Care Home: The Wells Nursing & Residential Home

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What the care home does well Peoples rights to privacy and dignity are respected by staff. Visitors to the home are encouraged and made welcome by staff and are now invited to attend events. All the people spoken to were very satisfied with the standard of the food served at the home. Individual preferences were known and catered for by care staff and the cook. Residents could choose to have their meals in the dining room or in their own rooms. The kitchen records were well kept and the kitchen clean and tidy. The home has a clear complaints policy that residents and visitors are aware of. Policies and procedures are in place to protect residents from the risk of abuse, including staff training and robust recruitment policies. The home, on the whole, was clean, tidy and free from unpleasant odours. People are able to bring in furniture and personal belongings to personalise their private room. Recent improvements to the overall decor of the home were seen. Resident and staff meetings have been held and the views of those living and working in the home are being taken into account by the manager. The majority of relatives said the atmosphere at the home was warm, caring and friendly, people living there confirmed that they shared this view. Staff were observed to be courteous and appropriately friendly towards people. One person described staff as `very good, very kind`. People living at the home are seen as individuals and the home tries hard to accommodate their individual needs and characters. The home provides a good induction to all new staff to ensure that they are confident in their role and feel well supported. What has improved since the last inspection? No requirements were made at the last inspection. What the care home could do better: The home needs to review the current staffing levels at the home. Although the needs of the people living at the home are being met this is in part due to the hard work of the current staff. The dependency of the people living at the home has increased over the last few months but the numbers of staff have not significantly increased. This could compromise the level of care afforded to people living at the home. The number and availability of social and recreational opportunities has been compromised over the last few months due to the lack of an activities organiser. It is hoped that this will improve over the next few months. The home needs to ensure that two written references are received, one from the last employer, for all new staff employed. This will ensure that robust recruitment procedures are followed and help to ensure that safety of people living at the home. In addition the home needs review the current application form for new staff. Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Wells Nursing & Residential Home The Wells Nursing & Residential Home Henton Wells Somerset BA5 1PD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Justine Button     Date: 0 7 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: The Wells Nursing & Residential Home The Wells Nursing & Residential Home Henton Wells Somerset BA5 1PD 01749673865 01749676878 sharon@avoncare.wanadoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Avon Care Homes Limited care home 40 Number of places (if applicable): Under 65 Over 65 40 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is 40 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home The Wells nursing and personal care home is registered with the Commission for Social Care Inspection for up to 40 people with nursing and personal care needs. The Wells Nursing Home can be found on the main road through the village of Henton approximately two miles from the City of Wells. The accommodation is on two floors with a passenger lift to the first floor where 25 of the 40 bedrooms are located. All the bedrooms are single occupancy, some with ensuite facilities, which includes a wash hand basin and toilet. On the ground floor there is a lounge, a dining area and a conservatory. Care Homes for Older People Page 4 of 30 Brief description of the care home There is a garden at the rear of the building with an open outlook and views across to the Mendip Hills. The garden is lawned and flat, the river Axe runs along the bottom of the garden. The home offers all nursing and personal care services to older persons over 65yrs. Experienced registered nurses and carers deliver nursing and personal care. There is a full complement of administration, catering and ancillary staff to support the registered manager of the home. The current fees are: Nursing From £721 TO £763 Personal Care only: £574 TO £623 Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This Key unannounced inspection was carried out over one days by one inspector. The Manager was available on the day of the inspection. The inspector would like to thank the manager and the duty staff for their time and hospitality shown to the inspector during their visit. The focus of this inspection visit was to inspect relevant key standards under the CQC Inspecting for Better Lives 2 framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: excellent, good, adequate and poor. These judgment descriptors for the seven chapter outcome groups are given in the report. Information is requested from each home by Care Homes for Older People Page 6 of 30 us on an annual basis. Information from the homes Annual Quality Assurance Assessment (AQAA) was been used throughout the inspection process. Information held in the AQAA was confirmed during the inspection visit. Records examined during the inspection were individuals care and support plans as part of the case tracking process, medication administration records, maintenance records, the homes Statement of Purpose, staffing rosters, menus, the homes complaints file, staff recruitment files, quality assurance processes and staff supervision records. We also conducted a tour of the premises. Current fee levels at the home range from £623 to £721 per week dependent on need and the room occupied. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the care home does well: What has improved since the last inspection? What they could do better: The home needs to review the current staffing levels at the home. Although the needs of the people living at the home are being met this is in part due to the hard work of the current staff. The dependency of the people living at the home has increased over the last few months but the numbers of staff have not significantly increased. This could compromise the level of care afforded to people living at the home. The number and availability of social and recreational opportunities has been compromised over the last few months due to the lack of an activities organiser. It is hoped that this will improve over the next few months. The home needs to ensure that two written references are received, one from the last employer, for all new staff employed. This will ensure that robust recruitment procedures are followed and help to ensure that safety of people living at the home. In addition the home needs review the current application form for new staff. Care Homes for Older People Page 8 of 30 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the information they need to enable them to make an informed decision about moving to the home. The home will ensure that people are appropriately assessed before a placement is offered. All people living at the home have been provided with a copy of the terms and conditions of their stay. Trial visits are offered. Evidence: The home has developed a statement of purpose and information for people thinking of moving into the home. A copy of this information was viewed. This document Care Homes for Older People Page 11 of 30 Evidence: provides all the necessary information and is supplemented with a range of photographs. Preadmission assessments made by a senior staff member from the home. The documentation for the assessments was viewed and this contains all necessary information. This assessment will ensure that the home can meet the needs of the individual prior to moving in. In addition to the preadmission assessment the homes asks the individual (if possible) and or a family member to come to visit the home to ensure that all parties are happy for the placement to proceed. Assessments are also sought by the staff at the home from other health care professionals or social worker. The home provides each individual with the terms and conditions of their stay (contract). The contract viewed clearly sets out the fees payable, payment terms, notice periods and any additional charges. Fees do not include hairdressing, visitors meals, newspapers, alcohol, private treatments such as physiotherapy or chiropody, taxi fares, toiletries, dry cleaning and escort duties. Invoices for these items are invoiced monthly. The contract states that a trial period of four weeks is in place. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual care plans detail how care needs can be met. These need additional development to ensure they are completed in a person centred way. People are treated with respect and dignity. Medication administration and management is safe. Evidence: Two people were case tracked during the inspection and their care plans reviewed. Case tracking involves identifying individuals at the beginning of the inspection and comparing the care and support they receive with the needs identified in the care plan. On the whole the health assessments and associated care plans had been completed to a good standard. The care plans however were ambiguous in places. For example one individual required the support of staff to change position and to move from bed to chair and visa versa. A hoist was used by staff for this purpose. When using a hoist, a sling is required. Different slings are available dependent for example on the weight Care Homes for Older People Page 13 of 30 Evidence: of the individual and any health issues. The care plans seen although stating that a hoist should be used did not tell staff which hoist nor which sling should be used. Care plans were in place explaining to staff the help that individuals required to meet their personal hygiene needs. The plans however were not person centered in that they did not explain the individuals personal preferences and choice. For example they did not state what time the person liked to get up or go to bed. They did not state if the individual prefers a bath or shower nor what time (morning or evening) they would like the bath or shower. The plans did not state the types of toiletries the individual liked to use. The care plans and assessments did not show any consideration with regard to the recent introduction of the mental Capacity nor the Deprivation of Liberties Act. The manager informed us that she was currently reviewing the care planning process and that these issues would be addressed in this review. It was clear from the care plans seen that staff have regular communication with other health care professionals. Staff seek the help and advise of GPs, Community Nurses, dietitians and speech and language therapists. Feedback from health care professional confirmed this. A number of people at the home are frail and as such staff had introduced charts to record such things as amount of fluids taken and frequency of positional change. The majority of the charts viewed had been accurately completed and demonstrated that staff had delivered appropriate care and support. One person had been admitted to the home with a large pressure ulcer. This ulcer had healed since the time the individual had been at the home. This demonstrates that staff provide a good standard of care. People have their own rooms and these are treated as their private space. Staff were seen to knock before entering a bedroom. No one was described as very ill and we saw a large majority of people living at the service during the day. A number were spoken with. People said they were happy and well cared for at the home. People living at the home, relatives and staff commented that the increasing needs of some people meant that the staff were busy and not always as available as they would like to assist them with tasks. It is important for the people living at the home that individual peoples changing care needs are recognized to ensure the level of care and the specialist care available is sufficient to meet the needs of all people living at the home. The dependency of people living at the home should be monitored to ensure there is sufficient staff on duty for people to receive the support they need with daily living activities. Care Homes for Older People Page 14 of 30 Evidence: No complaints were made to the inspector about the care or the support given at the home. People found the staff to be friendly and helpful. All interactions heard during the inspection visit were kind and helpful. Medication administration was observed at lunchtime. The Medication Administration Records (MARs) were examined. Medication is receipted onto the MAR and is signed. Hand transcribed transactions were signed by two people to verify the entry. Instructions for anticoagulation therapy such as warfarin dosages and blood monitoring were very clearly recorded. Any changes to the prescriptions are faxed through and the record is retained. Controlled medication is carefully managed and was checked as correct. There is a regular checking system in place. The storage and fridge storage was safe and was locked. Prescribed skin creams are kept in bedrooms and are signed for on administration. One sample was checked to confirm this practice. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The range of activities at the home is in the process of being reviewed and increased opperetunites will be available in the near future. Visitors were seen to be visiting the home on the day of the inspection. All stated that they are made welcome at any time. Choices are available to people living at the home. Meals and mealtimes are a pleasant experience. Evidence: People spoken to during the inspection stated that there was sometimes things to do at the home but they would like this to be developed. This was confirmed in the surveys obtained as part of the homes quality assurance system. This was discussed with the manager who stated that they have had recent issues with regard to the provision of activities and social opportunities due to the lack of an activities organizer. A new activities organizer has recently been employed. This individual will be working from 13:30 until 17:30 five days a week. It is hoped that this will increase the range Care Homes for Older People Page 16 of 30 Evidence: and availability of the opportunities on offer at the home. The manager stated that due to the increased frailty of people living at the home they were currently reviewing the activities on offer to include more 1:1 time with people rather than group activities. The home has a well maintained garden with views over the surrounding countryside. A number of people stated that they would like the opportunity to sit outside more often. The AQAA provided prior to the inspection stated We have a birthday cake for each residents birthday. Menus and Activities plans are distributed into each room weekly. A professional entertainer is contracted regularly. Monthly visit from a qualified Reflexologist for residents and relatives, at reduced rates. Every week we have music therapy with a pianist, singing and some percussion instruments such as the tambourine, maracas and bells. At Christmas time the brownies and members of the congregation from the village church come and sing carols on separate occasions. Residents who wish to attend the local church services are escorted by members of the congregation and they stay to have coffee and biscuits after the service. The Vicar and a lay member of the church come to The Wells Nursing home every third Wednesday of the month to give Holy communion to those who are unable to attend church. Everyone we spoke with said the food was very good or excellent. One person said there is always a choice and if you dont like that they will do you something else One relative stated that she felt the standard of food was good and that there was always a range of fresh vegetables available. The food served on the day of the inspection looked and smelt appealing with a range of vegetable available. A choice of meal was evident. A four week rolling menu has been developed including a hot option in the evening. A number of people required staff support at meal times. Staff sit down when they support people to eat. This allows staff to ensure that they have the time to spend with people during meals and ensures that meal times are a pleasant experience for all. This time also allows staff to monitor dietary intake effectively which will promote the general health of people living at the home. A number of people living at the home have difficulty in swallowing or require specialist diets, for example if they have skin damage or have experienced weight loss. On the day of the inspection a range of specialist diets and supplements were available throughout the day according to the individuals assessed needs and in line with care plans. It was however noted that on the afternoon drinks trolley biscuits only were available. Biscuits may not be appropriate for all people living at the home and consideration should be given to increasing the range of snacks available at these times. Although a choice of meals is available at all times and a written menu is on display it could not be confirmed how all people living at the home make choices in this area. Some people living at the home cannot verbally express their choices. Staff could develop a system were they plate up the choices and show these to people who can then make a choice. Alternatively staff Care Homes for Older People Page 17 of 30 Evidence: could develop pictures and photographs of the food again enabling people to have a greater understanding on what is being offered. It was noted during the inspection that all people living at the home were wearing food protectors. Whilst it is appreciated that this may be required for some people the use of this equipment for all did add a rather institutional feel to the meal. Staff need to consider how this impacts on peoples dignity and self esteem. Any soiled clothing could be changed following the meal. In addition it was noted that orange or blackcurrant squash was the only drink available. Staff need to ensure that at least water is also on offer. Visitors were seen visiting family and friends throughout the day of the inspection. People living at the home stated that visitors were made to feel welcome. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure and thorough investigations are undertaken if a concern is raised. People living at the home are protected from the risk of abuse by policies, procedures and good practice. Evidence: Regular meetings are held with people living at the home and regular care reviews are undertaken. People asked said they would be able to raise a concern at the home. Staff asked about safeguarding the people they care for, they were clear that they would report any abuse. Staff asked were clear about the whistle blowing policy. Staff comments indicated that staff knew what to do if a person, their relative or friend raised a concern about the home. The Complaint procedure is accessible and includes the Commission of Social Care Inspection and local Social Services contact details. This information is provided in the service users guide. CSCI contact details need to be updated to reflect the change in contact details and name to The Care Quality Commission this is recommended. A complaints record is kept, the AQAA indicated that the home has received no Care Homes for Older People Page 19 of 30 Evidence: complaints since the last inspection. The AQAA indicates that complaints are reviewed at the care home Regulation 26 visits by the owner of the home. We have received no concerns about care at the home. Staff recruitment includes an enhanced Criminal Record Bureau (CRB) check is made to reduce the risk to people living at the home from the employment of unsuitable people. The CRB evidence was seen in one new staff recruitment files although not in the other. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained and is suitable for purpose. People are able to personalize their bedrooms. It should be noted that a number of the bedrooms are relatively small. The home is fitted with an appropriate range of aids and adaptations. The standard of cleanliness is overall good however some areas required attention on the day of the inspection. The home has systems in place to reduce the risk of the spread of infection. Evidence: A tour of the premises was made. The home was found to be clean, tidy and odour free on the day of the inspection. The home is decorated and furnished to a comfortable standard. People are able to bring in items of their own furniture by agreement with the home and to personalise their rooms in line with their choices and preferences. It should be noted however that a number of the bedrooms are small and that this may restrict the items of large furniture which can be bought into the home. Care Homes for Older People Page 21 of 30 Evidence: There is a range of communal areas. A large dining room, lounge space, and conservatory with access to the garden. New carpets have been laid in the corridors and new furniture have been purchased for the lounge areas. The home has seating available in the gardens. The gardens are well maintained. The bathrooms seen were clean and tidy. There are a number of toilets and bathrooms strategically placed around the home. One small bathroom has recently been converted into a wet room. This has been completed to a high standard and is well used. The home has a call bell system throughout the home. All people asked confirmed that the call bell is answered promptly. There is a good laundry facility; no concerns were raised about the care of clothing or the laundry process. The large well-equipped kitchen.The cooks reported that all their equipment was in working order and their records were kept up to date. The home has received a recent visit from the Health and Safety Executive (HSE). This visit raised concerns with regard to window restrictors and the management of legionella within the home. The manager stated that they have been working hard to address these issues and that these have now been rectified. Staff were seen to regularly wash their hands and protective equipment such as gloves and aprons were readily available. This helps to reduce the spread of infection. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the needs of the people living at the home are being met the numbers of staff available need to be reviewed. up to date training records were not available however staff stated that they received sufficient training to fulfill their job role. Staff told us that they felt well supported by the management team. Staff recruitment procedures are satisfactory although one written reference should be obtained from the last employer. The home needs to review the current employment application form. Evidence: Although the standards of care and support afforded to people living at the home were observed to be good, feedback obtained during the inspection told us that staffing levels should be reviewed. Staff and people living at the home stated that they felt that staffing needed to be increased. Staff told us that the care needs of people living at the home had increased from what it historically was. In the past the home catered for nine to ten people who had personal care needs only (previously called residential care). Currently this has reduced to three people with the remaining having the higher Care Homes for Older People Page 23 of 30 Evidence: nursing needs. The occupancy on the day of the inspection was 39. Staffing had not increased substantially to reflect this increased need. The AQAA received prior to the inspection confirmed that the needs of people living at the home were relatively high. The home currently employs One registered nurse and two care staff on night duty. Two registered Nurses and six care staff in the morning. One Registered Nurse and five care staff in the evening. The home is run over two floors. Given this information it is recommended that the staffing levels at the home are reviewed. A range of ancillary staff including cooks, kitchen assistants administration staff and cleaners are also employed. The home has a stable staff group but two staff recruitment files were viewed. For one person who was working at the home references had been received however none of these was from the last employer. This is recommended under good practice guidelines. Checks (CRB AND POVA) had been sent to ensure that the individual was suitable to work with vulnerable adults however one of these (CRB) had not been returned. A risk assessment had been completed and the individual was not lone working. For the second file reviewed all necessary checks had been completed. It was apparent when reviewing the application form that this did not comply with equal opportunities guidance. The application form asked applicants for the number and ages of any children, marital status and if the individual had been declared bankrupt. The management at the home should review the application form to ensure that it meets good practice guidance. One of the staff members who previously has been redeployed and is now responsible for organizing the training of staff for all the homes within the company. This staff member is still based at the Wells Nursing Home and is responsible for updating and maintaining the training records. This staff member was not available on the day of the inspection. updated training records were requested to be forwarded to us following the inspection however to date these have not been received. Information was therefore obtained from the AQAA, sent to us prior to the inspection. This document however cannot confirm that all staff have undertaken all necessary mandatory training. Staff spoken to during the inspection stated that they felt that had received sufficient training in order for them to complete their job role. In addition outcomes for people living at the home are positive. The AQAA stated that the Registered Nurses have undertaken training in venapuncture and catheterisation. Two of the nurses have undertaken training in diabetes and have cascaded this to their colleagues. A number of staff have undertaken training in dementia. All new staff receive an induction which is complaint with good practice guidelines. A number of staff at the home are undertaking and NVQ. This includes One Care Assistant doing Level 3, three Care Assistants doing Level 2 and one Kitchen Assistant Care Homes for Older People Page 24 of 30 Evidence: doing NVQ Level 2 in Catering. As we do not have up to date training records it could not be confirmed how many staff have a current NVQ. Staff spoken to during the inspection stated that they felt supported by the management team at the home and that they received regular supervision and appraisals. Care Homes for Older People Page 25 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is opportunity for people to feedback on the day-to-day running of the home and on what it offers people living here. People living at the home are protected by robust policies and procedures at the home. The home is well and safely maintained. Evidence: The registered manager is Ms Rachel Collins. Ms Collins is a registered Nurse and has numerous years experience in the health care field and of running care homes. The manager was on duty and was helpful in assisting with the inspection process . Staff and people at the home had a good rapport with the manager. The manager demonstrated that she is knowledgeable about care and has a good understanding of Care Homes for Older People Page 26 of 30 Evidence: the people living at the home. Regulation 26 visit reports were sampled and were seen to be carried out on a monthly basis by a representative for the company. The AQAA indicated that the manager has a regular weekly meeting to update all departments. Regular meetings are held for the people in residence at intervals. This was confirmed by asking the people who are living at the home. Stakeholder surveys and meetings are undertaken annually. The results of the surveys for quality assurance 2008 were included in the service user guide. The AQAA indicated that maintenance of equipment had been addressed in 2008 and was up to date. This included the servicing of the passenger lift, people hoists, fire safety equipment, gas appliances and the heating system. The home regularly informs us of any incidents as required under Regulation 37. The manager regualry completes audits of the home to ensure that the standard of care and servcie provided remains good. This includes audits of such things as accidents and incidents. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 7 It is recommended that the care plans are further developed to ensure that they give clear guidance with regard to the care needs of individuals living at the home. Consideration should be given to including information with regard to the Mental Capacity Act into the care planning process. Staff need to continue to develop systems which enable people living at the home to make choices. This could include the development of pictures and photographs. This should include choices with regard to fluids and meals. It is recommended that the management review the current staffing numbers in line with the increased care needs of the people living at the home. It is recommended that the management review the current application form to ensure that it meets equal opportunities guidance. It is recommended that two written references are obtained for all people working at the home and that one of these should be from the individuals last employer. 2 14 3 27 4 29 5 29 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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