Care Home: Vecta House

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What the care home does well There is a pre admission process in place that ensures that the home can meet people`s needs prior to them moving in the home. The service users are provided with a warm, homely and well maintained environment that is appropriate to their needs. The meals are well managed that offer the service users choices and variety. There is a well organised activity programme with designated staff to support the service users. There is a well tended garden that surrounds most of the service where seating is available and accessible to the service users. What has improved since the last inspection? The home has continued their programme of refurbishment of the service to ensure areas the service users have access to are safe. The garden area has been further developed and looked attractive, safe and accessible to the service users. This includes a `pergola` and aromatic planting of jasmine, honeysuckle and sweet-peas As part of listening to the service users the manager states that the service has recruited another driver to join the activities` team, this has led to a greater programme of outings for the service users. What the care home could do better: The management of medication requires further development in order to ensure that people are protected at all times Records of referrals as safeguarding need to be recorded including any action taken and available at the service. Reports of all incidences that are detrimental to the service users and sent to the commission should also be maintained at the service and available. Key inspection report Care homes for older people Name: Address: Vecta House 24 Atkinson Drive Newport Isle Of Wight PO30 2LJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Anita Tengnah     Date: 1 5 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Vecta House 24 Atkinson Drive Newport Isle Of Wight PO30 2LJ 01983525521 01983522453 vecta@barchester.com www.barchester.com Barchester Healthcare Homes Ltd care home 54 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users to be accommodated is 54. The registered person may provide the following category/ies of service only: 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 (MD). Date of last inspection Brief description of the care home Vecta House is located within a residential area of Newport, the County Town of the Isle of Wight and therefore has good transport links to the rest of the Island.The home is registered to provide care and nursing to 54 service users with dementia and mental disorder. Barchester Healthcare owns the service and Mr Ian Leitch is the registered manager and has day-to-day responsibilty for the home. Care Homes for Older People Page 4 of 32 Over 65 0 0 54 54 Brief description of the care home The home is purpose built, with all accommodation and communal facilities situated on the ground floor. The service benefits from well- maintained and secure gardens that surround the building. There are seating facilities and the gardens are accessible with level access for the service users, including those with limited mobility. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: An unannounced visit to the service was undertaken as part of the inspection process on the 15th July 2009. The inspection was carried over one day. The registered manager was present throughout the day of the visit and feedback was given as part of our process. We also walked round the home and looked at a number of the service users bedrooms, communal areas such as the lounge, dining area, laundry room and bathrooms. As part of the visit, staff and service users views were sought, care, staff and other records were looked at. We sent out our Annual Quality Assurance Assessment to the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We received the completed AQAA and this gave us good information about the service. This is included in this report, as was information gathered by the Commission since the last inspection to contribute in assessing judgements in this report. Care Homes for Older People Page 6 of 32 We also received positive comments regarding the care that people are receiving at the home. Some of these were from our surveys and other comments were from people we spoke to at the time of the visit and will be reflected in the report . Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? 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 32 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 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The pre admission process is good and ensures that peoples needs are assessed prior to admission and the home can meet them. There is no intermediate care provision currently at the service. Evidence: We looked at the pre-admission process the home has in place in order to ensure that they can meet the needs of people prior to them moving into the service. The AQAA states that the registered manager, or his deputy always carries out a comprehensive pre-admission assessment of every potential service user. An initial care plan is generated by the named nurse within 24 hours of admission, based on the preadmission assessment and on admission assessments. Maintaining this standard ensures appropriate admissions to Vecta House. We looked at the records and spoke to the relative of a recently admitted service user. Care Homes for Older People Page 10 of 32 Evidence: It was evident that information was given to the prospective service users. The family visited and spent time with the staff who discussed the aims and objectives and ethos of care at the home. Comments we received indicated that people were satisfied with the information and they say that they were made welcome and liked the relaxed atmosphere at the home. People tell us that their relatives are very well cared for and one person said I can go out of here and not worry. Detailed assessments of needs were carried out and records were available in the care plans that we looked at. These included assessments such as diagnosis, information from previous home, allergies, mobility needs and personal care. There is a four week trial period that is offered to the service users on admission. The manager stated that other information such as the statement of purpose and guide were also available to people as required. The manager confirmed service does not currently provide intermediate care. Care Homes for Older People Page 11 of 32 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. There are detailed assessments and care plans in place to meet the assessed needs of people accommodated. However records and details of fluids for PEG need further development. Medication management does not fully meet the needs of people using the service. Care is provided in a respectful manner and the service users expressed high degree of satisfactions. Evidence: We looked at four care plans in detail and looked randomly at other sections in the service users plans that the home has in place as part of this visit. The care plans and assessments were arranged in an orderly manner that made them easily accessible and easy to follow. For any risk assessed, a detailed care plan was put in place to demonstrate how this would be managed in practice. Staff stated that some of the care plans would also identify short term needs such as short medical treatment and then further developed or discontinued. Care Homes for Older People Page 12 of 32 Evidence: The care records showed that the assessments of needs were completed and these included personal, health, mobility needs,dietary and communications. Risk assessments for falls were completed and measures put in place such as bed rails and pressure mats as appropriate. Detailed assessments in relation to moving and handling were seen in the service users records that we looked at. For one of them for example this gave details of the type of hoist, the colour of sling that is needed for that person. Other information in the care records included high and low bed. The AQAA states that the plans include comprehensive assessment tools for any challenge, and all risks are assessed and minimised. The plans demonstrate how each service users health and personal care needs are being met. Evidence from four of the care plans showed that risks such as falls and mobility are assessed and detailed care plans are developed to demonstrate how these would be met. One care plan for example to reduce risk of fall/ mobility gave details of walking aid, cream to be applied to reduce painful knee and wearing well fitted shoes. The six care plans that we looked at in relation to continence management gave details of the types of pads that were to be used for the day and night time. A continence assessment record was also available in each of the care plans as required. The registered person must ensure that where bedrails are in use, consents for their use are sought and records are put in place. These were not recorded in all the care plans that we looked at. The home has a system in place to ensure that the service users receive continuity of care from external healthcare professionals from the local primary care trust (PCT). Staff reported that the GP undertook weekly in house surgery and medical care was available at other times as requested. Information from the AQAA states that arrangements are in place for one of the Consultant Psychiatrists to visit and meet with the GP and the manager of Vecta House once every three months and is part of their support for the service users. One of the care plans seen gave detailed information regarding treatment as prescribed from the GP and included changes in treatment. This ensured that any changes are clearly identified and the service user receives continuity of care. Care Homes for Older People Page 13 of 32 Evidence: We looked at the records of two service users who were diabetics and this showed that detailed care plans were in place to reflect their assessed needs and action plan on how these would be met. Records included frequency of blood sugar monitoring and accurate records were maintained. One of the service users record contained detailed records of action taken when they had an episode of low blood sugar. This included blood sugar monitoring at appropriate intervals and food given. We looked at two records of service users who were receiving thickening agents in their food. These showed that for one of them a speech and language therapist (SALT) assessment has been completed and care plans were put in place. The other person had been referred for a SALT assessment, the staff had sought advice from the GP and records were available relating to the consistency of their diets in the interim period. Other information for the staff was available about different stages/ consistencies of meals in order to inform practice. We looked at the records of people who were receiving their sustenance via a percutaneous endoscopic gastronomy (PEG) tube. The record showed that a SALT assessment was completed and details of PEG regime was maintained that included amount/ type of food to be administered and fluids to be flushed in order to keep the tube patent during rest period. A record of food administered was available on the food/ fluid balance chart. The staff maintained some record of the amount of fluid flushed following medication administration. The record and care plan relating to PEG feeds were unclear and did not reflect whether a rest period was needed following medication administration. In particular as medication included antibiotics and was administered at different times of the day. We found that the amount of flushes differed from 60 -120 mls following medication administration, sometimes the amount was not recorded on the fluid charts. This poses a risk of the service user not receiving the appropriate prescribed care and shows a lack of consistency. The care plans did not clearly identify whether the amount of fluid prescribed should include the flushes following medication administration and the volume to be given in order to ensure that this correlates with the prescription. These were brought to the attention of the nurse in charge at the time of the visit who Care Homes for Older People Page 14 of 32 Evidence: confirmed that these would be looked into and action taken. We looked at the medication management that the home undertook on behalf of the service users. The home was using the monitored dosage system that ran over a twenty eight days period. The staff reported that the registered nurses were responsible for all the service users medications. We looked at the medication administration record (MAR) charts and this showed that the staff maintained records of medicines administered and there were no gaps on the MAR charts seen. Controlled drug was maintained and managed safely. A sample of staffs signatures was maintained that would identify the staff if needed as part of audit. When we walked around the home we found that not all creams and ointments were labelled with the service users names. In one of the service users bedroom we found a cream that was prescribed for another person and this was removed at the time of the visit. The nurse in charge stated that the home had bulk orders for certain items that included pain killers, cream/ ointments and apperients. However it was unclear which of those were homely remedy/ bulk orders. We found that the home had a homely remedy agreement that was dated 2006 and there was no evidence that this has been reviewed since. Procedures and records for the distribution and administration of medicines dispensed as bulk were not available and need to be developed to ensure that these meet with current regulations and are managed safely. A clear audit of all medication received as bulk, to whom these have been dispensed and creams labelled appropriately were not in place and must be developed to ensure that these are managed safely. The staff must ensure that all records of variable dosages are recorded, as this showed large discrepancy when a random audit was undertaken for one of the service users medicines. The records did not include as required medications that remained in stock and were not carried forward. We brought this to the attention of the registered manager and a senior representative of the company at the time of the visit .We were assured that a review Care Homes for Older People Page 15 of 32 Evidence: regarding medication would be undertaken and action plan put in place. Comment from an external professional regarding what the home does well was that it cares for people with advanced dementia and complex needs. Another comment was that the home can get oversubscribed as they are the only local provider. Can lead to problems with a high concentration of high dependency residents. People receive appropriate care always to meet their needs. From a relative states that they look after my husband well. The staff are kind and caring and treat me with respect as well as my relative. Relative on behalf of a service users this is an outstanding care home. All are treated with loving care and kindness. The dignity of my relative and others is maintained at all times. Other comments were I can go home and feel safe that my relative will be well looked after. I have nothing but praise for Vecta and my husband could not get better care. Comment from healthcare professional was An excellent home which acts as a role model for others to follow. We observed the staffs practices/ interactions and listened to them talking to the service users. It was evident that the staff and the service users had developed good relationships and care was provided in a respectful manner. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides a range of activities to meet the needs of people accommodated. The service users are supported to maintain links with their family and friends. The meals at the home is well managed and meet with the satisfaction of the service users. Evidence: The home has a planned activity programme that the staff and service users we surveyed said were well managed and the home offered varying programmes according to peoples abilities. The home employs an activity co ordinator and also there are four six hours support shifts from activities assistants. The manager reported that activities are varied and may take place on a one to one basis or in a small group. The service has their own minibus that the staff stated allows them more flexibility. Staff reported that the sensory gardens have been designed to allow for service users participation. The manager reported that frequent trips to the garden centre had been Care Homes for Older People Page 17 of 32 Evidence: undertaken this year and the service users involved in growing own vegetables and salads. The AQAA states that the service maps dates in advance and some of the celebrations have included special days for Burns Night, American Independence Day, Chinese New Year, St. David, St. Patrick, St. George and St. Andrew. All these have themed events to include the foods, drinks and music of a particular nation. Comments from the service users when we asked about activities were positive. A relative commented that there is always a variety of entertainment and fun times for those who wish to take part. Other comments were not a lot of activity, but difficult to please all. Residents tend to sit and sleep more than is good for them. Needs more stimulation. Staff comments were more activity sessions and staff to keep the residents stimulated. Activity staff work very hard with daily activities and social functions. But it would be nice if more outings could be arranged and also invite the families if they wish to go. These comments were shared with the manager at the time of the visit. As part of listening to people the AQAA states that the service has recruited another driver to join the activities team and this has enabled a greater programme of outings for the service users. These include drives to the seafronts at Cowes, or Ryde, picnics on Brading Down, visits to Osborne House and Ventnor Botanic Gardens. In the winter a drive around the countryside, maybe taking in the Military Road, and the stunning views of the South Coast White Cliffs provide a meaningful stimulation and distraction. The service users care records showed that some activities records were maintained but this was not consistent. Staff reported that activities were ongoing but not always recorded and need further development. The home has an open door policy and the visitors we spoke to stated that they could go to the office if they needed anything. The home maintains a record of visitors to the home and this showed that people visited at different times of day. People we spoke to confirm that they come and visit at anytime and they are always made welcome. We looked at the arrangement in the dining room and observed the lunchtime meal on Care Homes for Older People Page 18 of 32 Evidence: the day of the visit. We found that people were supported to eat in the dining room or their bedrooms. Each unit has a separate dining area and meals were provided in a calm and relaxed atmosphere. Staff were serving food from a hot trolley in one of the units and this ensured that people received their meals at the right temperature. Staff in the dining room were observed to offer assistance with meals in a sensitive manner and meals were not rushed. Other staff were assisting people in their bedrooms with their meals on a one to one basis. Meals appeared varied appetising and choices were offered. Comments from people were that the food is always very good. Very nice. Plenty to choose from. A relative commented the food is excellent and presented well. Care Homes for Older People Page 19 of 32 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. There is a good complaints process in place to deal with any issues raised and the service users are confident to raise any concerns with management. There is a satisfactory process to report safeguarding concerns. Records of referrals made and any actions taken are inadequate. Evidence: The home has information that is available to the service users regarding how to raise concerns and complaints. The home maintains a complaint log and information we have received indicates that a record of any complaint raised is recorded and action taken within the timescale. The three service users that we spoke to tell us that they are content with the care provided. They tell us that they would approach the staff or go to the office but say they have nothing to complain about. One comment was I can go home and not worry about my relative. Staff were aware of action that they must take if any allegation of abuse is reported to them. They tell us that they would report to the manager. Training in safeguarding is available to the staff and safeguarding information is also available in each unit enabling easier access for the staff. Care Homes for Older People Page 20 of 32 Evidence: The AQAA states that the home has developed critical incident analysis to help raise awareness and enable the staff to perceive and distract sooner. We looked at the records of safeguarding alerts and details of investigations/ action taken following investigations. These were not available when we asked to see them at the time of the visit. Staff showed us the record of a recent incident and the assessment that had been put in place. This was brought to the attention of the senior representaive from the company during the visit as action is needed to ensure that records as required are maintained. Care Homes for Older People Page 21 of 32 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 service provides an excellent environment for people to live in and the service users say meet with their needs. The infection control process in place is satisfactory. Evidence: We walked round the home as part of the visit and looked at a number of the service users bedrooms, communal lounges and dining areas, bathrooms facilities. The AQAA states that as part of the ongoing programme of refurbishment a rolling rota of bedroom refurbishments and anticipate achieving eight rooms per year. This would include complete re decoration and carpeting, new curtains, bedspread and furnishing. It was evident as we walked around the service that there is a commitment and achieved a clutter free corridor that allows the service users the flexibility of walking around safely. The service is warm, homely and welcoming. Furnishing is of high quality and appropriate to peoples needs. The home has a large number of profiling beds and these allow the beds to be adjusted according to the service users assessed needs. The bedrooms we looked at Care Homes for Older People Page 22 of 32 Evidence: were personalized and it was evident that people are supported to bring in items of personal belongings on admission. All areas of the home that we looked at different times of the day were clean and no adverse odours were detected. One of the unit we looked at has a small kitchenette where the service users are assisted to bake cakes. It was evident that the safety of this area had been thoroughly assessed and measures to eliminate the risk of the cooker/ hob could not be accidentally switched on were in place. We noted that bathroom in the new unit has been decorated and equipped to a very good standard. Two of the communal bathrooms and the shower room attached to the hairdressing room were impersonal and in need of refurbishment. The floor of the shower room was stained and had limescale. The bathrooms were also cluttered where hoists and other equipments were stored. The manager confirmed that they plan to refurbish two bathrooms and two public toilets within the next year. The service is also looking at developing another area to increase storage for equipment. The home has large well maintained gardens that are easily accessible and appropriate to the service users needs, including wheelchair users. It was evident that the garden areas continue to be developed to meet the needs of people using the service. The AQAA states that the architecture and design of the building, lending itself perfectly to the needs of this client group and it is evident that this has been achieved. Information regarding infection control procedures were available to the staff. Staff practices observed indicated that they were aware of these and equipment such as disposable aprons and gloves were available. We noted that the laundry bags were colour coded in order to assist staff when dealing with soiled /contaminated laundry. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has adequate staff to meet the current needs of people accommodated. There is a recruitment process in place that staff follow. Checks are undertaken, reference checks was not always adequate. There is a training programme in place to ensure that staff have the skills to deliver care safely. Evidence: The AQAA states that they have a robust recruitment policy and appropriate checks are made on prospective staff prior to employment, as per legislation. There is a full and planned training programme in place including mandatory training and fire safety. We looked at the staff roster and discussed the staffing arrangements the home has in place to meet the needs of people using the service.The staff stated that day duty has three registered nurses and eight carers in the morning and three trained staff and six carers in the afternoon/ evening shifts. Night duty has two trained and six carers. The duty roster that was provided to us showed that this was mainly achieved. The home also has ancillary support for the cleaning and kitchen duties that ensures care hours are not eroded. We sought the views of people regarding the care and support that they were receiving and received positive comments. These included that the staff Care Homes for Older People Page 24 of 32 Evidence: are excellent. They treat all the residents with kindness and respect. People say they usually staff around when you need them. Staff commented that staffing was usually adequate to meet peoples needs. Three healthcare professions that responded to our surveys were complimentary about the care that the service users were receiving. Visitors we spoke to tell us that the staff are wonderful and caring. They are always trying new things with them and my relative is always clean and well looked after. People here are working together for the benefits of the residents. Staff comments included Good co operation and team work, mostly everything is fine. We observed the staff s interaction throughout our visit and found them to be attentive and respectful at all times when dealing with the service users. One staff member was observed gently coaxing a service user to accompany her to the dining room at lunchtime. One comment we received was there are only two carers an a nurse on each shift for 15 to 16 residents, if one gets violent, one wonders how safely they can deal with it. We looked at the three new care records to assess the recruitment process that the home has in place. All new employees completed an application form and the home maintained evidence of staff identifications. One staff member had evidence of criminal record bureau(CRB) check and and POVA first as required. Another staff member had POVA first clearance and was undergoing an induction on the day of the visit. A senior staff confirmed that they would not start work until the full CRB clearance has been obtained. We noted that one staff member had been employed and we could not ascertain the date of her CRB clearance. There were two references in place , however these were not from the last employer as required. This was brought to the attention of the person in charge and will be looked into. The home has an ongoing training programme in place that included induction training. Staff stated that all new employees completed a week companys induction and and all new staff are supported and work as supernumerary for another week. Staff commented that the training was good and they have regular updates in Care Homes for Older People Page 25 of 32 Evidence: mandatory training. The AQAA states that the service plans in the next year to further develop the training such as National vocational qualification (NVQ) at levels 2-4 for the staff. Information from the AQAA shows that the home has 25 permanent carers, 18 of them have achieved NVQ qualification at level 2 or above. We observed that a large number of the staff had recently completed the Tomorrows Another Day, training in dementia. There is further plan to undertake another training in the autumn for the remaining staff. Certificates of training and updates were displayed in the entrance lobby of the service. The manager reported that this is an area that is constantly changing and the service looking at innovative ways of training for the staff. It is evident from the comments we have received that there is a commitment in updating the staffs skills in order that the care provided meets the needs of people. Comments from external health care professionals included that there is high level of staff training and up to date methods of working with people with dementia. The staff are highly trained and offer quality care to all the residents. Care Homes for Older People Page 26 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a good management process in place to support the service users. The health and safety of the service users are protected with regular equipment maintenance, care practices and staff training. Evidence: The AQAA states that the company has twice yearly quality audit. There is a quarterly newsletter sent to each next of kin and made available to service users and visitors. This provides the service with another forum for communication and for eliciting opinions and views. The home has a registered manager who has been at the service for a number of years and has experience of working with people in the category of old age and dementia. It was evident that the manager has developed good relationships with the staff, relatives and the service users. Interaction observed and the people we spoke to and comments we have received showed that the manager was held in high esteem. Care Homes for Older People Page 27 of 32 Evidence: Positive comments from the staff included that you can always go and see the manager with any problems and he listens. Other comments were that this is a very good home, all the staff and manager are very approachable. I know that I can go and see the manager and things will be done. It was evident that there are clear lines of accountability in relation to the daytoday management of the service. The AQAA we received was detailed and gives us an indication of the service future plans. The AQAA demonstrates that the manager has planned ahead and a statement was the service will always energetically pursue the latest thinking, incorporating all that is relevant to the resident population. Further development of the memory lane and life skills resources will also feature in the next years development plan. We looked at the process for managing any of the service users personal allowance. The homes administrator reported that the home did not manage any of the service users money. Invoices are raised for extra items such as chiropody, toiletries, hairdressing and these are sent to the the next of kins/ person responsible for the bills as appropriate and receipts of transactions are maintained. The service has an internal auditing process in place and a representative from the company undertook monthly unannounced visits as part of regulation. Reports of these visits are shared with the manager and the manager stated the records were maintained. The manager sends to us reports of incidents that are detrimental to the welfare of people living at the home and these are known as notifications. which is a legal requirement. We were unable to find any of these reports at the time of the visit. The registered person must ensure that these are maintained at the home an available to us on request. Information we have received indicates that there is an ongoing programme of servicing of equipment to ensure that they are safe and fit for purpose. Records show that the hoist, emergency lighting, emergency call bells, fire alarms and gas equipments have all been serviced between January and May 2009. The home has appropriate policies and procedures in place, however these have not been reviewed since 2007 and some 2008. These documents should be reviewed at regular intervals to ensure that they remain current and take in account any changes in regulations. Care Homes for Older People Page 28 of 32 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 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered person must ensure that arrangements are in place for the safe administration, recording, safe keeping and disposal of medicines in the care home. So that you can ensure that this is managed safely at all times in the best interests of the service users. 28/08/2009 2 18 17 The registered person must 28/08/2009 ensure that accurate records of all allegations of abuse and action taken are recorded and available at the service. To ensure that people are protected from the risk of harm. Care Homes for Older People Page 30 of 32 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 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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