Care Home: The Robert & Doris Watts Home

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What the care home does well This is a friendly and welcoming home with a family atmosphere. Meals are of a good quality. Survey comments included - `Provides a `home` from home - so much more than the large rather impersonal care homes. Always caring and friendly`. `The staff give residents a good level of care and it is evident to me that there is a lot of love in the home`. Residents are kept informed about changes in the home and are asked their opinions about ways in which the home can improve or develop the facilities and services. Residents are encouraged to maintain and improve their individual abilities, and their preferences about their care and how they spend their day are respected. What has improved since the last inspection? Information about the home has been updated, both in print and on a website. The home is better at setting out what it can offer to prospective service users. The three registered homes owned by Mr Watts now use more detailed and specific assessment information when considering whether they are able to meet the needs of people who may want to come to live here. The home has employed 2 staff to work in a new support role. This has helped to increase the manager`s and staff understanding of individual residents preferences about their care and developed opportunities for more outings and activities in response to people`s wishes. Peoples care plans are being developed to add more detail about their `life history` so that staff are more effective in getting to know peoples individual support needs and likes and dislikes. The opportunities for staff training and development have been increased with the organisations managers using local training advisors and courses to access courses for staff outside the home. There is a room dedicated for training purposes for staff at the nearby Doris Watts home. Staff are motivated to learn and improve their skills which in turn has a positive effect on the care and support for residents. Some improvements have been made to the building - for example redecorating the corridors and sitting rooms, which gives these areas a lighter and brighter look. The appointment of managers to Mr Watt`s other local care homes has helped to develop and update the organisation and administration and reduce some of the managerial workload for Ms Eastwood, who was overseeing the management of the Doris Watts home last year. What the care home could do better: The home does not use agency staff and so residents benefit from having continuity of care from the permanent staff team. However, despite increasing the number of staff on duty in the mornings, we consider that there is a risk that staff work excessive hours to cover colleagues absences and can become over tired. Staffing numbers should be constantly reviewed to makes sure there are sufficient numbers to allow for staff to have time off away from the home and to attend courses, discuss learning and new developments in care, and be more available to answer any queries from families and visitors. The home provider should improve the standard of furnishings and fittings to benefit the current residents. Whilst we accept that he proposes to build a new home, people living in the existing building should be confident that their living accommodation and facilities will be maintained at a consistently good standard. Key inspection report Care homes for older people Name: Address: The Robert & Doris Watts Home 32 Black Bourton Road Carterton Oxfordshire OX18 3HA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Delia Styles     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 29 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 29 Information about the care home Name of care home: Address: The Robert & Doris Watts Home 32 Black Bourton Road Carterton Oxfordshire OX18 3HA 01993844923 01993844432 linda@robert-and-doris-watts.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Harry Watts care home 31 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 to be accommodated is 31 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home The Robert & Doris Watts Care Home was originally a family guesthouse and was converted for use as a residential care home in 1993. The home is situated close to the town centre and facilities of Carterton. The home offers 31 places - 23 in single rooms, 15 of which have en-suite facilities (a washbasin and toilet) and eight places in four shared rooms, all of which are en-suite. The home is registered to provide nursing care for a maximum of 11 residents of the total of 31 residents that may be accommodated. There are two sitting rooms, a sun lounge, and a dining room on the ground floor. The Care Homes for Older People Page 4 of 29 Over 65 31 0 1 7 1 2 2 0 0 8 Brief description of the care home first floor is served by a passenger lift. Three local doctors surgeries provide medical cover to the home. Chiropody, dental and optician services are available locally, or can be provided by visiting practitioners. A hairdresser visits the home every week. There is a link walkway and access to the neighbouring house, 1 Butlers Drive, which is registered to provide care for four younger adults. The laundry, in a converted garage, and the kitchen in the Robert & Doris Watts Home provide laundry and catering services to the residents of both homes. The fees for this service range from 393 pounds to 658 pounds per week. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection visit to this home was on 17.12.2008. This was an unannounced key inspection visit to review the quality of care and support provided and the outcomes for the people living in the home. The inspection took place 10 days before Christmas and residents and staff were busy with Christmas preparations and activities. The inspection process included a review of the information provided by the manager in their Annual Quality Assurance Assessment (AQAA). Our survey questionnaires were supplied to some of the people using the service, their relatives, staff, and some of the health and social services professionals who visit the home regularly. We received 5 surveys from residents (which were completed with help of a staff member), 5 from relatives, 3 from staff and one from a health care professional. The inspector toured the building and looked at a sample of the paperwork and records that the home is required to keep. The inspector also talked to residents, a visitor, the registered manager, Ms Linda Eastwood, and registered person (the home owner) Mr Care Homes for Older People Page 6 of 29 Harry Watts, and some of the staff on duty. Feedback was given to Ms Eastwood and Mr Watts at the end of the inspection visit. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: The home does not use agency staff and so residents benefit from having continuity of care from the permanent staff team. However, despite increasing the number of staff on duty in the mornings, we consider that there is a risk that staff work excessive hours to cover colleagues absences and can become over tired. Staffing numbers should be constantly reviewed to makes sure there are sufficient numbers to allow for staff to have time off away from the home and to attend courses, discuss learning and Care Homes for Older People Page 8 of 29 new developments in care, and be more available to answer any queries from families and visitors. The home provider should improve the standard of furnishings and fittings to benefit the current residents. Whilst we accept that he proposes to build a new home, people living in the existing building should be confident that their living accommodation and facilities will be maintained at a consistently good standard. 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 29 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 29 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 information provided to service users in the Statement of Purpose and Service User Guide has been updated since our last visit to ensure that people can make an informed choice about whether the home is likely to suit them. Prospective residents needs are fully assessed before they are admitted to the home. Evidence: Since our last inspection the home has complied with our requirement to provide up to date information about the home in its Statement of Purpose and Service User guide. It has improved and updated these printed documents, and is in the process of creating a website, so that people can also access information on line. The provider is also looking at ways of producing a CD so that people with visual problems can hear about the home and what it offers. The homes own quality assurance survey undertaken in June 2009, showed that 5 out of 8 people questioned felt they had enough information about the home before coming to live here to help them make an informed decision about whether it was likely to suit their needs. Three of the people Care Homes for Older People Page 11 of 29 Evidence: asked were either unable to remember or said that their family or representative had received the information on their behalf. The people who completed our surveys that we received around the time of our inspection showed similar answers. The home manager followed up their quality assurance surveys by talking to those residents who could not recall having a contract and reminding them that they have a copy kept in their room. From discussion with the home manager, feedback from social and health care professionals and the assessment information seen in a sample of residents care records, we consider that the home goes to considerable lengths to get accurate information about the care and support needs of people before they are admitted to the home. The assessment process involves the prospective resident, family and advocates and includes other information from social and health professionals relevant to the individuals care prior to admission. This home does have an established reputation with social and health care professionals in meeting the varied and individual needs of people who might otherwise find it difficult to find a home that suits them. The home has appointed 2 people to work as what are described as concierges, who provide one to one time with residents to talk about their interests and abilities. The home tells us this has improved the way in which staff get to know prospective residents and can start to plan for their care and support when they come in to the home. The home has also done what it said it would do last year to make its admission criteria clearer and make sure that people are more carefully assessed in relation to the different facilities and home environments offered at the 3 registered care premises owned by Mr Watts, the provider, in Carterton. A project worker and the registered manager of 1 Butlers Drive have experience in mental health and offer additional skills in the assessment of people with mental and social care needs who may be looking to move into this home. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Since our last inspection the home has improved the systems for planning and writing care records, so that peoples health, social and psychological care and support needs are better described and staff have the information they need to consistently meet residents needs. Health care and medication needs of the people living here are regularly reviewed and monitored to ensure each individuals well being. Personal care is given in a way that promotes and protects peoples privacy and dignity, though the physical layout and facilities in parts of the home are not ideal. Evidence: A sample of three residents care plans was examined at this inspection. The assessment information, care plans and records of review meetings and health care visits are held in individual files for each resident. From the sample seen, it was noted that the risk assessments and care plans are regularly reviewed and mostly contained detailed and relevant information. There are risk assessments in place for nutrition, risk of falls, prevention of skin damage (pressure sores) and in relation to safety in the environment, for example, protecting people from injury from hot water and radiator Care Homes for Older People Page 13 of 29 Evidence: surfaces. The home is further improving the way staff get to know each individuals social care needs through developing a life history file with each person. This describes their likes and dislikes, former occupation and hobbies, the family and friends that are important to them and their usual daily routines. The care plans seen showed that the home has good arrangements in place to get the appropriate care and advice to meet peoples health needs. The answers we received from 5 residents in our surveys showed that they feel they receive good care and support from staff, and the medical care, that they need. A survey from a health and social care professional was also positive about the fact that the home has good communication with GPs and brings patients to the GP where possible and appropriate. Of our 5 relatives, carers and advocate surveys we received back, 4 felt their relative or friend in the home always gets the support or care that they would expect, and that was agreed at the time of them coming to live at the home; one person felt this was usually the case but had some reservations about some aspects of personal care their relative receives. The homes arrangements for storage and administration of peoples medicines in the home were discussed. The homes AQAA describes safe practices and up to date policies that are regularly monitored by the dispensing pharmacy who visits. Staff are given information and instruction about protecting the privacy and dignity of the people who live here in their induction and training programme. Responses in our surveys showed that people feel they are well looked after and that staff are friendly and caring. Staff were observed to be polite, kind and patient when talking with, and assisting residents. Staff knocked residents room doors and awaited a response before going in. Care Homes for Older People Page 14 of 29 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. Social activities and meals are both well managed, creative and provide daily variation and interest for people living in the home. Personal support is offered in a way that promotes and protects residents privacy, dignity and independence. Evidence: Four out of the five residents who completed our survey indicated that there are always activities that they can join in organised in the home and one person felt this is usually the case. One relative suggested in their survey that the home could do better in some aspects - As always, more one to one attention to stimulate the mind would always be welcome. However, another commented that Residents are encouraged to join in activities (such as) bingo, art sessions, games, craft etc. The outside space has been improved and we have enjoyed sitting outside with Mum. The introduction of a new staff role in the home (what the home calls a concierge role) has improved the opportunities for staff to get to know individual residents preferences and abilities and to help people realise some of their wishes. For example, the manager tells us in the AQAA that it has encouraged several residents to meet and greet old friends and relatives who they have not had contact with for many years. The concierges act as internal advocates for residents and give direct representation Care Homes for Older People Page 15 of 29 Evidence: for residents at internal meetings. The home manager feels this has developed a better focus on the quality of life for all service users. On the morning of this inspection, residents had enjoyed having a visit from local school children who sang carols. In the afternoon residents had their Christmas tea party and the draw of raffle prizes. Representatives of the various Christian church denominations visit those residents who request this and if people wish to attend services and meetings at a local church of their choice, they are helped to do so. There is a ground floor dining room where most residents have their main meals, but people can choose to have their meals in their own rooms or smaller sitting rooms if they wish. Meal menus are planned on a four weekly cycle and ideas and requests for meal choices are made through regular discussion with residents. Residents are asked to make their choices for the lunch and supper meals on the day before. Residents spoken with said they had enjoyed their lunch and that the food is always good. The lunch time main course choices were were gammon steak with parsley sauce or chicken casserole. All the food served looked and smelled appetising. One out of the 5 residents surveys we received stated that they always like the meals in the home; 3 said they usually like the meals and 1 sometimes. Relatives survey comments are positive about the food and the benefits to residents living here. For example - menus are displayed on a board with choices offered. Mum says she enjoys her meals - she benefits from a good routine, good food and fluid intake and from the stimulation of being with other people. From our conversation with visitors, survey responses and observations on the day, we saw that visitors are made welcome in the home. Written comments included - we have come to feel part of the family at Robert and Doris Watts - thanks to all staff for welcoming Mum and us; Visitors are made welcome; and provides a home from home - so much more than the large rather impersonal care homes. Care Homes for Older People Page 16 of 29 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 has a satisfactory complaints system with evidence that residents feel safe and listened to. Staff have a good understanding of adult safeguarding issues so that they are aware of situations that may place residents at possible risk of harm or abuse and the actions that must be taken to protect residents. Evidence: The home has acted on a requirement we made at our last inspection to update the information about the home, including how to make a complaint. The operations director for the home has also recorded the complaints procedure on a CD format to make it more easy to understand for people with visual problems. The results of the homes own quality audit undertaken in June 2009 and the responses to our surveys received at the time of this inspection, showed that people living here know how to make a complaint. However, two of 5 relatives answered no to the question in our survey Do you know how to make a formal complaint. The home manager confirmed that they have received no formal complaints in the past 12 months. The commission has not been made aware of any concerns or complaints about this home. The homes AQAA (for 2009) tells us that they hold quarterly resident forum meetings at which residents are encouraged to give their suggestions and raise any concerns about how the home is run. Notes of these meetings are published and displayed in Care Homes for Older People Page 17 of 29 Evidence: the home, and individual residents who want a copy are given one. There are also regular review meetings with residents, their relatives and advocates and the homes manager that give the opportunity for people to voice any concerns or make suggestions about the care and support of the individual living here. When visiting The Doris Watts home a week earlier, the manager and operations manager showed that the company has improved the way in which it records any comments, suggestions and complaints received, so that they record any actions taken in response, and the outcomes for the residents. The home feels that the appointment of two new staff in the role of concierges, who act as advocates for residents at internal meetings, has also improved the way in which residents can share any concerns or complaints. From observation and discussion with residents it is evident that people feel comfortable with making any concerns known and that they would be taken seriously by the manager. The home has policies and procedures in place for protecting residents from possible harm and abuse. Staff are given information about safeguarding and how to identify and report suspected abuse during their induction training and at regular updates as part of their training programme. This was confirmed in th spot check of a sample of staff files seen at the inspection visit. Three staff members completed our survey and indicated they know what to do if a resident, relative, advocate or friend has concerns about the home or safety and wellbeing. Care Homes for Older People Page 18 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall the home is clean, well decorated and comfortable, and provides residents with a homely environment. Some further improvements to the furniture, fixtures and facilities of the home are needed in order to continue to consistently meet the expected minimum standards for residents. Evidence: This home is not purpose-built and has been adapted from its original use as a family run guest house over many years. The home owner plans to build a new care home on the land adjacent to the current buildings. Further progress has been made in the planning application process since our last inspection and Mr Harry Watts the home owner said that they are hoping to be in a position to start building in 2010. We acknowledge that the provider is unlikely to commit to major expenditure to improve the current home environment and facilities because of the prospect of the large new replacement building project starting in the next twelve months. Some work has been done to improve the decor - notably the corridors and communal living areas have been repainted. The colour scheme was chosen by residents and the painter, and have given a lighter and brighter appearance. However, in several areas of the home furniture and carpeting looks old, worn and shabby. This was especially obvious in the conservatory room. Care Homes for Older People Page 19 of 29 Evidence: Comments we received in response to our survey questions, confirmed that though people appreciate the homeliness and friendly atmosphere, they consider that the physical appearance of the building lets it down. Comments included - Some of the furniture is old i.e. wobbly arms on dining chairs. This needs monitoring for health and safety reasons - to prevent accidents; needs refurbishing; dingy decor and surroundings. We are quite happy with this home despite its disadvantageous setting and building. Though the home has made improvements to the way it monitors the cleanliness and tidiness in peoples rooms, it was evident that there had been a recent lapse in the system where domestic staff complete a check list for each persons room - the last written entries had been made on 09.12.2009. The manager confirmed that there had been a recent shortfall in staff because of sickness and people leaving, so that the priority had been on keeping up with the cleaning schedules. Answers to our questions about the standard of cleanliness in the home were that 2 out of 5 residents said it was always fresh and clean, and 3 that this was usually the case. We noted that most areas visited on the day of the inspection were clean and fresh smelling. One room smelled unpleasantly and the carpet was frayed and stained in places. The manager is aware of this and action will be taken to change the carpet or consider laying washable flooring over part of the floor. We found that, despite the new checks in place, and the homes recruitment of a maintenance person, there was still a problem with the home finishing off repair work and making good. For example, the new assisted bath fitted in the ground floor bathroom had uncovered pipework and missing tiling. Some en-suite rooms and bedrooms with hand basins did not have a bathroom cupboard for the separate storage of peoples toiletries. This adds to a rather untidy and cluttered appearance. At our last inspection we made a requirement that the home installs sluice facilities so that commode inserts and other sanitary equipment can be properly cleaned and disinfected to safeguard residents and staff from infection. This has not been done, but the home owner assured the inspector that they were currently consulting with a company about the best type of sluice machines to install and this work will be shortly completed. For this reason, we have not repeated this requirement at this time. The home has laundry facilities in a converted double garage between the Robert and Doris Watts and 1, Butlers Drive properties. The laundry processes and systems meet the required standards and the laundry was tidy and well-ordered on this occasion. One relatives survey comment was that laundering of clothes is efficient Care Homes for Older People Page 20 of 29 Evidence: and servicing of rooms and cleaning of toilets appears ongoing. Care Homes for Older People Page 21 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing numbers and skills meet the current residents care needs but there are not always sufficient hours allowed to ensure that staff have time for training and fully implementing new practices and initiatives for the benefit of residents. The management team has improved the opportunities for staff training which should result in better outcomes for residents. The homes procedures for the recruitment and screening of new employees is good, ensuring that people living here are protected. Evidence: The rota confirmed that there is always a registered nurse on duty together with five care staff during the day and two care staff at night. The manager or deputy manager are available during weekdays in addition to the staff providing direct care to residents. Responses from residents, relatives and staff to questions in our surveys showed that though people feel staff are approachable, friendly and caring, there are not always enough people on duty to meet residents care and support needs. A relative said that they sometimes had difficulty in getting information about how their loved on is getting on because staff are so busy. This person suggested that staff could give regular feedback rather than relatives feeling they are interrupting them. Staff comments included - I feel that more training of care staff would be beneficial Care Homes for Older People Page 22 of 29 Evidence: and time practically to implement what is learnt...and perhaps more staff to allow others time off to reflect and rest. The home manager agreed that staff were stretched because of holidays and sick leave and she had arranged additional bank staff to relieve permanent staff over the Christmas and New Year period. The AQAA states that 6 care and nursing staff have left the home in the 12 months up to October 2009. The homes AQAA (October 2009) tells us that the staffing numbers have been increased between the hours of 07.00 and 14.00 to meet an increased dependency of residents. The home has also improved the range and opportunities for training and development of staff, through links with local training organisations. There is a dedicated training room for all staff, located at the nearby Doris Watts care home. Examination of the homes staff training matrix, conversation with the manager and staff and responses to our surveys, confirmed that training and development of staff is well planned and organised and includes relevant topics. The home is looking to expand its training to include caring for people living with dementia, and how the Mental Capacity Act affects the way in which staff promotes and protects peoples rights to make decisions about their lives. The manager confirmed that there are 8 staff enrolled on a nationally recognised training course for care staff - the National Vocational Qualification (NVQ) in Care at level 2. Three of the 14 permanent care staff already have this qualification. The proportion of carers who have NVQ Level 2 is still considerably below the 50 per cent expected by us. However,it is recognised that there are a number of registered nurses who add to the skills and experience of the staff team. The home is showing it is committed to achieving 50 per cent of care staff who have a NVQ level 2 or above (or an equivalent) qualification. The home shares a common recruitment and employment process with its partner home, the Doris Watts. There are a few staff who work between the two homes as required and the housekeeping manager also works between both homes to coordinate the housekeeping service and staff. Examination of a sample of staff files showed that the home has improved the documentation and record keeping for the recruitment and selection of employees. The records seen showed that the home had received satisfactory responses for the required checks and references, before new employees start to work at the home. This shows a systematic and thorough approach to recruitment that protects residents from people who are not allowed to work with vulnerable adults. Care Homes for Older People Page 23 of 29 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 is well managed and residents views are both sought and acted upon. Since our last inspection, the home provider has taken some action to improve certain aspects of the environment and the ways in which staff practices are monitored and recorded to make sure that the health, safety and wellbeing of people living and working here is protected. More work is needed to make sure that repairs and replacement of old equipment is undertaken promptly to improve the appearance of the environment, and minimise the risk of inconvenience or accidents to people living and working at the home. Evidence: The registered manager, Ms Linda Eastwood, is a registered nurse and has achieved the Registered Managers Award (National Vocational Qualification Level 4) and has considerable experience in managing the care home as she has been in post for eleven years. Feedback from residents confirms that the manager is approachable and available to them if they have any concerns or problems. It is evident that she has a good understanding of residents care needs and ensures that the stated aims of the Care Homes for Older People Page 24 of 29 Evidence: home - to support and encourage residents independence and individuality - are the values that underpin the standards of care expected from the staff. She has shown great commitment to her own and other staff members education and development and has considerable knowledge and experience about the care of the residents and support for their families and friends. Written comments received in response to our surveys included - Linda is doing a great job considering all the constraints she and her team have to put up with. I have always found the manager very approachable and the staff as well. (The home) cares for the service users in a strong way, above the call of duty, especially the home manager, Linda Eastwood. Since our last inspection, new registered managers have been appointed to the Doris Watts care home and 1 Butlers Drive. This has reduced the managerial responsibilities for Ms Eastwood, as she had to oversee the Doris Watts home last year. The registered managers work closely together and this has improved the training and administrative systems in place. A new administrator, who has an office in the Doris Watts home, also adds support to the managers, as does the operations manager, Mr Anthony Watts. The home distributes satisfaction questionnaires to residents annually. The AQAA tells us that they have improved their system by also sending questionnaires to family, advocates and visiting professionals. These have been distributed in December each year, but it is intended to change this to May, to improve the feedback response. The majority of residents are unable to complete surveys independently but their relatives or a member of staff not directly involved in the day to day care of residents helps them to complete them. There are also regular resident forum meetings with the manager so that she can hear residents views about the service and suggestions about improvements. The role of the concierges, two staff appointed since our last inspection, has added to the internal feedback and advocacy for the people living here. The homes administrator manages residents personal money allowance records. Most residents relatives help them to manage their financial affairs or have Power of Attorney. The records seen indicated that the homes records of residents personal allowance expenditure are up to date. We discussed how the charges for the concierge service are administered - where this includes escorting and transporting people to appointments or trips out in the homes transport. People are informed about the charges and by working with individual residents to share journeys or trips out, the cost is also reduced. Staff records show that the home has a programme of induction and on going training Care Homes for Older People Page 25 of 29 Evidence: for staff in health and safety topics such as manual handling, basic First Aid, falls assessment and prevention, infection control, and fire awareness and evacuation. During the inspection the accident records for a sample of residents and the fire records of staff training and fire equipment checks were examined. These were up to date. The manager confirmed that the environmental health officer recently visited the home and made some requirements for improvement work to be carried out in the kitchen. This work has been done. There remain concerns around the effectiveness of the infection control measures in place in the home because of the continuing lack of functioning sluice disinfection machines. However, the home owner told us new machines will be installed in the near future. Since our last inspection, an audit of mattresses and pillows has been undertaken and any damaged or old ones have been replaced the manager said. Care Homes for Older People Page 26 of 29 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 27 of 29 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 19 The home should fully implement its system of routine checks and audits of the premises and grounds and maintain a programme of repairs, refurbishment and replacement of old and damaged equipment or furniture. Records should be kept of the achieved compliance within agreed timescales. Install new sluice disinfector machine(s) to suitable locations in the home with adequate ventilation, storage room for equipment and waste bins for clinical waste, and adequate hand washing facilities for staff. Improve the use of the audit systems in the home to make sure that the living environment is well maintained and that staff and residents safety and wellbeing is consistently protected. 2 26 3 38 Care Homes for Older People Page 28 of 29 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. 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