Care Home: The Orchard

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What the care home does well Potential service users receive a thorough needs assessment to ensure the home can meet the care needs of the service users. We spoke with some people who were receiving a service at The Orchard and they told us that they had been given information before they moved into the home about the services the home offered and one person said, "Staff here have made me feel very welcome. They are all so nice and very helpful." There is a motivated and established staff team who respond to service users in a respectful and appropriate manner. Service users spoken to on the day of the visit said that staff are "so helpful and help me with anything" and another person said, "the girls are very kind to me and always so cheerful". The home provides a pleasant and comfortable environment in which people can live. Individuals are encouraged to personalise their own rooms with their own furniture and personal belongings. People spoken to on the day of the visit said, "I love having my own room and I`m happy I have been able to put my own things in here. It makes it feel more like home" and "Its lovely here, very homely and I like this home because its small and personal". Communication between people who use the service and staff was observed to be positive and open. There is joint working with the GP surgery and community nurses to the benefit of the service users. One comment received from a healthcare professional tells us, "the home creates a warm, family atmosphere. Regular staff know the residents well. There is a large garden area where residents are encouraged to sit out and get fresh air. There is active involvement with the village community". Feedback from people using the service informs us that the carers treat them with dignity and respect, offering help and support discreetly and sensitively. The provision of meals and mealtimes are of a good standard. Comments made about the food include, "the food is lovely, its always nice" and "the food is good and the puddings are especially nice". A further comment made by one person was, "The cooking could be better. The vegetables are always too soft". There is an effective complaints procedure with all complaints and concerns being acted upon promptly, within stated time scales. There is a robust recruitment procedure in place that ensures service users are protected from harm. There is a good range of policies and procedures, providing staff with relevant information about all aspects of care and the home/organisation. The evidence seen and comments received indicate that this service meets the diverse needs e.g. religious, racial, cultural, disability of individuals within the limits of its Statement of Purpose. What has improved since the last inspection? The home has purchased a mobile medication trolley and this has now been fixed securely to the wall. Recording on the Medication Administration Records (MAR) has improved and staff sign the MAR chart when they have administered medicines. All staff personnel files now contain an up to date photograph of the person. What the care home could do better: Information about people using this service was contained in three different files and was not easily accessible. Files were not user friendly. To make sure information is readily accessible to staff the files from benefit from reorganisation and the home should address this. In the file for one person new to the home the care plan section was not completed. A full and comprehensive care plan must be in place for all service users before they receive a care service from the home. In some care plan review notes, it was noted that the only comment made is "fine". The review should inform the reader of the progress made by the service user, any strengths, or any changes that have been identified at the review. The home must put a system in place that makes sure service users plans include guidelines for the administration of all `when required/when needed` medicines. These guidelines must include when the medicine is to be given and when it is not and include a strategy for when variable doses can be given. During lunch, service users spoken to were not aware of the days meal or that they could have a choice of meal. The home should make sure that a choice of meals in written or in other formats to suit the capacities of all service users, is available and on display, read or explained to service users. This should be addressed. During a tour of the home a bedroom door was noted to be wedged open by a personal possession of the person living in the room. The home must look at alternative ways of keeping doors open and must consult with the local fire authority. Key inspection report Care homes for older people Name: Address: The Orchard High Street South Stewkley Bucks LU7 0HR     The quality rating for this care home is:   one star adequate 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: Barbara Mulligan     Date: 1 5 1 2 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 Orchard High Street South Stewkley Bucks LU7 0HR 01525240240 01525240464 orchardstewkley@supanet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Pauline Hannelly care home 11 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 11 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Date of last inspection Brief description of the care home The Orchard is registered to provide personal care for up to eleven older people. It is a large detached house set in attractive gardens in the village of Stewkley and is close to local amenities. The home is privately owned and managed and is also the private residence of the owner/manager. All bedrooms are single occupancy and have en-suite facilities. People using the service have their own sitting/dining room and there are attractive accessible gardens. All service users are registered with a local doctors practices and have access to National Health Service facilities. 1 6 0 3 2 0 0 9 0 Over 65 11 Care Homes for Older People Page 4 of 28 Brief description of the care home Fees for the home range from £650 pounds per week. 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was conducted over the course of one day and covered all the key National Minimum Standards for older people. Prior to the visit, a detailed self-assessment called The Annual Quality Assurance Assessment (AQAA) was sent to the registered manager for completion. The AQAA focuses on how well outcomes are being met for people using the service. This was returned to the Commission by the day it was due and was fully completed, giving us the information we needed. It also gave us some numerical information about the service. Eighteen surveys were sent to the home for staff, healthcare professionals and people using the service to complete. Eleven of these were returned to the Care Quality Commission and any further completed surveys we receive will be considered as part of our ongoing regulatory responsibilities for registered services. Information received by the Commission since the last inspection was also taken into account. Care Homes for Older People Page 6 of 28 The Regulation Inspector was Barbara Mulligan. The inspection consisted of discussion with the management of the home, discussion with other staff, opportunities to meet with some people who use the service, examination of some of the homes required records, observation of practice and a tour of the premises. A key theme of the visit was how effectively the service meets needs arising from equality and diversity. Feedback on the inspection findings and areas needing improvement was given to the management of the home at the end of the inspection. The management of the home, the staff and service users are thanked for their cooperation and hospitality during this unannounced visit. Care Homes for Older People Page 7 of 28 What the care home does well: Potential service users receive a thorough needs assessment to ensure the home can meet the care needs of the service users. We spoke with some people who were receiving a service at The Orchard and they told us that they had been given information before they moved into the home about the services the home offered and one person said, Staff here have made me feel very welcome. They are all so nice and very helpful. There is a motivated and established staff team who respond to service users in a respectful and appropriate manner. Service users spoken to on the day of the visit said that staff are so helpful and help me with anything and another person said, the girls are very kind to me and always so cheerful. The home provides a pleasant and comfortable environment in which people can live. Individuals are encouraged to personalise their own rooms with their own furniture and personal belongings. People spoken to on the day of the visit said, I love having my own room and Im happy I have been able to put my own things in here. It makes it feel more like home and Its lovely here, very homely and I like this home because its small and personal. Communication between people who use the service and staff was observed to be positive and open. There is joint working with the GP surgery and community nurses to the benefit of the service users. One comment received from a healthcare professional tells us, the home creates a warm, family atmosphere. Regular staff know the residents well. There is a large garden area where residents are encouraged to sit out and get fresh air. There is active involvement with the village community. Feedback from people using the service informs us that the carers treat them with dignity and respect, offering help and support discreetly and sensitively. The provision of meals and mealtimes are of a good standard. Comments made about the food include, the food is lovely, its always nice and the food is good and the puddings are especially nice. A further comment made by one person was, The cooking could be better. The vegetables are always too soft. There is an effective complaints procedure with all complaints and concerns being acted upon promptly, within stated time scales. There is a robust recruitment procedure in place that ensures service users are protected from harm. There is a good range of policies and procedures, providing staff with relevant information about all aspects of care and the home/organisation. The evidence seen and comments received indicate that this service meets the diverse needs e.g. religious, racial, cultural, disability of individuals within the limits of its Statement of Purpose. Care Homes for Older People Page 8 of 28 What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking 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. The assessment process works well and potential residents and their families have information about the home to help them decide whether their needs can be met, before they decide to move permanently. Evidence: Three completed needs assessments were examined, including those most newly admitted to the home. The home uses a purchased package to record the assessment of peoples needs and any associated risks that may be present when delivering the care. Each file had a completed needs assessment and showed that all areas and conditions of people using the service were assessed prior to offering them a place in the home. Each assessment contained further information about the persons family and friends, likes, dislikes and preferences. We spoke with some people who were receiving a service at The Orchard and they told us that they had been given information before they moved into the home about Care Homes for Older People Page 11 of 28 Evidence: the services the home offered and one person said, Staff here have made me feel very welcome. They are all so nice and very helpful. The assessment demonstrates that prospective service users, family members or their representatives are included in the assessment process if this is appropriate. The home does not provide intermediate care, so this standard is not applicable. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have a good understanding of service users care needs, but the health, personal and social care needs of the person new to the home are not identified in a care plan, preventing the home from meeting all the needs of the individual. Guidance for the administration of as required medicines must be recorded in service user files to ensure service users are protected by the homes medication practices. Evidence: The care of three people using this service, including those new to the home were looked at and their care plans were examined. Care plans for two people were up to date and contain sufficient detail for staff to learn about the people they support, however, the information was contained in three different files and was not easily accessible and files were not user friendly. To ensure information is readily accessible to staff the files from benefit from reorganisation and the home should address this. Care Homes for Older People Page 13 of 28 Evidence: In the file for the third person the care plan section was not completed. This person was in the home for respite care and had been residing there for just over two weeks. The initial needs assessment for this person was fully completed and so were risk assessments for moving and handling, a physical risk assessment, mental health, nutrition, falls, behaviours and tissue viability. The inspector asked the senior carer present if the individuals care plan may be held in another place. The care plan could not be located for this person and the inspector was informed its completion must have been over looked. A requirement is issued for improvement in this area. Visual observations of people using this service showed that people were smartly dressed including jewelry, make up and nail varnish. People were seen to be wearing the aids needed, for example hearing aids and clean glasses. The care plans show that that service users, family members or representatives are included in the care planning process. One comment received in a returned survey told us, I know whats in my care plan. I like to take part and be involved. A person spoken to on the day of the visit confirmed that the care plan had been explained to them. The staff spoken to are knowledgeable about service users care needs and preferences. There is evidence that care plans are reviewed monthly and updated when appropriate. However, in some reviews observed the only comment made is fine. The review should inform the reader of the progress made by the service user, any strengths, or any changes that have been identified at the review. This should be addressed. Daily notes were examined and these are detailed and informative and record the personal care received and activities that the individual has undertaken throughout the day. The home receives district nurse support and they are available for advice regarding pressure area care and assist in the provision of pressure relieving equipment. There were no individuals with pressure sores at the time of the visit. Tissue viability assessments are in place for service users and these were seen to be reviewed on a monthly basis and pressure relieving equipment was in place for individuals who need it. Staff provide support to individuals needing to attend outpatient and other appointments. One survey received from a healthcare professional tells us, the home creates a warm, family atmosphere. Regular staff know the residents well. There is a large garden area where residents are encouraged to sit out and get fresh air. There is active involvement with the village community. Risk assessments are in place covering areas such as falls, moving and handling, nutritional assessments, wound assessment and pressure area care. These are up to date, signed and dated by the person completing the assessment. Healthcare records Care Homes for Older People Page 14 of 28 Evidence: are in good order and include records of contact with various healthcare professionals. The records indicated appropriate regularity of appointments and appropriate one-off consultations where necessary, including opthalmology and audiology appointments at the outpatient departments. The procedures for the administration of medicines were examined during this inspection. At this visit we looked at the medication administration record (MAR) charts, medication supplies and care plans for the three people whose care was being looked at as part of this inspection, and at the MAR charts for the remaining people living in the home. At the previous inspection it was identified that the service had obtained a suitable medication trolley in which all medication is stored, but this was not affixed securely to the wall and a requirement was issued. The inspector noted that this has now been fixed to the wall and this requirement has been complied with. The home was not using any controlled drugs at the time of the visit. The home uses a monitored dosage system (MDS) and medicines are stored in a mobile, lockable trolley. Medication administration records (MAR) show no gaps or omissions. The inspector noted on the Medication Administration Records (MAR) that some of the service users had been prescribed (PRN) as required medicines. The medication policies and procedures and the service user care plans were examined and there was no written guidance recorded for the administration of as needed medicines. This was discussed with the registered manager and the senior carer. The home must implement a system to be put in place that ensures service user plans include guidelines for the administration of all when required/when needed medicines. These guidelines must include when the medicine is to be given and when it is not and include a strategy for when variable doses can be given. A requirement is issued for improvement in this area. Training records show that staff have completed medication training and have been deemed competent. Staff training records demonstrate this to be the case. The inspector observed staff assisting people who use the service in a kindly and respectful manner. During lunch is was pleasing to see staff supporting service users with their meals in an appropriate way. Staff are obviously aware of the importance of privacy and dignity and were seen to knock on doors before entering and always addressing the individual by their preferred term of address. The homes induction programme includes training regarding privacy and dignity. 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. There is a range of activities available to residents who are encouraged and supported to remain in contact with their families and friends and to use local community facilities ensuring people do not become socially isolated. The presentation and standard of food is good and meets the nutritional needs of people who use the service but the choice of meal should be made clear to people using the service. Evidence: Care plans show individual routines of daily living and include bathing, rising and retiring times. As part of the admission process, the home complete a section in the initial assessment called A Life History which gives staff information about previous leisure pursuits, hobbies and other interests. A part time activities co-ordinator is employed at The Orchard who works at the home twice a week. She puts together a programme of events and keeps a record of these. Activities such as poetry, making Christmas cards, discussion groups and old time musical events were seen recorded in the activities book. In discussions with one person using this service they said of the activities, The staff will take me out if I ask. The staff are lovely but have limited time. People spoken to during lunch said they had taken part in residents meetings, coffee mornings and some said they had been Care Homes for Older People Page 16 of 28 Evidence: out to the theatre. One person said they had been to Ascot. A visiting hairdresser attends the home on a weekly basis and they were present on the day of the inspection. The inspector was informed that a local minister visits people in the home and a joint service has recently been undertaken where the home invited people from the local village. Service users are able to receive visitors in the privacy of their own rooms and are able to choose whom they see and do not see. One service user said, the staff are lovely and always make my family feel welcome when they visit. One comment received from a resident in a survey, under the section what the home could do better tells us more entertainment during the week days when most people do not have visitors. Family and friends are invited to participate in some of the social event organised organised by the home. Service users are offered three meals a day. The inspector had the opportunity to join service users for a lunchtime meal in the main dining area. Several people had chosen to take their meals in their room on the day of the visit. The meal was relaxed, unrushed and well organised. People were supported by staff and the food was attractively presented. Comments made about the food include, the food is lovely, its always nice and the food is good and the puddings are especially nice. A further comment made by one person was, The cooking could be better. The vegetables are always too soft. During lunch, service users spoken to were asked by the inspector what the meal for the day was going to be. All said they didnt know what the meal was and that they were never told. One service user said they thought it was going to be fish and the person sat next to them said, oh not fish again, I dont like fish. The inspector asked the group if they could have something different if they didnt like the meal provided. Three people said they had to have what they were given and a further individual said, there is no choice, or at least I dont know if there is. The registered manager said she decides upon the menu for the home. It is apparent that people using this service are not aware of an alternative choice of menu and this was not seen to be recorded any where. The home should ensure that a choice of meals in written or other formats to suit the capacities of all service users is available and on display, read or explained to service users. This should be addressed. 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. The home is able to effectively manage complaints and safeguard service users ensuring people are listened to and kept safe from harm and abuse. Evidence: The home has a complaints procedure which illustrates timescales and how complaints are dealt with. A copy of this is displayed in the entrance hallway of the home. We discussed with the registered manager how complaints are managed by the home and the manager said she welcomes any complaints or concerns and actively encourages residents and relatives to raise any issues they have at the earliest opportunity. The Annual Quality Assurance Assessment (AQAA) tells us that the home has not received any complaints since the last inspection. A summary of the complaints procedure is included in the Statement of Purpose and Service Users Guide. One comment made in a returned survey stated my relative doesnt like to make a fuss, but they feel heard and that is important. Procedures are in place for the protection of vulnerable adults and staff have access to a whistle blowing policy. The home has a copy of the local authority Safeguarding policy. Training records demonstrate that staff have undertaken training in adult protection. The Annual Quality Assurance Assessment tells us that there has not been any safe guarding referrals in the previous twelve months. The home has continued to keep the Commission informed of any safeguarding incidents. Care Homes for Older People Page 18 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. The standard of the environment within the home is good, providing people who use the service with an attractive and homely place to live. Evidence: The Orchard is a large detached property located on the road into Stewkley. It is a three storey building with the top floor providing staff accommodation. There is a sign clearly identifying the home from the road. The grounds are enclosed behind a high brick wall and parking is available for visitors on the road. Accommodation for people using the service is on the ground and first floors; there are nine single rooms and one double room all with en-suite facilities. There are two communal lounges that people can choose from, one of which contains a dining area and overlooks the well maintained gardens and a swimming pool. The lounge and seating areas are comfortably furnished and spacious and on the whole these are in good decorative order. Efforts have been made to make these areas look homely, with many personal touches such as pictures, side lamps, books, plants and ornaments. Bedrooms vary in size and are comfortably furnished, clean, tidy and those seen have been personalised. Care Homes for Older People Page 19 of 28 Evidence: There are accessible toilets available for service users throughout the home and several are close to the lounges and dining area. Bathrooms and toilet areas have the appropriate aids and adaptations to meet the needs of individuals and to promote independence. People spoken to on the day of the visit said, I love having my own room and Im happy I have been able to put my own things in here. It makes it feel more like home and Its lovely here. Very homely and I like this home because its small and personal. Laundry facilities are sited so that soiled articles, clothing and infected linen are not carried through areas where food is stored, prepared, cooked or eaten and do not intrude on service users. The laundry floor finishes are impermeable and these and the wall finishes are readily cleanable. The home has an infection control policy and the Annual Quality Assurance Assessment tells us that all staff have completed Infection Control training. Care Homes for Older People Page 20 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. The staffing numbers and skill mix is satisfactory and staff training is sufficient and up to date to ensure that people who use the service benefit from staff who are competent to do their job. Recruitment procedures are undertaken to ensure staff have the right skills and competencies to support the people who live there. Evidence: The homes staff rota demonstrates that there are adequate numbers and skill mix of staff on duty at all times. The Annual Quality Assurance Assessment (AQAA) tells us that the home presently employs eight permanent care workers. The manager is extra to the staff on the roster, allowing for flexibility during peak and holiday periods. The care team are also supported by full time housekeeping laundry and catering teams. Service users spoken to on the day of the visit said that staff are so helpful and help me with anything and the girls are very kind to me and always so cheerful. The AQAA tells us that four care staff have completed NVQ training in care or health and social care level 2 or above, and two care staff are currently working towards completing this. At the previous inspection it was identified that two out of three staff recruitment files did not contain a recent photograph of the staff members for which a requirement was issued. Care Homes for Older People Page 21 of 28 Evidence: During this visit the recruitment files for three staff were examined, including those new to the service. These contain the necessary documentation as detailed in schedule 2 of the Care Homes Regulations for older People. Staff files are kept in lockable filing cabinets in the managers office. A requirement was issued at the previous inspection that any staff who start to work at the home with preliminary POVA first clearance are supervised and made aware of the limitations of their role until full Criminal Records Bureau clearance is received, and that a written record is kept, signed by the manager and member of staff, to show that this has been done. There is evidence in the file for the newly employed staff members to show that this has taken place. All staff complete an induction programme that covers the common induction standards for social care and this was seen in the three files examined. During the initial induction to the home staff are extra to the numbers on the staff rota and work alongside more experienced staff. Training records show that staff are up to date with their mandatory training. This includes moving and handling, fire, basic food hygiene, infection control, safeguarding and first aid. There is specialist training available for staff, and an example of this is nutritional training, dementia awareness and care planning training. Care Homes for Older People Page 22 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed by a stable experienced management team and service users are protected by safe working practices ensuring the health and safety of people using the service, however the home must ensure that an alternative method of holding fire doors open is implemented to ensure the safety of people using this service. Evidence: The homes manager has worked in social care for 50 years and has achieved the Registered Managers Award and is registered with the Commission. Comments made in returned surveys tells us that the management of the home is approachable and they operate an open door policy. The inspector noted good teamwork in progress and all the staff spoken to had a good working knowledge of the individual residents and their care needs. The organisations management system includes a quality assurance module which includes a satisfaction survey and the registered manager said these are sent out on a Care Homes for Older People Page 23 of 28 Evidence: quarterly basis. The home holds regular residents meetings and minutes are maintained of these. Service users are encouraged to look after their own financial affairs where at all possible. If this is not practicable then families will undertake this role. There are secure facilities available for the safe-keeping of money and valuables and record and receipts are kept of possessions left for safe keeping. There is a health and safety policy in place and health and safety training is completed and up to date for all staff. Records were seen for fire safety.These cover the homes fire procedures, fire prevention and fire alarm testing. Testing of the homes fire alarm system is undertaken on a weekly basis and evidence was seen of this. There is a fire based risk assessment dated September 2009 and this is reviewed annually. During a tour of the home a bedroom door was noted to be wedged open by a personal possession of the person living in the room. The home must look at alternative ways of keeping doors open and a requirement is issued for improvement. Service reports are in place for the maintenance of hoists and the lift. There are service certificates for electrical installation, Portable Appliance Testing and Gas Appliances. Legionella testing is carried out every six months and this was last undertaken on 08/12/2009. The latest visit from the environmental health department on 27/07/2009 awarded the home five stars. Health and safety training demonstrates that staff are up to date with all mandatory training. Care Homes for Older People Page 24 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 25 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 1 7 15 A care plan must be in place for all service users which provides the basis for the care to be delivered. To ensure the service users health, personal and social care needs are met. 30/01/2010 2 9 13 Clear guidance must be recorded within care plans for the management of as required medicines. To ensure service users receive their medicines safely and as prescribed. 28/02/2010 3 38 23 The home must consult with 30/01/2010 the local Fire Authority about a safe method to keep fire doors open. To ensure the health and safety of service users and staff in the home. Care Homes for Older People Page 26 of 28 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 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. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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