Care Home: The Withens Nursing Home

Similar services:

• Springfield House
• Sutton Lodge Nursing Home
• The Shelley
• St Helier`s Residential Hotel
• St Joseph`s
• Ridgemount
• Wingham Court
• Old Hastings House

What the care home does well The care plans contain good details to instruct staff in carrying out care. Small details in regards to residents` habits for getting up and going to bed, preferences for a bath or shower, and meal and drink preferences, make a real difference to the residents` sense of well being. The nursing staff access input from other health professionals as needed. One health professional stated that staff always attend them well when they are giving treatment to residents, and would be happy to have one of their own relatives in the home. Residents said that the staff are "very good", and wrote in surveys that the staff "always have a caring and supportive manner". Several residents and relatives commented that staff are always willing to "go the extra mile"; and some even go into the home on their days off to take residents out or to spend time with them. Relatives said that they are always welcomed into the home, and can visit at any time. Residents are confident that staff will listen to them, and will act on what they say. There are good ongoing processes in place to enable residents to share their views. The manager has an open door policy, and is known by the residents. Residents said that the home is kept fresh and clean, and the premises are well maintained. What has improved since the last inspection? The pre-admission format has been improved since the last inspection, and these documents were seen to be appropriately detailed and well completed. Care planning and risk assessments have also been improved since the last inspection. The staff have improved the dining experience for residents, by providing tablecloths and napkins, and having fresh flowers on the tables as much as possible. The staff have implemented some outings for residents, especially to the local public house for meals and drinks. There have been ongoing improvements to the premises, and this includes extending the car parking space at the front. Some furniture items have been replaced; and forty-three "dorguards" have been fitted to individual doors to promote safety in the event of fire. Staff training programmes have been improved, ensuring that all staff keep up to date with training in mandatory subjects. The manager has also implemented formal supervision sessions for all staff. A new manager has been appointed, and is demonstrating her awareness of the changes that are needed in the home; and is being proactive in implementing these changes. What the care home could do better: The activities organiser works very hard to give input to the residents as a group, and as individuals. However, she has insufficient time to spend with all of the residents, and there are not enough staff to take residents out as much as they would like. The manager must make a formal application to CQC to apply for registration. Key inspection report Care homes for older people Name: Address: The Withens Nursing Home Hook Green Road Southfleet Kent DA13 9NP     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: Susan Hall     Date: 0 2 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: The Withens Nursing Home Hook Green Road Southfleet Kent DA13 9NP 01474834109 01474833082 withens@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ranc Care Homes Ltd care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered perosn 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) The total number of service users to be accommodated is 33 Date of last inspection Brief description of the care home The Withens Nursing Home is owned by Ranc Care Homes Ltd., a company who currently own six care homes. The premises are situated in the village of Southfleet, which is near to the towns of Dartford and Gravesend. The home can easily be reached via the M25 and M2 motorways, and there are train services to Gravesend and Longfield. There are also local bus services. Accommodation is provided on two floors, with a passenger lift providing access between the floors. Most rooms are for single use, and some have en-suite toilet facilities. There are three communal rooms, and these include a large conservatory. Care Homes for Older People Page 4 of 28 Over 65 33 0 2 4 0 9 2 0 0 8 Brief description of the care home The home is surrounded by pleasant and well maintained gardens. As this is a care home with nursing, there are trained nurses on duty twenty-four hours per day. The current fee levels range from £579.00 to £750.00 per week, depending on the room available, and the assessed needs of individual residents. The nursing contribution is deducted from this amount. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 home is assessed as having a rating of good, two stars. This was a key inspection, which includes assessing all the information obtained by the Commission since the previous inspection, as well as a visit to the home. Information is obtained from phone calls and letters about the service; legal notifications which the home is required to send in; any complaints or safeguarding issues in which we are involved; and an Annual Quality Assurance Assessment (AQAA) provided by the home. This is a comprehensive document which the home is required to complete each year, telling us about ongoing developments in the home, and any changes. We received the AQAA back within the specified timescale, and it was well completed. The visit to the home commenced at 08:45, and lasted until 4:45 pm. The manager and the administrator were present throughout the day; and the manager of St. Peters Nursing Home,which is also a Ranc Care Home, attended from approximately 10:00a.m. This is because the manager is not yet registered with the Commission, and Care Homes for Older People Page 6 of 28 it was her first experience of an inspection visit. It was good to see that the managers support one another within the company. During the visit, we (i.e. CQC) talked with eight staff (apart from the manager); eight residents; and four relatives. We also observed staff interaction with the residents and with each other. We viewed all areas of the building; inspected medication; and read documentation, such as care plans, maintenance and servicing records, staff recruitment and training files and minutes of staff and residents meetings. CQC sent out survey forms to residents, health professionals and staff, and received eight replies. Some residents were assisted by their relatives in completing the survey forms. The surveys included many positive comments. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? The pre-admission format has been improved since the last inspection, and these documents were seen to be appropriately detailed and well completed. Care planning and risk assessments have also been improved since the last inspection. The staff have improved the dining experience for residents, by providing tablecloths and napkins, and having fresh flowers on the tables as much as possible. The staff have implemented some outings for residents, especially to the local public house for meals and drinks. There have been ongoing improvements to the premises, and this includes extending the car parking space at the front. Some furniture items have been replaced; and forty-three dorguards have been fitted to individual doors to promote safety in the event of fire. Staff training programmes have been improved, ensuring that all staff keep up to date with training in mandatory subjects. The manager has also implemented formal supervision sessions for all staff. A new manager has been appointed, and is demonstrating her awareness of the changes that are needed in the home; and is being proactive in implementing these changes. Care Homes for Older People Page 8 of 28 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides suitable information for enquirers and new residents. Detailed preadmission assessments are carried out prior to arranging admission. Evidence: The homes statement of purpose and service users guide are available in the reception area for enquirers to view. The statement of purpose contains all the required information, such as the types and sizes of rooms available, insurance cover, additional payments, and the complaints procedure. Information is included about Ranc Care Homes, and the responsible individual. However details of the manager had not been included since the new manager commenced her post in May 2009. The manager said that this would be rectified immediately. The service users guide is sensitively produced in large print, so that it is easier for residents with impaired vision to read it. A copy is kept in each residents room, so that they can access the information at any time. The guide includes details of the Care Homes for Older People Page 11 of 28 Evidence: aims and objectives of the home, stating that the staff aim to provide a high standard of personal and nursing care, while creating a relaxed and homely environment. It includes details of social activities available; arrangements for meals and meal times; meeting religious and cultural needs; and how residents are consulted about their care and their views of how the home is running. A pre-admission assessment is carried out prior to arranging admission, and these are currently carried out by the manager. We viewed four pre-admission assessments, and found that the documentation is very detailed, and includes comprehensive information about the person and their individual needs. This enables the manager to make an informed decision about whether or not the home is able to offer a place to prospective residents. All admissions are for a trial period of approximately four weeks, after which a review is held with the resident and their representatives, to decide whether or not to make the placement permanent. Residents are provided with a contract which includes the terms and conditions of residency, arrangements for leaving the home, and the fee payable. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans contain detailed information, enabling staff to provide individualised care. Residents said that the staff look after them well. Evidence: A comprehensive admission assessment is carried out for all new residents, to update any changes which have occurred since the pre-admission assessment. Ongoing assessments and care plans are then implemented from this information. A life diary is recorded, with details of the residents family, previous working life, and hobbies and pastimes, so as to provide a basic understanding of the residents life and preferences. We viewed four care plans, and found them to contain detailed information, enabling nursing and care staff to give effective care. Assessments are carried out for items such as moving and handling, falls assessments, eating and drinking, skin integrity, pain management and mental health. There are generic risk assessments included for use of wheelchairs, and safe bathing, which remind the care staff to carry out these procedures according to the homes policies. Care Homes for Older People Page 13 of 28 Evidence: Care plans and assessments are evaluated every month and updated with relevant changes. The care plans follow all aspects of daily living, such as maintaining safety, mobility and dexterity, eating and drinking, continence, hygiene and dressing, and socialising. They have specific details such as the name the resident prefers to be called by; preferred times for getting up and for daily routines (e.g. if someone wishes to be washed and dressed before having breakfast); the residents ability to communicate with staff; if they need assistance with eating and drinking, wear dentures, and need help with mouth care; and assistance needed with toileting. Nursing intervention includes checking blood sugar levels for residents with diabetes at least once per day; and recording monthly observations of temperature, pulse and blood pressure for all residents. Wound care is generally well managed, with documentation for each dressing change, so that the pathway for the progress of healing or deterioration can be followed. Photographs are taken at regular intervals to show the state of the wound. There are good records to show that the nursing staff contact the local Tissue Viability Nurse for advice on wound management. Some of the documentation was rather haphazard and on plain pieces of paper rather than specific evaluation forms, but the content was good. Daily records are written by the care staff, and these are properly signed, dated and timed. The records were seen to be generally well written, and to contain clear information. Nursing staff add further information as needed. Care plans include some information relevant to the Mental Capacity Act, whereby assessments will be carried out in respect of making decisions on behalf of any residents who lack mental capacity. We discussed the importance of ensuring that the supporting documentation shows clearly how a residents mental capacity has been assessed, and who is making decisions on their behalf and why. We also discussed the companys planned change to implement a computerised system for care planning. It is important for the senior staff to review if hard copies will be needed as well, in respect of ensuring residents can continue to be involved in their care planning, and if this will be more helpful to visiting professionals such as GPs and care managers. This is the companys decision, and a requirement is not applicable in this respect. There is evidence for good contact with other health professionals as needed, such as GPs, dietitian, chiropodist and hospice nurses. Medication is stored in a small clinical room, and is mostly administered via a monitored dosage system. The stock cupboards and medication trolley were seen to be in good order, and with evidence of good stock rotation. No out of date medication Care Homes for Older People Page 14 of 28 Evidence: was found. The room temperature and the drugs fridge temperature are checked daily, and the room is fitted with air conditioning to ensure storage of medication at the correct temperatures. Controlled drugs (CDs)are correctly stored in a CD cupboard which meets the required specifications, and the CD register is well maintained. Audit checks are carried out at regular intervals. We viewed all of the Medication Administration Records (MAR charts) and these were seen to be well completed. Handwritten entries are usually checked and signed by two nurses. We noted two areas where there was only one signature and brought this to the attention of the manager. MAR charts are accompanied by a photograph of the resident, and any allergies are highlighted using a traffic light system. There are currently no homely remedies in use, but the manager is currently arranging for a supply of homely remedies with the agreement of the local GP practice. The manager has implemented new weekly checks to ensure that the suction machine is in order, the first aid box is checked, and that oxygen cylinders are properly stored, and this is a sign of good practice. We observed staff carrying out their duties with attention to retaining residents privacy and dignity. Care staff were heard speaking gently to residents, and carefully explaining procedures prior to commencing them. Residents said that the staff are always very caring; and they look after us very well. Another resident said that I know that the staff will listen to me, and if I have any problems they will help me to sort them out. The manager and nursing staff ask residents (or their agreed representative) about their preferences for end of life care. Some do not wish to discuss this, although the staff are concerned to follow any particular wishes in the event of any emergency. They try to ensure that residents who are dying are kept as comfortable and pain free as possible, and will ask advice from the local Hospice if this is indicated. Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with a varied range of activities, but there are not enough staff available to meet all of their individual needs in regards to activities and going out. Evidence: The activities organiser implements the homes activities programme, and a copy of this is provided to each resident. Day to day activities include games such as skittles and quoits; arts and crafts; reminiscing; bingo; and gentle exercises. The programme is flexible so as to take into account how residents feel each day. The activities organiser has familiarised herself with residents different preferences, and gives one to one time as well as carrying out group activities. She was seen to be gently encouraging residents to take part, and several said that they appreciate her and the work that she does. Two residents said that they like her taking them out in wheelchairs, either in the garden, or for a walk around the village. The activities organiser also arranges outside entertainers (such as a singer), and trips out to the local pub, or to the shops at Gravesend or Bluewater. She is well known in the local area for taking residents out for walks, and residents enjoy this contact with the local community. Other events are arranged at specific times of year, such as inviting local schoolchildren into the home to sing at Christmas. Care Homes for Older People Page 16 of 28 Evidence: Residents religious and cultural needs are discussed at admission, and arrangements are made on an individual basis to ensure that residents can attend church or receive visits from a minister or priest. Three of the CQC surveys sent out prior to the inspection included comments that the home could improve by taking residents out more (e.g. in a minibus, to the coast or for shopping); they could take residents out more to places such as the local pub more often; and they could have more functions for residents and their families e.g. bonfire night, Easter egg hunt. We also spoke with two relatives on the day of the visit (not the same ones who had completed surveys) who made the same comments. Residents and relatives were firm in their praise of the care staff and the activities organiser, several of whom have gone into the home to take residents out on their days off. But the general feeling expressed by residents and relatives is that this is unfair on the current staff, and that the home should pay more hours for staff to carry out activities. Higher dependency levels have also increased the number of residents who prefer one to one time instead of joining in with group activities. Relatives said that they are always made welcome and comfortable when visiting, and are always offered drinks. One relative suggested that the home could supply tea and coffee making facilities which would save the staff time - even though the staff dont mind doing this. Residents are invited to bring in personal items for their own rooms, and are able to take part in choosing the decor when rooms are being redecorated. Meals can be taken in residents own rooms or the dining room. The food is home cooked, and there is always a choice of main courses and desserts. The chef is willing to make extra dishes for residents who do not feel like having the choices on the menu. Cooked breakfasts are available on request, and snacks are available at any time. The chef and a kitchen assistant prepare breakfast and lunch; and also prepare food for supper prior to going off duty during the afternoon. Suppers are currently being served by one of the four care staff on duty, which takes one away from care duties. This situation has already been discussed by the manager with senior management, and the manager has been able to recruit kitchen staff to carry out supper preparation and serving. She was waiting for police checks and other recruitment checks prior to these staff taking up their duties. Residents said that the quality of the food is good, there is sufficient choice, and there are generous portions. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All complaints are taken seriously and are appropriately investigated. Evidence: The complaints procedure is displayed in the entrance hall, and is therefore easily accessible for any visitors. It is also included in the service users guide, and all residents are provided with a copy of this document. We viewed the homes complaints log, and noted that five complaints have been received during 2009. The records show that in each case the concern or complaint has been taken seriously, and properly investigated and addressed. The manager, or the companys Nursing Director, ensure that complainants feel that the issue has been satisfactorily resolved, and that appropriate action is taken to prevent the same complaint from reoccurring. All staff are trained in the recognition and prevention of adult abuse. The company follows the agreed Kent & Medway protocols for any matters which may involve the safety of vulnerable adults, and the manager and senior staff are familiar with these processes. A copy of the Kent and Medway guidelines are kept available for all staff. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained, and provides a safe and comfortable environment. Evidence: The home is situated in a quiet village location, and comprises two original detached houses which have been joined into one unit. The home is surrounded by pleasant gardens, and these include a patio and different seating areas. The home has a large lounge on the ground floor with an adjoining conservatory. There is also a large dining room. Most of the corridors are sufficiently wide for moving equipment around quite easily. The decor and carpeting is well maintained, and there is a continual ongoing programme of redecoration and replacement of furniture items as the need arises. Accommodation is provided on two floors with a lift providing access between floors. Most rooms are for single use, but there are currently five rooms for shared use. Seven rooms have en-suite toilet facilities. Bedrooms were seen to be decorated and personalised according to residents personal preferences. The home has a sufficient number of bathrooms and disabled toilets; but two bathrooms on the first floor are rarely used, as residents and staff currently prefer the bathroom and shower facilities on the ground floor. The manager said that the Care Homes for Older People Page 19 of 28 Evidence: company may consider altering one of the bathrooms on the first floor into a shower facility in the future. The home has suitable hoists and slings, and other equipment available such as pressure relieving mattresses and cushions; hospital beds or profiling beds; bed rails with cushioned sides; grab rails, and commodes. There is a sluice room on each floor, and one of these includes a sluicing disinfector. All the radiators are covered for safety; and bedroom doors have been fitted with dorguard fitments, which will close the doors if the fire alarm sounds. There are regular maintenance checks for hot and cold water temperatures; shower fitments; fire equipment; and wheelchair checks. The laundry is situated on the ground floor and contains two washing machines with sluice facilities; and one commercial sized tumble dryer. The pipes for the boilers are also in the laundry room, and the manager stated that she would check that these do not heat up to a level which could cause burning. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a competent and caring staff team, who carry out good standards of care. Evidence: Staffing levels are usually one nurse on duty throughout the twenty-four hour period, in addition to the manager, who is also a trained nurse. In the day time there are currently four care staff on duty throughout the day, and two care staff at night. There were several vacant beds at the time of the inspection visit, and the manager stated that numbers of care staff would be increased as needed in line with the numbers of residents admitted, and their dependency levels. Other staff available include an administrator, who also carries out reception duties; a laundry assistant and two domestic staff seven days per week; a chef and a kitchen assistant. As we have stated earlier in the report, at the time of the inspection visit, suppers were being served by the care staff. However, successful recruitment will bring about additional kitchen staff for this purpose, which will provide more time for the care staff to concentrate on care duties. The manager is also in the process of recruiting more trained nurses, as some shifts are being covered by agency nursing staff. There will be improved continuity of care for the residents when permanent nursing staff are employed for all shifts. Care Homes for Older People Page 21 of 28 Evidence: The company are committed to enabling care staff to train for NVQ levels 2 and 3. At the time of the inspection, thirteen care staff had completed level 3, and three care staff had completed level 2. This is 64 per cent, which is very good. It is also commendable that so many care staff have trained up to level 3. We examined three staff files (chosen by the inspector) to assess recruitment practices, and found that there are excellent procedures in place. Each file contained all the required documentation, such as two written references; POVA First and Criminal Record Bureau (CRB) checks; proof of identity; a recent photograph, and confirmation of previous training. Nurses PIN numbers are checked. Applicants are interviewed by two senior staff, and a record is retained of the interview. The application form requests applicants to provide a full employment history, but does not state that dates should be included. The manager had already noticed this, and is verbally requesting applicants to provide all of the dates until such time as the form has been amended by the company. A comprehensive staff training matrix shows that all mandatory training has been brought up to date, e.g moving and handling, health and safety, fire awareness and basic food hygiene. The manager has been in post since May 2009, and noticed that there had been some previous shortfalls in mandatory training prior to her appointment. She has successfully addressed this situation. The company now employs a training manager who arranges training as needed. Other training subjects are also being included, such as understanding the implications of the Mental Capacity Act, palliative care, and understanding dementia. The home does not admit residents who have a diagnosis of dementia, but some residents develop dementia, or levels of confusion, and this training provides staff with a good basis for supporting these residents in a helpful way. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is implementing good processes in the home to enable it to run smoothly. Evidence: The manager is a trained nurse, and has relevant training and experience for understanding the nursing and care needs of older people. She has previously held a deputy managers post, and this is her first managers post. She is familiar with the current National Minimum Standards, and since her appointment, has implemented changes in the home in order to bring about compliance with these. She showed awareness of issues which still need attention, but has been concentrating first on ensuring that nursing and personal care are carried out to good standards. It will be easier for her to develop further with the management of the home, when there are a greater number of permanent nursing staff to assist her. The Commission has not yet received an application for her formal registration, and this is a requirement. Staff were seen to interact well with each other, as well as with the residents, and Care Homes for Older People Page 23 of 28 Evidence: demonstrated good team working. There are regular staff meetings for different staff departments, as well as general staff meetings. This enables staff to be practically involved in discussing changes. Residents are confident that they are listened to. Several said that if they have any concerns, they know that they can speak to staff, and that they will take action accordingly. The activities organiser holds monthly residents meetings, whereby residents can discuss their choice of subjects, and can request changes. A recent request was to have fish and chips from a fish and chip shop every so often, and this is being accommodated by the chef and the manager. Relatives have separate meetings, and one relative said that it was helpful to meet other relatives, and to have a forum to discuss things together. The company arrange for residents to have satisfaction surveys each year, and the last survey included detailed questions covering all aspects of the life in the home. The results of these are used as a basis for further changes. Residents can arrange for small amounts of personal pocket money to be stored in the home. The administrator oversees these accounts, which are kept as individual records, and which can be viewed at any time by the resident or their authorised representative. All credits and debits are recorded, and all receipts are retained. The administrator said that she usually checks these records with a senior nurse, on a random basis. We recommended to the manager that a more formal auditing system is put into place to check these accounts on a regular basis. The manager has implemented systems for regular staff supervision, including clinical supervision. The supervision schedule was not fully up to date at the time of the inspection, but is being addressed. Records were seen to be in good order, and stored appropriately, although some folders are old and could do with replacing. We viewed some of the maintenance and servicing records (such as checking fire points and fire extinguishers; hoist servicing; hot water temperatures; and PAT testing); and these records are well maintained and up to date. There is a building risk assessment in place, with regular checks and repairs for items which need attention. Accidents are properly recorded, and comply with HSE requirements. The manager carries out a monthly accident audit, so that patterns of behaviour can be noticed, and changes can be made to promote accident prevention in the future. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 12 12 To ensure that residents 02/11/2009 individual wishes can be met in regards to the amount of social activities and outings. The registered provider must promote and make proper provision for the health and welfare of service users. 2 31 9 A formal Managers Registration Application must be made to the Commission by the date given. It is an offence against the Care Standards Act 2000 for a person to be in day to day management of a registered service if he or she is not registered with CQC. 02/10/2009 Care Homes for Older People Page 26 of 28 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!