Care Home: Vale House

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What the care home does well The home has an established reputation for providing a high standard of care for people living with dementia. Each person is treated as an individual with a life history known by staff. The managers and staff continually look at ways in which the quality of life for residents can be improved. All the staff team work well together and relatives and health and social care professionals comments tell us that they are highly regarded for their skill, kindness and care. Comments included were - `They`re exceptionally alert and responsive to their clients needs`; `highly skilled nurses and care team`; `the deep understanding of the needs of people with dementia at Vale House is exceptional - a truly inspirational Nursing Home`. The home has a group of volunteers who contribute to resident`s good quality of life. The role of the family support worker is highly valued, because they are a source of information and contact for the family from the admission process and throughout the resident`s stay at the home. Communication with residents families is good and staff are welcoming and supportive of family members so that relatives have confidence that their loved ones are well cared for - `It`s a wonderful House and I feel comfortable within myself when I have to say goodbye, and to me this is so important and helps adjust to the life without her`. The home is very well managed and demonstrates `a positive approach to dementia`. The registered manager, Patricia O`Leary, is described in our survey responses as providing `strong leadership`, `dedicated and inspires all who know her`, `understanding and approachable, very fair and well respected`. What has improved since the last inspection? Each resident has a personalised care plan and these have been improved by the introduction of an holistic care team approach, so that each member of staff is involved in contributing to the care plans to make sure that residents individual preferences are known and catered for. Improvements have been made to the lighting in the corridors, which helps people finding their way around the home and recognising their surroundings more easily. The home has reduced the number of agency staff it has had to use and has recruited more permanent staff so that residents have fewer staff changes and good continuity of care. The home continues to expand the training and development opportunities for staff to meet good practice initiatives, for example, care of people at the end of their lives. Staff are also developing the number and variety of activities on offer to residents and there are more opportunities for residents to go on trips and outings away from the home. What the care home could do better: We consider that Vale House continues to provide an excellent service to the people living here and their families. We did not consider it necessary to make any requirements or recommendations at the end of this report. Some recommendations discussed at the time of the inspection have been made in the body of the text. The home has inadequate outside space for residents to access safely. A great deal of work has already been done in finding and drawing up plans for a new site that has been bought by the charity in the outskirts of Oxford. A new home is to be built that will provide more beds, improved facilities, and access to gardens and grounds. Key inspection report Care homes for older people Name: Address: Vale House The Botley Alzheimer`s Home West Way, Botley Road Botley Oxford OX2 9UD     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: Delia Styles     Date: 2 8 0 1 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 27 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 27 Information about the care home Name of care home: Address: Vale House The Botley Alzheimer`s Home West Way, Botley Road Botley Oxford OX2 9UD 01865794096 01865794095 botleyalzheimers@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Botley Alzheimers Home Name of registered manager (if applicable) Patricia O`Leary Type of registration: Number of places registered: care home 20 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 Additional conditions: The maximum number of service users to be accommodated is 20 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories; Dementia (DE) Mental disorder, excluding learning disability or dementia (DE) Old age, not falling within any other category (OP) Date of last inspection 20 20 0 Over 65 0 0 20 Care Homes for Older People Page 4 of 27 Brief description of the care home The Botley Alzheimers Home (known as Vale House) is registered to provide care for up to twenty male and female service users, aged 60 years and over, suffering with severe dementia. Vale House is a registered charity and is managed by a voluntary Board of Directors. Accommodation is provided on the ground and first floors, and there are sixteen single bedrooms and two double rooms. At least one room is available for respite care. Bedrooms do not have en-suite facilities but all rooms have washbasins. There are two bathrooms, one shower room and seven toilets. A communal lounge/dining room is situated on the ground floor. A second sitting room has been opened up to provide access to a comfortable area called the family room. Access to this room was previously from outside. A link corridor has been opened up to allow access from within the home. Leading off this room is a small paved area of garden with borders planted with shrubs and herbaceous plants. This provides a small secure outdoor space for service users. The home is situated on the outskirts of Oxford and is on a regular bus route to and from Oxford. The weekly charge is 843.00 pounds (Sterling), and there are no extra charges for services such as chiropody or hairdressing. Care Homes for Older People Page 5 of 27 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: This inspection of the service was an unannounced Key Inspection during which we assessed a number of the standards considered most important by the Commission out of the 38 standards set by the government for care homes for older people. The inspection visit took place over 5 hours and was a thorough look at how well the service is doing. We took into account detailed information provided by the homes manager in the form of the Annual Quality Assurance Assessment (AQAA) - a self assessment and summary of services questionnaire that all registered homes and agencies must submit to the Commission each year. We also considered any information that the Commission had received about Vale House since our last Annual Service Review in 2008. A tour of the building, and inspection of a sample of the records and documents about the care of the residents and the recruitment and training of staff, were part of the inspection. Care Homes for Older People Page 6 of 27 We talked to residents, relatives, visitors, staff and volunteers who were at the home during the inspection. The home manager, Mrs OLeary, and the deputy manager, were available to answer questions about the home and its organisation. Some of the Commissions comment cards (surveys) were sent to the home before the inspection for staff, relatives, and visiting health and social care workers to have an opportunity to have their say about the home. We received completed surveys from 5 relatives, 5 health care professionals and 3 staff and their opinions and some of their comments are included in the report. We would like to thank all the residents, staff, and manager for their welcome and the time taken to help us with the inspection process. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: We consider that Vale House continues to provide an excellent service to the people Care Homes for Older People Page 8 of 27 living here and their families. We did not consider it necessary to make any requirements or recommendations at the end of this report. Some recommendations discussed at the time of the inspection have been made in the body of the text. The home has inadequate outside space for residents to access safely. A great deal of work has already been done in finding and drawing up plans for a new site that has been bought by the charity in the outskirts of Oxford. A new home is to be built that will provide more beds, improved facilities, and access to gardens and grounds. 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 27 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 27 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. The homes process for assessing prospective residents needs is thorough and highly individualised. A Family Support Worker helps the prospective residents and their families to adjust to their changing situation and provides support for those awaiting admission. Evidence: We looked at a copy of the colour printed folder - the Welcome Booklet - that contains the background information about the founding of this non-profit making registered charity, its philosophy of care, the Statement of Purpose and Service User Guide information and a copy of the homes most recent Newsletter. The information is clearly set out and includes the Summary of Terms and Conditions for residents and complaints procedure. The registered manager or her deputy visit prospective residents to carry out an assessment and gain all the necessary information from their family about their care Care Homes for Older People Page 11 of 27 Evidence: needs, both physical and emotional, and preferences. The assessment tool used is one developed at Vale House especially for people living with dementia. Where appropriate, the assessment includes information supplied by persons GP and the Social and Health Care professionals involved with the persons care and situation at home. Once assessed, the homes Admissions committee reviews all the paperwork and decides on the suitability and degree of urgency for admission. When the assessment process is complete, the prospective resident and their relatives are informed that they are on the waiting list and will be kept informed about the prospects of admission. The homes Family and Carer Support worker also keeps in contact with them, to provide support and information during the waiting period. Each new residents family or representative signs a Placement Agreement with the Botley Alzheimers Home when the individual is admitted and this forms their contract. The first month of residence is on a trial basis for both the new resident and the home. The home undertakes to support each resident to the end of their lives so that their families have the reassurance that their loved ones will not have to move to another care establishment. The assessment process and documentation for 2 people who had recently come in to Vale House was examined and seen to be detailed and comprehensive. One person had been admitted as an emergency for short term respite care. The admission process for those needing respite care is the same as for long-term care and includes update letters about subsequent admissions and any changes in the persons condition and care needs. The responses to our survey questions from 5 relatives show that they consider they always have enough information about the care service to help them make decisions and that the care service always meets the needs of their loved ones in the home. Care Homes for Older People Page 12 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Vale House provides an excellent standard of care and support based on detailed assessment of peoples changing needs. Personal care is provided by staff in a way that promotes and protects the dignity and individuality of the people living here. Evidence: The care records for 3 residents were examined. Information from peoples individual assessments is used to draw up their care plans. Risk assessments are carried out for key topics, such as nutrition, moving and transferring people safely, and falls. Additional information about the persons capacity to consent to care, and assessments where a person may be subject to deprivation of liberty for their own safety and well being, are also included. The care records are regularly reviewed and updated and discussed with each persons relative and representatives at regular review meetings. One of the sample of care plans seen did need updating in relation to recording how effective one persons pain relief medication is, and about the types of passive activities and interactions that are most helpful to them. This was discussed with the deputy manager. Care Homes for Older People Page 13 of 27 Evidence: The home continues to develop the way in which staff record the care and support given, and consider peoples needs in an holistic way. Social and emotional care needs are planned for using a social care profile, based on the individuals life history. This helps staff to get to know peoples individual likes and dislikes and to develop the best ways of communicating and connecting with them. A Thinking Ahead plan helps relatives and loved ones to avoid the shock and loss they may feel when the death of a family member occurs. We observed that the care set out in peoples assessments and care plans was detailed and included the views of their family members and reflected the care and attention seen to be given during our inspection visit. People are able to keep their own family doctor if that is practicable, or transfer to the homes own medical officer, a GP from a local practice. The doctor visits regularly and all residents are reviewed annually by a consultant psychiatrist for older people who provides specialist advice. Our feedback from health and social care professionals who visit the home regularly is very positive - comments included I consider it to be an excellent care home; A positive approach to dementia; communication with patients seems very good, have a very warm and friendly approach that service users with dementia really need. The home has policies and procedures that ensure the safe storage, administration and disposal of peoples prescribed medication. Medication is supplied by a national pharmacy branch and is stored securely and safely. The registered nurses are responsible for administering medication. In practice, all the staff clearly have a very high level of understanding and empathy with the people living here. The comments we received from relatives show that they hold a very high opinion about Vale House and the care, commitment and skill of the staff team. Comments included - (Staff are) exceptionally alert and responsive to clients needs. (Clients) are treated with respect and dignity, as are relatives who are always kept up to date; Truly inspirational. Deep understanding of the needs of people with dementia at Vale House is exceptional; Personal care and support excellent; Vale House provides all the things that one could wish for as the loved one of a resident - love, care and comfort. Each patient is treated as the individual each one is - likes and dislikes are taken into consideration. Care Homes for Older People Page 14 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers a good range of activities and opportunities for people to take part in meaningful and enjoyable pastimes that suit their personal preferences and abilities. Mealtimes are relaxed and social occasions. The food is varied, nutritious and meets peoples needs and preferences. Evidence: Daily life for each individual is managed as far as possible according to their individual preferences on the day. The home has continued to develop the way in which it provides activities, both individually and in organised sessions, such as music sessions. All the staff team help to identify each residents interests and so are able to spend time with them throughout the day in a meaningful and helpful way. Responses to our surveys showed that people living here are able to express their personalities and preferences in a way that creates a sense of family life and respect for peoples identity. Comments we received included - try to make quality of life good by providing things that people like - e.g. fry-up for breakfast; (the home) has increased knowledge of carers to interact with residents and to offer appropriate stimulation through activities. All carers have undergone training with an occupational therapist. Care Homes for Older People Page 15 of 27 Evidence: The home manager said that they have a designated member of care staff to organise and coordinate a regular programme of activities and celebrations of special days, such as Hogmanay, Valentines Day, Shrove Tuesday, and national Saints days. The home is building on the work of an external trainer to develop a range of activities that will meet the range of needs of people living at Vale House. There is always a staff member who is available to arrange activities and chat with people in the communal lounge areas where most residents spend the day. A weekly rota ensures that either staff or volunteers to ensure that residents have individual input and stimulation. The homes AQAA tells us that it has improved in the last 12 months by having more outings for individual residents to cater for their personal preferences, for example, one resident goes out regularly to a concert with a volunteer. On the day of the inspection, we noted that 2 residents went out for a walk and to the local shops with staff. The home has a small courtyard garden, but little outside space for people to walk around safely on their own. This will be resolved when the home moves to a new site on the outskirts of Oxford - it is anticipated this will be in 2012. Food and mealtimes have a high priority to ensure that people have tasty and nutritious meals and snacks that they enjoy. The homes chef has been in post since 2001. He has a great deal of experience and plans meals carefully, paying close attention to peoples individual preferences. Feedback in surveys from relatives show that the home is very good at making sure that peoples nutritional needs are met making food and meals available to residents throughout 24 hours a day is a policy I support and endorse. People with dementia keep their own time and this can differ from our set times for meals. Drinks are also available at all times and are offered frequently throughout the day. We saw how staff make sure that one resident who is very active throughout the day has regular drinks and snacks as they move around the home. Visitors are made welcome - the homes information for relatives tells them that they are welcome to visit at any time. Relatives spoken to during the inspection and who returned surveys to us commented on how friendly and welcoming staff are, how good they are at keeping in touch with them and updating them about any changes or concerns about their loved ones. One relative summarised the feedback of others in writing - Its a wonderful House and I feel comfortable within myself when I have to Care Homes for Older People Page 16 of 27 Evidence: say goodbye and to me this is so important and helps adjust to the life without her. Many also mentioned the importance of the contact they have from the Family Support Worker - who pays you a call on a regular basis at home which is very helpful in coping with such a sudden change in your life. Care Homes for Older People Page 17 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints system. Relatives and residents representatives feel that any concerns or complaints raised on behalf of people living here, are listened to and acted upon. The homes policies and staff practices ensure that residents are safeguarded from abuse. Evidence: The home has an appropriate complaints policy and procedure and this is on display in the home as well as included in the printed information about the home given to all relatives and representatives of residents. One person felt that the home could do better in relation to the laundry service - Take more care of clothing, items get lost or mixed up (i.e. with other residents). The manager said that they have taken action to improve this aspect of the service. The home has policies and procedures to safeguard people living here and all staff members have received training in safeguarding vulnerable adults and are required to attend updates and refresher courses every year. Staff handover times are also used to discuss any concerns about the well-being and safety of residents. The home has a policy that care staff work in pairs together so no carer is left alone with a resident; this adds security and safety for both the resident and staff members. There are stringent financial safeguards in place so that residents are protected from financial exploitation or abuse. Care Homes for Older People Page 18 of 27 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 internal and outdoor environment is well maintained and an on-going programme of improvements and refurbishment ensure the safety and well-being of people living and working here. Rooms and communal areas are very clean, comfortable and attractive, providing people with a good standard of accommodation and facilities. Evidence: The home is about to realise their development plan - they have found and purchased a new site on the outskirts of Oxford to build a new home that will offer more places, and much better outdoor space, facilities and access for residents. The present environment lacks outdoor space, although the small courtyard garden is very attractive and well used in better weather. Written comments in our surveys show that people are looking forward to the development of the new home - We have outgrown our home and are in the middle of planning our new home - we have the land and therefore the space to work in will be a bonus. We will be able to look after more dementia sufferers in a purpose built unit. The Board of Directors, manager and staff are keeping relatives informed about the progress of the planned new building. Some relatives expressed concerns that the home could lose the family atmosphere when re-located to a new larger building. The manager said this is something that all those involved in the planning are very aware Care Homes for Older People Page 19 of 27 Evidence: of and will work hard to maintain the same standards of communication and partnership with residents and their families. The current building is clean, bright and fresh-smelling. Individual residents rooms seen are highly personalised and reflect the persons interests and choices. Residents and their families are invited to choose colour schemes and soft furnishings and layout in keeping with the residents tastes, and add photos, pictures and small pieces of furniture and ornaments to create familiar surroundings. The homes AQAA states that the home is committed to maintaining the current accommodation and facilities in good condition for people living and working here, until the new building is finished, which may be in 2012. In the past 12 months they have updated and improved the corridor lighting. The laundry area has good systems in place to prevent the spread of infection, such as use of colour coded bags for heavily soiled items of laundry. Protective clothing and disinfectant hand gel is available for staff protection. Care Homes for Older People Page 20 of 27 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. The number and skills of the staff team meet the care and support needs of the people living here. There is a good programme of training in place for staff that results in positive care and support outcomes for residents and their families. Staff work together well as a team and provide an excellent level of care for people living here. Evidence: We looked at the homes staff duty rota and discussed the management of the staffing rota with the manager. There are always 7 staff (including a registered nurse) and the manager on duty (week days) in the morning. One registered nurse and 3 carers are on duty in the afternoon from 14.00 to 22.00 and one registered nurse and 2 carers overnight. The duty rota is planned so that there is a good overlap of staff in the afternoon so that staff have time for handover, discussion and some training or updating together. The administrator is also available during weekdays until mid afternoon to greet visitors and liaise with the manager, her deputy, Family Support Worker and staff, and answer phone enquiries. Two domestic staff are on duty from 09.00 to 15.00 and one covers between 17.00 and 20.00 each evening. The AQAA tells us that they have recruited more domestic staff to provide additional cover at week ends and to help in the kitchen. The homes AQAA (December 2009) tells us that 7 out of a total of 20 care staff have achieved nationally a recognised qualification in care - the National Vocational Care Homes for Older People Page 21 of 27 Evidence: Qualification (NVQ) at Level 2 or above. This is below the proportion (50 per cent) of care staff we expect to have this qualification. However, the home has a strong commitment to staff training and is expecting to increase the number of staff who are registered and complete NVQ training. The deputy manager is an NVQ Assessor and takes the lead in organising the training and updating programme for staff. The homes induction training for new staff meets the national standards for induction and is adapted to meet the needs of the home. The AQAA tells us that all staff hold the Alzheimers Society Care to Make a Difference certificate. More recent developments in staff training has been a new approach to staff working together in holistic teams, so that all members of the staff team have a good understanding of residents care needs and preferences and all can contribute to each individuals support throughout their shift of duty. The home is also using the care plans and national best practice guidance in relation to caring for people at the end of their lives. We looked at the recruitment and training files for 2 staff members recently employed. The files selected and checked and were found to be well organised and showed evidence of a thorough and consistent vetting and recruitment process for new staff so that residents are protected from unsuitable or people not allowed to work with vulnerable people. The 3 staff who completed our survey were very positive about working at Vale House and the support and training they receive to do their job. They feel that there are always enough staff; staff work well together as a team; they are well supported by the manager; there is a positive and close relationship with relatives; and that there are always study days and courses open to them to improve their knowledge and skills. Additional comments included Very important to me is that Im satisfied with my job and the care we give is excellent. I have worked in many places, but Vale House is the best; Care given to residents is 100 per cent, as I have been here (many years) I have had job satisfaction throughout. Relatives and professionals comments were all very positive about the staff too - for example - All staff at the home go out of their way to make sure the home is run smoothly; Staff are very well presented and professional, but also warm in approach; (the staff) have a warm and friendly approach that service users with dementia really need. Care Homes for Older People Page 22 of 27 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 management arrangements in this home are very good. People who live here and their families and representatives are consulted about, and do influence, the way in which the home is run. The manager has exceptional leadership skills and she and the team of directors offer focused clear leadership to the home. Evidence: The registered manager (Head of Home) has been in post for 19 years, since the home opened and has extensive management and nursing experience. Both she and the deputy manager hold a Level 4 (NVQ) in Management. The manager also holds a Diploma in Health Care Management. Some of the registered nurse and care staff have worked at the home for more than 10 years. This means that the home has benefited from having a consistent and stable senior staff team for many years. Relatives and staff comments are highly complimentary about the manager and organisation of the home - for example, strong leadership from manager; Tricia OLeary, Head of Vale House, is dedicated and inspires all who know her. Her Care Homes for Older People Page 23 of 27 Evidence: leadership and support I know the staff respect very much; there is no doubt in my mind the reason Vale House scores so highly in their care for people with dementia and their relatives is that it is such a specialist home - it is known as a leader in its field of expertise. That is what those with dementia and their carers need from diagnosis onward; the manager is understanding and approachable, very fair and well respected; My boss is the best I ever had. The Board of Directors have developed a quality assurance system that requires the manager and staff to review and evaluate all the policies and procedures regularly. Relatives receive a questionnaire and are invited to regular review meetings to discuss how well they feel the home is meeting the care and support needs of their loved ones. The Family Support Worker meets with the directors 2 or 3 times a year to feedback any suggestions or concerns arising with families, as does the registered manager. The home produces a newsletter for relatives staff and residents. The home does not manage residents financial affairs - their families or appointed legal representatives manage their finances on their behalf. The homes AQAA states that due to our residents mental incapacity, their financial interests are safeguarded by stringent administration and close liaison with their families. The home now uses a Health and Safety management programme produced by an established care industry company, to ensure that staff work safely and the well being of residents and visitors is protected. Staff induction and on-going training sessions include safe manual handling, infection control, managing challenging behaviours, infection control, care of substances hazardous to health (COSHH) - for example, cleaning fluids, First Aid, fire safety, and food hygiene. Care Homes for Older People Page 24 of 27 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 27 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 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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