Care Home: The Old Rectory

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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 "the staff are always kind and gentle with us". Premises and accommodation visited were well maintained to reasonable standards and internal redecoration was being conducted throughout. The is a redecoration plan in place and the manager was confident about it being completed as quickly as possible and in the best interest of the people using the service. People were able to confirm that they had been consulted about the colours and general redecoration. 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 suing the service. One relative commented "there is good communication with relatives and improvements to activities has recently occurred". What has improved since the last inspection? The AQAA tells us that the service has made a number of improvements over the past twelve months. This includes a focus on staff development and training to increase their skill base and knowledge which will improve on the delivery and quality of the service to the people they care for. A more detailed and varied activities programme is in place which is tailored to meet the individual needs of people. Care staff are being made aware of the National Minimum Standards and how their direct work is linked to the standards which should help raise the standards of care to help benefit the people they care for. Re decoration is ongoing at service. Improvements have been made, although this must continue in a timely manner. All new staff are commencing the skills for care induction programme being rolled out throughout the service. One staff member commented "on day one I observed other carers. I am really enjoying it now". The AQAA also tells us that "supervision structure has been implemented, senior staff are taking on board this role and are thriving; care staff feel more supported by theseniors". Supervision records showed that structured supervision was occurring in a timely manner. What the care home could do better: The service must ensure that all medications with an "as and when required" statement have additional administration guidelines in place, in order for staff to follow to ensure they are being administered as prescribed and recommended by the GP. Large televisions should be provided in the lounge areas, as this is what the people who use the service tells us they would like. The smoking room carpet must be replaced with a suitable alternative. A shopping trolley should be considered for the people who use the service, enabling them to purchase items such as sweets, news papers, toiletries, stationary and drinks, in addition to accessing the local community. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Old Rectory Spring Lane Lexden Colchester Essex CO3 4AN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Louise Bushell     Date: 1 1 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: The Old Rectory Spring Lane Lexden Colchester Essex CO3 4AN 01206572871 01206573198 theoldrectory@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ashbourne Boss Limited Name of registered manager (if applicable) Miss Lisa Anne Curtis 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 Additional conditions: Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 21 persons) Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 60 persons) The total number of service users accommodated in the home must not exceed 60 persons Date of last inspection Brief description of the care home The Old Rectory is a large fully detached property that was originally built as the rectory for the local church in Lexden. The property has been considerably extended over the years to provide Care Homes for Older People 0 0 Over 65 21 60 care home 60 Page 4 of 30 Brief description of the care home accommodation for up to sixty elderly people (over the age of 65) on three floors although, more recently, none of the bedrooms on the less accessible top floor have been in use and so the maximum number of residents has declined to 55. Most bedrooms are for single occupancy, although there are four double rooms. Communal space is provided with three lounges and three dining rooms situated on the ground and first floors of the home. A further small resident smoking lounge is provided on the first floor. Access between floors is provided via two passenger lifts. To the front of the home there are extensive, mature gardens. One small fully enclosed patio garden is provided to the side of the home with a second patio to the rear. Limited car parking for visitors is available inside the main entrance gate; further public car parking is available close by in Spring Lane. Bus services run along the main road at the top of Spring Lane, which provide access to/from Colchester town centre. The home provides personal care and support for residents with varying levels of dependency, including up to twenty one places for people who have dementia. Past inspection reports are available from the home, and from the CSCI internet website. 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: 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 Commission is based 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 four 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 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. Care Homes for Older People Page 6 of 30 We looked at the last Inspection Report and information on safeguarding and complaints since the last inspection and we looked at the feedback received from questionnaires circulated to relatives, staff and people who use the service. We also reviewed the recent Annual Quality Assurance Questionnaire (AQAA) that was sent to us from the service. this document outlines how the service believes it meets the National Minimum Standards, what improvements they have made and what areas they feel they need to develop. The AQAA is a legal document that the service must produce annually. Four safeguarding referrals have been made since the last inspection visit. These were reported in a timely manner following the correct procedure, ensuring best outcomes for the people who use the service. The visit took place between 09:15am and 16.45pm. This enabled us to directly and indirectly observe the care practices and the day to operations of the service. A selected tour of the building was conducted and we spoke with people who use the service, staff, any visitors and the Registered Manager. What the care home does well: What has improved since the last inspection? The AQAA tells us that the service has made a number of improvements over the past twelve months. This includes a focus on staff development and training to increase their skill base and knowledge which will improve on the delivery and quality of the service to the people they care for. A more detailed and varied activities programme is in place which is tailored to meet the individual needs of people. Care staff are being made aware of the National Minimum Standards and how their direct work is linked to the standards which should help raise the standards of care to help benefit the people they care for. Re decoration is ongoing at service. Improvements have been made, although this must continue in a timely manner. All new staff are commencing the skills for care induction programme being rolled out throughout the service. One staff member commented on day one I observed other carers. I am really enjoying it now. The AQAA also tells us that supervision structure has been implemented, senior staff are taking on board this role and are thriving; care staff feel more supported by the Care Homes for Older People Page 8 of 30 seniors. Supervision records showed that structured supervision was occurring in a timely manner. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 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 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. 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. 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, the staff are good and always help me out. Care Homes for Older People Page 11 of 30 Evidence: 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 areas of diversity including preferences, religious and cultural needs, involvement from family, partners and advocates, race and disability. 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 over all the service does well in all areas as far as I can see. They treat the elderly with great respect and care. The staff are always very friendly and helpful. I am pleased that X is in The Rectory. 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 fourteen comment cards were received from people who use the service, all determined 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. The Annual Quality Assurance tells us that we ensure the Service User Guide and the Statement of Purpose is updated as required. We ensure that a detailed pre admission assessment is carried out with the in put of the service user and relative where appropriate; ensuring these referrals are suitable throughout the process. This was seen on the day of the inspection, where the Statement of Purpose had been revised and case tracking showed that people had detailed assessments completed held on their files. 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 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. It was observed that personal support is responsive and tailored to meet the individual Care Homes for Older People Page 13 of 30 Evidence: 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 service user care plans are reviewed on a regular basis to ensure it meets their current needs and continues to be person centred. 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, the staff are friendly and if you need anything they always help you out. 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 care, kindness and friendly staff are beyond reproach. A person using the service commented very good at providing staff to accompany me on hospital / consultant appointments. 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. Care Homes for Older People Page 14 of 30 Evidence: 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 manager who agreed to implement new guidelines following the inspection. 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 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. 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 employs an activity organiser and is now offering a seven day programme of activities. One person using the service commented there are activities available and the girls always ask me if I want to join in, although I choose not to, it is nice to be asked. Care Homes for Older People Page 16 of 30 Evidence: A further person commented we have an activity lady who comes about twice a week, we also have someone who comes to sing to us, we all love that. One person also added that we would like a large television in the lounge as we all struggle to see it. 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 activities are delivered in a one to one style or group depending on the needs of the service user and their choice. We have created a memory tree for service users that wish to join in. All service users are given a schedule of the following months events and these are also placed at various points around the home. 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. One person using the service commented they have something going on everyday, whether we chose to attend or not. 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. One person using the service commented they cook fish well, whilst a further person stated we have a menu coming around every day. We have two choices so on the whole we dont do too badly. Feedback received from a relative commented that the service could do better by improving the menu to suit individual needs, and commented that they the service could do better if a weekly trolley came round selling crisps, tissues, magazines, sweets, stationary, drinks etc. The AQAA has identified that improvements are required and states we continue to explore the service we provide at meal times, menus re now placed on tables and Care Homes for Older People Page 17 of 30 Evidence: sugar bowls, but we feel we can do more to ensure we are offering a service that maintains Independence and choice. One person using the service commented the food is always very good here and its good that we do a few things. We had a cheese and wine night a few days ago, it was very nice. In addition to this many people commented about drinks being available. One person commented drinks are always available, whilst one relative commented that they would like to see improvements by making tea available during early mornings when X awakes or cant sleep. The AQAA has also identified that it is planning to develop a sensory garden within the next twelve months and support the activity coordinator to attend a course regarding activities for the elderly. 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 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 am very happy here, staff are kind, friendly and caring. I know who to go to if I had a complaint of any kind. The manager of the service has identified in the Annual Quality Assurance Assessment that improvements are being made including the commencement of a dignity champion for the service. 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 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 Care Homes for Older People Page 19 of 30 Evidence: managed, resolved quickly in the best interest of the person using the service. The AQAA states all complaints are treated seriously and are used as a working tool, to assist us in improving services. 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. There have been four referrals made in the previous twelve months. 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. 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. There is a designated smoking area for the people who use the service. It was observed that the smoking area flooring was carpeted and was heavily marked. This was brought to the attention of the manager. The Annual Quality Assurance Assessment completed by the service demonstrates that the the home is undergoing continual decoration and improvement. Our working practices are monitored and evaluated with the aid of documentation such as premises checks and cleaning schedules. Care Homes for Older People Page 21 of 30 Evidence: The people who use the service appear to like the changes being made and were settled and eating communally or as they wished. However it was noted that the service still remains in need of the continuous decoration in a number of areas. The manager stated that the works would be continuing. 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 a rolling programme of furniture replacement. 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. At the time of the inspection the garden was a little unkempt and in need of attention. The manager discussed the recent improvements to the fountain area and plans for a sensory garden. 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 my room is very nice I like it here. 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 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. 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. This enables staffing levels to be maintained for the safety of all and that record keeping was completed and monitored as required. 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 Care Homes for Older People Page 23 of 30 Evidence: effective recruitment procedures in the delivery of good quality services and for the protection of individuals. A total of five staff files were audited and were seen to contain all the required documentation. Three individual 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 on day one I observed other carers. I am really enjoying it now. The AQAA also tells us that all new staff are commencing the Skills For Care 12 week induction programme. The service also has a training and development plan in place for 2009 - 2010. This showed that a number of courses are being provided and included, Fire Safety, Dementia Awareness, Moving and Handling, Infection Control and Safeguarding. 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. A comment received from a relative states that; over all the service does well in all areas as far as I can see. They treat the elderly with great respect and care. The staff are always very friendly and helpful. I am pleased that X is in The Rectory. During the inspection positive manual handling practices were indirectly observed where by a person was being hoisted from a chair to their wheelchair. Throughout the process the care workers were talking to the person and making them fell at ease. Care Homes for Older People Page 24 of 30 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 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 manageress is very good and helpful when I have needed to talk to her. 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 Care Homes for Older People Page 26 of 30 Evidence: becoming increasingly more involved. The format reviews the persons entire needs. The Registered Manager and senior team lead and support a stable staff team who have been recruited and trained to satisfactory levels. The manager is aware of the continued need to ensure that enough staff hold a National Vocational Qualification In Care Level 2. 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. This includes the management of finances within the service. 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. Recent in house training has occurred regarding safeguarding issues. There has recently been a revised fire contingency plan which is well completed and individualised to the person. Through discussions with the management team and it was determined that priority is given to ensure that all staff are in receipt of training, including in house refresher courses and a full complete induction programme. Individual training plans are being developed and will be used, once complete to review the annual performance of staff in their appraisal. One person using the service commented I can always talk to the manager if ever I need to she is very nice. 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 1 25 13 The flooring in the smoking room requires placement. To ensure that the safety of those people smoking is protected as much as possible. 31/08/2009 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 4 7 12 12 12 The service should reflect whether the weekly progress reports are required. The service should provide a trolley selling goods. The service should provide training for the activity organiser in the provision of activities for the ageing. The service should provider large screen televisions. Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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