Care Home: The Moat House Residential Care Home

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What the care home does well People who use the service said that staff spoken to them in a friendly fashion, with respect, and they welcomed visitors to the units without restrictions. Staff were observed to treat all people as individuals with dignity and respect. One person using the service commented "Its wonderful. I have started to live again now". Premises and accommodation visited were well maintained to high standards and internal redecoration is being conducted throughout on a rolling programme of works. There The large garden provides areas for people to sit outside. Rooms visited were personalised with photo`s and ornaments. A robust pre and post assessment package is in place to ensure that the changing needs of people who use the service are being met. Care plans are completed and up to date and the format used is person centre focused. Pre employment checks are in place for all staff which safeguards the people using the service. One relative commented "the service has come on leaps and bounds more recently". In addition to this a further relative commented "the Moat House gives 100% in every aspect. I consider them to be a home offering 5 star quality". Staff are suitably and adequately trained. People using the service praised the activities co ordinator who now works over five days a week covering 25 hours of activity time within the service. Many positive comments were held regarding the approach and the manner of the staff member. Direct and indirect observations were made of activities occurring in a very relaxed, enjoyable environment. Meals were well presented and people reported that they enjoyed the meals and were offered choices. One person using the service stated "the food really is wonderful". What has improved since the last inspection? A number of improvements have occurred since the appointment and registration of the new manager. Since the last inspection all of the requirements that were made have been met. People using the service can be assured that the service is outcomes focused and aims to improve the provision of care and support at all times. The AQAA tells us that improvements have been made and states "we have reviewed and updated all documentation including policy and procedure files. We have replaced the care plan system with Standex and all existing care plans have been reviewed and transferred. A weekly district nurse surgery has been set up within the home to support the senior team with resident issues. A new medication monitoring dosage system has been implemented through Lloyd`s Pharmacy. Activities co-ordinator has become well established and supported residents to register on Dial a Ride to have access to the community. The manager has open door policy and has introduced a Relatives Surgery every Wednesday from 4.30/5.30. We introduced an advocacy service with Age Concern. There has been extensive purchasing of artwork and ornaments to give a homely atmosphere. We have implemented a robust recruitment procedure. All policies and procedures have been reviewed. The manager has implemented a robust procedure for monitoring of accident and incidents within the home". What the care home could do better: The service should further expand on the information gathered as part of the assessment process in relation to equality and diversity issues. Where medication is administered and prescribed on an as and when required basis, that guidelines should be in place for staff to follow. Hand written entries on the Medication Administration sheet should be double signed and the service should obtain a copy of the Royal Pharmaceutical Guidelines for Care Homes. The service should consider extending the pathway around the building to enable and empower people with limited mobility to access the grounds. Key inspection report Care homes for older people Name: Address: The Moat House Residential Care Home The Moat House Great Easton Great Dunmow Essex CM6 2DL     The quality rating for this care home is:   two star good 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: Louise Bushell     Date: 0 2 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 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 31 Information about the care home Name of care home: Address: The Moat House Residential Care Home The Moat House Great Easton Great Dunmow Essex CM6 2DL 01371870192 01371870193 annestrange@retirementvillages.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: RV Moat House Ltd care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 24 The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Physical Disability - Code PD Date of last inspection Brief description of the care home The Moat House Residential Home (formally known as St. Georges residential home) is registered to provide care for older people over the age of sixty five years. The home can accommodate up to twenty four service users. The home is set in a private woodland area with large gardens, and a patio area accessible to service users who use wheelchairs. The home is set in a quiet rural location, approximately three miles from the town of Great Dunmow. The home has car parking facilities. The Moat house Care Homes for Older People Page 4 of 31 Over 65 24 0 0 24 1 6 1 2 2 0 0 8 Brief description of the care home changed registered providers in April 2008, and is now managed by Retirement Villages. Care Homes for Older People Page 5 of 31 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: two star good 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 focus of the inspections undertaken by the Care Quality is upon outcomes for the people who use the service and their views of the service provided. The primary method of inspection used was case tracking which involved selecting a number of people and tracking the care they received through looking at their care records, discussion where possible with the people who use the service, the care staff and observation of care practices. The last key inspection took place on the 16th December 2008. The visit was unannounced and planning for the visit included assessment of the notifications of significant events, which had been received from the service to the Care Quality Commission. We looked at the last Inspection Report and information on safeguarding and complaints since the last inspection. We also looked at the Annual Quality Assurance Care Homes for Older People Page 6 of 31 Assessment (AQAA) and reviewed what the service has improved in the last twelve months and its plans for the next twelve months. During the visit information was gathered directly from the staff, people who use the service and relatives and or visitors to the service. The fee range for the service is from £465.57 to £650 per week. This excludes any personal items, hairdressing and chiropody. The visit took place between 09:30am and 15.30pm. This enabled the inspector to directly and indirectly observe the care practices and the day to day operations of the service. A selected tour of the building was conducted during which the inspector spoke with people who use the service, staff and visitors and the manager. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? A number of improvements have occurred since the appointment and registration of the new manager. Since the last inspection all of the requirements that were made have been met. People using the service can be assured that the service is outcomes focused and aims to improve the provision of care and support at all times. The AQAA tells us that improvements have been made and states we have reviewed and updated all documentation including policy and procedure files. We have replaced the care plan system with Standex and all existing care plans have been reviewed and transferred. A weekly district nurse surgery has been set up within the home to support the senior team with resident issues. A new medication monitoring dosage system has been implemented through Lloyds Pharmacy. Activities co-ordinator has become well established and supported residents to register on Dial a Ride to have access to the community. The manager has open door policy and has introduced a Relatives Surgery every Wednesday from 4.30/5.30. We introduced an advocacy Care Homes for Older People Page 8 of 31 service with Age Concern. There has been extensive purchasing of artwork and ornaments to give a homely atmosphere. We have implemented a robust recruitment procedure. All policies and procedures have been reviewed. The manager has implemented a robust procedure for monitoring of accident and incidents within the home. What they could do better: 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 31 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 31 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. People who use the service can expect that their assessed needs can be identified, recorded and put into practice. Evidence: The service has developed a Statement of Purpose, which sets out the aims and objectives of the service, and includes a guide, which provides basic information about the service and the specialist care that is available. The guide details what the prospective people using the service can expect and gives a clear account of the specialist services provided, quality of the accommodation, qualifications and experience of staff and how to make a complaint. One person using the service stated I dont have any complaints, but I would always talk to a team leader. During the inspection we found that in the foyer area of the service that significant information was available to all, covering a range of needs and services. It was pleasing to note that during the inspection that pople were accessing this information Care Homes for Older People Page 11 of 31 Evidence: and a member of staff was directly observed showing a member of the public the information. One person using the service stated there is information in the foyer for us to read, we have a monthly residents meeting now. We talk about improvements, meals and choices. All people who use the service are given a copy of the guide. When requested the service can provide a copy of the statement of purpose and guide in a format which will meet the capacity of the individual. One person using the service stated, Its wonderful here, I have started to live again now. Further information gathered as part of the inspection process determined that the service has a quarterly magazine called media matters. One was available and on display in the service and provides and update the people using the service with information. The AQAA tells us that we provide our prospective residents with our information brochure, Statement of Purpose and Residents Guide. All prospective residents and families are consulted and preassessment date agreed to ensure their needs will be met before entering the home. Residents are informed of a six week review of their placement. Family/Advocates encouraged to arrange where possible personal items/pictures etc in the room to make it more familiar and welcoming on arrival to the home. On arrival the resident is greeted by Manager or senior person on duty and given a full tour of the home and its facilities. We facilitate respite care to support residents to return home. It was directly observed that admissions are not made to the service until a full needs assessment has been undertaken. A skilled and trained person always completes the assessment prior to admission to the service. The assessment format was detailed and appropriate to the policy and procedure in place. The assessment explored a few areas of diversity including preferences and religious needs. Further information regarding the persons cultural and diversity needs are limited. This was brought to the attention of the manager. The assessment process details vital links to further risk assessments, care plans and additional management plans that will be required, based on the completion of the assessment. The assessment is index linked and detailed in order for a holistic view of the person to be formed. One relative surveyed commented The Moat House gives 100 in every respect. I consider them to be a care home offering 5 star quality. The service has the capacity to support people who use the service and respond to diverse needs that may have been identified during the assessment process. A total of eight comment cards were received from people who use the service, all determined Care Homes for Older People Page 12 of 31 Evidence: that they always or usually have enough information to make informed choices about the service. Privately funded people who use the service are provided with a statement of terms and conditions or a contract. This sets out in detail what is included in the fee, the role and responsibility of the provider, and the rights and obligations of the individual. People who are funded receive a social service contract. Care Homes for Older People Page 13 of 31 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 use the service can expect that their medical, health and social care needs will be met. Evidence: A total of two care plans were case tracked fully, it was established that people who use the service receive personal and healthcare support using a person centred approach. Personal healthcare needs including specialist health; nursing and dietary requirements are clearly recorded in each persons care plan. The care plan provides clear information and a comprehensive guide for staff to know how to support the person. The care plan is generated from the pre admission assessment and includes clinical guidelines, risk assessments for the management of falls, bed rails, manual handling and self medication. The AQAA tells us that a new care planning system has recently been introduced to the service. The AQAA states we have reviewed and updated all documentation that was in place when the home was purchased. We have reviewed and replaced the care plan system with Standex and all existing care plans Care Homes for Older People Page 14 of 31 Evidence: have been transferred. During the case tracking process it was evidenced that the system is working well within the service and is easy for the care staff to interpret and understand. It was observed that personal support is responsive and tailored to meet the individual choices, needs and preferences. Staff were observed to respect the privacy and dignity of all people. The service listens and responds to individual choices and decisions about who delivers their personal care. People are supported and helped to be independent and can take responsibility for their personal care needs. The AQAA tells us that we provide each resident with a comprehensive and personal centred care plan and are reviewed monthly or at the point of any changes to residents care needs. We provided support to our residents to make independent choices and decisions regarding the care needed. All care staff are trained from induction, Skills for Care through to NVQ standard. All Senior staff are trained in the safe handling of medication. We have robust policies and procedures for handling of medication within the home. We strive to maintain the dignity, individuality and privacy to all residents through supporting staff with the understanding of our policy and statement of values and philosophy of care within the home at all times. We support our residents and families at the time of dying/death with care, respect and where possible familiar surroundings. Individuals have access to healthcare and remedial services. The health care needs of individuals unable to leave the service are managed by visits from local health care services. Clear evidence was seen in the care plans of specialist health care support services visiting the service and in addition to the care plan there were detailed notes made by the specialist visiting the service for example the General Practitioners. A number of comments were received directly from people that use the service, their relatives and friends. One person commented that, I know I have a care plan, they need the knowledge, so they write it down. Its all about me an my medication. A number of comments have been received that have determined that the care is provided to meet the needs of the people who use the service. One relative commented that the home has recently come on leaps and bounds. A person using the service commented in response to what the home does well, all that is asked of it. During the inspection process time and feedback was spent with a visiting G.P. They commented care staff are efficient and always contact us in time. In addition to this the G.P stated we have a good working relationship with the home and they are always pro active in managing the health care needs of the people in the home. The Care Homes for Older People Page 15 of 31 Evidence: Matron comes with me on a Thursday each week. The AQAA tells us that the manager has instigated a weekly District Nurse surgery to support the senior team and residents. The GP is also working with District Nurse to visit and do 6 monthly reviews on all residents medication. We have introduced a new system for medication administration and now use the Monitored Dosage System through Lloyds Pharmacy. The service has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. Medication records are fully completed, contain required entries, and are signed by appropriate staff. The management of controlled drugs is effective with records being accurate and stock balances being correct. A total of two peoples medication was case tracked in order to ensure compliance with the National Minimum Standards and to access that people were receiving the medication as prescribed. Fridge and room temperatures were being recorded in all the medication rooms. Ordering and returns documentation was up to date and accurate. The service works with individuals regarding any refusal to take medication. The people using the service are given the support they need to manage their medication. If individuals prefer or where they lack capacity, care staff can manage medication on their behalf. Thought has been given to providing safe but sensitive facilities for keeping medication. Risk assessments are in place for the self administration of medicines. The service has a good record of compliance with the receipt, administration, safekeeping, and disposal of controlled drugs. Staff have completed and passed an appropriate medication course. The service has a daily audit checking system in place for the management of controlled drugs. This was directly observed and seen to be accurate and effective. Some people are prescribed medication which is to be administered on an as and when required basis. Some of the medications viewed did not have additional administration guidelines in place to inform staff of the circumstances where administrating should take place. This was brought to the attention of the team leader who agreed to implement new guidelines following the inspection. A number of medicines were observed being used from one month to the next. An audit of a random selection of these was carried out. It was found that the actual available balances was difficult to find due to the fact that balances of stock had not been carried forward from one month to the next. The service did not have a copy of the Royal Pharmaceutical Guidelines for Care Homes. Care Homes for Older People Page 16 of 31 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 use the service encouraged to join in with a variety of activities available. Evidence: The service understands and actively promotes the importance of respecting the human rights of people using the service, with fairness, equality, dignity, respect and autonomy all being seen as central to the care and support being provided. During the inspection staff were indirectly and directly observed offering people equal dignity and respect in a manner of ways. A good practice example was directly observed whilst a number of people using the service were sitting in the foyer and the small front lounge, The activity person was listening and directly engaging in meaningful conversation with all people of equal importance. It was observed event those people who were less able to communicate and engage where involved and time was spent with them holding their hands and chatting in a calm manner. People who use the service are sometimes able to enjoy a stimulating lifestyle with a number of options to choose from. The service has sought the views of the individuals and considered their varied interests. The service has recently introduced my life story. During the inspection we indirectly observed people chatting about their personal life books and gathering information from family members. Care Homes for Older People Page 17 of 31 Evidence: The service employs an activity organiser and is now offering a seven day programme of activities. One person using the service commented since I have come here, we have played bingo, chatting and socialising. We do brain teasers, they are good for the mind you know. A further person commented have started painting again since moving here, its wonderful. One person also added that we would like a walk way around the outside of the building, as the grounds are lovely but I cant get round due to my wheelchair. The routines, activities and plans are person centred, individualised and reflect diverse needs of people, including their gender, age, race, religion and disability. They are regularly reviewed, and are very responsive to individuals changing needs, choices and wishes. The AQAA tells us that we promote choice in all aspects of daily living with the person centred care delivered. We have dedicated activities co-ordinator with a weekly activity programme which includes quizzes, art, flower arranging, discussions and handicrafts, bingo, reminiscing. We respect the residents right of choice in all activities they are involved in during their day. There is a visiting library along with an in house collection of films and music. The service has strong focus on involving people in all areas of their life, and actively promotes the rights of individuals to make informed choices, providing links to specialist support when needed. This includes developing and maintaining family and personal relationships. Records are maintained where individuals have engaged and or participated in any activity. Outcomes for people are positive, and there is evidence that they are enjoying the life opportunities that they experience. Meals are well balanced and nutritional and cater for varying cultural and dietary needs of individuals. For those individuals who need support during mealtimes, including those who have difficulty swallowing or chewing, staff give assistance. They are discrete and sensitive to the feelings of both the person they are helping and also to others present. Mealtimes are flexible and relaxed, staff are patient and helpful, and allow individuals the time they needed to finish their meal comfortably. Lunch was sampled and was presented well and was tasty. The dinning experience for people was pleasant with the feel of a hotel. One person using the service commented the food is very good - what I like, whilst a further person stated the food is really wonderful. Care Homes for Older People Page 18 of 31 Evidence: The AQAA has identified that improvements have been made over the last twelve months and includes activities co-ordinator has become well established and regular calendar of events based on individual needs and wishes. A gardening club has been established with residents growing their own flowers and vegetables. An arts morning with residents making birthday cards. Residents have been registered on Dial a Ride and have established a fortnightly visit to Tescos to purchase personal items. Feedback from the activity person established that they had recently completed a course specifically designed for providing activities to an ageing group of people. She commented that it was very useful. During the inspection process the manager stated that the service has recently established links with Age Concern for advocacy input at the service as required. Care Homes for Older People Page 19 of 31 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 use the service can expect that complaints or concerns will be listened to acted upon. Evidence: The service has an open culture that allows people who use the service to express their views and concerns in a safe and understanding environment. People who use the service have commented that they are happy with the service provided, feel safe and well cared for. A number of comments received determined that people who use the service and relatives and friends are aware of what to do if they have any concerns. One person who uses the service stated I have never been so wanted and feel so spoilt. The manager of the service has identified in the Annual Quality Assurance Assessment that improvements are being made including the commencement of advocacy services through Age Concern. The AQAA states the manager has an open door policy. The manager has introduced a Relatives Surgery every Wednesday between 4.30 -5.30pm. The Statement of Purpose and Service Users Guide has been reviewed in line with Retirement Villages. Introduced an advocacy service with Age Concern. The service has a complaints procedure that is clearly written and easy to understand. It is available in a number of formats such as different languages on request. The complaints procedure is supplied to everyone living at the service and is displayed in a Care Homes for Older People Page 20 of 31 Evidence: number of areas within the service. There is a detailed record of all complaints and compliments made and received. It was evident that verbal concerns are also well managed, resolved quickly in the best interest of the person using the service. The AQAA states we listen to our residents/families/advocates. We have c comprehensive complaints procedure within the home. e monitor and review complaints, following the complaints process. We have procedures within the home to support our residents to enable them to vote at election times. There have been three written complaints made which have both been investigated and responded to within the time scales as required. All of the complaints had been dealt with within the timescales. Compliments were also present. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Staff commented that they have received training in safeguarding and felt confident in reporting any issues as they occurred. Staff had a clear understanding of the Whistle-blowing policy and when the use of this may be put into practice. The service understands the procedures for safeguarding adults and attends meetings or provides information to external agencies when requested. Care Homes for Older People Page 21 of 31 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 physical design and layout of the service enables the people who use the service to live in a safe, well-maintained and comfortable environment, which encourages independence. Evidence: The service provides a physical environment that is appropriate to the specific needs of the people who live there. The environment provides specialist aids and equipment to meet their needs. The service is a pleasant, safe place to live, the bedrooms and communal room provide a personal and homely feel. The layout of the building enables people to move freely with several different seating areas throughout to encourage socialising or enabling the person to have privacy. The Annual Quality Assurance Assessment completed by the service demonstrates that the encouraged to personalise their rooms to create a feeling of being at home. There is an ongoing decorating programme to include all bedrooms. The communal areas have been redecorated. A areas are deep cleaned on a regular basis and carpets maintain and replaced were necessary. Extensive garden area is being maintained/improved at all times. The people who use the service appear to like the changes being made and were settled and eating communally or as they wished. Care Homes for Older People Page 22 of 31 Evidence: The people who use the service are encouraged to personalise their bedrooms. All the homes fixtures and fittings meet the needs of individuals and can be changed if their needs change. The AQAA identified that they intend to improve through the provision of an on going redecoration programme. The dining rooms are laid out to encourage communal dining with a calm relaxed atmosphere. The environment promotes the privacy, dignity and autonomy of individuals. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in private. There is a large garden to relax in. The garden has been adapted with time and consideration spent making separate seating areas and areas of interest for all the people who use the service. The home has a robust infection control policy. The service is clean, well lit and in general smells fresh. One person using the service commented Its lovely here, very peaceful and relaxing. There was restricted access to high risk areas such as the main kitchen and the laundry areas to reduce the risk of cross infection. Care Homes for Older People Page 23 of 31 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. Staff are suitably trained and skilled and are in sufficient numbers to support the people who use the service, in line with their care plan, ensuring that the needs and changing needs are being met by a consistently competent team. Evidence: Feedback from the people who use the service shows that they have confidence in the staff who care for them. Staff rotas were seen and displayed adequate numbers of staff on duty to meet the needs of the people using the service. Specific attention was given to the busier periods of the day. A manager was usually on shift and supernumerary to the care staff. In addition to this each shift was covered by a team leader who managed the day to day running of the shift. Staff members undertake external qualifications beyond the basic requirements. Managers encourage and enable this and recognise the benefits of a skilled, trained workforce. Accurate job descriptions and specifications clearly define the roles and responsibilities of staff. People who use the service report that staff working with them are very skilled in their role and are consistently able to meet their needs. There is a good recruitment procedure that clearly defines the process to be followed. This procedure is followed in practice with the service recognising the importance of effective recruitment procedures in the delivery of good quality services and for the Care Homes for Older People Page 24 of 31 Evidence: protection of individuals. A total of five staff files were audited and were seen to contain all the required documentation. Staff commented on the strong team culture of the service and felt that following recent recruitment, there are enough staff on duty to meet the needs of the people who use the service. Staff confirmed that the service was clear about what was involved at all stages and was robust in following its procedure. There are clear contingency plans to cover for vacancies and sickness and the use of agency staff was limited. Once recruited staff receive an induction and training. The programme is then signed at the end of each stage. Following discussions with a number of staff and the manager it was determined that this process was being reintroduced to the service to ensure that all staff had fully received this and that evidence was held on their file. The person commented we always support the residents , person centred care plans and activities The AQAA tell us that have a good quality and skill mix of staff to meet the needs of our residents. The home has dedicated staff team for each of the following areas Care, Catering, Domestic, Maintenance and Administration. We have a robust rota system to allow for all necessary changes within the home. All staff employed at the home have gone through a strict recruitment procedure. Newly recruited staff have full induction into the home and this includes Skills for Care. All staff receive at least 3 days paid training throughout the year. The service also has a training and development plan in place for 2009 - 2010. The service is aiming to complete courses in activities, dementia, nutrition, end of life and catheter care. The service also describes in their AQAA that they are aiming to achieve the Gold Standards Framework. Staff confirmed that the senior team provide supervision. Records showed that this was occurring. Staff meetings take place regularly. Notes and action points are taken of meetings and sessions, and progress is regularly reviewed by revisiting actions points made at the last meeting to monitor progress and development. Staff reported that they felt supported in their roles and that they were able to discuss issues with a member of the senior team if required. During the inspection positive manual handling practices were indirectly observed where by a person was being hoisted. The care workers were talking to the person Care Homes for Older People Page 25 of 31 Evidence: and making them fell at ease. One person using the service commented the are staff are so jolly, they are wonderful, they are very caring. Care Homes for Older People Page 26 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service can expect that the service is run by a competent qualified manager ensuring best outcomes for all. Evidence: The Registered Manager has the required qualifications and experience and is competent to run the service. The Registered Manager and the senior team have a clear understanding of the key principles and focus of the service, based on organisational values and priorities. They work to continuously improve the service. Feedback received on the day of the inspection from staff and as part of the feedback questionnaires received determines that the management are effective and approachable. One relative commented the home has come on leaps and bounds more recently. The care planning format encourages and enables staff and the people who use the service to focus on person centred thinking, with the people who use the service becoming increasingly more involved. The format reviews the persons entire needs. Care Homes for Older People Page 27 of 31 Evidence: The Registered Manager and senior team lead and support a stable staff team who have been recruited and trained to satisfactory levels. The AQAA tells us that the manager is qualified with RMA and has had 5 years experience within residential settings. The home manager encourages that there is an open and positive atmosphere at all times and that the home is run in the best interest of our residents. The home has robust policy and procedures system regarding all financial administration. The home has quarterly health and safety meetings with all heads of departments. The manager has a monitoring system of all accident and incidents within the home. The manager promotes equal opportunities, has good people skills and understands the importance of person centred care and effective outcomes for people who use the service. This is reflective in the managers leadership style, her ability to work with the team and ensure that the service is run in the best possible interests of the individual. The service has sound policies and procedures, which are corporately and internally reviewed and updated, in line with current thinking and practice. The manager ensures that staff follow the policies and procedures of the service, through close monitoring, supervision and training. The staff team are positive in translating policy into practice and showed good knowledge of care principles, health and safety and safeguarding issues. Staff meetings take place regularly and minutes of the meetings are available on each unit, this increasing effective communication throughout the teams. The service works to a clear health and safety policy. Safeguarding is given high priority and provides a range of policies and guidance to underpin good practice. It was directly observed that the manager and the service has a sound recording and reporting procedure in place for all health and safety issues. Records were actually recorded and good examples of data recorded. All certificates were in place and were easily accessible. The manager has also commenced an evidence folder to support the inspection process. this was used throughout the process to ensure supporting evidence was available. Care Homes for Older People Page 28 of 31 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 31 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 2 3 9 Assessments should further explore and document peoples preferences in relation to equality and diversity issues. Hand written entries should be double signed and balances carried forward on medication used from one month to the next. Where medication has been prescribed on an as and when required basis that suitable guidelines are in place for safe administration. The service should obtain a copy of the Royal Pharmaceutical Guidelines for Care Homes. The service should consider providing access to the grounds out doors which is accessible for those with limited mobility and or wheel chairs users. 3 9 4 5 9 12 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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