Care Home: The Kingfisher Care Home

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What the care home does well We received 12 completed surveys prior to the visit. Six were from residents and six were from staff members. The responses were extremely positive with everyone who responded expressing their satisfaction with the service provided. Comments in the surveys included; `I can only speak for myself and my relative but I feel we are fortunate to have found such a good care home.` `The staff are so supportive and are always there if I have any problems.` `There always seem to be plenty of staff on duty and the care they give is very good.` `Carers are very good and very attentive.` `The manager is very approachable.` `The service works very well because they understand that every person has a different personality and different needs.` During our visit we spoke with a number of residents and staff. People told us that the home provided a good service and were complimentary about the management. One resident said ``I feel very happy to be here, we are all very well looked after.`` A staff member said ``There is always a nice atmosphere here, the staff get on very well which benefits the residents.`` We observed staff going about their duties in a pleasant and professional manner. Carers appeared to have plenty of time to spend with residents and there were a variety of activities going on. There was a happy atmosphere in the home and staff and residents appeared to get along well. Residents we met appeared content, relaxed and comfortable in their surroundings. The Expert by Experience who accompanied us on our inspection reported `I felt the home was a busy place with plenty on offer for the residents. The home was clean and bright and the residents all seemed well cared for and were wearing clean cared for clothing.` The Service User Guide is an important document that describes the facilities available in the home, the services offered and also provides information about daily routines such as mealtimes and activities. We were able to confirm that the home`s Service User Guide was fully up to date and reflected recent changes to the management team. In addition, we were pleased to note that the guide is available in a variety of formats such as braille and audio to help ensure that more people have access to the information. We found that the home have a thorough approach to the assessment of people`s needs. On all the care plans viewed we found comprehensive care needs assessments that had been carried out prior to the person moving into the home. This is importantbecause it means that people can be assured that their needs will be met and also enables staff to plan people`s care effectively from the point that they move into the home. We found that care had been taken to establish people`s preferences in relation to activities and that activities were provided in line with people`s individual needs. There are two activities coordinators employed at the home who oversee the area and ensure that people are being offered regular opportunities to take part in enjoyable activities. During our visit there were various different activities going on and residents appeared to be enjoying taking part in them. As well as activities within the home there are some opportunities for residents to take part in trips out. The manager advised us that this was an area she is hoping to develop further. We found that the manager and owner of the home have a positive view of complaints and have implemented a number of ways in which people can express their views about the service. A thorough approach to the recording of complaints was evidenced as was the fact that all concerns and complaints received are regularly reviewed as part of the home`s quality assurance systems. This is important to help ensure that lessons are learnt from any complaints that are received. We found that people living at this home are provided with a good standard of accommodation. During our visit we noted that all areas were clean, warm and comfortable and decorated and furnished to a good standard. The Expert by Experience reported that the home was clean and bright and that people`s bedrooms were personalised with their own possessions. We received very positive feedback from staff members who told us they felt the home was well managed. Carers also told us that they received a good amount of training and that they felt well supported by the management. During our visit we noted that there appeared to be plenty of staff on duty to meet the needs of residents and residents and staff that were consulted all told us that they felt the staffing levels were adequate. Personnel files confirmed that the home follow careful procedures when recruiting new staff to help safeguard the wellbeing of people living there. In addition, training records confirmed that almost all carers hold nationally recognised qualifications in care which is a very good achievement. Throughout our inspection we found the manager to be very cooperative and helpful. She demonstrated a genuine commitment to person centred working and was able to give us a number of examples of how this was put into practice on a daily basis. We also held discussions with the owner of the home and were able to establish that she has a thorough approach to monitoring quality and constantly developing the service. There are a number of ways in which people who use the service and their relatives and other stakeholders are given the opportunity to express their views andcomments about the home including regular meetings. What has improved since the last inspection? Following the last inspection of the home there were a number of requirements and recommendations made. We were able to confirm during this inspection that these had been addressed and a number of significant improvements had been made. We found that the home had a much more thorough approach to the assessment of people`s needs and care planning. Care plans were found to be comprehensive and contained a good amount of guidance for carers. There were processes in place for assessing the risk to residents in areas such as developing pressure sores and falling. This helps ensure that carers have the information they need to keep people safe. Procedures for managing people`s medication were much improved and we found that the home now operates safe systems. Medication was found to be safely stored and all records relating to medication were in good order. We checked stocks of medicines and found these to be correct and variable dose medications had been administered in line with guidance from health care professionals. Procedures for recruiting new staff had been improved and all the staff files viewed contained the appropriate information and evidence that the necessary background checks had been carried out. A number of improvements had been made to the environment including the redecoration of several areas and the provision of a new stair lift. Further improvements are planned for the near future. What the care home could do better: We were accompanied on our inspection by an Expert by Experience who joined residents for lunch. The expert reported that she was disappointed with her meal and also noted that there was no menu on display to inform residents what the meal of the day was. We discussed the expert`s feedback with the manager who agreed to look into the issue. We also made a recommendation that all residents be offered a choice of main meal on a daily basis. We found significant improvements in the way medication is managed in the home. However, we have made some minor recommendations to assist the home in further improving practice. These include ensuring that any hand written entries on residents` medication administration records are witnessed and double signed. We also made a recommendation that information in relation to residents` `as and when required` medicines is always in place. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Kingfisher Care Home 10 Crossways Cleveleys Lancashire FY5 1LA     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Marie Cordingley     Date: 1 2 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: The Kingfisher Care Home 10 Crossways Cleveleys Lancashire FY5 1LA 01253853136 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): wylie@thorntoncare.com Mrs Lindsay Margaret Wylie Name of registered manager (if applicable) Mrs Tracy Heyes Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only : Code PC To people of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category: Code OP The maximum number of people who can be accommodated is 20 Date of last inspection Brief description of the care home The Kingfisher Care Home is registered with the Commission for Social Care Inspection to provide care and accommodation for up to 20 older people. The home is located in a residential area of Cleveleys, within easy reach of local transport services, a variety of shops and leisure facilities and the sea front. It is a detached property with pleasant gardens that are accessible to residents. Accommodation is provided in fourteen single bedrooms and three double bedrooms. Three of the single rooms have en-suite facilities. The bedrooms are situated on the Care Homes for Older People Page 4 of 32 0 Over 65 20 care home 20 Brief description of the care home ground and first floors. First floor bedrooms are accessed by two stair lifts. There are two lounges, a conservatory and a dining room. Care is provided on a 24 hour basis including waking watch care throughout the night. All the above information and more can be obtained on request from the home. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection of this home included an unannounced visit which was carried out over one day. As the visit was unannounced the residents, staff and manager did not know it would be taking place until we arrived. During the visit we spent time talking with people who live and work at the home as well as the manager. We viewed a variety of documents including residents care plans and staff personnel files and conducted a tour of the home viewing residents communal and private accommodation. We were accompanied by an Expert by Experience during our visit. This is a person who has some personal experience of care services. The expert spent time observing Care Homes for Older People Page 6 of 32 residents and carers and spoke with a number of people about their opinions of the service provided. Her findings are reflected throughout this report. Prior to our visit we wrote to the manager and asked her to complete a comprehensive self assessment. The self assessment explored the strengths of the service and asked the manager to identify areas for development. We received the completed assessment within agreed timescales and noted that it was completed to a very good standard. We also wrote to a selection of residents and staff and asked them to take part in a written survey. We received a good response to our survey with 12 completed questionnaires returned to us. What the care home does well: We received 12 completed surveys prior to the visit. Six were from residents and six were from staff members. The responses were extremely positive with everyone who responded expressing their satisfaction with the service provided. Comments in the surveys included; I can only speak for myself and my relative but I feel we are fortunate to have found such a good care home. The staff are so supportive and are always there if I have any problems. There always seem to be plenty of staff on duty and the care they give is very good. Carers are very good and very attentive. The manager is very approachable. The service works very well because they understand that every person has a different personality and different needs. During our visit we spoke with a number of residents and staff. People told us that the home provided a good service and were complimentary about the management. One resident said I feel very happy to be here, we are all very well looked after. A staff member said There is always a nice atmosphere here, the staff get on very well which benefits the residents. We observed staff going about their duties in a pleasant and professional manner. Carers appeared to have plenty of time to spend with residents and there were a variety of activities going on. There was a happy atmosphere in the home and staff and residents appeared to get along well. Residents we met appeared content, relaxed and comfortable in their surroundings. The Expert by Experience who accompanied us on our inspection reported I felt the home was a busy place with plenty on offer for the residents. The home was clean and bright and the residents all seemed well cared for and were wearing clean cared for clothing. The Service User Guide is an important document that describes the facilities available in the home, the services offered and also provides information about daily routines such as mealtimes and activities. We were able to confirm that the homes Service User Guide was fully up to date and reflected recent changes to the management team. In addition, we were pleased to note that the guide is available in a variety of formats such as braille and audio to help ensure that more people have access to the information. We found that the home have a thorough approach to the assessment of peoples needs. On all the care plans viewed we found comprehensive care needs assessments that had been carried out prior to the person moving into the home. This is important Care Homes for Older People Page 8 of 32 because it means that people can be assured that their needs will be met and also enables staff to plan peoples care effectively from the point that they move into the home. We found that care had been taken to establish peoples preferences in relation to activities and that activities were provided in line with peoples individual needs. There are two activities coordinators employed at the home who oversee the area and ensure that people are being offered regular opportunities to take part in enjoyable activities. During our visit there were various different activities going on and residents appeared to be enjoying taking part in them. As well as activities within the home there are some opportunities for residents to take part in trips out. The manager advised us that this was an area she is hoping to develop further. We found that the manager and owner of the home have a positive view of complaints and have implemented a number of ways in which people can express their views about the service. A thorough approach to the recording of complaints was evidenced as was the fact that all concerns and complaints received are regularly reviewed as part of the homes quality assurance systems. This is important to help ensure that lessons are learnt from any complaints that are received. We found that people living at this home are provided with a good standard of accommodation. During our visit we noted that all areas were clean, warm and comfortable and decorated and furnished to a good standard. The Expert by Experience reported that the home was clean and bright and that peoples bedrooms were personalised with their own possessions. We received very positive feedback from staff members who told us they felt the home was well managed. Carers also told us that they received a good amount of training and that they felt well supported by the management. During our visit we noted that there appeared to be plenty of staff on duty to meet the needs of residents and residents and staff that were consulted all told us that they felt the staffing levels were adequate. Personnel files confirmed that the home follow careful procedures when recruiting new staff to help safeguard the wellbeing of people living there. In addition, training records confirmed that almost all carers hold nationally recognised qualifications in care which is a very good achievement. Throughout our inspection we found the manager to be very cooperative and helpful. She demonstrated a genuine commitment to person centred working and was able to give us a number of examples of how this was put into practice on a daily basis. We also held discussions with the owner of the home and were able to establish that she has a thorough approach to monitoring quality and constantly developing the service. There are a number of ways in which people who use the service and their relatives and other stakeholders are given the opportunity to express their views and Care Homes for Older People Page 9 of 32 comments about the home including regular meetings. What has improved since the last inspection? What they could do better: We were accompanied on our inspection by an Expert by Experience who joined residents for lunch. The expert reported that she was disappointed with her meal and also noted that there was no menu on display to inform residents what the meal of the day was. We discussed the experts feedback with the manager who agreed to look into the issue. We also made a recommendation that all residents be offered a choice of main meal on a daily basis. We found significant improvements in the way medication is managed in the home. However, we have made some minor recommendations to assist the home in further improving practice. These include ensuring that any hand written entries on residents medication administration records are witnessed and double signed. We also made a recommendation that information in relation to residents as and when required medicines is always in place. Care Homes for Older People Page 10 of 32 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 11 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 12 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 can be assured that carers understand their needs and that their needs will be met. Evidence: A Service User Guide is provided to anyone who is considering a move to the home. This is a useful document that includes information such as services provided, facilities available and arrangements for daily routines like mealtimes and activities. We viewed the guide and noted that it had been updated to reflect recent changes in the management team. We were also able to confirm that the guide is made available in a variety of different formats including audio and braille so that more people have access to the information. Care Homes for Older People Page 13 of 32 Evidence: We received six completed surveys from people who live at the home. Everyone who sent us a survey told us that they felt they received a good amount of information about the home before they moved there. As part of our case tracking exercise we viewed the pre-admission assessments for several residents. We found that the assessments were of good quality and contained a lot of information about peoples individual care needs. Assessments included person centred information to help carers provide a personalised service. We also noted that where possible, peoples personal preferences and wishes about how they would like their care to be provided had been included. All the assessments we viewed had been completed prior to the residents admission to the home. This means that people could be assured their needs would be met at the home and that it was the right place for them. It also means that carers would have enough information to plan peoples care effectively from the point of their admission. Care Homes for Older People Page 14 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care provided to residents is carefully planned to ensure that their individual needs are met. Evidence: There were written care plans in place for every resident that outlined their care needs and the support they required. We viewed a number of these as part of our case tracking exercise and found that they contained a good level of information. Care plans covered all areas of daily life and contained clear guidance to carers about the help people needed in each area. We also noted that where possible, peoples own preferences and views about how they wanted their care to be provided were included in their plans. People we met during our visit looked comfortable and well cared for and most people we spoke with told us they were happy with the care they received. One resident said I am very well looked after, the staff are very kind. Care Homes for Older People Page 15 of 32 Evidence: We received six completed surveys from people who live at the home. Five people told us that they always received the help they needed and one person said they usually did. All six carers who returned surveys told us that they always received enough information about individual peoples needs to provide the right level of care. Records viewed showed that carers monitored residents health closely and acted promptly if concerns were identified. We were able to confirm that people were supported to access community health care when necessary. We spoke with one resident who explained that she had some pressure sores when she moved into the home, but with the care of district nurses and staff within the home, said they were healing nicely. One resident we case tracked had experienced a deterioration in their mental health which had been identified by the manager and carers. Through discussion, we were able to confirm that the manager had supported the resident to access the appropriate specialist services and was working closely with their family. We also noted that the residents care plan had been updated to provide specific guidance to staff about this issue. We looked at the way the home stored medication and found that this was done in a safe and well organised manner. However, we noted that there was no dedicated fridge for storing medicines. We discussed this with the manager and advised her to ensure that there was a secure fridge available for this purpose. We found records relating to the receipt, administration and disposal of medicines were in good order and no errors or omissions were apparent. However, we made a recommendation that any handwritten entries on peoples medication records be witnessed and signed to further safeguard against any errors being made. We checked the numbers of some peoples tablets against the records and found these were all correct. We examined records of medicines prescribed on a variable basis and found that carers had implemented changes accurately in line with instructions from health care professionals. Some people have medicines which are prescribed on an as and when required basis. In most cases there was good information for carers about when these medicines should be given. However we found a small number of examples where this information needed to be clearer. We made a recommendation in relation to this. Care Homes for Older People Page 16 of 32 Care Homes for Older People Page 17 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to spend their time doing things they enjoy. Evidence: In all the care plans we viewed there was a good amount of information about the persons individual needs and preferences and how they liked to spend their time. Valued hobbies and pastimes were recorded as were details of all activities the person had chosen to take part in. In discussion, the manager showed an understanding of the need to provide individual opportunities for people as opposed to a one size fits all approach. There are two activity coordinators employed at the home who ensure that a wide variety of activities are regularly offered. During our visit we saw a number of different activities going on including arts and crafts and singalongs. We noted that there seemed to be plenty of staff on duty to facilitate the activities and spend time with residents. Four of the six residents who responded to our written survey said that there were always activities organised within the home. One person said that there were usually Care Homes for Older People Page 18 of 32 Evidence: activities and the remaining person answered sometimes. One resident we spoke with during our visit said We do a lot of nice things here, I enjoy my days. As well as activities within the home we noted that there were opportunities provided for residents to take part in trips out to their local community. Such outings included shopping trips and tea dances. In discussion, the manager explained that this was an area that she was hoping to develop further to ensure that all residents had regular opportunity to take part in their local community. The Expert by Experience who accompanied us on our inspection described the home as a busy place and reported that there seemed to be plenty on offer to residents. The expert also wrote There appears to be something happening each afternoon. Taxis are organised to take residents out to tea dances locally or shopping. There are visiting vicars and some of the residents go weekly to churches locally. The Expert by Experience joined residents for their meal. She reported that the meal was a pleasant and social occasion and wrote We had fabric napkins and were offered water or orange juice with our meal. There was salt and pepper on the table as well and sugar basins and milk jugs also. Out of the six people who responded to our written survey, five said they always liked the food provided and one said they usually liked it. However, the Expert by Experience reported that the quality of her main meal was disappointing although she said the dessert was quite nice. The expert also reported that during her discussions with residents throughout the day, she received mixed feedback about the quality of meals. Comments made to her about the food included Could be better, plain but nice. We viewed menus that showed a varied and nutritious diet is provided. However, it was noted by the Expert by Experience that no one was offered a choice of main course during our visit. The expert also noted that there were no menus on display letting people know the meal of the day. We discussed the experts feedback with the manager who advised us that attempts were made to meet individual preferences. This was also evident in discussion with one resident who told us that she developed her own menus on a weekly basis. She confirmed that the home always met her requests. However, we made a recommendation that menus be reviewed to ensure that all residents are offered a choice of main course on a daily basis. Care Homes for Older People Page 19 of 32 Care Homes for Older People Page 20 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. People are enabled to raise concerns and can be assured that their concerns will be dealt with appropriately. Evidence: The home has a complaints procedure in place which is clearly written and available in a variety of formats to ensure more people have access to the information. The procedure explains how to go about raising concerns and also provides advice to those who are not satisfied with the way their complaint has been managed. In discussion the manager and owner of the home demonstrated a positive approach to complaints and confirmed that people are encouraged to raise any concerns that they have. The six residents who responded to our survey all told us that they knew how to make a complaint and the six staff who responded all said they knew what to do if any concerns were raised with them. A record of complaints received and action taken is kept in the home. The record confirmed that the home had received one minor verbal concern which was recorded and dealt with appropriately. We were pleased to note that the home ensure that all verbal concerns are recorded as well as written complaints. The manager explained Care Homes for Older People Page 21 of 32 Evidence: that the records are reviewed on a regular basis as part of the homes quality assurance processes. All homes are required to have a policy and procedures in place to follow if it is suspected that a resident has been the victim of any kind of abuse. These are generally referred to as safeguarding procedures. The manager and all the staff members consulted showed a good understanding of the procedures. One staff member who responded to our written survey wrote I am confident that any concerns of this nature would be dealt with straight away by the manager. Care Homes for Older People Page 22 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at this home are provided with a very good standard of accommodation. Evidence: The Kingfisher is a spacious home with all accommodation offered on a single room basis. In addition there are a variety of communal areas for people to spend their time. Since taking over the home the current owners have made a number of improvements to the environment including redecoration of a number of areas and the replacement of a stair lift within the home. A number of further improvements are planned for the home which include the provision of a new conservatory and the relocation of the laundry area. We carried out a tour of the home and found all areas to be warm and comfortable. We noted that the home was maintained and furnished to a good standard and residents bedrooms were nicely personalised with items such as pictures and ornaments. We were able to confirm that all residents bedrooms were lockable and that all Care Homes for Older People Page 23 of 32 Evidence: residents who wanted a key were provided with one. The Expert by Experience who accompanied us on our inspection described the home as welcoming and in relation to the residents lounge wrote The bright room had lovely clean traditional carpeting and felt warm and comfortable. Residents were sitting in chairs of a good height. We noted that there had been attempts by the manager to meet peoples individual needs. For example one resident who had recently moved to the home had a love of gardening. She had been provided with a bedroom with patio doors leading directly to a small area of garden that had been allocated for her personal use. Another resident told us that she was expecting delivery of a new carpet for her bedroom. She said that she had chosen the colour and style of the carpet herself. During our tour of the home we found that all areas viewed were clean and well maintained. Out of the six residents who sent us completed surveys four said that the home was always fresh and clean and the remaining two said it was usually so. The manager confirmed that the home has infection control procedures in place and training records showed that all staff are provided with training in this area at the start of their employment. Care Homes for Older People Page 24 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. People receive their care from carefully recruited well trained staff. Evidence: We viewed a selection of staff files during our visit and found that the home follow careful procedures when recruiting new staff. Evidence was available in each file to confirm that the necessary background checks had been carried out, for example police checks and previous employment references, prior to each candidate being offered employment. However, we did make a recommendation about how the process could be further improved. Some of the staff members application forms viewed did not include a full employment history. We discussed this with the manager who advised us that any gaps in a candidates employment history would be followed up during interview. We advised the manager to record these discussions to demonstrate that the gaps had been investigated. People we consulted both in writing and during our visit told us that staffing levels were appropriate to meet the needs of residents. One staff member said We have time every day to spend with the residents which is nice. Care Homes for Older People Page 25 of 32 Evidence: During our visit we found the atmosphere to be relaxed and observed staff providing support in an unhurried manner. There were a variety of activities going on and staff were seen spending one to one time with residents chatting. All the carers observed went about their duties in a pleasant and professional manner and residents appeared relaxed in their company. Records showed that all new staff members are provided with induction training to ensure they have an understanding of their role and what is expected of them. We were able to confirm that the induction package used is in line with Skills for Care Standards. Ongoing training is provided in all the mandatory areas such as moving and handling as well as additional training in areas such as working with people with dementia. We were also able to confirm that almost all the staff team (94 per cent) had achieved National Vocational Qualifications in care at level two or above. This figure exceeds the national target and is a good achievement. Staff consulted told us that they felt well supported and this was reflected in the fairly low turnover of people who work at the home. One staff member said The manager is easy to talk to, I would never have any worries about approaching her. Records showed that all staff are provided with regular one to one meetings with their manager during which they can discuss areas such as training, general work performance and any concerns that they may have. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This is a well managed home where the best interests and wellbeing of those who live there is promoted. Evidence: The home has a suitably qualified and experienced registered manager. Throughout the inspection the manager demonstrated a good understanding of her role and a commitment to providing good outcomes for people using the service. The Expert by Experience reported that the manager Was working alongside staff and setting her standards by example. The manager showed a good understanding of person centred working and was able to provide number of examples of how this was put into practice on a daily basis. During our consultations with people who live and work at the home we received very positive feedback about the management of the home. People told us that the manager and owner were very approachable and supportive. One resident wrote I am sure if I ever Care Homes for Older People Page 27 of 32 Evidence: had any concerns the manager would be very keen to sort them out. We received the homes self assessment within agreed timescales and this was completed to a very good standard. The self assessment demonstrated that the manager and owner of the home have good systems in place to monitor quality and are constantly looking at ways to develop the service. The owner of the home has regular contact with people who live and work there and encourages involvement of various stakeholders to help develop the service. We noted that there were regular residents and relatives meetings and systems in place to ensure that people are enabled to express their views and ideas about the running of the home. Findings from various quality assurance exercises such as satisfaction surveys were posted on the notice boards of the home along with the homes annual business plan. It was also pleasing to note that the home have an external quality assurance system in place, namely Investors in People. To retain this award the home must meet certain standards in relation to staff training. There is a health and safety policy in place which is supported by a number of procedures in areas such as fire safety and infection control. Training records viewed confirmed that all staff are provided with training in the mandatory health and safety areas such as moving and handling. We also viewed full and clearly written recording of all safety checks and accidents. These records also confirmed that analysis takes place of all incidents and accidents within the home as part of the quality assurance system. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 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 1 7 Clearer records of care plan reviews should be kept to help demonstrate that residents and their relatives have taken part in them. The way incidents relating to a residents behaviour are recorded should be reviewed and a record kept that helps identify any triggers or patterns. A specific risk assessment in relation to pressure sores should be completed for every resident to help ensure that people are kept safe. A dedicated fridge should be available for the storage of medication that requires refrigeration. Any handwritten entries on residents medication records should be witnessed and double signed to further safeguard against errors being made. Detailed information should be recorded for residents on as and when required medication so that carers have a clear understanding as to when it should be administered. The manager should continue to develop the provision of community based activities to ensure that people have regular opportunity to take part in their local community. 2 8 3 8 4 5 9 9 6 9 7 12 Care Homes for Older People Page 30 of 32 8 9 10 15 15 16 A choice of main course should be available for each resident on a daily basis. Residents should be provided with daily information about meals so that they know what options are available. The reviews that are regularly carried out of the number and nature of complaints received should be recorded to demonstrate the homes good practice in this area. Records should be made of investigations in relation to gaps in a candidates employment history. The core training for senior carers should be reviewed to ensure that it covers the supervisory aspects of senior roles. 11 12 27 30 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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