Care Home: Vicarage Court Nursing Home

What the care home does well The management and staff make the people who use the service and their visitors welcome. There are frequent visitors to the home. Management meetings are held regularly with the provider, registered care manager and operations manager. These are held in conjunction with the managers of the sister home. Formalised meeting minutes are planned for at future meetings. Staff demonstrated great respect for the people who use the service, and people were addressed in an appropriate manner. Discussions with staff were positive, and showed a clear determination that they belong to a committed team. People spoken with and surveys received were very positive about the care that they were receiving. The home was clean, warm and comfortable. People commented on the good standard of cleaning and maintenance at the home. Care plans seen were comprehensive and clearly written. Reviews and risk assessments were up to date. They evidenced that peoples health needs were being met. The general decor of the home was in good order, there is an ongoing programme of renewal and replacement throughout the home. With new carpets and new flooring having been laid where needed in the past year. What has improved since the last inspection? The Annual Quality Assurance Assessment completed by the registered care manager and operations manager told us about the following improvements: "New brochures are in place. Visitors comments box. Regular discussions with the service users and families. Our plan to renew all beds with profiling beds is ongoing due to the lack of authority increases this project will run into the next 12 months, still we remain on target and have only 8 more of our 39 beds to replace. In line with our new evacuation procedure we requested a visit from the local fire brigade who confirmed that it was well planned and gave positive feedback on documentation. We said that we would like to implement some outside activities and have more visits to local attractions these have been achieved with the extra visits from local providers to the home. A new activity plan has been implemented and is on display in all residents rooms. Service Users families and friends are very supportive of all events at the home and help to organise special events. New complaints procedure in place. Formal staff training. Better Fire Evacuation Procedure. Replaced carpets and equipment. Replaced beds to profiling beds. Infection control training for all staff including housekeeping and kitchen staff. New Manager in Post. Senior Carers on each shift. New trained staff have been employed to improve staffing levels on day shifts. Have enrolled with SSCWP for support with funding for all staff training. All care including hospitality staff have NVQ 2 as a minimum. In house link nurses implemented to support with awareness and training. Care Plans continue to be reviewed and changes made. Regular meetings with Manager of sister home for support and sharing of good practice. All staff either trained or working towards NVQ qualification. Regular training sessions both internal and external. Link Nurses have proved to be a valuable asset to the home. Implemented the suggested staffing levels during the day shifts. Staff induction in line with skills for care." What the care home could do better: People using the service would benefit from shelving in their en suite bathroom to enable appropriate storage of toiletries. Staffing levels should be maintained to ensure the health, safety and welfare of the people using the service. A more comprehensive quality assurance system needs to be implemented which encourages and seeks feedback from people who use the service, their relatives and or representatives, and other visitors to the service. This information should be acted upon and outcomes feedback through staff and meetings for people using the service. Staff should receive formal supervision at least 6 times per year, in line with the National Minimum Standard. Key inspection report Care homes for older people Name: Address: Vicarage Court Nursing Home 160 High Street Chasetown Staffordshire WS7 3XG     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: Pam Grace     Date: 0 8 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Vicarage Court Nursing Home 160 High Street Chasetown Staffordshire WS7 3XG 01543685588 01543677034 morecare@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Morecare Limited Name of registered manager (if applicable) Miss Caroline Anne Perkins Type of registration: Number of places registered: care home 39 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 39 The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 39 Physical Disability (PD) 39 Date of last inspection Brief description of the care home Vicarage Court is a 39 bedded care home with nursing, situated in Chasetown. It comprises of a purpose built building set in a town location, and close to a local shopping centre, and is also on a bus route. The proprietors Morecare Ltd., have run the home since it was first registered in 1995. The home is currently registered to admit 39 older people over the age of 60yrs, and comprises of single and double Care Homes for Older People Page 4 of 30 Over 65 39 0 0 39 1 0 0 6 2 0 0 9 Brief description of the care home bedrooms, some of which have en-suite facilities. There are two lounge and dining rooms; other facilities include a hairdressing salon and conservatory. All areas of the home have access to a passenger lift. There are car - parking facilities. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The overall quality rating for this service is Good 2 star. This means the people who use this service experience good quality outcomes. This key unannounced inspection was carried out over one day, by one inspector. The inspection had been planned using information gathered from the Care Quality Commission (CQC) database, the Annual Quality Assurance Assessment (AQAA) document that had been completed by the registered care manager and operations manager, surveys and comments received from people who use the service and their relatives. The key National Minimum Standards for Older People were identified for this inspection and the methods in which the information was gained for this report included case tracking, general observations, document reading, speaking with staff, people who use the service and their visiting relatives. Observation of the environment was also undertaken. The Statement of Purpose and Service User Guide were available for us to view. These had been reviewed and a new information pack was available for people wishing to use Care Homes for Older People Page 6 of 30 the service and or their representative. The previous inspection report was available to read in the main entrance hallway of the home. At the end of our inspection, feedback was given to the registered care manager and the operations manager, outlining the overall findings of the inspection, and giving information about the recommendations that we would make. People spoken with were very positive about the care they were receiving. Comments have been included in this report. We observed people who were unable to communicate. Our observations showed that these people were well cared for, and were happy in their surroundings. There had been no complaints and no Safeguarding Adult Protection (POVA) referrals made to or by the home, since the previous inspection. There were no requirements, and 4 recommendations made as a result of this unannounced inspection. The fees for this service are not included in this report. The reader may wish to obtain more up to date information directly from the service. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? The Annual Quality Assurance Assessment completed by the registered care manager and operations manager told us about the following improvements: New brochures are in place. Visitors comments box. Regular discussions with the service users and families. Our plan to renew all beds with profiling beds is ongoing due to the lack of authority increases this project will run into the next 12 months, still we remain on target and have only 8 more of our 39 beds to replace. In line with our new evacuation procedure we requested a visit from the local fire brigade who confirmed that it was well planned and gave positive feedback on documentation. We said that we would like to implement some outside activities and have more visits to local attractions these have been achieved with the extra visits from local providers to the home. A new activity plan has been implemented and is on display in all residents rooms. Care Homes for Older People Page 8 of 30 Service Users families and friends are very supportive of all events at the home and help to organise special events. New complaints procedure in place. Formal staff training. Better Fire Evacuation Procedure. Replaced carpets and equipment. Replaced beds to profiling beds. Infection control training for all staff including housekeeping and kitchen staff. New Manager in Post. Senior Carers on each shift. New trained staff have been employed to improve staffing levels on day shifts. Have enrolled with SSCWP for support with funding for all staff training. All care including hospitality staff have NVQ 2 as a minimum. In house link nurses implemented to support with awareness and training. Care Plans continue to be reviewed and changes made. Regular meetings with Manager of sister home for support and sharing of good practice. All staff either trained or working towards NVQ qualification. Regular training sessions both internal and external. Link Nurses have proved to be a valuable asset to the home. Implemented the suggested staffing levels during the day shifts. Staff induction in line with skills for care. What they could do better: People using the service would benefit from shelving in their en suite bathroom to enable appropriate storage of toiletries. Staffing levels should be maintained to ensure the health, safety and welfare of the people using the service. Care Homes for Older People Page 9 of 30 A more comprehensive quality assurance system needs to be implemented which encourages and seeks feedback from people who use the service, their relatives and or representatives, and other visitors to the service. This information should be acted upon and outcomes feedback through staff and meetings for people using the service. Staff should receive formal supervision at least 6 times per year, in line with the National Minimum Standard. 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 10 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service and their representatives have the information needed to choose a home that will meet their needs. Evidence: The Annual Quality Assurance Assessment document AQAA, which was completed by the registered care manager and operations manager, told us: The home continues to have a good reputation within the community and holds a waiting list for admissions. All potential admissions and their families are encouraged to visit the home prior to admission. When agreement has been made that the service user is happy for admission to take place a full pre assessment is carried, the assessment is always carried out by the care manager and in the cases of Continuing Care Funding being highlighted the operations manager will also attend this enables a quick decision on acceptance and all equipment that needs purchasing is authorised at that time. Families are always involved with every process of the initial care plan and Care Homes for Older People Page 12 of 30 Evidence: are invited to attend regular reviews with the service user. Service users are encouraged to bring in small items of memorabilia to help with the settling in period. We viewed the revised Statement of Purpose and Service User Guide which met the National Minimum Standard Schedule 1. This is now available within an information pack for all prospective people wishing to use the service. People spoken with and surveys received confirmed that they had received appropriate information prior to admission, which had included the Statement of Purpose. That they had been able to visit the home, and spend time talking with people who use the service to help them decide if the service would be suitable for them. Comments received included, staff could not have been more helpful, we had a cup of tea and a chat with people. People also confirmed that they had been provided with a contract and or terms and conditions of service. We were told that Contracts had been reviewed. We looked at three care plans. These showed that a full assessment of needs had been undertaken for those individuals on admission. The assessments gave comprehensive information about the persons needs across all activities of daily living. Examples being cognitive awareness, skin integrity, confusion, risk assessment including falls, bathing, moving and handling and fire safety. Intermediate care is not provided in this home. Care Homes for Older People Page 13 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: The Annual Quality Assurance Assessment document AQAA, which was completed by the registered care manager and operations manager, told us: Care planning with the named nurse and key worker continues to work well and relationships with all outside agencies remain very strong with positive feedback from those concerned. Having such good relationships with agencies such as the McMillan Nurses enables us to support and implement Advance Directives within the care plan for service users who have been diagnosed with terminal illness. We are maintaining the individual care plans and external health professional continue to be involved for example Tissue Viability Nurses, SALT and if required CPNs. All staff including kitchen and housekeeping have attended an awareness session on Infection Control. A new cleaning regime in conjunction with the care staff to limit infection has been implemented this includes such things as weekly mattress cleaning. The home has Care Homes for Older People Page 14 of 30 Evidence: signed up with the Essential Steps programme for extra support. The named link nurse for infection control attends external meeting and disseminates information to all staff as well as carrying our in house training sessions. The Care Manager regularly audits the administration of medication there have been no abnormalities recorded. We continue to use Lloyds Pharmacy and have been very supportive to the home. Oxygen cylinders are still stored had the home and procedures are carefully monitored by the care manager. Regular comments form families and visitors are that there is never an offensive odour in the home. This is due to a number of reasons Residents are properly assessed for incontinence products and there is no set times for offering toileting facilities. Service users are taken when they ask or when the need arises The incontinence link nurse attends meeting and support junior members of staff. Excellent housekeeping with all staff trained in infection control Individuals personal hygiene and grooming No air fresheners allowed it is felt that they only mask odours if there are any stains or spillages they are dealt with straight away. We examined three care plans. All care plan documentation including risk assessments had been regularly reviewed. We spoke with staff, people who use the service, and their visiting relatives. Staff spoken with could tell us exactly how each of these people were to be cared for, what these staff told us reflected what was written in individuals care plans. People we spoke with told us they had been involved in their care planning processes and their review. Care plans are signed by individuals or their representative wherever possible. All three care plans contained evidence of a pre admission assessment, which had informed the care plan. We found evidence of health professionals involvement, for example tissue viability nurse, physiotherapy, stroke nurse and dietician. There was also evidence that some details were recorded in the event of terminal illness, however not all care plans contained this information. We were told that the Specialist Palliative Care Nurse had visited the home, and that training had been offered and was being undertaken by staff. Staff were observed appropriately interacting with relatives and people using the service. People and relatives spoken with during our visit said that they were very happy with the care that they and or their relative received. Comments received included the following, they keep me clean, tidy, fed well with plenty to drink, they do everything well, the home is super. staff are very hardworking.They take good Care Homes for Older People Page 15 of 30 Evidence: care of me and give full support to family members. One person visited in her room told us that staff were kind and considerate. She said she was comfortable and well looked after by staff. A spot check of medication administration procedures showed no anomalies, we were told that qualified staff are responsible for daily auditing of medication. One named nurse is responsible for ordering, checking and returning medication. Eye drops were appropriately stored and dated. Oxygen cylinders were appropriately stored. There was an auditable trail for returned medication, and records were signed for by two people. Medication Administration Records were signed appropriately. We were told that Boots pharmacy continue to regularly visit the home to audit medication. Care Homes for Older People Page 16 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use services are able to make choices about their life style, and supported to develop their life skills. Social, educational, cultural and recreational activities are meeting individuals expectations. Evidence: The Annual Quality Assurance Assessment AQAA document, which was completed by the registered care manager and operations manager told us: Activities continue within the home and are planned around the service users choice. The gardening club has been quite fruitful where the service users actually reaped their rewards and the fruit and vegetables grown where prepared and served with their meals. Specials days are still celebrated and have a good attendance from families. Families even take part in the fancy dress competitions and the pancake race. Two members of staff have attended the training on activities and planning delivered by SSCWP and a new activity plan has been devised around everyones choice. It came as a surprise to all when our residents asked for a WI Games Console with the funds raised during the Christmas events. Its proven to be a great success and is regularly Care Homes for Older People Page 17 of 30 Evidence: used, its helped with coordination and we have a Keep Fit game. The new menu plans are working well and regularly changed with the seasons and with service users likes and dislikes. During the warmer month there is a regular trip to the local carvery where our service users can have their lunch and socialise with local people. The local pub often let our residents bring in their own fish and chips and put on a game of bingo for them. We have also made links with local shop keepers and they arrange to bring in their good and arrange a stall so our service users who chose not to go out can make their purchases, they include local pharmacist, fashion stall, gifts and cards to mention just a few. Religious dominations regularly visit the home and we have good links with the Priest, Vicar and Lay preachers. People spoken with and surveys received told us we do a bit of gardening now, potting seeds, and sitting under the gazebo in the garden is lovely when the weather is good. We do a few more activities now, and its better than it was.There has been an improvement in the activities during the day for residents, like Bingo, craft projects and local outings.Its a pleasure for anyone visiting at anytime to see the overall cleanliness and facilities in the bedrooms and social areas.Vicarage Court has improved a lot over the past year for the better. We were told that breakfast times had been staggered, and that people can now have breakfast on a much more flexible basis, from 7 a.m up until 10 a.m. People told us they liked this option, as they could lie in if they wanted to in the mornings, and not worry about having to get up on time for breakfast. Lunches are served at 12:30, people can have a snack or a sandwich if they are not ready or wanting a full lunch. Visitors are able to see people in private if they so wish, there are no restrictions placed upon visitors unless asked to do so by the person using the service. Meals were eaten in comfortable and bright surroundings. There is a three weekly rotational menu which included seasonal choices of hot or cold meals as well as choices for afternoon tea. There is also a cooked breakfast option twice weekly for people who want that option. There are regular meetings held for the people using the service, at which they can contribute their ideas and suggestions for meals. Suggestions are then fedback to the cooks so that changes can be implemented or tried out. Care Homes for Older People Page 18 of 30 Evidence: There had been no complaints about the cooking or the meals since the previous inspection. We therefore did not inspect the kitchen on this occasion. Care Homes for Older People Page 19 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns and have access to a robust, effective complaints procedure, are protected from abuse, and have their rights protected. Evidence: The Annual Quality Assurance Assessment AQAA completed by the registered care manager and operations manager told us: We have not received any written or formal complaints during the last 12 months. This we believe is because of our open door policy where families and service users speak openly about any complaints or concerns that they may have. We have the suggestion box that has help with feed back and we have a grumbles or complaints folder where any concerns are dealt with before they develop into formal complaints. The home continues to have an open door policy with both staff and service users and everyone is aware of the Whistle Blowing policy. and are more than comfortable to speak to senior management about their concerns. There have been no referrals to POVA or ISA over the last 12 months and all staff have received training and updates and all issues around abuse and safe guarding. All pre employment checks are carried out and documented. Service Users Monies are regularly audited by accounts manager and ops manager. We examined personal monies held for three people using the service, these were all Care Homes for Older People Page 20 of 30 Evidence: in order, and showed that a robust procedure is in place for peoples finances. The AQAA told us that there had been no complaints, and or Safeguarding Protection of Vulnerable Adult (POVA) referrals made or received by the service since the previous inspection. We saw that the complaints procedure was clearly displayed in the main entrance to the home, and noted that this is also available in the information pack given to all prospective people wishing to use the service. We discussed the need to ensure that appropriate timescales are included in this written information. People spoken with during the inspection visit confirmed that they had been given a copy of the complaints procedure, and knew who to complain to. They said that their grumbles are listened to and acted upon by staff. A grumbles book had been introduced. One relative spoken with said, the home is great, we always know that we can talk to the manager if we need to. Another person said, I just tell someone, and they do something about it straight away. The care manager confirmed that the home has an open door policy in regard to complaints. We spoke with staff, they were able to confirm their knowledge with regard to issues of abuse, its identification and types of exploitation. Individual staff training records confirmed that Safeguarding (POVA) abuse training had taken place in March 2010. Staff recruitment records evidenced that appropriate Criminal Records Bureau (CRB) and Protection of Vulnerable Adult (POVA) had been undertaken prior to employment. Care Homes for Older People Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables people who use the service to live in a safe, well maintained and comfortable environment, which encourages independence. Evidence: The Annual Quality Assurance Assessment AQAA completed by the registered care manager and operations manager told us: The environment continues to be safe well maintained and exceptionally clean, and refurbishment is planned and maintained to a high standard. Our Bedrooms are bright and cheerful and are always redecorated and cleaned for every new service users that is admitted. The home is always odour free and receive regular comments on the good house keeping from visitors and service users Outdoor communal areas are well kept and regularly maintained by the handy man and external services such as gardeners and window cleaners. Linen are replaced when needed and bedrooms continue to be refurbished and no slip flooring replaces carpets. We observed the improvements made, and spoke with people using the service. We observed that the home provides a clean, well maintained environment throughout. The programme of carpet replacement, and refurbishment continues. Care Homes for Older People Page 22 of 30 Evidence: The AQAA confirmed that health and safety checks had been made, including servicing and maintenance of equipment, for example the Oxford and electric hoists that had been serviced in March 2010. People told us they were comfortable and happy in their surroundings, including the communal lounges, dining areas and their own bedrooms. However, some en-suite bathrooms would benefit from shelving, to enable people to appropriately store their toiletries. People spoken with and surveys received told us its a pleasure for anyone visiting at anytime to see the overall cleanliness and facilities in the bedrooms and social areas. Its always kept clean and tidy here. New non slip flooring had been fitted to some bedrooms. Accommodation is personalised to suit individuals. Communal areas are comfortable and homely. Bathrooms and toilets are conveniently sited around the home. We noted that equipment and adaptations were provided as necessary to maximise independence. For example, wheelchairs, raised toilet seat, bed rails, pressure mattress, handrails, and assisted baths. Bed rail bumpers were in place where needed, to promote the comfort and security of the people using the service. Care plans showed that risk assessments were in place and up to date for those in use. Kitchen and laundry areas were clean and tidy, with appropriate measures in place to prevent cross infection. Care Homes for Older People Page 23 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service. Staffing levels should be maintained to ensure the health, safety and welfare of people using the service. Evidence: The Annual Quality Assurance Assessment AQAA document, completed by the registered care manager and operations manager told us: Good skill mix of staff on each shift All new staff receive a formal induction in line with skills for Health Staff have regular training and updates Each shift has a dedicated Senior Care to work along side and support Trained Nurses The care manager holds regular staff meeting for all levels of staff Employment checks prior to commencement of work always take place. Regular training sessions Agency staff only used in an emergency All Staff are either NVQ qualified or working towards and senior carers have enrolled on NVQ3. The care manager is now Registered with the Care Quality Commission. We were told that staffing levels had been maintained until recently. The home is actively recruiting for one quaified night staff and one qualified day staff member. However, the existing qualified staff are filling in for this shortfall, this means that on Care Homes for Older People Page 24 of 30 Evidence: occasions day staff are asked to fulfil night duties. The operations manager confirmed that agency staff would be used if needed to keep staffing levels maintained. The staff rota for end of May to June 2010 confirmed that staffing levels are being maintained with agency cover as required. The care manager and staff spoken with confirmed that staff supervision was consistent, and that staff meetings had recently been resurrected. However, there was little written evidence that staff supervision takes place. New staff confirmed that they had received appropriate induction into their role and responsibilities. Staff meeting minutes were available for us to view. We looked at three staff recruitment records, these showed that a robust system of recruitment is in place, ensuring the safety of the people using the service. People spoken with and surveys received told us that staff were available when needed, and that staff are given up to date information about the needs of the people they care for. Care Homes for Older People Page 25 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home should further develop its quality assurance system to ensure that services are provided in the best interests of those who use them. Staff supervision should be formalised documented and recorded. Evidence: The Annual Quality Assurance Assessment AQAA completed by the registered care manager and operations manager told us: Good robust systems in place to monitor service users and staff. Good care plans with positive feed back from all professionals in involved. Staff training plan for all mandatory training and extra training support supplied by SSCWP. Thorough risk assessments in place and are audited by the care manager. Residents finances are regularly audited and checked by the accounts manger and operations manager. Good networking with sister home and regular meetings take place to share good practices. Manager allocated administration days and continues to have the support of the Operations Manager to grown into the management role. The Care Home and staff are Care Homes for Older People Page 26 of 30 Evidence: positive and committed and strive to make continuous improvements We continue to have a open door policy with senior management Equipment is regularly checked and serviced to ensure that all Health & Safetey requirements are met. The Annual Quality Assurance Assessment (AQAA) document, which was completed by the registered care manager and operations manager, was returned to the Care Quality Commission on time, and was completed to an adequate standard. Management meetings have been regularly established between the provider, operations manager and registered care manager. These are held in conjunction with the sister home, and formal meeting minutes are being planned for. The Statement of Purpose and Service User Guide, in line with Schedule 1 of the National Minimum Standards had been reviewed. A new information pack is now available ensuring that prospective people wishing to use the service and or their representative, receive appropriate and up to date information about the service. The operations manager had previously improved the care planning process used by the service, care plans were clear, up to date, and contained comprehensive information about the person using the service. Work still needs to be done in relation to current staffing levels, staff supervision, and the full implementation of the Quality Assurance system There had been no complaints and or Safeguarding (POVA) referrals made to or by the home since the previous inspection. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 24 People using the service would benefit from shelving in their en suite bathroom to enable appropriate storage of toiletries. Staffing levels should be maintained to ensure the health, safety and welfare of the people using the service. A more comprehensive quality assurance system needs to be implemented which encourages and seeks feedback from people who use the service, their relatives and or representatives, and other visitors to the service. This information should be acted upon and outcomes feedback through staff and meetings for people using the service. Staff should receive formal supervision that is documented and recorded, at least 6 times per year, in line with the National Minimum Standard. 2 3 27 33 4 36 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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