Care Home: The Old Vicarage

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What the care home does well People who live in the home said they are treated well and looked after. One person said, `I like the companionship and staff are good`, another person commented `staff do a wonderful job`. A relative also said, `people are well looked after`. Care is provided in a person centred way so that people`s individual needs are met in the way they prefer. One person at the home said, `staff are fantastic`. Staff respect people`s privacy and dignity and are sensitive and patient in meeting people`s needs. People enjoy the opportunities on offer to take part in activities. This enable people to socialise with others and to do things they enjoy. One person said, `activities are well done`. The home is clean and comfortable for people living there. There is a relaxed atmosphere and people looked at ease in their surroundings. Staff received good training, which helped to maintain and develop their skills and knowledge and kept them up to date on how to meet the needs of people in the home. A staff member said, `we have loads of training`. People felt that the home was managed well so that any concerns would be addressed properly and good standards of care maintained. What has improved since the last inspection? Staff are following infection control procedures to minimise the risk to people from cross-infection. Recruitment procedures make sure that any gaps in employment are explained. This helps in making sure only suitable workers are employed at the home. Records of daily events are now explained in slightly more detail although further improvements are needed in this area. Medication procedures have improved so that eye drops are dated when opened and the medication records specify which eye is to be treated. Hand written entries on medication records are now countersigned by another person to help in making sure the details entered onto the records are accurate. The complaints procedure is on display at the home and people living at the home and their relatives are given copies of this. This will help in making sure people know how to complain and understand what will happen in response to this. The Whistleblowing policy has been reviewed and is now in clearer format so that it easily understood by staff. This will help staff in understanding what they need to do if they have concerns about people being at risk. Advocacy arrangements have been put in place to ensure the safe handling of people`s monies and people can now have access to their monies at any time. What the care home could do better: Better recording systems could be put in place so that where medication is prescribed in variable doses, the actual amount of medication administered is recorded. When activities are undertaken, especially with people who are unable to communicate, the outcomes from these activities should be recorded to monitor what people are enjoying. This will help in making sure activities are planned in a person centred way. Arrangements could be put in place to make sure that the lighting in the ground floor corridor and first floor corridor is always adequate. This will help people with their mobility and minimise any potential risk from accidents. Some equipment in a bathroom and on the first floor corridor could be better stored. This will help in making sure people can access all areas of the home safely. More formal systems could be put in place to seek the views of visiting professionals about the home. This will help in identifying what works well in the home and possible areas for improvement. Key inspection report Care homes for older people Name: Address: The Old Vicarage Vicarage Gardens Featherstone Wakefield W Yorks WF7 6AH     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: David White     Date: 3 0 0 6 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 28 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 28 Information about the care home Name of care home: Address: The Old Vicarage Vicarage Gardens Featherstone Wakefield W Yorks WF7 6AH 01977708368 01977708083 oldvicarage@f2s.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Calsa Care Limited care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home The Old Vicarage is a detached a four-storey building, situated in Featherstone near Pontefract. The home was refurbished to provide accommodation for 30 people over the age of 65 years who may have dementia and mental health needs, physical disabilities and requiring personal care needs. The building with a newer extension is set in its own large grounds and is in close proximity to local amenities including the post office, public house and shops. Public transport is easily accessible with bus stops located a short walk from the home. The residential accommodation is set on three levels with two lifts for access. TwentyCare Homes for Older People Page 4 of 28 Over 65 30 30 30 30 0 0 0 0 Brief description of the care home four of the thirty places provided are single accommodation only one of these has a toilet facility. The three-shared rooms have toilet facilities. Toilet and bathing facilities are located on all floors. The manager occupies the fourth floor of the building. The provider makes people aware of the service and the Commission through the service user guide and information on their website. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We went to the home without telling them we were going to visit. This report follows the visit that took place on 30th June 2009. The visit lasted from 09:00 until 16:00. The purpose of the visit was to make sure that the home is operating and being managed in the best interests of people living there. Information has been used from various sources for this report. These sources include reviewing information that has been received about the home since the last inspection visit. The registered persons provided information in their Annual Quality Assurance Assessment (AQAA) questionnaire. Surveys were received from people living in the home, from staff who work there and from a health professional who visits the home. During the visit time was spent talking to people who live at the home, members of the care team, the activity co-ordinator, a relative, the manager and the registered providers. Care Homes for Older People Page 6 of 28 The manager and registered providers were available throughout the visit and the findings were discussed at the end of the inspection. At the time of the site visit on 30th June 2009 the weekly fees ranged from 396 pounds per week. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations-but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The previous inspection visit took place on 11th July 2007. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? Staff are following infection control procedures to minimise the risk to people from cross-infection. Recruitment procedures make sure that any gaps in employment are explained. This helps in making sure only suitable workers are employed at the home. Records of daily events are now explained in slightly more detail although further improvements are needed in this area. Medication procedures have improved so that eye drops are dated when opened and the medication records specify which eye is to be treated. Hand written entries on medication records are now countersigned by another person to help in making sure the details entered onto the records are accurate. The complaints procedure is on display at the home and people living at the home and their relatives are given copies of this. This will help in making sure people know how to complain and understand what will happen in response to this. The Whistleblowing policy has been reviewed and is now in clearer format so that it easily understood by staff. This will help staff in understanding what they need to do if they have concerns about people being at risk. Advocacy arrangements have been put in place to ensure the safe handling of peoples Care Homes for Older People Page 8 of 28 monies and people can now have access to their monies at any time. 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 28 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 28 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. Proper pre-admission procedures were in place and being followed so that people who are thinking about moving into the home can feel confident that their needs will be met. Written information is also available to help them with their decision-making about whether the home can meet their needs. Evidence: The home has a Statement of Purpose that provides information about the care and services that are on offer. This is updated to reflect any changes to the home. The records showed that the home carries out detailed pre-admission assessments when referrals are made to the home. The manager or joint owner visit people and get information from relatives and other professionals to help them decide if they will be able to meet peoples needs before a place is offered. On the day of the site visit one person was in the process of being admitted. A member of the persons family had previously made a visit to the home to have a look around. A relative of another Care Homes for Older People Page 11 of 28 Evidence: person living at the home commented that they were invited to look around the home before making any decision about whether they would like their relative to move there as their relative was unable to make this decision for themselves. They also said I was given information about the home and this included what I needed to do if I had any concerns. A survey returned by someone living in the home said, we are kept informed about things that are going on. The home does not provide intermediate care. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal and health care needs were well met by respectful staff. Evidence: Each person has an individual plan of care detailing their individual needs and the actions that staff needed to take to meet these. People living at the home said they are encouraged to make their own choices about their daily routines and the care plans supported this. Information within care plans included peoples preferences in relation to things such as their preferred times for getting up and going to bed, food likes and dislikes and their activity interests. Staff spoken to said they were kept updated about peoples needs and had undertaken training about person centred care. Each person also had a Life History booklet about their life. These were very personalised and focused on peoples achievements. One person said, I like the companionship here and the staff are good. A relative had helped one person to complete a survey. The survey said, people are well looked after and there are activities to keep people occupied. Peoples care plans are regularly reviewed and a relative said that they receive invites Care Homes for Older People Page 13 of 28 Evidence: to attend meetings about their relatives care. One relative spoken to said, I can not fault the care and support given. Although the home reviewed peoples needs on a regular basis, the information in the reviews was often repetitive. There was discussion with the registered persons about this and how information in the reviews should provide more detail about the care and support being given. They said training had already been planned to accommodate this and that this issue is to be also discussed at the next staff meeting. The care plans included risk assessments in relation to pressure ulcers, nutrition, falls and moving and handling. The risk assessment identified any potential risks to individuals and where this was identified there was a risk management plan in place to say how these risks were to be minimised. One person was at risk from falls and the care plan clearly stated the level of support this person needed with their movement and how this was to be achieved. One person was at risk of nutritional problems. A care plan was in place to say how this was to be addressed and the persons weight monitoring records showed that the persons weight had remained stable. The home continues to use a tick box method to record daily events and this had been developed further since the previous inspection visit. In addition to this staff also write comments about other events that are not contained on the form. Staff spoken to felt that this method of recording what people did on a shift to shift basis worked well. However, further work is needed in this area to make sure that the information is individualised and person centred and the registered persons agreed to review the current system to look at how this can be achieved. The care records showed that people have access to a range of health care services. At the time of the site visit a GP (General Practitioner) and a chiropodist were visiting the home to see people. People living at the home said that they soon got to see a GP if they became unwell. The service has a physiotherapist, aromatherapist and reflexologist. Referrals are made to appropriate agencies as needed. One of the owners of the home has completed Dementia Care Mapping at Bradford University. The home also has links with Age Concern and the Alzheimers Society. This helps in making sure people receive health care support that is based on current good care practices. Staff also received training on health care topics such as diabetes. A survey returned by a health professional who visits the home said that the staff always had the the right skills and experience to meet peoples health, social care and diversity needs. There are improved systems in place to make sure that medication is managed safely. The Medication Administration Records were up to date and had no omissions. A Care Homes for Older People Page 14 of 28 Evidence: random check of one persons medication tallied with the records. One person required eye drops and there was clear direction about which eye was to be treated and the date the eye drops were opened so that staff could make sure they did not exceed their timescale. Hand written entries on medication records are now countersigned by staff to minimise errors. One person had been prescribed a form of medication to be taken on a when needed basis. The dosage of medication to be given at this time was variable. When this medication had been administered staff had not specified the dosage of tablet that had been given. This needs to be done to provide a clear audit trail so that any errors could discrepancies can be accounted for. The medication systems were audited on a weekly basis so that any discrepancies could be detected at an early stage and acted on. People said that staff treated them with respect and dignity. One person living at the home commented we are treated well, staff are good to us. The home has become a Dignity in Care champion. This is an initiative from the Department of Health to ensure that everyone is treated with dignity and respect as is their human right. The home has received many compliments from relatives about the care they provide. Some examples of these were seen. One relative had sent a letter to the home that said, we express our thanks and gratitude for the considerate and compassionate care given to our relative especially during the final period of her life. Another letter thanked the staff for the love, respect and dignity that had been shown by staff towards their relative. Throughout the site visit staff could be seen treating people in a caring, patient and dignified way. Care Homes for Older People Page 15 of 28 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 have the opportunity to enjoy a lifestyle to suit their needs and they are encouraged to maintain relationships with their family and friends. Evidence: The home employs an activity co-ordinator who works for 2 hours on each day throughout the week. Some people said they liked to take part in the activities on offer whilst others preferred not to join in and this was respected. The activity coordinator has a record of peoples preferred hobbies and interests and said this helped in planning activities. On the day of the visit some people were playing bingo and individual activities were also undertaken. One person was being supported to complete a crossword. A relative said, I like to play dominoes with my relative as they enjoy this. When I am not here staff continue with this. A survey returned by a person in the home said, food and activities are done well. One person had been on pub visits and another said they had enjoyed a shopping trip to a local shopping centre. Entertainers also visit the home and people have access to a mobile library service. A person at the home commented that they used to like the church services but that these did not happen any more. The manager said that church services were held at the home on a monthly basis and that representatives from the local churches can visit at any time if people wish to see them as was the case at the time of the Care Homes for Older People Page 16 of 28 Evidence: visit. Information received from the management of the home shortly after the site visit said that the manager had contacted the local vicar to discuss how an improved service could be provided at the home. It was recommended to the activity coordinator that records are maintained of outcomes from the activity sessions. This will help to monitor peoples level of enjoyment and participation, especially those people who have difficulty or who are unable to communicate their needs and choices. It will also help in making sure that activity planning is person centred to suit individual needs. Peoples personal achievements such as birthdays were celebrated and there were numerous photographs on view to show this. A number of bedroom doors also had a photograph of the person the bedroom belonged to, to help maintain the persons individuality and orientation. A complimentary letter from a relative thanked the staff for making their relatives birthday extra special and brilliant. People were encouraged to maintain relationships with their family and friends. A relative said, I can visit whenever I want . One person has relatives living overseas and keeps in touch with them through e-mail. The homes menus were seen and showed that a varied and healthy diet was provided. Specialist diets were catered for such as for one person who requires a gluten-free diet. Information had been obtained from the Gluten Free Society about what types of food could be provided. The menus showed that there was a choice of meal. One person said, the meals are very good, you get given too much. However, another person commented I could do with bigger portions at mealtimes. A mealtime was observed and people were not asked if they wanted second helpings. This was discussed with the manager who said that this was unusual and would make sure that extra food was offered to people at mealtimes. People were offered drinks and snacks between meals. Those people that needed prompting or helping with their meal were given this support in a sensitive manner. The mealtime was unhurried and relaxed. Care Homes for Older People Page 17 of 28 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. A complaints system was in place to make sure peoples concerns were listened to and acted on. Policies and procedures had been followed to safeguard people from risk of possible harm. Evidence: The home has a complaints procedure that was on display at the entrance to the home. Information about the complaints procedure was also included in information about the home that was given to people living in the home and their relatives. The home has a system in place to log all complaints. The joint owner said that all complaints would be investigated within the agreed timescales and outcomes from this would be provided to the complainant in writing. The home had not had any internal complaints since the previous inspection visit. Two external complaints had been made about the home. These had been investigated by the local authority and no further action was needed. People living in the home who were spoken to said they would know who to speak to if they had any concerns. One person said, Ive never needed to bring any concerns up because I have never had any. All the surveys returned by people living in the home stated that the person would know how to make a complaint if this was needed. The home had policies and procedures in place to safeguard people from abuse. All staff receive training about this and this is updated as needed. Since the previous Care Homes for Older People Page 18 of 28 Evidence: inspection visit a flow chart has been introduced to help staff have a better understanding of the Whistleblowing policy. Those staff spoken to demonstrated a good understanding of the policies and procedures. There have been three incidents that required safeguarding procedures to be followed. Referrals had been made to the appropriate agencies to keep people safe. The recently introduced Mental Capacity Act has implications on how peoples rights are safeguarded, particularly in the areas of capacity and consent. The manager said that staff had attended training on this although she felt further training would be useful in enhancing knowledge about this aspect of care. The home has documentation in place for assessing peoples capability for issues around capacity and consent. People rights are respected as was demonstrated recently when people at the home had the opportunity to vote in the local election if they chose to do so. Care Homes for Older People Page 19 of 28 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. Improvements to the living environment are constantly ongoing to make the home more comfortable and pleasant for the people living there. Evidence: The registered providers are planning to expand the home to create additional beds. Building work is currently ongoing and it is going to be some time before the work is completed. At the time of the visit building work was taking place in another part of the grounds. This was not having any detrimental impact on people living in the home. Accommodation was over four floors. There was ramped access to the home and there were passenger lifts to enable people with mobility problems to have access to all parts of the home. The home has an enclosed garden and patio area where people can sit out and have a smoke if they choose to do so. Bedrooms that were seen were personalised and spacious. People spoken to said they liked their bedroom and living at the home. In some cases people shared a bedroom and screens were used to make sure people could still have privacy. Photographs of the person living in the bedroom were on their bedroom door and toilets were identified with pictorial signs. This helped people to find their way around the home. Some people had their own bedroom key if the risk assessment supported that the person was able to manage this. A range of aids and equipment were in place to Care Homes for Older People Page 20 of 28 Evidence: support people with their independence and mobility and the home has purchased further moving and handling equipment such as bath hoists. The home has a modern call system that specified where call bell requests were coming from so that staff knew exactly where support was needed and could respond quickly. A number of improvements had been made to the environment. Stainless steel units have been fitted in the kitchen which has been extended to create additional space. The laundry has been made larger with more up to date equipment. A number of lounge, corridor and bedroom carpets had been replaced with new flooring. New fire doors have been installed and extra fire doors have been fitted. The installation of new boilers had led to improvements in the heating systems.Work had been carried out in the grounds of the home to create extra car parking spaces for visitors. During a look around the environment it was observed that the lighting on the ground floor corridors and in one corridor on the first floor was dim. This made these parts of the environment less pleasant and could have caused potential harm to people from tripping, especially for people with sensory impairment. Information received from the registered provider shortly after the site visit told us that higher wattage light bulbs had been put in place. It also explained that planned structural changes would enhance the amount of natural lighting in the areas identified. One sluice area was not locked and this was discussed with the management who took immediate action to rectify this. Written information was received from the registered providers shortly after the site visit confirming that key pad locks had been fitted to all sluice areas to keep them secure. A hoist was being stored in a corridor on the first floor and one bathroom stored a number of wheelchairs. The manager explained that the bathroom was hardly used although it could still be accessed by people. The registered persons agreed that they would look at alternative storage arrangements in order to maintain peoples comfort and safety. The home employed cleaning staff to help maintain hygiene standards. Environmental Health had awarded the home a five star rating (excellent) for hygiene standards. A relative commented what I like is that the home is always kept clean. People living at the home also commented positively about the cleanliness of the home. Staff were observed to follow infection control procedures and have regular training about this to keep their knowledge updated. A new labeling system has been introduced in the laundry. Staff said this had helped to reduce the chances of clothes going missing. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People received very good care from a settled staff team who were well supported in developing the skills and knowledge they needed to care for people properly. Evidence: The home has a settled staff team with low turnover. The majority of staff were very experienced and so people received consistent care from staff who knew them well. The manager said that there were 3 carers as well as the manager on duty in a morning and three carers on duty in the afternoon. Two carers were on duty throughout the night. The owners were also based at the home for six days of the week and the manager lives on the premises and can be accessed at all times. Catering and domestic staff were also employed to maintain food and hygiene standards and the activity co-ordinator organised the activity programme. People living in the home said that their daily routines were flexible and that they could make their own choices about things such as getting up and bathing. A survey returned by a staff member said, the home has a good staff team who work very well together to provide the best care to each individual person. A person living in the home commented staff do a wonderful job. Three staff recruitment files were looked at. These showed that all the necessary checks had been completed before people started working at the home. This included information about the persons previous employment history. The management said Care Homes for Older People Page 22 of 28 Evidence: that any unexplained gaps in a persons employment history would be further explored and recorded. One member of staff had only recently started working at the home. The duty rotas showed that the person was supernumerary and that one of the owners was going to be working alongside the member of staff in the initial period to provide supervision. People living at the home were encouraged to be involved in the recruitment procedure where possible by meeting prospective members of staff and offering their opinions. The management of the home were very keen on providing training to staff to develop their skills and knowledge. All the staff have completed NVQ (National Vocational Qualification) at level 2 or above. Six staff have also completed NVQ level 3 and a further nine staff are due to complete the course. There was an ongoing training programme for staff. They had attended training on various topics such as dementia care, diabetes, the Mental Capacity Act and in different areas of health and safety. An external training provider visited the home on a weekly basis to provide training and updates. One member of staff said, the training is very good. Another staff member said, we get loads of training. All new staff received a period of induction before they started working at the home to prepare them for their new jobs. Care Homes for Older People Page 23 of 28 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 home was well managed in the best interests of people living there and proper attentions was given to maintaining their health and safety. Evidence: The manager is very experienced in running the home and has completed management qualifications to help develop her role. She was supported in the running of the home by two deputy managers who both have NVQ level 4 and by the owners who were based on-site most of the time. People living at the home felt said they were treated well and a staff member said, we couldnt ask for better management, you are treated as people. Another staff member commented management are fantastic and are always there when you need them. There were systems in place to seek the views of people about the home. Annual questionnaires were sent out to people living at the home and their relatives. The findings from the questionnaires were seen to be positive. It would be beneficial if more formal systems were put in place to seek the views of others who visit the home Care Homes for Older People Page 24 of 28 Evidence: such as GPs and health and social care professionals. People living at the home were regularly asked for their opinions about the choice of menus and activities. Relatives were invited to attend care plan review meetings to discuss their relatives care. Staff meetings and supervision were regularly held to support staff in doing their jobs. The home had maintained the Investors in People Award for their efforts in maintaining and improving the care and services on offer. One of the owners said that the service is aiming to attain the Champions in People Award for the quality of care and services at the home. Since the previous inspection visit advocacy arrangements have been put in place to manage peoples monies where the person lacks the capacity to do this for themselves. The providers confirmed that they no longer act as appointees for any of the people living at the home. The home does hold spending monies on behalf of people and people can have access to these monies at all times. Records of incoming and outgoing monies was documented and receipts kept of all transactions. The home had good systems in place for maintaining peoples health and safety. A random selection of health and safety certificates were up to date. The providers had carried out a detailed fire risk assessment of the premises and fire equipment was regularly updated and fire safety measures followed. Incidents were well recorded and had been referred on to the appropriate agencies where needed. All staff had attended a range of health and safety training and this was regularly updated as needed. Care Homes for Older People Page 25 of 28 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 26 of 28 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 9 The actual amount of medication prescribed to be taken in variable doses should be recorded so that a clear audit trail can be maintained. When people take part in activities, the outcomes from these should be recorded. This will help in making sure activities are planned to suit peoples individual needs including those with communication difficulties. Better storage arrangements should be put in place so that equipment is stored appropriately and to help make sure people can move about safely. Formal systems should be put in place to seek feedback from health, social care and other professionals who visit the home. This will inform the home on what they are doing well and areas for improvement. 2 12 3 19 4 33 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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