal and nursing care for up to 76 people who are over 65. The Sundials Unit (for 12 people) specialises in care for residents with dementia. The home is situated on a 23-acre site of well-established parkland on the edge of Durdham Downs in Bristol. The premises are purpose built and are fully accessible for people who have physical disabilities. There are numerous aids and adaptations Care Homes for Older People Page 4 of 29 Over 65 12 64 0 0 Brief description of the care home throughout the building. Each bedroom has an ensuite facility. The communal areas are situated on the ground floor and these include a large dining area, two spacious lounges, a library and computer room, and hydrotherapy pool. The cost per week to reside at The Garden House and The Sundials can be provided by the home manager the weekly fee includes chiropody but does not include provision for items such as hairdressing, dental or ophthalmic services. Prospective residents can be provided with information about the home by accessing the Service Users Guide, which will detail the services and facilities available at the home. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We completed an unannounced inspection of The Garden House Nursing Home in one day and spent a total of eight hours in the home. The last inspection of this service was undertaken on 6 and 7 February 2007 and our overall judgement about the quality of the service provided for the people who lived in the home was that they received an excellent service. After that inspection we planned to visit again within three years. In the meantime we have completed annual service reviews on 15 June 2008 and 23 January 2009. We remained of the opinion that people still received an excellent service. Prior to this inspection we asked the home manager to complete the annual quality assurance assessment (AQAA). This is a self assessment document that focuses on how well outcomes are being met. The assessment was received back within the timescale we had set. The assessment had been completed in detail and provided a clear overall view of the service. Care Homes for Older People Page 6 of 29 We sent surveys to the home manager to be dispersed to people who live in the home, relatives and to GPs who visit. We received a total of 11 forms back and they gave us some useful information about how people felt about the home, what they do well and what they could do better. During the inspection we looked around and saw all the faciltities they have to offer. We joined a group of people for the midday meal and we spoke to others in their private bedrooms. We looked at records kept by the home, including care records and those that are kept in respect of the running of the home, we spoke to those staff on duty and to the home manager. We observed the interactions between staff and the people who live in the home. At the time of this report the fees for placement in the home range between 773 pounds (for a residential placement in The Sundials Unit), and 829 to 910 pounds per week for a nursing care placement. Additonal charges are made for other services and these are detailed in the homes brochure. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 29 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 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 29 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. The information that is available about the home provides clear details of the service and its facilities and placement in the home is only offered after a robust preadmission assessment. This means people can be assured that their specific care needs can be met. Evidence: The Statement of Purpose and Service Users Guide were last reviewed and updated in October 2009. Both documents are informative and provide a very clear picture about the home and what services and facilities it has to offer. Up to date information is included in respect of the Care Quality Commission. A copy of the homes brochure is given to people who enquire about the home and who have been assessed as appropriate for placement. A copy of the service user guide is placed in each bedroom and will be given to new people as they are admitted into the home. This means that people will have the necessary information to make an informed choice that the home is the right place for them. People will know what to expect when they choose to live Care Homes for Older People Page 11 of 29 Evidence: at The Garden House. We spoke to one person who had recently moved in to the home - they told us that their relative had made all the necessary arrangements and they had been given a leaflet about the home. The nine people who completed our survey forms said that they had been given enough information to enable them to make an informed choice. Each person will be provided with a contract or a set of terms and conditions of stay a Licence Agreement. This sets out the conditions for living at The Garden House. For those people who are part funded by the local authority, or funded by the primary care trust (under continuing health care arrangments), a schedule of payments will be set up with the funding authority. Prior to any placement being offered, a pre-admission assessment will be completed to ensure that the home has any necessary equipment that the person may need and the staff team have the required skills. We looked at the documentation completed for two people who had recently moved in to the home. We could see that they had been assessed prior to the admission date. A full and comprehensive Easy Care assessment is recorded that covers all aspects of physical health, personal care, communication, mobility, mental health, well and ill-being, social leisure and spiritual wishes. Those assessments seen in respect of physical health recorded these are my ilnesses and this is how they affect me. This assessment is then used as a basis of the care planning documentation. New placements are always arranged on an initial trial basis with a review of how things have gone being completed at the end of this time. This review will be undertaken with the funding authority where appropriate, the person if possible, any family or representatives, and home staff. This trial period can be extended if necessary. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning processes ensure that peoples specific care and support needs will be identified and met in the way that they want. The monitoring of peoples health status is good and medical care is arranged as and when necessary. Medication procedures are safe and follow good practice guidelines. Evidence: Each person will have a plan of care prepared that details their nursing care needs and the actions that need to be taken by the care staff to meet those needs. We looked at a sample of five care files, one person who had wound care needs, one person with dementia and the others randomly selected. We found that in four cases detailed care plans had been prepared, but for the fifth person, the plans were in the process of being completed, despite them having been in the home for a three week period. Only basic care information was recorded so far but we were told that the delay was brought about because of a further hospital admission. The home manager was aware of the need to complete these plans as a matter of priority. We looked at the wound care planning documentation prepared for one person - there was a lot of old records and amendments that had been made to the plan which made it difficult to work out Care Homes for Older People Page 13 of 29 Evidence: what was current information. The plan did state the medical products to be used and the frequency that dressings needed attending to, but the whole plan should be rewritten to make it clearer and easier to understand. The manager agreed to action this. An evaluation was recorded each time the dressing was changed. We saw that where a persons body weight was of concern, the home were monitoring this regularly - the records clearly evidenced any weight loss or gain, and the actions taken. A number of risk assessments are completed alongside the care plans, and we saw those in respect of manual handling tasks, the likelihood of developing pressure sores (waterlow), nutrition and falls. The manual handling risk assessment result in a risk reduction plan being devised - those seen record information about the specific equipment to be used and the number of staff required. When the likelihood of developing a pressure sore is identified, appropriate equipment is provided. All plans and risk assessments are reviewed on a monthly basis, but there needs to be greater care in ensuring that old information is crossed through, and that current instructions are clear. A daily report is completed and those we looked at provided a good account of care given. There are processes in place to monitor peoples health care status - this may include diabetes management, fluid or dietary intake. People are able to retain their preferred GP upon admission as long as the GP is able to undertake domiciliary visits to the home when necessary, or they will be registered with the doctor who visits the home on a regular basis and looks after the majority of peoples medical care needs. We received two of our survey forms back from GPs who visit the home. Both stated that the home ensures that peoples social and health care needs are properly monitored, reviewed and met. Very well organised quality care and A big strength is the full range of care available on the same site. There are physiotherapy and hydrotherapy services available to the people who live in the home - referrals can be requested by registered nurses and GPs. Examples of other healthcare professional who may visit the home include tissue viability nurses, chirpodists, dieticians, opticians and dentists. Medications systems are safe. There are procedures in place for the ordering, receipt, administration and disposal of medications. Most medications are supplied from the pharmacy in blister packs. Medication administration records (MAR charts) and stocks are regularly audited. Signage is in place where oxygen cylinders are in use - any additional cylinders are securely stored outside . During the time we spent in the home we observed the staff team interacting with the people they were looking after and visitors, in a kind, thoughtful and professional manner. Staff were courteous and polite, but there was a lot of friendly banter. People told us that they were well looked after - I feel very priviledged to be living here. My every need is met, I am certain this is the best home in Bristol, I have lived here Care Homes for Older People Page 14 of 29 Evidence: many years, it is like a first class hotel and I am sure that the staff are all hand picked, they are so kind, friendly and helpful. As part of the care planning process, end of life care needs are discussed where appropriate. Resident wishes regarding their death documentation will be completed detailing advanced directives, enduring power of attorney, wills and organ donation information. They will also include the persons general views, thoughts and choices, how they feel about medical intervention and what they want to happen when their health deteriorates. These measures will ensure that the person receives the end of life care that they want. We discussed where do not resuscitate decisions have been made - the records must clearly evidence GP consultation and relatives or advocates involved. Where the actual person can not be involved in these discussions, an account of the reasons why should be made. Care Homes for Older People Page 15 of 29 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 opportunities for the people who live in The Garden House to participate in a full range of social activities. Family and friends are encouraged to visit and welcomed to participate in home activities. The standard of catering is high and people will be provided with well balanced and nutritious meals. Evidence: The home provides a weekly itinerary of events and activities, and information is displayed upon noticeboards in each persons private bedroom. On the day of inspection, a Christmas Carol service was arranged. The home has a well stocked library (open three days a week), complete with large print books, talking books and DVDs. For those people who are unable to get to the library, a library trolley will be delivered around the home on a weekly basis. The TV system is linked into the chapel and main hall, so that church services can be enjoyed from the comfort of their own rooms, if people are unable to get to the chapel. There is also a Tuesday Shop and coffee morning each week with a trolley shop taken to those people who are unable to leave their rooms. A computer suite with internet access is available for people to use so that they can keep in touch with family/friends who live far away. St Monicas Trust transport is made available to take both mobile and wheelchair dependent people for weekly shopping trips and outings. There is a hairdresser salon and this is open five Care Homes for Older People Page 16 of 29 Evidence: days a week. We have a very good social life here, There is always something going on and We dont have to join in, it is up to us, but they do encourage us to keep active and alert. There are no restrictions on visiting and people are able to have visits from family and friends at any reasonable time. One visitor told us it is a pleasure to visit, the staff are polite and friendly and we are always offered refreshments. We received survey forms back from relatives who made the following comments - it was my relatives birthday recently and it was celebrated. The catering staff made a lovely cake, and my relative is always told what is going on, but wants a quiet life, They prefer to spend their time quietly in their own room. For those visitors who are visiting the Sundials unit, there is a door bell they must ring to gain access. This measure is in place to ensure that the staff team are aware of when visitors are in the unit - there is a coded keypad to exit the unit. The overall opinion is that people who live in The Garden House are encouraged to make their own decisions where possible. They are asked about where they want to spend their time, what they would like to eat and what time they would like to get up and retire to bed. We have come to this conclusion because of observations we made during the inspection visit, comments we received from people we spoke with and comments made in our survey forms that were completed by people who live in the home, and relatives. The home has a varied and well balanced menu and there are a number of daily choices for the midday meal. A selection of red meat dishes, chicken, fish and vegetarian options are included. The days menu is displayed upon each table and people will choose what they would like to eat and then the meal will be served to them waitress style. A copy of the weeks menu is also displayed on a notice board in the dining room so that people can refer to it and make alternative arrangements with the catering staff if they dont like any of the planned meals on offer. We were able to join a group of people for the midday meal and they made the following comments the meals served are always well cooked and nicely presented, I have just had a very nice curry. I had never had a curry before moving here, it was very tasty and I really enjoy the midday meal, it is a sociable event. Its like going out to lunch every day to a fine restaurant. Morning coffee and afternoon teas are served, The kitchens were awarded the top five star rating when they were last visited by an environmental health officer. Care Homes for Older People Page 17 of 29 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. The home has a clear complaints procedure and any complaints people may have will be listened to and acted upon. Staff awareness of safeguarding issues will ensure that people are protected from being harmed. Evidence: The homes Complaints Procedure is included in the Statement of Purpose and the welcome pack given to each person who lives in the home. The procedure is also displayed in the main reception area of the home. Information needs to be changed regarding the Care Quality Commission contact details. People who completed our survey forms all said that they were aware of the homes complaints procedure. Those people we spoke with during the inspection said they would feel happy about raising any concerns. They always listen to us and put things right, but everything is to my liking, I have nothing to complain about and I have had a grumble a couple of times, but only over silly little things. They still listened to me though and sorted things out. The manager maintains a complaints log and has received twelve formal complaints in the last year. The records evidenced the actions taken and the outcomes of all complaints. We were also shown the log of compliments received - this totalled 28 in the last year. People can be assured that they will be listened to and any necessary actions will be taken. The home has a safeguarding and protection of vulnerable adults policy and all staff will receive safeguarding adults training. Those staff spoken with during the course of Care Homes for Older People Page 18 of 29 Evidence: the inspection demonstrated good awareness of safeguarding issues and of their responsibilities in protecting the people who live in the home. Information about how to report any concerns staff may have about people is displayed on staff noticeboards. This includes the Bristol No Secrets guidance and the St Monica Trusts whistleblowing policy. People who live in the home who we spoke with said that they were well looked after and were living in a safe and caring environment. Care Homes for Older People Page 19 of 29 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 Garden House Nursing Home is an extremely comfortable and well equipped care home, that is furnished and fitted out to the highest standards. It is kept clean and fresh. Each bedroom has en-suite facilities and all communal areas are well furnished. Evidence: The Garden House Nursing Home is a purpose built two storey care home, situated on a 23 acre site of well established parkland on the edge of Durdham Downs. It is well maintained, fully accessible for people with mobility impairment, and has level access to the front door from the car parking area. The main entrance is not always staffed but security systems are in place. Communal facilities are all located on the ground floor and consist of a large dining room, two spacious lounges and other quiet rooms, a library and a computer room. CCTV cameras are installed in the main entrance and site boundaries to alert the porters to visitors arrival and are solely used for security purposes. Access to the upper floor is via passenger lifts or via staircases, making the whole home fully accessible. All areas of the home are well decorated and appropriately furnished - there is a corporate St Monicas Trust theme in the decorations - providing a luxurious and calming feel about the home. There is access out in to the gardens from several places in the home. The gardens are well designed and planted out with established shrubbery. The garden areas surrounding the Sundials unit have been designed with the needs of people who have dementia in mind. Care Homes for Older People Page 20 of 29 Evidence: The home is divided up into three units. A twelve bedded dementia care unit, Sundials Unit, and two nursing care units, The Oaks and The Cedars. The Sundials has been designed to aid and support the specialist needs of the people it accommodates. For example, well designed signage is in place to locate toilets and bathrooms and visual aids to remind people of daily life skills. Intelligent lighting is installed that switches on when detecting motion and sensor pads are installed in bedrooms to alert staff to peoples movements. Ceiling fans have been installed in both the Oaks and Cedars to keep the temperatures comfortable in the warmer weather. There are two lounges and one large dining room on the ground floor. The dining room is set out hotel style and the lounges are furnished with comfortable armchairs and elegant fixtures and fittings. There are kitchen areas where visitors and able people can make themselves refreshments. Each unit has a nursing station, and there are a number of sluice rooms. The corridors are wide and have grab rails on both sides. There are several places in the home where people can sit and watch the world go by. There are a number of communal bathrooms located throughout the home fitted with assisted baths, but all bedrooms have ensuite facilities consisting of a toilet, wash handbasin and level access shower. Separate toilets are also located near the lounges and dining rooms. All bedrooms and bathrooms are fitted with overhead tracked ceiling hoists plus there is a supply of manual hoists, stand aids and other types of equipment to assist with moving and handling tasks - additional equipment will be purchased if necessary to meet peoples changing needs. In the AQAA they told us that they have purchased much new equipment. All nursing beds are specialist electric beds and there are plans to replace the remaining divans in the Sundials with electric low level beds. Specific items of equipment will be provided for people with particular care needs as and when required. The home has a number of different mattresses and alternating air mattresses and people are provided with the one that meets their specific needs. A nurse call bell system is installed throughout the home, and in each of the bedrooms. The home is able to analyse the time taken for call bells to be answered so as to ensure that all bells are responded to within a timely manner. All bedrooms are for single occupancy, and have ensuite shower rooms. Some rooms are referred to as enhanced rooms - these are larger and have additional space to provide a spacious and comfortable living area. People are encouraged to personalise their rooms and to bring in any small items of furniture and other items. When rooms Care Homes for Older People Page 21 of 29 Evidence: become vacant there is a robust audit of the room and identification of works that may need to be carried out. No room will be offered to a new person until it meets the high quality standards that the home have. The home was warm, well lit, clean throughout and fresh smelling. Care Homes for Older People Page 22 of 29 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 people who live in The Garden House will be cared for by staff who are skilled and competent and able to meet their specific care needs. Recruitment of staff is in line with safe procedures, which means that only suitable staff will be employed to work in the home. Evidence: Many of the staff have worked in the home for a number of years and there is a well established team of registered nurses and care staff. There has been a degree of staff turnover and the home feels they could do better in retaining staff. There is a bank of staff who are used to cover any vacant shifts and agency staff will only be used as a last resort. There has been recent high use of agency staff but this has been due to exceptional circumstances. Staffing levels for each unit will be seperately arranged and are based upon the collective dependency levels of each person in residence. Adjustments are made to the numbers of staff on duty when people develop higher dependency levels. They told us that they have introduced twilight staff to cover the period of time early until late evening, when there is a high demand for support. Those staff spoken with said that the staffing levels were correct. A team of housekeeping, catering, administrative staff, maintenance, porters and activities staff, are also employed in sufficient numbers to provide support in meeting peoples daily living needs. Care Homes for Older People Page 23 of 29 Evidence: All care staff are expected to complete National Vocational Qualification (NVQ) Level 2 in Care after they have completed their initial training and probationary period. At the current time approximately 39 of the care staff have already achieved an NVQ and there is an ongoing programme of NVQ 2, 3 and 4 training. We looked at six recuitment files to check the procedures that are followed before new staff are employed to work in the home. We found that safe recruitment procedures are always followed. Pre-employment checks include written application form, attendance for a face to face interview, two satisfactory written references and CRB and POVA1st checks. Staff spoken with confirmed these arrangments. One person who lives in the home made the comment The staff are hand picked, that is why they are so good. The manager told us in the AQAA that they plan to involve people who live in the home in the recruitment process. A personal training log is kept for each staff member and we were told that each member is expected to attend three training days over and above mandatory training. St Monicas has its own internal training department and training is organised for registered nurses and care staff, and the ancillary staff who work in the home. All new recruits will complete an induction training programme and this consists of manual handling, fire safety, infection control, safeguarding of vulnerable adults (SOVA), corporate Trust policies and procedures. These mandatory training sessions are repeated on a regular basis to ensure that the staff work within the homes policies. In addition to mandatory training sessions are arranged in respect of wound care, health and safety, mental capacity act (MCA) and deprivation of liberty safeguards (DOLS), plus various other clinical and nursing subjects. The range of training on offer for the staff team is excellent. Care Homes for Older People Page 24 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Garden home is a well managed care home, run in the best interests of the people who live there. Peoples views will be sought to ensure that they receive the care and support that meets their expectations. Peoples health and safety will be promoted because of safe working practices. Evidence: The home manager Mrs Danielle Drew was appointed in November 2007, and the registration process with the Care Quality Commission was completed with a couple of months. She is a registered nurse, an NVQ Assessor, and is working towards attaining an NVQ 4 in Leadership and Management in Care. She has all the necessary qualifications and skills to be the registered manager and cooperated well with the inspection process. She is supported in the management of the home by a team of senior St Monicas Trust personnel. Regular meetings are held by the home manager, with staff teams, people who live in the home, and with relatives. Records evidence that the opinions of others are sought Care Homes for Older People Page 25 of 29 Evidence: and acted upon where possible. Regulation 26 visits are undertaken by Trustees and a report of the visit made. It is evident that there are robust procedures in place to monitor customer satisfaction and the quality of the service provided. Prior to this inspection we asked the home manager to complete the annual quality assurance assessment (AQAA) and submit to us within a timescale. The AQAA is a self assessment document that focuses on how the service is doing, what they do well and what improvements they have planned. The assessment was completed in detail and provided a very clear view of the service. There are Resident Liaison Committees, and Staff Consultation Groups plus other management meetings that ensure that the service continue to meets peoples expectations. Regular Health and Safety audits are completed and there is an ongoing programme of refurbishment and replacement furniture to ensure that The Garden House remains a nice place to live and work. The home looks after personal monies for people if they want this service. Paper records are kept of all transactions in and out of each persons individual account and these are audited by St Monicas finance department on a regular basis. We checked a randomly selected sample and found that records tallied with the amount of money held. There is a cascade system of staff supervision in place and all staff will be supervised by a senior worker at least six times per year. On a day to day basis care staff are supervised by the senior carers and registered nurses, and there is a handover report at each shift change. One senior carer told us that they will mentor new staff for training and supervision purposes and that they were trying to ensure that shifts were always covered together, to improve things. Safe working practices ensure the safety of both the people who live in the home and the staff team. Manual handling risk assessments result in risk reduction strategies being devised so that staff know what is expected of them. There are a number of staff who have completed KeyMover Training who are available to give advice about moving and handling tasks and will instruct staff. All the necessary environment and equipment checks are completed regularly by the maintenance team or companies that are contracted to complete the work. All of the porters are fire wardens plus the Trust employs a fire officer who visits the home regularly. The fire log evidenced that all the necessary checks are made of the fire alarm system, emergency lighting system and fire fighting equipment. Fire drills are held regularly. Other environmental checks that are made include hot and cold water temperatures monitoring. We did note that the Fire Risk Assessment is overdue for a review and the home manager agreed to action this straight away. The home is well maintained throughout and no health and safety concerns have been raised as a result of this inspection. Care Homes for Older People Page 26 of 29 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 29 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 Care plans should always remain clear and informative and be rewritten if too many amendements have made them difficult to follow. Amend the information on the Complaints Procedure in respect of the Care Quality Commission. Continue working towards a 50 ratio of care staff with an NVQ Level 2 qualification. The Fire Risk Assessment needs to be reviewed to ensure that it is still relevant. 2 3 4 16 28 38 Care Homes for Older People Page 28 of 29 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. 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