Care Home: The Leonard Elms Care Home

What the care home does well Care plans accurately reflect the individuals` needs and how they will be met. People who live in the home and their families are involved in this process wherever possible. Systems are in place to help ensure that there is consistency in assessing, planning, implementing and evaluating the care when required. We saw improvements in people making choices about how they choose to live their lives, this is detailed in the care documentation and staff we spoke with told us about the people living in the home, their likes and dislikes and their preferred routines. Safe, effective systems of practice are in place in receiving, storing, administering, and disposing of drugs which will help protect the health and wellbeing of people living in the home. Staff have a good awareness of individuals` needs and treat people in a warm and respectful manner, which means that they can expect to receive care and support in a sensitive way. Mealtimes were dignified and unhurried. The dining experience was a sociable occasion and people were given adequate support where needed. The complaints policy and procedure in the home is effective and all concerns are taken seriously and acted upon efficiently. People can be sure that they will be listened to and that their thoughts and feelings are taken into account. Recruitment procedures have meant that vacancies have been filled with people that are suited to the job with the right skills, this will also help ensure more continuity of care to the people who use the service. The home encourages and supports staff with training in order for them to develop their knowledge so that they have the required skills to meet the needs of the people. What has improved since the last inspection? The home is well organised and managed by an effective, stable management team that promotes the views and interests of all people who use the service. The home has continued to improve following the last inspection and further examples are detailed throughout this report. What the care home could do better: All of the National Minimum Standards assessed at this inspection were met. No statutory requirements have been made as a result of this inspection. We would like to thank everyone who took part in the inspection, their enthusiasm and support was greatly appreciated. Key inspection report Care homes for older people Name: Address: The Leonard Elms Care Home Brinsea Road Congresbury North Somerset BS49 5JH     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: Wendy Kirby     Date: 3 1 0 3 2 0 1 0 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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 Leonard Elms Care Home Brinsea Road Congresbury North Somerset BS49 5JH 01934853834 01934852673 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Paul Bliss Name of registered manager (if applicable) Mrs Susan Haywood Type of registration: Number of places registered: care home 73 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 73. The registered person may provide the following category of service only:Care home with nursing (N) to service users of either gender whose primary care needs on admission to the home are within the follwoing categories: Old age not falling into any other category (code OP) - maximum of 36 places Dementia (Code DE) - maximum of 37 places. Date of last inspection Brief description of the care home The Leonard Elms is divided into two units. The Elms provides nursing care for up to thirty six people. The Leonard provides dementia care for up to thirty seven people. The home is in a rural setting on the edge of the village of Congresbury. Care Homes for Older People Page 4 of 29 Over 65 0 36 37 0 1 5 0 7 2 0 0 9 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: This was an unannounced Key Inspection which included a visit to the home. The visit was completed by two inspectors and lasted approximately nine hours. Prior to the inspection we (The Commission) looked at various pieces of information to gather evidence in preparation for our visit, which included the following: The homes inspection record, which gives us an account of any information we have received about the home since the last inspection. The Annual Quality Assurance Assessment, known as an AQAA. The home is requested annually to complete and return this assessment to us by a specified time. We received the AQAA on time, which contained detailed information about what the home considers it does well and what plans they have for further improvements in the coming year. Care Homes for Older People Page 5 of 29 We sent surveys Have Your Say to people who live in the home and health and social care professionals, nine were completed and returned. Comments received from the surveys will be referred to throughout this report. During our visit we spoke with some of the people who live in the home, visitors, the registered provider, the registered manager, and other staff members who were on duty. We also looked at how effectively staff engage with people in the home and how they were interacting and communicating with each other. We looked at six individual care files, which included, pre admission assessments, care plans and risk assessments. We also looked at a number of records and files relating to the day to day running and management of the home. We spent time in all communal areas of the home and some of the bedrooms. Feedback was provided to the management team throughout our visit. Care Homes for Older People Page 6 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 7 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 8 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 9 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. Peoples needs are assessed prior to admission to determine the suitability of placement. They can be confident that staff will have the resources and skills to meet their assessed needs. Evidence: We looked at the pre admission assessments, which were fairly comprehensive covering all activities of daily living, a full health screen and personal history background. The information gathered pre admission should provide a sound benchmark of the persons ability, state of health prior to admission and subsequent needs when they move into the home. People wishing to live in the home, family and carers are involved in the pre admission assessment wherever possible and all information is used to determine the suitability of the placement. Where possible the manager also obtains comprehensive assessments and care plans from other health and social care professionals involved, Care Homes for Older People Page 10 of 29 Evidence: for example, social workers and hospital staff. We spoke with the manager who was able to clearly demonstrate the importance of pre admission assessments in order to ensure that the home can meet individuals identified needs. The AQAA tells us, We undertake a robust pre admission assessment of individuals needs prior to admission, establishing and maintaining detailed accurate, relevant and updated, individual care plans. Health care professionals agreed that the homes assessments ensure that accurate information is gathered and that the right service is planned for people. Care Homes for Older People Page 11 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Because they are consulted about their health and personal care needs people can be sure their views and expectations will be considered. The health and personal care that people receive is based on individual needs. There are safe systems of practice are in place in receiving, storing, administering, and disposing of drugs which will help protect the health and wellbeing of people living in the home. People can be confident that staff have a good awareness of their needs and that they will be treated with dignity and respect. Evidence: From the pre admission assessments the staff are able to develop a set of care plans based on identified needs. During the first four weeks the plans are reviewed and developed accordingly. The home is currently reviewing the format so that more information can be documented and this will help make them more person centered. Care Homes for Older People Page 12 of 29 Evidence: Care plans were completed with regards to health and social needs including, psychological, emotional, and cultural needs which demonstrates that the home takes an holistic approach to the provision of care. The plans that we looked at were fairly detailed and person centered, including personal preferences and likes and dislikes. Some plans told us that people had specific requests and routines, this is very good practice and helps demonstrate that people are involved in deciding how they wish to receive care. The plans showed consistency in assessing, planning and evaluating care as required. The manager conducts random monthly audits on the care files and written feedback is given to staff including any further action required. Regular care reviews take place for people living in the home, which can include family members and care staff wherever possible. This allows the opportunity to discuss and evaluate care and any issues or concerns people might have. Staff agreed that they had up to date information about individuals needs and confirmed that care plans were reviewed at least monthly unless there were any other significant changes. Staff are requested to read and sign that they understand people needs. Staff told us, People living in the home seem a lot more happy and content, Staff dont feel rushed anymore and care seems more meaningful and Staff seem much more optimistic and person centered care is improving. Health care needs are monitored and documented in peoples care files. Nutritional assessments are completed on admission and reviewed monthly, people are weighed monthly as part of this review. Care plans are written for people who are nutritionally at risk and how this is to be managed. Specialist health care support is often sought and referrals are made to community dietitians and speech and language therapists. One survey said, The nursing care is excellent, including monitoring, healing and improving well being. Records of General Practitioner (GP) visits and the outcomes were recorded. Specialist referrals and visits from other professional including, Chiropodists, Dentists and Opticians were also seen. Our surveys told us that people living in the home feel that they are receiving the medical support they need. People living in the home are registered with a local doctors practice. Medicines are supplied to the home using a monthly blister pack system. All the medicines used in the home are given by staff. We checked the medication systems used to make sure that they meet the required standards. The home uses a local pharmacy for their Care Homes for Older People Page 13 of 29 Evidence: medications and gets support and training from them. Good practice guidelines are followed such as having a photograph of the person needing the medication on their chart. The pharmacy provides printed medicine administration record sheets for staff to complete when they give medicines. These are kept with each persons medicines, along with a copy of the homes medicine policy. This means that staff can be clear about how to give medicines safely. Medicines were given from the labeled packs provided by the pharmacy. Staff signed the administration record as they gave the medicines. We checked a sample of medicines and these indicated that they had been given as prescribed by the doctor. The records of administration had been completed fully. We saw that the home has a medicines disposal book to record how unwanted medicines are disposed of. The home promotes privacy and dignity to all people who use the home. Staff attend training on induction, which covers aspects such as closing doors and pulling curtains when delivering personal care and knocking on doors and waiting for an invitation to enter before going in to their bedrooms. We saw staff knocking on peoples doors before entering, members of staff spoke respectfully about individuals needs and referred to them in the term of address that they preferred, this information was also recorded in the care files. One survey said, They treat me with dignity, respect and affection. Care Homes for Older People Page 14 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. People benefit from a varied activities programme, which is both enjoyable, stimulating and meets individual preferences and expectations. People maintain family contact and staff encourage family and friends to join in with activities and any outings. The home actively promotes individuals to exercise choice and control over the lives they choose to live. People receive a varied and wholesome diet that they are able to influence. Evidence: There does not appear to be any unnecessary rules and it seemed that daily routines are flexible within the home. We saw evidence that people can get up and go to bed when they like, have their meals in their bedrooms, they can go out when they wish and participate in activities they have a particular interest in. This was confirmed in discussion with individuals and through observation during our visit. We met with one of the activity coordinators who was very enthusiastic about her role. Care Homes for Older People Page 15 of 29 Evidence: She was very knowledgeable about the people in her care, including their likes, dislikes, communication needs, personal history, hobbies and interests. We saw her throughout our visit interacting with people in a dignified, gentle manner. She told us, I love the job and I couldnt imagine doing anything else. I just love being involved with all the residents. The AQAA tells us about how things have improved in the last twelve months, We have increased our activity support. The Leonard Unit now has seven afternoons each week, and the Elms has four whole days. We strive to ensure that the majority of people have one to one or group activities on a daily basis. We keep daily records to evidence this. We have combined the two units for outside entertainment by using the larger lounge at The Leonard, which results in greater frequency of entertainment. The home continues to strive for excellence and look at innovative ways to do this. The AQAA tells us about many new ideas that they wish to initiate for the benefit of all people who use the service. The manager tells us in the AQAA, We plan to take people out on more small trips. The Registered Provider is going to provide a minibus with a tail lift to facilitate our wheelchairs. In the Leonard unit we are going to personalise and decorate the corridors with sensory and tactile displays. Lounges in the home provide good entertainment systems including televisions, videos, DVD players and musical systems. People living in the home told us that there were activities arranged in the home that they could participate in should they wish to do so. The home operates an open door policy for visitors and people are able to see visitors in the privacy of their own rooms and there are several semi private seating areas around the home and in the gardens. One relative told us, They are so supportive to relatives. During our visit we observed people who live in the home, time was spent with people in their private rooms and also with people in communal areas. We did this because we wanted to see how the needs of people with dementia were being met and to talk with people about their life at the home. We saw that staff engaged with those who live at the home in a meaningful way. People were spoken to politely and respectfully. Staff were attentive and supported people in an appropriate manner. Staff we spoke with were able to tell us in depth about the needs, wishes and preferences of people who live in the home, demonstrating a sound understanding of the individual person. Care Homes for Older People Page 16 of 29 Evidence: The size and layout of the dining room makes it possible for everyone to enjoy the social advantages of dining together. The dining rooms are light and spacious with good quality dining furniture. Staff members supported people that required assistance with eating their meals in a respectful sensitive manner. Staff sat at the same level and assisted them without rushing. We saw jugs of juices, beakers and glasses and these were being handed to people whilst waiting for lunch. Later when we visited people in their rooms we saw that jugs of fluid had also been provided for individual use. The chef and staff were able to demonstrate an awareness of individual requirements and needs including special dietary requirements and personal preferences. The food is home cooked offering various choices of hot and cold alternatives and fresh fruit is available at all times. The menus display traditional meals and menus are reviewed to reflect seasonal trends and availability of produce. Extras are ordered on request for birthdays and special occasions. The chef talks to people to find out if they have enjoyed the meals and encourages them to come forward with new ideas. The AQAA tells us, We spend one to one time choosing meals. People seem to be eating more and enjoying the food. The kitchen was very clean, well equipped and spacious. Stores exhibited a good range of foods. The AQAA states, We have promoted an interest in gardening by supplying high planters. Last summer people living the home grew salad vegetables and then consumed them. Food hygiene training was up to date for all staff. Documentation shows provided that the required temperature checks are being carried out on fridges and freezers and that food was also being probed after being cooked. 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. There are good policies and procedures in place to manage complaints and people can be confident that their concerns will be listened to and acted upon. There are good arrangements in place for staff training and the awareness of protecting vulnerable adults so that people living in the home are further protected from abuse. Evidence: The complaints policy and procedure is detailed and contains all the relevant information required, this can be found in the service user guide and welcome pack, which is given to people on admission. It is also displayed on notice boards throughout the home. We would receive details from the home about any internal complaints investigations and safeguarding referrals. Complaints and concerns are dealt with openly and effectively. The manager told us that she is committed to encourage an open culture within the home so that people feel comfortable and able to make a complaint or a suggestion without fear of reprisals. One relative told us a survey, We formally complained. The home listened and we are now happy. They do put complaints right. The manager told us the AQAA, In the next twelve months we plan to continue building relationships with family and friends , in hope that if they feel anything is Care Homes for Older People Page 18 of 29 Evidence: amiss, they will have the confidence to talk to us. The manager makes every effort to see people living in the home Monday to Friday. Being available means that people can discuss any concerns or issues with the manager before they potentially escalate into complaints. Systems that are in place at the home such as regular care reviews, key workers and holding meetings for people living in the home, relatives, and staff means that there is opportunity to communicate and share information. This further promotes people becoming less frustrated thus relieving anxieties and any potential complaint referrals. All of our surveys told us that people knew how to make a complaint and who to talk to if they were unhappy. There are policies and procedures as well as a range of guidance information on the topic of protection of vulnerable adults from abuse. The availability of this information should increase staff awareness and the understanding of their role in protecting vulnerable adults who live at the home. We were told that the home actively promotes staff training and education in the they were able to demonstrate its effectiveness when discussing the content of the training. A number of staff have either completed or are enrolled on the National Vocational Qualification (NVQ) in care award and a component of the award addresses issues around the topic of the protection of vulnerable adults from abuse. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home meets, and in some areas, exceeds the standards, providing a clean, comfortable, well equipped and a safe environment for people to live in, which meets their individual needs. Evidence: The home is fully accessible and has a number of aids and adaptations throughout the premises to enable physically disabled people to maximise their independence. This includes wide corridors and pathways, passenger lifts, specialised bathing facilities, grab rails and assisted toilet facilities. The AQAA tels us that, The Leonard Unit is a purpose built home for people with dementia and was commissioned and designed to the highest standard. It is supported by the provision of the latest equipment ensuring the home is user friendly for staff and people living in the home. The Elms is a traditional farmhouse style home, both units are managed by a Domestic Housekeeper who maintains the cleanliness of both. The Elms is more suited to people who are physically independent and as such is becoming less conducsive to care for people with increased, complex, nursing needs. The home is currently seeking planning permision to create a twenty five bedded extension to the existing Leonard Unit. Care Homes for Older People Page 20 of 29 Evidence: We walked around the inside of the home and viewed some of the bedrooms and the communal areas including the dining rooms, lounges, conservatory and bathrooms. Most room sizes are spacious for their stated purposes, particularly the lounges and dining rooms. Bedrooms have en suite facilities provided and communal bathing areas, showers and toilet facilities are located throughout the home. All areas of the home were tastefully decorated, clean and well maintained. Attention has been given to ensure that all areas are homely. Various lounge areas allow for people to be seated together enjoying the entertainment systems on offer. People had been supported to personalise their bedrooms with pictures and ornaments and they are able to bring items of furniture should they wish. The AQAA tells us about some improvements to the home this year, All gardens have been updated with a myriad of fresh planting. Garden furniture has been renovated and new planters made at waist height to allow people to plant salad and flowers. Within the Leonard unit all communal areas have received new flooring. Care Homes for Older People Page 21 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The relationships between staff and people living in the home are good and create a warm positive environment to live in. People are supported and protected by the homes recruitment policy. The people are cared for by skilled staff that are trained, supported and supervised by management. Evidence: The manager told us that staffing levels are indicative of needs and the level of care required and confirmed that levels of staff would rise should dependency levels increase. We know that the home also increases the levels of staff at certain busy times of the day to ensure that needs are met. People living in the home and staff agreed that there were enough staff to meet their needs. When there have been staff vacancies regular agency or bank staff have been used to provide continuity and the permanent staff will often cover extra shifts. A sample of staff recruitment records were looked at and showed us that the home follows a good recruitment procedure. This will help ensure that the right people are employed to work at the home, and people living in the home will be further protected. Records contained completed application forms with a full employment Care Homes for Older People Page 22 of 29 Evidence: history, two written references and Criminal Records Bureau (CRB)disclosures. Qualified nurses, are required by law to register annually with the Nursing and Midwifery Council (NMC) to be able to practice, these registrations are checked annually by the manager to ensure that the staff have done this. Staff confirmed that these checks had been completed before starting work at the home. There is an induction programme which covers all mandatory training. The home has a mentor system where all new staff are linked with and shadow a senior staff member during shifts to help with continued training throughout the induction process. Staff told us that the induction was good and covered everything they needed to know in order for them to do their job. The home provides the staff at the home with training and development opportunities tailored to individual needs. The manager and all staff are conscientious in attending training relevant to the care needs of the people they are caring for and those relevant to the roles they perform. The AQAA states, Both homes have an established staff team with a good skill mix to meet the assessed needs of people. Every member of staff either has an NVQ or has commenced on the course. Comments from staff included, The training relates to the conditions of the clients we are caring for, The training is very good, I had great support when I did my NVQ, There is so much more training now and I attend all the training thats made available. When we spoke to staff they were able to demonstrate a sound understanding of the needs of people in their care, those we spoke to had a good understanding of the needs of people with dementia, as well as respecting each person as an individual, with differing needs and choice requirements. Comments received about the staff included, They are caring and kind all the time, Staff have a good caring attitude and The staff are clearly well trained and well informed. We spent some time throughout the day talking and observing staff carrying out their duties and assisting people. Staff were respectful, warm, good humoured and sensitive towards people within a relaxed calm environment. The AQAA tells about improvements in the next twelve months which includes, Continue to recruit and develop a permanent staff team. To build this team into a cohesive unit. To introduce the homes own training on How it feels to be a Resident by giving staff the opportunity to experience the residents life in a care home. Care Homes for Older People Page 23 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. Peoples needs and best interests are central to the management approach in the home. The home continues to improve its quality assurance by introducing continuous monitoring of polices, procedures and practices in order to ensure that the home is run in the best interests of the people who use the service. Staff feel that they receive supervision and support that is appropriate to their roles and responsibilities in the home. The health and safety of people who use this service should be protected by systems in place. Evidence: We spoke at length with the registered manager of the home who demonstrated effective leadership and management skills that relate to the aims and purposes of the Care Homes for Older People Page 24 of 29 Evidence: home. She shared various new initiatives in order to further develop the care, standards and services that the home provides to the people living there. Her passion, knowledge and enthusiasm of the home, the people living there and all staff was very evident. The staff are a stable team that supports a commitment to providing quality care for the benefit of the people living in the home. People we spoke with told us that they were happy in the home and with the services provided. Comments included We have felt uplifted since the registered provider has been investing in the home to enhance the environment, Its great to see people living in the home doing exactly what they want, Since joining the two homes together we have become more united as a staff team, The manager has made some great improvements in the home, We work together like an extended family and We are gaining confidence with the new senior management team week by week. The home continues to monitor and assess the quality of services provided, by giving people questionnaires to complete and holding meetings for people living in the home and their relatives , families and friends. Internal audits are also carried out in the home with regards to care documentation, medication and other procedures in the home. The AQAA states, Quality assurance questionnaires are circulated to staff, residents, relatives and health professionals on a twice yearly basis. Those circulated to staff are completed on an anonymous basis with an option to request a meeting with the Registered Provided if required. The findings are analysed and where appropriate, improvements are suggested, these then form part of the agenda for our management meetings. There is an annual appraisal process which ties in with the supervision arrangements. The manager has established a formal recording of any supervision for all staff. A plan is devised for discussion including people living in the home, work issues staff issues, personal development and training. The manager felt that staff find the sessions are useful and confirmed that they received them on a regular basis. The home also encourages and supports practical supervisions in addition to the formal ones they receive. This has enabled staff to develop their skills on the floor. The home has written policies and procedures in relation to the promotion of the health and safety for all people who use the service and associated training was provided for staff in all health and safety matters. Some of the Health and Safety Care Homes for Older People Page 25 of 29 Evidence: records in the home were examined. Documentation showed that relevant checks were maintained correctly and at the required intervals including all fire alarms, equipment and emergency lighting. The homes records showed all necessary service contracts were up to date including, gas and electrical services and the passenger lift. 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 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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