Care Home: Turfcote Nursing Home

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What the care home does well People were given clear and useful information about the home and had been encouraged to view the facilities and to meet other residents and staff; this would help them to decide whether Turfcote was the right place for them. Information about people`s needs was collected prior to admission; this would ensure every aspect of people`s needs were considered and helped to determine whether their needs would be met. The care plans detailed the care each resident should have to meet their needs. Residents had been involved in decisions about the care they received; this would help to make sure they received the care they needed and wanted. Residents said they were treated well and were happy with the care they received. They made positive comments about the staff including `staff are lovely` and `staff are splendid`. Staff were trained in health care matters which would help staff to recognise and respond to any changes in resident`s health. Residents were able to participate in meaningful activities either as a group or individually; this would help to ensure their social needs and expectations were met. Some staff had received training that helped them to understand the importance of listening to and responding to people`s concerns. One resident said `they (staff) know how to speak to people and how to be kind`. Staff were observed responding to residents and visitors to the home in a welcoming, friendly and respectful manner. Residents said they were able to make choices about how they spent their day; one said `I can generally do what I want` and another said `its up to you what you do`. Records showed that residents were offered a varied, nutritious and healthy diet; comments included `the food is excellent`, `we can have what we want`, `we often have a curry and a bottle of wine`, `if we don`t like whats on the menu we always get something else`, `the food is good and plentiful` and `we can have what we please, its our choice`. Residents knew who to speak to if they were unhappy and were sure they would be listened to; comments included `the manager visits me to ask how I am, I would be able to speak to her if I had any problems`, `I am happy here and I`m sure they would sort any problems out` and `Liz (manager) and Jim (owner) are always around if you have any worries`. The safeguarding procedures were clear and staff had received appropriate training; this would ensure staff had the skills to recognise and respond to any reports of abuse or neglect. The home was safe and well maintained providing residents with a comfortable and pleasant place to live. Residents spoken to were happy with their rooms; comments included `I like my room it overlooks the garden which is lovely`, `my room is always clean` and `I have everything I need`. Staff were suitable, competent and provided in sufficient numbers to meet residents needs. Residents and their relatives were able to express their views and opinions about the service and were involved in day to day decisions regarding the running of the home. There were systems in place to monitor the quality of the service, whether residents needs were being met and whether staff were following safe policies and procedures; these results had been used to improve and develop the service. What has improved since the last inspection? The way that residents medicines were managed had improved and showed that they were handled in a much safer way. The home kept us up to date of any changes that affected residents` well being; this allowed us to monitor the management of the home and would help to identify any areas of concern. A number of improvements had been made since the last key inspection which would ensure the home continued to meet residents` needs and provided a safe and pleasant place for them to live. What the care home could do better: It was not always clear how some residents social needs would be met; more detailed information about residents routines and preferences would help staff to plan meaningful activities for them. The way in which some information was recorded in the care plan could be improved; this would ensure staff had detailed information to help them to respond to residents needs. Key inspection report Care homes for older people Name: Address: Turfcote Nursing Home Helmshore Road Haslingden Rossendale Lancashire BB4 4DP     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Marie Matthews     Date: 2 0 0 4 2 0 1 0 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 30 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: Turfcote Nursing Home Helmshore Road Haslingden Rossendale Lancashire BB4 4DP 01706229735 01706229231 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Marshmead Limited Name of registered manager (if applicable) Elizabeth Ford Irwin Type of registration: Number of places registered: care home 76 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following category/ies of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Physical disability - Code PD (maximum number of places: 46) Mental disorder, excluding learning disability or dementia - Code MD (maximum number of places: 30) Dementia - Code DE (maximum number of places: 30) Old age, not falling within any other category - Code OP (maximum number of places: 46) The maximum number of service users who can be accommodated is: 76 Date of last inspection Care Homes for Older People 0 7 0 5 2 0 0 9 Page 4 of 30 Over 65 0 0 46 0 30 30 0 46 Brief description of the care home Turfcote is registered to provide care to a maximum of 76 residents. The home is split into 2 separate units. Tor View provides nursing and personal care to up to 46 adults and Grane View provides nursing and personal care for to up to 30 people who have mental health care needs. Turfcote is a detached, extended building set in its own grounds. Bedroom accommodation is provided on two floors with the upper floor accessed by three passenger lifts. There are a mix of single and double bedrooms, most with en-suite facilities. There are a variety of communal areas on both units. Turfcote is located on a bus route close to the towns of Haslingden and Rawtenstall and is close to local amenities such as shops, a post office, a pharmacy, a pub, churches and a sports centre. Information about the services offered by the home is provided in the form of a welcome pack and is available, with a summary of the most inspection report, to existing and prospective residents and their relatives. On the day of the inspection the weekly fees ranged from £399.00 to £675.00. Items not included in the fee include toiletries, hairdressing, newspapers, transport and staff escorts to hospital appointments. 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The key unannounced inspection, including a visit to the home, took place on 20th April 2010. The last inspection on this service was completed on 7th May 2009. The inspection process included looking at records, a tour of the home, discussions with the registered manager and owner of the home, two members of staff and five residents. There was a second inspector who looked at how the home managed residents medicines. The home sent us their annual quality assurance assessment (AQAA) before the inspection visit; this gave us a good picture of what had improved over the last twelve months and where further improvements were needed. Care Homes for Older People Page 6 of 30 What the care home does well: What has improved since the last inspection? Care Homes for Older People Page 7 of 30 The way that residents medicines were managed had improved and showed that they were handled in a much safer way. The home kept us up to date of any changes that affected residents well being; this allowed us to monitor the management of the home and would help to identify any areas of concern. A number of improvements had been made since the last key inspection which would ensure the home continued to meet residents needs and provided a safe and pleasant place for them to live. 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 8 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 9 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were given appropriate and useful information about Turfcote and were assured their needs would be met. Evidence: The information about the home was clear and up to date and was available to prospective and existing residents and their families; this would help people to decide whether Turfcote was a suitable place for them to live . A Welcome Pack was given to new residents and included clear and useful information about available services; this would help new residents to settle into the home and to understand what to expect during their stay. The registered manager said the information could be made available in alternative formats. Surveys were used to obtains peoples views of their first days in the home; these were used to improve the admission process and the content available in the Welcome pack. Information from these surveys indicated that people were given useful Care Homes for Older People Page 10 of 30 Evidence: information about the home and had been encouraged to spend some time in the home to view the facilities and to meet other residents and staff. One resident said my son came to look around the home and was told everything we needed to know, he was able to tell me all about it which made me feel much better. Each resident had a contract or statement of terms and conditions; this would advise them of their rights and obligations during their stay at Turfcote. Detailed assessments were completed before anyone was admitted to the home. A senior member of staff collected information from a range of sources to ensure every aspect of peoples needs were considered; this helped to determine whether Turfcote was the right place for them. Staff said they were provided with a range of training to give them the skills and knowledge to meet residents needs; training records supported this. Care Homes for Older People Page 11 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. Residents health and personal care needs were met although some aspects of record keeping could be improved. Evidence: The individual care records of four residents were looked at as part of the inspection process. The care plans had been developed from the initial assessment information and detailed how residents needs would be met. The format of the care plans was being reviewed which would reduce the duplication of information and help to make them easier to understand; this was important as residents and their relatives were involved in the review process. The care plans reflected the care that was being given and it was clear from observation that staff knew their residents well; however information regarding likes, dislikes and preferences could be improved to help to ensure residents received the care they both needed and wanted. Care Homes for Older People Page 12 of 30 Evidence: Care plans had been reviewed and updated and it was clear that residents or their relatives had been invited to review meetings and involved in decisions about care. Records showed that residents had access to health care services; residents health had been monitored and appropriate advice and support had been sought in response to any changes. Aids and adaptations had been provided to support residents with maintaining their independence and to provide comfort; these were safe and maintained and recorded in the care plan. Any risks to residents had been identified and action taken to reduce or eliminate the risk. However staff should ensure that when a risk is identified a care plan should be generated to record any interventions; this would ensure residents were protected from harm. The home had close links with the falls audit team which would help to improve standards of care for residents. The use of bed rails had been assessed, discussed with the resident or their relatives and kept under review; this would ensure their use was appropriate. There were systems in place to check whether care documentation was up to date and whether staff were following procedures. Registered nurses were available twenty-four hours a day and most of the care staff were trained in health care matters; this would ensure staff could recognise and respond to any changes in residents health. Staff had regular meetings to discuss residents individual needs; this would ensure residents received the care they needed and wanted. As part of the inspection a pharmacist inspector looked at how medicines were being handled because we found some shortfalls on our last visit. Overall we found significant improvements that meant medicines were now being handled in a much safer way. Our checks of the medicines stock and records showed medicines were usually being given to people correctly and we found good improvements in the way external medicines such as creams were being given and recorded that helped make sure they were being used properly. A new packaging system was now being used for most medicines and our checks showed this was being used correctly. Medicines such as liquids that could not be kept in this system were more difficult to check so we gave some general advice about how to improve this so they could be easily accounted for. We looked at the times Care Homes for Older People Page 13 of 30 Evidence: medicines were given to people and found some were not given at the right and best time because medicines that needed to be given before food were sometimes given at mealtimes. We gave some advice about how to improve this because receiving medicines at the wrong time can stop them working properly. We checked how controlled drugs (medicines that can be misused) were handled. The cupboards used for storage were reasonably secure but we raised concerns about them not being fully compliant with the law so we gave some advice about how to put them right. Stock levels of all current stocks were correct and the register used to make witnessed records was used properly. Secure storage and witnessed records of controlled drugs helps prevent them being mishandled and misused. We checked a sample of care plans and found some good information about the use of when required medicines and detailed information about specific medicines and the health issues they were prescribed for. The care plan for a person that was regularly refusing their medicines was properly written and the correct procedures were being followed. We looked at how the mental capacity of people was being assessed and found this was not always clearly recorded because the reason why and for what purpose the assessments were made were not recorded. Having good assessments of mental capacity help make sure the rights of people who live in the home are fully protected. We found good improvements in the records of medicines receipt and disposal but found some discrepancies that were due to mistakes made by staff so we discussed these with the manager and gave advice about how to prevent them happening again. We looked at how medicines were checked by the managers and saw efficient recorded audits that found mistakes. When mistakes were found suitable action was usually taken to help prevent them happening again. All staff had received regular medicines training and this was repeated on a regular basis. Regular audits of the medicines and good training help make sure staff have the necessary skills to handle medicines safely. Staff had received training on the principles of privacy, dignity, choice and fulfillment; this would help staff to respond to people properly and as individuals. During the inspection staff were observed responding to residents and visitors to the home in a welcoming, friendly and respectful manner. Two residents said they were treated with respect and one said staff always knocked on the door before entering. A number of staff had received customer services training which would help to develop their skills when dealing with people. Care Homes for Older People Page 14 of 30 Evidence: There were procedures to support residents who were nearing the end of their lives. A number of key staff had completed specialised training to help them to support residents and their families and staff with death and dying. The home worked closely with the MacMillan nurses; this would help staff to provide high standards of care and to meet peoples needs in this area. 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. Routines were flexible and residents were able to make choices. A range of suitable activities and entertainments had been provided to help to ensure residents social and recreational needs were met. Residents were provided with a choice of healthy and nutritious meals that met their dietary needs and preferences. Evidence: Residents said they were able to make choices about how they spent their day; one said I can generally do what I want and another said its up to you what you do. Staff were responsible for ensuring residents social needs were met. Records had improved since last key inspection and supported that a range of suitable activities had been provided and indicated who had been involved and whether the activity had been enjoyed; this would help to determine whether residents social needs were being met. Some activities involved small groups of residents and other residents had been supported on an individual basis; one resident said he was able to go to the local shops and enjoyed sitting in the gardens, another resident assisted the hairdresser each week and another enjoyed setting and clearing dining tables. Care Homes for Older People Page 16 of 30 Evidence: Comments included there is always something going on, we have occasional entertainment, you can join in but I prefer to stay in my room and watch TV or read, we would enjoy some outings, staff are sometimes too busy to stop and have a chat and there is not always something that I would be interested in but I suppose its hard to suit everyone. Not all residents had information in their care plans to indicate how their social needs would be met. Memory diaries had been introduced in an effort to obtain information about residents lives prior to admission however these were incomplete for some residents; this information would help staff to plan suitable and meaningful activities for individuals. Ministers visited regularly to meet residents religious needs. A number of residents enjoyed reading and it was suggested that the services of the mobile library would be beneficial. There was an open visiting policy and visitors were welcomed in a friendly manner. Some residents were able to get out and about in the local community either independently or with family, friends or staff. Records showed that residents were offered a varied, nutritious and healthy diet; alternatives to the menu had been provided ensuring residents dietary needs and preferences were met. Staff were observed giving assistance and encouragement during the lunch time meal and ensuring everyone had enough to drink throughout the day. There was a choice of bright and pleasant rooms for residents to dine in. Residents said they enjoyed the lunchtime meal and made positive comments about the meals including the food is excellent, we can have what we want, we often have a curry and a bottle of wine, if we dont like whats on the menu we can always have something else, the food is good and plentiful and we can have what we please, its our choice. The menu was discussed at residents meetings and residents were involved in decisions to change the menu. The home was registered on the Recipe for Health Food Business Award and a number of staff had undertaken training in Nutrition and Health; this showed the organisation was committed to improving the standard of services for residents. Care Homes for Older People Page 17 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were protected by the organisations procedures and by staff awareness. Evidence: The complaints procedure clearly explained who people could speak to if they were unhappy; the manager said it could be made available in other formats to ensure everyone could access the information. There was also information about how to contact an advocate; advocates would offer impartial advice and support to people. Records showed there had been two complaints since the last inspection visit which had been dealt with according to procedures. The number and nature of complaints were reviewed as part of the quality monitoring systems and appropriate action had been taken to improve the service. Some staff had received training that helped them to understand the importance of listening to and responding to peoples concerns. One resident said they (staff) know how to speak to people and how to be kind. The majority of residents, who were spoken to, said they were happy with the service they received. Residents spoken to at the time of the visit knew who to speak to if they were unhappy and were sure they would be listened to; comments included the manager visits me to ask how I am, I would be able to speak to her if I had any problems, I am happy here and Im sure they would sort any problems out and Liz (manager) Care Homes for Older People Page 18 of 30 Evidence: and Jim (owner) are always around if you have any worries. The safeguarding adults procedures were clear and records showed that all staff had received training to help them to recognise and respond appropriately to any signs of abuse or neglect; further update training was planned. Safeguarding issues were regularly discussed with staff which would help to improve awareness and there was evidence to support that the management team understood when incidents should be referred to the Local Authority. There were procedures to support staff with reporting or blow the whistle on any poor practice; this would help to protect residents from abuse and neglect. Some staff had received training that would help them to understand their responsibilities when supporting residents who were unable to make decisions and choices for themselves; further training was planned. Procedures supported staff with dealing with any verbal or physical abuse; this would ensure they responded properly and kept people safe. The use of any restraint such as bed rails had been assessed, discussed with the resident or relatives and kept under review; this would help to determine whether this method of restraint was appropriate. Procedures were in place to ensure staff understood issues around restraint which would ensure appropriate use and involvement in residents in decisions about limitations to choices. Care Homes for Older People Page 19 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was clean, safe and well maintained and provided residents with a comfortable and pleasant place to live. Evidence: During a tour of all areas it was clear the home was well maintained, safe and comfortable with records of ongoing and planned improvements. A number of improvements had been made since the last key inspection which would ensure the home continued to meet residents needs and provided a safe and pleasant place for them to live. The home was compliant with the environmental health department and the fire safety officer and any recommendations had been actioned; this would ensure the home was a safe place to live. Gardens were pleasant, safe and accessible and outdoor seating areas were available for residents and their visitors. External areas had been improved since the last key inspection to make them safer and more attractive; one resident said that hundreds of bulbs had been planted and was looking forward to seeing the results. There was a separate safe garden for residents on the dementia unit. Residents made complimentary comments about the gardens including the views from my window are lovely, the gardens are spectacular and we enjoy sitting in the garden in the warmer Care Homes for Older People Page 20 of 30 Evidence: weather. There were a variety of communal areas where residents could either sit quietly or they could enjoy the company of other residents and their family and friends. These areas were bright and spacious and furnishings were comfortable and of a high standard. A number of bedrooms had en suite facilities; other rooms were located near to clearly marked toilets and fully equipped bathrooms. The home was well equipped with aids and adaptations to meet residents needs and to maintain their comfort and independence. All rooms had accessible call facilities to enable residents to summon help from staff; one resident said I press the button and staff come immediately and others said staff always responded to any calls for assistance. Residents spoken to were happy with their rooms; comments included I like my room it overlooks the garden which is lovely, my room is always clean and I have everything I need. Some residents had brought in personal items to enhance the homely feel. Residents could have keys to their rooms and secure storage; this would help to promote their privacy. Residents said the home was clean, bright and odour free; one resident said it is spotless and clean. There was a problem odour in one room although this was being dealt with. The laundry was organised and very well equipped for the size of the home; some of the ceiling tiles were broken or missing although work to address this was planned. Residents said their clothes were looked after properly and any lost items were quickly identified and returned. The manager carried out infection control audits to ensure the home was clean and staff had received training in this area; this would help to reduce the risk of infection. Care Homes for Older People Page 21 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff were suitable, competent and provided in sufficient numbers to meet residents needs Evidence: Duty rosters showed there were sufficient staff available to meet residents needs. Residents and staff also confirmed that there were sufficient staff; residents said staff came when they called and said I pressed the button and staff come immediately and I ring when I need staff. Residents made positive comments regarding staff including staff are lovely and staff are splendid. Residents were looked after by staff of various ages, gender and culture; this would help to ensure all aspects of their needs would be met and allow for a choice of male or female staff. The staff team was stable and the use of agency was rare; this helped to provide residents with continuity of care by staff who knew them well. From observation of practices it was clear that staff knew the residents well and were able to meet their needs. The files of three staff were looked at in detail. These showed that recruitment processes had improved since the last key inspection and would help to ensure residents were protected from unsuitable people. Each file had the appropriate checks in place prior to employment although records should support that references were Care Homes for Older People Page 22 of 30 Evidence: verified by telephone. Staff were given job descriptions and contracts to ensure they were aware of their responsibilities. It was recommended that a record of the interview was maintained to support an equal and fair process. Records showed that new staff had been supported through a period of induction during which additional training and support was provided; this would ensure they were aware of the routines of the home, the needs of the residents and were safe to practice. The majority of staff had achieved an appropriate qualification in care; this would ensure they had the skills and knowledge to look after people properly. Staff said they received relevant and up to date training to help them to meet residents needs; one staff said the provision of appropriate training was very good and another said I get all the training I need to do my job properly. Records supported that a range of appropriate training was provided which would give staff the skills and competencies they needed; this also showed that the service was committed to improving standards by the provision of quality training. Staff met regularly as a group and said they were kept up to date and could express their views and opinions. Records showed they met regularly with their manager which would help to identify whether any additional training and support was needed. Care Homes for Older People Page 23 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was safe and well managed and people were able to express their views and opinions about the service they received. Evidence: The manager of the home is a registered nurse with many years experience caring for adults; she has a recognised management qualification and records show that she has updated her skills and knowledge. The manager and the owners work closely together; they are able to demonstrate that they are competent and knowledgable in a wide range of areas, have a good understanding of current legislation and understand the purpose of having effective quality assurance systems in place. From discussions with residents and staff it was clear that they are responsive to peoples needs and are committed to providing people with a high quality service. The residents know the manager and the owner and say they make time to talk to Care Homes for Older People Page 24 of 30 Evidence: them and act on what they say. Staff were confident that management would listen to their views and opinions. There were clear lines of responsibility and the manager was supported by a deputy manager and the owners of the home. The home held the Investors In People award which is a nationally recognised quality assurance system that monitors the management of the home and development of staff; the results from the regular assessments were used to improve the service. There were other systems in place to monitor the quality of the service, whether residents needs were being met and whether staff were following safe policies and procedures; these results were also used to improve and develop the service. Residents and their relatives were able to express their views and opinions about the service and were involved in some day to day decisions regarding the running of the home. Annual surveys were sent out to residents and their relatives. It was recommended that the results of these surveys should be analysed, made available for prospective and existing residents and their visitors and for inspection; this would help to keep people up to date and support that their views were valued and had been used to improve the service. Records showed that residents meetings had not taken place on a regular basis; residents said we dont have any meetings but nothing changes anyway and I dont think we have had any meetings but I can speak to them (staff) anytime. Minutes from the last meeting showed they had been consulted about mealtimes. The home kept us up to date of any changes that affected residents well being; this allowed us to monitor the management of the home and would help to identify any areas of concern. Records were accurate, up to date and stored properly; any concerns regarding record keeping were referred to under the individual outcome areas. The home sent us their annual quality assurance assessment (AQAA) when we asked for it; this gave us a good picture of what changes had been made since the last inspection and of any improvements needed. The home had responded to any concerns raised at the last inspection; this showed they were committed to improvement. Care Homes for Older People Page 25 of 30 Evidence: The home did not deal with residents finances other than payment of fees; records were maintained of any transactions and were regularly audited to ensure residents finances were safeguarded. Policies and procedures had been reviewed and updated and provided clear and safe guidance for staff in all aspects of their work. Staff met regularly to discuss policies and procedures; this helped to increase staff awareness of procedures and kept residents safe. All staff received regular training that would help to keep themselves and others safe. Working practices were safe and any accidents or incidents were monitored to prevent any re occurance. Staff had access to and followed a range of health and safety policies and procedures that would protect residents from harm. Care Homes for Older People Page 26 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 27 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 Information regarding residents likes, dislikes and preferences should be included in the care plans; this will help to ensure residents receive the care they both need and want. Staff should ensure that when a risk is identified a care plan should be generated to record any interventions; this would ensure residents were protected from harm. The timings of giving medicines should be fully reviewed to help make sure they are always given at the right and best time. Care plans should include information to indicate how each residents social needs and expectations will be met; this will help staff to plan suitable activities and entertainments. A record of the interview should be maintained to support that a fair and equal selection process was followed. Records should support that references had been verified by telephone. Consideration should be given to increasing the frequency of residents meetings. Page 28 of 30 2 8 3 9 4 12 5 6 7 29 29 33 Care Homes for Older People 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 8 33 The reults of service user surveys should be analysed and made available to interested parties. Care Homes for Older People Page 29 of 30 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. 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