Care Home: The Mead

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What the care home does well "The Mead offers my mother so much. The entertainment and activities are excellent which keeps her busy. The staff are caring, efficient and understanding and I feel that I could talk to the management about anything if I had any concerns". That is a comment received in a letter from one relative during the course of this inspection. The standard of care provided is good and in particular the dementia care is provided by a staff team who have been provided with a high standard of specific dementia care training to enable them to achieve good care outcomes for those people living in the home with dementia. In general, training, recruitment, medication and other record keeping like care plans is thorough and robust and provides people living in the home with confidence that their safety and well-being is being safeguarded. The management and quality assurance systems of the home are strong and this provides people living in the home not only with the opportunity to express their point of view about their care but to be heard and listened to and action taken to tailor care, wherever possible, to their individual needs and preferences What has improved since the last inspection? There is now more evidence of occupational based activities for people living with dementia and previous issues with the personal hygiene of some people living in the home and any instances of poor infection control and cleaning appear to have been successfully addressed. The rating of the home as three star in June 2007 came at the beginning of the use of the `star rating` system by the then Commission for Social Care Inspection. After three years not all homes have been able to demonstrate that they have maintained their standard of care outcomes sufficiently to retain that rating. It is therefore a credit to The Mead, its manager and staff team, that they have been able to demonstrate successfully that they have been able to maintain standards and performance at the same high level as previously. What the care home could do better: There were some minor shortcomings with the standard of linen storage, but the area that provided the most negative response from people who responded to our surveys was staffing levels at times and in particular the way that impacts on routine engagement and stimulation outside of the formal engagement and activity programme. "Having more staff so they can spend more time with residents and maybe do activities with them" was the answer of one person to the question `what could the service do better`. This does not detract from the good standard of activities and engagement seen to be in place, exceptionally provided over a seven day programme, nor were there obvious failures observed during this inspection due to lack of staff numbers. It recognises however that all staff need to be part of an almost constant underlying process of individual engagement and `activity` and that at key times, when care staff are otherwise engaged there can be periods of inactivity and lack of obvious stimulation for some people living in the home. These comments and observations arising from this inspection need to be taken account of in the forward planning of the home, but also need to be kept in proportion, as by far the majority of feedback received and observations made during this inspection were positive. Key inspection report Care homes for older people Name: Address: The Mead Castleford Close Borehamwood Hertfordshire WD6 4AL     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: Jeffrey Orange     Date: 2 2 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 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: The Mead Castleford Close Borehamwood Hertfordshire WD6 4AL 02089538573 02073133961 mead@quantumcare.co.uk www.quantumcare.co.uk Quantum Care Limited care home 60 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The home may admit one named service user who is under 65 years of age for a short period of time from 02/05/06 to 19/05/06. Date of last inspection Brief description of the care home The Mead is a two storey, purpose built residential care home for older people. It is situated in a quiet residential area of Borehamwood. Access to local shops, public transport and other local amenities are a short walk away. The home is built in a horseshoe shape around a courtyard garden, there is ample off road parking. Four separate suites each offer accommodation to fifteen residents. Bedrooms are designed for single occupation and each has an en-suite toilet and wash hand basin. There is one communal lounge and a dining area in each suite. Communal bathrooms are spacious and accommodate assisted baths and showers. There is a hairdressing salon and a guest room. The home also has a day centre however the Care Quality Care Homes for Older People Page 4 of 30 Over 65 60 60 60 0 0 0 Brief description of the care home Commission (CQC) does not currently inspect day care services. The charges for the home range from £535 to £635 per week. (Correct at March 2010) Hairdressing and Chiropody is not included and separate charges are made for these services. There is a detailed Service User Guide which includes contact details for the CQC and copies of the latest report by the CQC are available in the home. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We last inspected The Mead on the 20th June 2007. The current inspection was unannounced and was conducted by one inspector, where this report refers to we it recognises that it written on behalf of the Care Quality Commission (CQC). The inspection started early in the morning, which provided an opportunity to see the morning routine of the home as people who live there were getting up, having breakfast and getting ready for the day ahead. We were able to speak to people who live in The Mead and chose to speak to some people who have lived in the home for some time as well as to some who have only recently moved in. This gives us a range of views on the experience of moving into and then living in The Mead. We spoke to some visitors and briefly to a health care professional, we also spoke to Care Homes for Older People Page 6 of 30 care staff and to the Deputy Manager who was in charge of the home on the day of this inspection. In March this year the home sent us their annual quality assurance assessment or AQAA. The AQAA is a self-assessment document that sets out how well care outcomes are being achieved for the people who live in The Mead, it also includes some useful statistical information, for example about complaints and staff training. We sent surveys to some of the people who live in The Mead, to relatives and to care staff and health and social care professionals. Where these have been received back they have been used in drawing up this report, any received after it is completed will be recorded and used to inform the future regulation of the home. We also make use of any other information we may have received about The Mead since June 2007. This could be in the form of notifications sent to us by the home about significant events affecting the home and the people who live there, from relatives or other people who are associated with the home in any capacity, including health and social care professionals, or from current or past care staff or residents. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: There were some minor shortcomings with the standard of linen storage, but the area that provided the most negative response from people who responded to our surveys was staffing levels at times and in particular the way that impacts on routine engagement and stimulation outside of the formal engagement and activity programme. Having more staff so they can spend more time with residents and maybe do activities with them was the answer of one person to the question what could the service do better. This does not detract from the good standard of activities and engagement seen to be in place, exceptionally provided over a seven day programme, nor were there obvious failures observed during this inspection due to lack of staff numbers. It recognises however that all staff need to be part of an almost constant underlying process of individual engagement and activity and that at key times, when care staff are otherwise engaged there can be periods of inactivity and lack of obvious stimulation for Care Homes for Older People Page 8 of 30 some people living in the home. These comments and observations arising from this inspection need to be taken account of in the forward planning of the home, but also need to be kept in proportion, as by far the majority of feedback received and observations made during this inspection were positive. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering The Mead as their home can be confident that they will be provided with all the detailed and comprehensive information they need to help them make a well-informed decision and that they will be able to visit the home as part of that process. They can also be confident that they will only be admitted after a thorough assessment process has established that their care needs can be fully and appropriately met. Evidence: When we asked people who now live in the home if they had enough information to help them decide if The Mead was the right place for them before they moved in, 83 answered yes with 17 answering that they did not know. When we asked them if they had a written contract setting out the terms and conditions of their residence 66 answered yes, 17 no and 17 did not know. When we looked at information provided for people who may be considering The Mead Care Homes for Older People Page 11 of 30 Evidence: as a home for themselves or someone they are responsible for we found that it was exhaustive, comprehensive and clearly presented. The homes Personal Guide includes a detailed home information sheet, details of the complaints procedure, helpful advice about the Mental capacity Act and its implications, a schedule of fees so that everyone can see clearly what the costs of residence will be, what is included in the standard fee and what will attract additional costs. In addition, in other parts of the documentation provided there is general guidance and information about, for example dementia care. The Personal Guide is available in large print and audio formats and Quantum Care also have a web site giving this and other information on line, together with individual web-pages for each of their homes, including detailed contact information. All of this should make sure that anyone considering The Mead as their home should have all the information they need to help them make a well-informed decision. When we spoke to some people in the home who had only recently been admitted, they confirmed that they had been able to visit the home beforehand if they chose to so that they could see it for themselves and meet some of the key staff and people already living there. All our expectations were met was one comment made during the inspection. When we looked at assessments of the care needs completed for people being considered for admission into The Mead we found that they were comprehensive and included the information required to ensure that only those people whose care needs can be met in a way that takes account of their individual circumstances, preferences and life history are admitted. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in The Mead can be confident that they will receive effective health and personal care support, that they will be treated with respect and as an individual and that systems and records for medication are accurate and efficient. Evidence: When we asked people who live in the mead if they receive the care and support that they need, 17 said that they always do, 66 said that they usually do and 17 didnt know. When we asked if staff are available when they need them 17 said that they always are, 50 that they usually are and 33 that they sometimes are. When we asked if staff listen to you and act on what you say, 33.3 said that they always do, 33.3 that they usually do and 33.3 that they sometimes do. When we asked if they receive the medical care that they need 50 told us that they always do and 50 that they usually do. Care Homes for Older People Page 13 of 30 Evidence: When we asked the relatives/carers of people living in the home if The Mead gives the support or care to their relative that they expect or agreed, 60 said that they always did, 20 that they usually did and 20 that they never did. One relative wrote; I cannot sing the praises of The Mead enough, the staff are caring, efficient and understanding. When we asked health care professionals in surveys if people living in The Mead have their social and health care needs properly monitored, reviewed and met all those who responded said that they did. One health care professional told us that the standard of record keeping was generally satisfactory and that there were very few instances where inappropriate referrals to their service were made. When we looked at the care plans of people who live in The Mead, including some who have there for several years as well as some who had only recently moved there, we found that they were clear and quite comprehensive, setting out their individual health care needs and how they were to be met in line with their own preferences and choices. They included evidence of a system of regular review which should ensure that any changes in a persons needs are identified and the care plan adjusted to meet them. Care plans seen included good life history and personal preferences information which should mean that personal care is provided in line with the person concerneds wishes and choice. When we observed care at breakfast and other times we heard people living in the home being given choice as to what they wanted to eat and where they wanted to sit in an open way which meant they were not being led to any particular conclusion but could genuinely choose. Throughout the inspection we observed a good standard of care, which ensured the dignity of the person was upheld and their rights and wishes respected. When we spoke to people living in the home they were very positive about the care staff and the standard of care they receive; They look after me very well indeed was a typical comment and one relative noted; I am very pleased with the staff and the care they give. When we checked the medication administration and records we found that a good standard of accuracy and hygiene was maintained with a very robust and effective Care Homes for Older People Page 14 of 30 Evidence: system of monitoring and checks in place. This should give people who receive help with their medication confidence that their health, safety and well-being are protected and maintained. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in The Mead can be confident that they will be encouraged and enabled to exercise choice in and over their lives including their daily activities and routines. They can also be assured that they will be able to build and maintain contacts with family, friends and the community. Evidence: When we asked people who live in The Mead if they are provided with activities for them to take part in if they want to, 50 said that they always are, 17 said they usually are and 33 that they sometimes are. Relatives views on activities varied quite widely.The entertainment and activities are excellent, which keeps her busy was one comment, whilst another relative said in answer to the question what could the service do better ; provide more activities to motivate and keep people active. When we spoke to one of the engage workers for the home, we were provided with details of a typical programme for the week together with information about monthly events, special celebrations and visits both from the community, for example from local churches and library service together with visits to make use of community Care Homes for Older People Page 16 of 30 Evidence: facilities. We were told that engage workers receive training from Quantum Care and from a nationally recognised provider of training and advice on activities for older people. This should mean that engage staff are kept up to date with developments in the provision of activities which should in turn benefit people who live in the home. The home benefits from having a day centre based on the premises which we understand is available to people living in the home. The CQC does not regulate day care, however we observed some people who live in the home going into the day centre with the assistance of staff. When the day centre is not operational the room provides a useful resource for engage and social care staff to use for activities such as film nights for example. As was noticed during the previous inspection there were periods during this inspection when people living in the home appeared to be sleeping or certainly not being actively engaged whilst sitting in lounges with the television on, whether or not they were watching it. The engage staff informed us that they do carry out some one to one activities, either in peoples own rooms or communal areas and we were able to see a manicure being provided to at least one individual during this inspection. It would be positive if care staff could fill gaps for those people who would otherwise be without stimulation or engagement for long periods, recognising that this is done to some extent and that personal care activity has to take priority. We saw evidence of the provision of occupational material such as an ironing board and clothes to fold, rummage boxes and soft toys and dolls. This is positive especially for people who may be living with dementia. The provision of more typically male occupational items was discussed with one of the engage workers so that the range of occupational material might be wider. All of the visitors we spoke to or contacted during this inspection process told us that they felt that they could visit the home at any reasonable time and that in general they were kept well informed about the person living in the home and were always made to feel welcome. When we asked people living in the home if they liked the meals at the home, 17 said that they always did, 49 that they usually did and 34 that they sometimes did. When we observed breakfast, it appeared to be a relaxed and sociable time, with Care Homes for Older People Page 17 of 30 Evidence: those people who require assistance with their meals being treated with respect and in a way that preserved their dignity. Choices were very clearly and openly being given as to what people would like for breakfast and where they would like to eat it. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in The Mead should be confident that they are able to make a complaint and that they will be listened to and appropriate action taken, however not everybody appears to be aware of the formal process to enable them to do so. They can be assured that staff have received training that should enable them to protect people living in the home from actual or potential abuse. Evidence: Although the complaints policy and procedure is included in the Service User Guide and Statement of Purpose for the home and is also prominently displayed in the home and in other brochures and leaflets as well as on the homes web-site, when we asked people living in the home if they knew how to make a formal complaint, only 50 said that they did and in the case of relatives and carers who responded twice as many did not know as did know. The homes management should address this and see if there is any way that the existing information could be more successfully disseminated as it is important that people know how to make a complaint if they feel they need to. In view of the above it is perhaps not surprising that in their AQAA the home informed us that only one complaint has been received in the previous 12 months. One relative indicated; I feel that I could talk to the management about anything if I had any concerns. Care Homes for Older People Page 19 of 30 Evidence: When we spoke to care staff and looked at staff training records we found that they were familiar with the principles of safeguarding vulnerable adults from abuse and that they were given the training they require in order to be able to recognise actual or potential abuse and knew what to do if it was seen or suspected. The management of The Mead have made referrals to Hertfordshire County Council Adult Care Services pro actively and appropriately and where referrals have been made by other parties they have co-operated fully in the process. This should give people confidence that the management and staff are committed to protect the health, safety and well-being of all the people living in the home that they have a duty of care for. When we spoke to the visiting auditor, we were informed that Quantum Care ensure that all administrative staff recognise the possibility that some people in residential care may be deprived of the financial allowances to which they are entitled and the appropriate action that should be taken if that was suspected to be the case in order to safeguard the financial interests of the person concerned. All of the above should provide those people who live in The Mead and those responsible for them with confidence that they or their relatives are being protected from any form of abuse and that if it is seen or suspected robust, appropriate action is taken. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living or working in The Mead can be assured that the environment is safe, comfortable, clean and well-maintained. Evidence: When we asked people who live in The Mead if it is fresh and clean, 50 said that it always is and 50 that it usually is. Throughout the inspection we were able to observe staff cleaning communal areas and the bedrooms of people living in the home. Any incidence of unpleasant smells were dealt with promptly and effectively during the inspection. In their AQAA the home noted that housekeeping staff had won awards for the cleanliness of the home in 2008. We did find that some of the linen storage in communal bathrooms was untidy and badly organised, which could result in linen becoming crumpled and less attractive when put into use. The overall standard of decor was good and care and attention has been taken to make appropriate areas suitable and supportive of people who live with dementia by sympathetic signage, and provision of relevant style furnishings and decoration. Those bedrooms seen, with the permission of the people whose rooms they were, were personalised with furniture, pictures or ornaments and photographs in order to Care Homes for Older People Page 21 of 30 Evidence: reflect their interests, personalities and life histories. The grounds of the home were tidy and well laid out, we were informed in the AQAA that the patio had been extended and additional gazebos purchased, this enhances the facilities for people living in the home and enables them to make better use of the grounds and garden when the weather permits. Decoration and renewal is carried out in the home in a structured and planned way, the foyer for example has recently been upgraded and there is some opportunity for development in addition, for example it is hoped that it might be possible to establish a best friends cafe where people can have something akin to the experience they might have in the community whilst visiting a cafe or coffee shop. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in The Mead can be confident that they are protected by the recruitment policies and procedures followed by the home and that there are usually sufficient numbers of care and ancillary staff with the training, support, skills and experience to meet their needs. Evidence: When we asked people who live in The Mead if staff are available when they need them, 17 said that they always are, 50 that they usually are and 33 that they sometimes are. When we asked relatives and carers if care workers have the right skills and experience to look after people properly, 20 said that they always did, 40 that they usually did and 40 that they sometimes did. Health care professionals who responded to surveys told us that in their opinion care staff always had the skills and experience required to meet peoples health and social care needs. Comments from surveys and during the inspection were in general very supportive of staff, for example; The staff are caring, efficient and understanding, I am very pleased with the staff and the care they give. Care Homes for Older People Page 23 of 30 Evidence: Where there were any less positive comments they invariably related to staffing levels; I always feel most of the staff work hard and do their best, but I sometimes feel that there is not enough staff to cope with all the demands of the home, They need more staff so they can spend more time with residents and maybe do activities with them. In their AQAA the home tell us that staffing levels are maintained on all shift patterns to ensure the correct ratio of staff to residents is maintained. Those staff who responded to our surveys all agreed that there was usually enough staff to meet the individual needs of all the people who use the service. One staff member told us; I can honestly say that I love my job and its not always easy to please everyone but I know that the home always strives to deliver excellent care in sometimes difficult circumstances When we spoke to staff they all said that the training provided was excellent and when we looked at training records we found this view was supported by schedules seen of training completed and planned to ensure that all staff have the skills they require to meet the needs of people living in the home. Although the AQAA informs us that currently the number of care staff with NVQ2 in care is less than 50 , this is largely explained by the number of staff leaving and being replaced with new staff who have not yet undertaken the NVQ course. The deputy manager told us that priority is being given to achieve the required level of care staff with at least NVQ2 in care. Supervision records and conversations with staff suggest that care staff are being supported in their challenging roles to ensure that they can promote the health, safety and well-being of the people for whom they provide care. When we looked at recruitment files for some staff who had recently joined the staff team we found that the required checks had been completed and the information needed obtained to ensure that people receiving care and services from them are safe. When we spoke to people in the home and observed care throughout this inspection, when we monitored call bell response times whilst in the home and observed one mealtime, we found that staffing levels appear adequate although as mentioned previously and noted by some relatives, it would be a positive assistance to dedicated engagement staff if care staff also regularly had the time to help provide consistent stimulation and activity for people who live in the home. Care Homes for Older People Page 24 of 30 Evidence: One area where The Mead excels is in the standard of dementia care training it provides for its care staff, this means that people living in the home who live with dementia receive care in a way that reflects an individualised, person-centred approach to care, taking due account of their life-history, background and individual preferences and requirements. Care Homes for Older People Page 25 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in The Mead can be confident that it is well managed and has an effective administrative and management infrastructure in place in order to support and enhance their health, safety and well-being. Evidence: When we spoke to care staff, people living in the home, relatives, visitors and visiting health care professionals they were all positive about the way the home is managed. The manager was not present during this inspection but the deputy manager provided excellent support throughout and was familiar with all the management processes and facilitated the provision of all records requested. The AQAA was received within the agreed timescale and was well-completed, including a realistic appraisal of what the home has achieved and where further improvements can still be made and how this is going to be achieved. Care Homes for Older People Page 26 of 30 Evidence: The system of quality assurance is comprehensive and robust, including a managers dashboard covering key areas of the homes operation. Quantum Care offer effective support to their home managers through their senior management team and for example through their central human resources section, who provided us with helpful clarification on one point of recruitment practice during this inspection. We spoke to Quantum Cares auditor during this inspection and this provided confirmation that processes are in place to check and regulate the way that the financial interests of people living in the home are safeguarded by the systems and procedures in place. We saw minutes of management, all staff and relatives meetings that had been held recently and the AQAA indicated that the home has an open door policy, that should provide anyone that needs to, ready access to the manager and her team. One relative told us; I feel that I could talk to the management about anything if I had any concerns The CQC have been kept informed of a number of significant events in the home since the last inspection including some where the safeguarding process to protect people living in the home has been instigated by the home itself. This openness and transparency is a positive indication of the priority given by the manager and their team to the protection and well-being of people living in the home. We were informed that there is no one currently living in the home who is subject to a deprivation of liberty authorisation under the Mental Capacity Act. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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