Care Home: Walmer House

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What the care home does well Walmer House is a welcoming and homely home. The manager and the staff team pride themselves on providing an `extended family` to the people living there. The service was described as `you could not ask for anything better` with one person saying `I often think I am very lucky to have found a place like this` The admission procedure is good and shows that staff make sure they can meet the person`s needs before they are admitted. People tell us that the admission process is made easier by the staff at the home and comforting because of the Christian approach. People receive a very good standard of personal care, and communication with healthcare professionals in the community is very good. The care people receive is provided in a safe way and medicines are well-managed by the staff. Staff at the home make sure people see healthcare professionals when they need to. Care of the dying is also performed very well with the help of community and Macmillan nurses. One thank you card from a relative read `Our deepest gratitude to you personally and your staff who loved and cared for him in the final weeks of his life. His last years were made so calm and comfortable and he was cared for with such respect and dignity he so richly deserved`. The care planning documentation at home are good and mean that staff know how to care for somebody in a safe and consistent way that meet their individual needs and preferences. People have access to a range of activities and are able to maintain contact with their family and friends. People are grateful for the the spiritual aspects and other activities provided by the home particularly the opportunities for the 1:1 time with staff. People tell us that the food is `excellent` and `gorgeous`. Any issues regarding dietary requirements, preferences or weight issues are sensitively managed. People say there is plenty of food and staff know what they like and don`t like. People who use the service and their relatives can be confident that if they complain, their concerns will be listened to and acted on. People feel able to complain and know how to do this, although people said they have never needed to complain. The staff group are popular with people who live in the home who describe the staff as `caring and patient` `very kind` and `wonderful`. Thank you cards described the care as `loving` and `devoted`. Walmer House is a safe and clean place to live and work. Maintenance systems are very well managed and a good level of decor and furnishings is provided at the home. The manager and staff group have suitable qualifications and experience to care for people who require personal care. The home is well-managed by the manager and supporting team. What has improved since the last inspection? In addition to the routine maintenance programme additional work has been carried out. This has included re carpeting the dining room and replacing dining chairs with ski fittings for easy movement. Some rooms have been redecorated, the kitchen has been steam cleaned and redecorated and the staff room has been redecorated. In addition to this, the store room and laundry room have been decorated which has included a new roof being fitted on the laundry. The garden has been improved and the outside of the home and fascia boards have been redecorated. Some lounge chairs have been replaced and a new plasma screen TV has been wall mounted in the lounge to enable people to have a clearer view. The AQAA also states that the home are experimenting with the growth of some fruit, herbs, and vegetables. Residents have already enjoyed some strawberries and raspberries. The washing machines are now fitted with automatic washing liquid and conditioner dispensers to ensure the correct amount of detergent to wash soiled laundry. Specialist training continues at the home. Since the last inspection another member of the stable staff team has done NVQ three and two others have completed NVQ two. One of the cooks has completed food hygiene training and two have attended a nutritional course. Movement and handling refresher courses have been completed and two Boots medication administration training sessions have also been completed` What the care home could do better: The manager now needs to look at ways to ensure she is able to improve her record keeping at the home. This will show that training and recruitment programmes are robust and information provided to potential residents is accurate and up to date. The manager must also look at ways to further protect people who use the service. This can be achieved by ensuring staff do not work in the home until two written references have been received. Extra checks on the medication administration records would also mean errors spotted and reduced when prescriptions are being hand written onto the record. Staff should also be provided with contact details of who to report any allegations of abuse to outside of the charity. The manager should also ensure robust storage facilities are provided for secure storage of people`s money. This will protect people from financial abuse but also protect staff. Key inspection report Care homes for older people Name: Address: Walmer House 6 Ash Hill Road Torquay Devon TQ1 3HZ     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: Clare Medlock     Date: 1 4 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 34 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 34 Information about the care home Name of care home: Address: Walmer House 6 Ash Hill Road Torquay Devon TQ1 3HZ 01803292734 01803292734 keychangewalmer@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Keychange Charity care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Walmer House is a care home run by a Christian charity called Keychange, which has Christian based projects across the country. There are no expectations of belief or faith on the part of any person at the home. The home is situated approximately half a mile from the town centre of Torquay and is a well maintained large detached Victorian house within its own grounds. The home provides 24-hour care for up to 17 persons who require care for old age or mild dementia type illnesses. Accommodation is provided in single rooms throughout, 14 bedrooms have on suite facilities available. A large comfortably furnished communal lounge is situated on the ground floor. Meals are taken in a dedicated dining room at small tables seating up to four persons. A vertical lift is provided and appropriate aids for persons with mobility issues. At the front of the home there is a large off road parking area, to the side and rear of the building there is a well-tended garden with extensive views of the surrounding area. The weekly cost of care ranges between three hundred and eleven pounds and Care Homes for Older People Page 4 of 34 Over 65 17 17 0 0 Brief description of the care home eleven pence and five hundred and sixteen pounds. This varies on needs and does not include haidressing and foot care (chiropody). Care Homes for Older People Page 5 of 34 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 quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. Prior to this inspection we sent surveys to people who use the service and staff who work at the home. We received five surveys from people who live at the home, four surveys from staff and two from health care professionals. The findings of these surveys are incorporated into the report. This key inspection included a visit to the home on Tuesday 14th July 2009. During this time we spoke to the registered manager, at length with three people who live in the home, to two relatives and to two members of staff. We case tracked two people who use the service. This means we looked in detail at the care these people receive. We spoke to staff about their care, we looked records that related to them, Care Homes for Older People Page 6 of 34 and made observations if they were unable to speak to us or provide feedback. We looked at care plans, maintenance records, five staff recruitment records, training records, policies and procedures. We did this because we wanted to understand how well the recruitment and safeguarding systems work and what this means the people who use the service. During inspection we also watched interactions between staff and people living at the home. At the inspection the manager gave us the annual quality assurance assessment (within timescales). The AQAA is a self-assessment record that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. All this information helps us to develop a picture of how the home is managed and what it is like to live at Walmer House. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? Care Homes for Older People Page 8 of 34 In addition to the routine maintenance programme additional work has been carried out. This has included re carpeting the dining room and replacing dining chairs with ski fittings for easy movement. Some rooms have been redecorated, the kitchen has been steam cleaned and redecorated and the staff room has been redecorated. In addition to this, the store room and laundry room have been decorated which has included a new roof being fitted on the laundry. The garden has been improved and the outside of the home and fascia boards have been redecorated. Some lounge chairs have been replaced and a new plasma screen TV has been wall mounted in the lounge to enable people to have a clearer view. The AQAA also states that the home are experimenting with the growth of some fruit, herbs, and vegetables. Residents have already enjoyed some strawberries and raspberries. The washing machines are now fitted with automatic washing liquid and conditioner dispensers to ensure the correct amount of detergent to wash soiled laundry. Specialist training continues at the home. Since the last inspection another member of the stable staff team has done NVQ three and two others have completed NVQ two. One of the cooks has completed food hygiene training and two have attended a nutritional course. Movement and handling refresher courses have been completed and two Boots medication administration training sessions have also been completed What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 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 admission procedure is good and shows that staff have detailed information to decide whether they are able to meet the needs of the person. Minor improvements to the information provided would mean that people have accurate information about Walmer House before they come to the home. Evidence: People told us either themselves or their family and friends had an input into deciding whether Walmer House was the right home for them to move into. One relative said the home was an obvious choice because of the Christian ethos, whilst another said the spiritual aspect did not deter them, the home had a good reputation in the local community. We were told that most pre admission information is passed onto the person verbally and that written information is given in the form of brochure initially. All surveys said that they had been provided with enough information to help decide Walmer House Care Homes for Older People Page 11 of 34 Evidence: was the best place to be. Comments also read This was very highly recommended by three well respected professional personal friends. The Statement of purpose and Service User Guide and had not been updated for some time. Minor details regarding staff changes and change of name of the care quality commission were highlighted for update. The manager told us she performs the pre admission assessment either at the place where the person is or at the home if the person opts to come and visit the home and have lunch. This assessment is recorded in depth on a tailor made document. This was well completed and contained sufficient information to decide whether the home would be able to care for the person. Information is also obtained from the person, their family, social services and healthcare professionals. the AQAA states all prospective residents are assessed either in hospital or their own home to assess the care needs. A decision is made if the home can meet the persons care needs. We invite prospective resident and a family member or representative to visit the home for a meal to meet the staff and other residents. Full details of the home and services we provide are given. In addition to this information regarding our activities and outings which are provided by our friends committee. The same service is used for both permanent and respite residents. Information provided by the home shows that the organisation is a Christian based charity. The AQAA states that the home follow their equal opportunities policy for all at Walmer house. The AQAA states are strengths are giving spiritual support no matter the race or creed. We welcome all people, and support individual needs and wishes without judgment. The AQAA also states that key change charity has updated the equal opportunities policy this year. The majority of people in the home were mobile, with the use of walking aids. The pre admission assessment included an assessment for mobility. Each person is provided with a contract from either the home or social services. Care Homes for Older People Page 12 of 34 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 personal care people receive is provided in a respectful way. The care planning systems at the home are good and mean people have their health needs identified and met in a safe and consistent way. The management of medicines is generally good and helps protect people from risk. Minor improvements to medication records would help minimise any risk. Evidence: People living at Walmer House have access to a range of health care services both at the home and in the community. Each person has a GP who attends when staff request. One person said you only have to ask and staff will contact the doctor for you. Surveys were also complimentary about the care provided. One comment read Staff are extremely patient and caring and you feel they can be trusted with a vulnerable inmate. Its good to know that they are prepared to fight the corner of the inmate and sees their interests as paramount. Im thinking of when they chase a hospital about medication or improving waiting time when attending a clinic. Care Homes for Older People Page 13 of 34 Evidence: During the inspection people looked cared with the finer details such as eye care, nail care and appropriate foot wear present. People told us they thought the standard of personal care was good at the home. One person said I really appreciate that they encourage but dont take over Another person said I really like bath days as this is a time when I have a good old natter and giggle with the girls. One person said They really are marvellous and dont mind my fussy ways. Staff also stated that they thought the standard of care was good at the home. One survey read the care that we give to each resident is the best care that we can give. You only have to report that someone is not well and the Doctor is called immediately. I have worked in many care homes and Walmer house is the best. Health care needs are communicated both verablly betwen staff and within care plans. Each person has a plan, which sets out his or her needs. Each plan contains personal information, social information, medical information, medicine information and routines and preferences Risk assessmnets are performed on issues which are considered relevent for that person. Examples included moving and handling, skin assessment and nutrition. One person had a risk assessment for self medication. The home use a key worker system to ensure communication is effective between people, the staff and families. Key workers are also responsible for making sure that care plans are kept up to date. The manager informed us that any specialist equipment is obtained through the community equipment supplies. This has included specialist beds and matresses. Other equipment such as sit on scales ar provided at the home. All surveys said that people always receive the care and support people need. All respondednts said the home always makes sure people get the medical care needed. Specialist health care professionals are sought for advice and guidance. This input is recorded in the persons notes. Examples included chiropodist, physiotherapist, dentist, district nurse, specialist nurses, and GP. Surveys from health care professioanls were very positive. Surveys confirmed that staff always respects peoples privacy and dignity, and always supports people to live the life they choose. Comments included Very caring environment. Staff are always welcoming and give high standards of care. They will proactively seek and act on advice given. Care Homes for Older People Page 14 of 34 Evidence: The management of medications is generally performed well at the home. Medications are supplied in individual blister packs and stored in a locked portable medicine trolley. Controlled drugs are stored within two locked boxes. Medicines needing to be stored within the fridge are kept in a designated fridge with temperature records being performed daily. Patient information leaflets are stored within a medication folder. There are also well maintained mediciene administartion records and a separate homely remedy policy and medication administration guidance. The records of administration were clear. A discussion was held about the benefit of obtaining two signatures to show that two staff have checked any hand written entries on the administration record. This will minimise any errors when copying a prescription. Records showed that many of the care staff have attended medication training, however records were out of date. This is reported on in a later section of the report. The maanger informed us she was preparing for the supplying pharmacists audit. The manager told us people are able to end their life at the home where possible and that the district nurse, macmillan nurse and hospice nurses support the home with specialist equipment, pain relief and support for staff. Staff at the home find out the wishes and preferences of people in resepct of terminal illness when they are admitted to the home. One health care professional survey read As part of the Rowcroft Hospice at home pilot, the hospice at home team support Walmer house in looking after residents in the terminal phase of a disease. The staff of Walmer house were keen to learn how to care for a dying patient. They followed advice on physical care and give appropriate medication and support to their resident enabling them to die peacefully at Walmer house. People were encouraged to move freely around areas of the home if they are able to do so. Walking aids were present for those that required them. Grab rails, ramps, lifts, and stair lifts were present throughout the home to reduce risk. People said response to call bells was very quick. People who use the service were treated with respect during the inspection. They were offered choice regarding activities and addressed using their chosen term of address. People were full of praise for the staff saying, Staff are wonderful, they are excellent, and you only have to ask and they they give you if they can Surveys also Care Homes for Older People Page 15 of 34 Evidence: complimented the care, with one survey reading M, is happy at Walmer house. Staff all very kind and caring and will go the extra mile when needed. Care Homes for Older People Page 16 of 34 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 routines of daily living are provided in accordance with the wishes and feelings of people in the home. The satisfactory activities programme helps to provide people with spiritual and recreational stimulation. Evidence: Surveys said the home either always or usually provide activities they can take part in. People we spoke with said they were able to come and go as they pleased and sometimes joined in the activities. People we spoke with particularly enjoyed the 1:1 with staff and the trips out. One person said they particularly enjoyed the recent garden party despite the poor weather. Another person said they did not like joining in and staff respected this. We saw evidence of a mobile library service and posters advertising a clothes show which was planning to come to the home. Evidence of craft and art work was displayed in the home and staff said this was a weekly event. One person had been given a prize for coming third in a hat decorating competition. During the inspection people in the communal areas were being provided with a hand massage as relaxation therapy.Another person was talking of their interest in chess. The homes diary showed an appointment that had been made for a visitor to come to Care Homes for Older People Page 17 of 34 Evidence: the home to play chess with this person. the AQAA states that care staff treat residents with dignity, give gentle exercise sessions, help with reading and writing letters, and have walks in the garden, and perform reminiscing, play board games, and organise arts and crafts activities once a week. People were still being enthusiastic about the recent garden fete which was raising money for a specialist bath at the home. Staff told us there is a friends of Walmer group who regularly fund raise and support the home. The majority of people were sitting in the lounge during the inspection listening to music. Many of the people at the home have an active Christian faith and this is supported by the generally ethos of the home and provision of daily devotion services where people are able to join in with hymn singing, a time of reflection and scripture study. Many rooms had evidence of bibles and prayer books. Posters are displayed around the home showing words of encouragement and guidance. Relatives said this Christian focus is not off putting and people are offered as much support as they need but religious views are not forced on non practicing Christians. The AQAA stated we follow on equal opportunities policy for all at Walmer house. Our strengths are giving spiritual support no matter their race or creed, the residents have daily devotions for those who wish to take part, we have visitors from various backgrounds. Our literature states that no expectation of faith is placed on anyone. We welcome all and support individual needs and wishes without judgment. We were told people still enjoy going out with friends and family. We were told some people attend a local social club where they have speakers, activities and social events. One person told us of a recent holiday to stay with a relative and another said future outings are being planned as and when a person gets a bit better. One person told us like to and are encouraged to go for walks to the local park or shops. The AQAA stated we have lots of outside help and support, which we feel very blessed with. This is due to the friends of Walmer house, volunteers, and assistance with outings. Some even help with craft recreation. The interactions between staff and people in the home were positive, affectionate and very professional. The staff were seen to display a genuine caring attitude with suitable laughter and light banter. Staff providing care behind closed doors were heard to continue with positive interactions speaking to people in a respectful way. People told us they appreciated the fact that staff do not take over, but encourage them to do as much as they like to do. One person said I like to help get the breakfast tables Care Homes for Older People Page 18 of 34 Evidence: ready each day and staff encourage me to do this. Feedback at the inspection regarding food was overwhelmingly positive. Staff told us alternatives would always be found because the home is small enough to know what people like and accommodate individual preferences. Comments such as excellent marvellous and lovely were received. People told us the choice of puddings is amazing and staff bend over back wards to find an alternative. We were told that the meals were always served on time and were always hot. On the day of inspection people were being offered home made steak and kidney pie, mash, broccoli and swede. Deserts included semolina, home made peach gateau, mandarin mouse and rhubarb crumble. Grace was said before lunch was served and mealtimes appeared to be a sociable affair with people sitting at their preferred table. Tables were set with table cloths napkins, condiments and drinks. Vegetables were served in side dishes to encourage independence. People who were requiring help were assisted In a quiet and sensitive way. Staff informed us that tables took it in turns being served first. The feedback regarding meals in the surveys was also good with all but one people saying they always liked the food and the remaining one saying they usually liked the food. People told us the portion sizes were good and extra food out of meal times was available but not needed. The kitchen, food cupboard and freezers were well stocked. The kitchen areas were well managed with the use of the recommended safer food better business programme plus extra more detailed cleaning and temperature records being kept. The manager said they considered they were due for an environmental health inspection as they had not had one for a long time. Care Homes for Older People Page 19 of 34 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 can be confident that complaints will be well managed at the home. The training, and staff knowledge helps to protect people from abuse. Further information would mean staff are aware of which numbers to use if a report is needed in the absence of the manager Evidence: The manager told us they had not received any complaints since the last inspection. The AQAA confirmed this and read that the Manager at the home speaks to the residents daily to ensure they are happy and that they act on any changes as quickly as possible to support people. The AQAA also read key change has a comprehensive complaints policy which is available for all to see on the noticeboard. We openly encouraged discussion between staff, residents, families and friends so any concerns can be dealt with as soon as possible. The complaints process is clearly displayed within the home, on notice boards and within the resident information folder. People at the inspection all said they knew how to complain with comments given such as I know how to, but why would I need to, everthing is perfect. Survey responses Care Homes for Older People Page 20 of 34 Evidence: confirmed that people knew who to speak to if they were unhappy and knew how to make a complaint. Everyone we spoke with felt confident that their complaints would be dealt with appropriately. Everyone we spoke with said they felt safe living at home. People told us the staff were very kind and very caring. Several people told us the staff felt more like family rather than carers. All staff we spoke with knew how to report any allegations of abuse to the manager but also who to report outside of the home. Hoowever, staff were not aware of how to contact the oputside agencies. The manager said she would put a poster up giving staff this information. Staff said they had received training in safeguardng adults. the AQAA stated staff are aware of what constitutes abuse and how to report it. the AQAA also states at induction new staff members watched the no secrets video and are trained on abuse awareness and how to report it. No serious complaints have been launched, I speak to the resident every day I am in the home, and they know they can speak to me in confidence if they wish. I have an open door policy for anyone wishing to speak to me. We did not find any evidence where people were being restrained or deprived of their liberties. Care Homes for Older People Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is a pleasant, clean, and safe place to live and work. Evidence: Walmer House is situated within a quiet residential area of Torquay. Accommodation is provided on both the ground and first floors. The home offers a large lounge room that has 2 seating areas. A separate a dining room is also available. All communal rooms and bedrooms were pleasantly decorated and furnished, reflecting the period of the building. The home was found to be very clean and tidy. All the surveys we received confirmed that people thought the home was clean and tidy. People told us that the home was always clean. Staff told us there were designated cleaning staff for each floor. People told us they had been provided with a lockable facilities in which they were able to store personal items or valuables. All areas of the home were clean tidy and free from obvious risks. Furnishings throughout the home were of a good standard. All bedrooms visited were clean, tidy and contained varying amounts of personal memorabilia and furniture. Care Homes for Older People Page 22 of 34 Evidence: Radiators have been covered to prevent the risk of burn injuries should someone come into contact with them when on. In addition to the routine maintenance programme additional work has been carried out. This has included re carpeting the dining room and replacing dining chairs with ski fittings for easy movement. Some rooms have been redecorated, the kitchen has been steam cleaned and redecorated and the staff room has been redecorated. In addition to this, the store room and laundry room have been decorated. The garden has been improved and the outside of the home and fascia boards have been redecorated. The AQAA informed us some lounge chairs have been replaced and a new plasma screen TV has been wall mounted in the lounge to enable people to have a clear view. The AQAA also states that the home are experimenting with the growth of some fruit, herbs, and vegetables. Residents have already enjoyed some strawberries and raspberries. The home has 17 bedrooms, 14 of which are en suite. During the tour of the building the manager explained which bathrooms were used on a regular basis, and which bathrooms were not. People we spoke with said they particularly enjoyed having a bath in the green bathroom as there was plenty of space to put her personal items. A tour confirmed this was a domestic style bathroom. The laundry was well equipped with equipment suitable for washing foul laundry. Dissolvable red bags are used to transport dirty linen. The washing machines are fitted with automatic washing liquid and conditioner dispensers. Systems are in place for keeping dirty and clean linen separate. Personal protective equipment and hand washing facilities are available. The manager informed us that she had purchased a light box which is used to train staff on effective hand washing. The staff we spoke to said they had not received infection control training. This shortfall is reported on in a later section of this report. The AQAA confirmed equipment in the home had been serviced or tested as recommended by the manufacturers or other regulatory bodies. The AQAA showed recent reviews for electrical circuits, portable electrical equipment, lifts and stair lifts, hoists, fire detection and alarm systems, fire fighting equipment, emergency lighting, emergency call equipment, heating systems, soiled waste disposal, and gas appliances. Care Homes for Older People Page 23 of 34 Evidence: On the day of inspection the gardens were being maintained by outside contractors. The manager informed us that the garden had been improved since the last inspection. The garden was full of colourful flowers and well maintained border plants. Care Homes for Older People Page 24 of 34 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 are well-trained and motivated and employed in sufficient numbers to meet the needs of those currently living in the home. Improvements in recruitment practices would show that staff have had all the necessary pre-employment checks to show they are suitable to work with vulnerable people. Evidence: Everyone we spoke with were very complimentary about the staff at the home. Surveys read Staff are extremely patient and caring and you feel they can be trusted with an vulnerable inmate. Its good to know that they are prepared to fight the corner of the inmate because it sees their interests as paramount people we spoke with described staff as wonderful excellent loving and caring. Relatives said the staff were always polite and welcoming. People said there were always staff to meet needs. People said call bells were answered very quickly. Staff spoken to said they thought there were enough staff on duty. Staff surveys confirmed that staff thought there were either usually or always enough staff on duty to meet the needs of people in the home. Care Homes for Older People Page 25 of 34 Evidence: The manager informed us that generally there were three care staff on in the mornings, one cook, one or two cleaners, and the manager. At night there are two carers one of which is a senior or NVQ three trained. Staff duty records confirmed these levels. Staff recruitment records were consistant. All staff are asked to complete an application form which contains details of employment history and health declaration. Two forms of identification are checked and two written references are sought. However, two of the five staff files inspected did not contain evidence that references had been obtained before the member of staff worked at the home. The manager stated that she had thought she had obtained references for one member of staff, and they were chasing the other member of staff for references. Both members of staff were working at the home in a supervised capacity. All staff files contained a CRB (police check) and POVA (protection of vulnerable adults pre employment check) All staff had either completed a recognised induction programme or were doing this. An example of this induction was seen, which showed a nationally recognised induction programme was used at the home. The manager explained that all staff receive basic information on their first couple of days which includes fire and emergency procedures. Staff surveys all stated that they considered the induction covered everything they need to know to do the job very well. Staff said the manager encouraged and supported staff to do NVQ training. the AQAA states that over the last year, one staff member has done NVQ three and two others have completed NVQ two. One of the cooks has completed food hygiene and two have attended a nutritional course. Movement and handling refresher courses have been completed and two Boots medication administration training sessions have been completed. Care Homes for Older People Page 26 of 34 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 approachable manager ensures there is a positive working environment and eat lots at the home. However, improvements to records and record keeping are needed to show the home is well-managed. Evidence: Staff, relatives and people at the home were extremely complimentary about the manager at the home. Surveys from staff commented that the Manager leads by example and there is a Very good working relationship between the home manager and staff, very supportive any problems are dealt with quickly and efficiently. Another comment read Ive worked at Walmer house for many years, couldnt imagine working anywhere else. I enjoy my job immensely get full support from the management in all areas of my job. Another comment read this home is a wonderful place to work, we have so much togetherness with staff it is like one big family. People at the home were also complimentary about the manager and said she was number one and the best. People appreciated being able to share a joke with her Care Homes for Older People Page 27 of 34 Evidence: and said she really is tremendous. Staff informed us that there are staff meetings held on a regular basis. Records for these meetings were requested, but the manager explained she any keeps brief notes. Discussion was held regarding the importance of having a formal record of these meetings to show what action had been taken. Staff said there are clear lines of accountability, and contact details for managers within the charity. The AQAA stated All the staff work well as a team, this was evident when I was on holiday, visitors and residents were complimenting me on the staff, and said they were all supportive of one another and loyal to me. I also have great support from my operations manager who is always contactable. The AQAA stated that the manager would like the time to give more supervision is, as I work alongside the staff on a regular basis we discuss things as they occur, they feel more relaxed than they do when it an official supervision and will open up more. Staff all know if they need a one-to-one they can ask to see me.The manager explained she holds staff supervision sessions by prioritising the need. Records were shown for one supervision session that had been performed recently. The manager explained that informal supervision occurs on a daily basis, but records are only kept for serious issues. Staff all said they felt well supported by the manager and appreciated the open door policy. Discussion was held regarding the importance of recording all supervision sessions. Quality assurance is performed in a variety of ways at the home. Annual satisfaction surveys are sent, friends meetings are held, one-to-one sessions are held with people, regulation 26 visits are performed by a representative from the charity, and feedback from healthcare professionals is also used for quality assurance. Records for regulation 26 visits, and friends meetings were produced for inspection. The manager explained that satisfaction surveys are due to be sent out in the near future. The AQAA states we promote an open and approachable attitude so that residents and staff are comfortable raising any issues which concern them. There were no obvious signs where the health and safety of people was being placed at risk. However, the management of mandatory training was not clear. Two staff we spoke with were unclear of who the first aider on duty was and two staff said they had not receiving training in infection control apart from using the light box. Fire training records did not clearly show that all staff at the home had received suitable training in fire safety issues. Care Homes for Older People Page 28 of 34 Evidence: People at the home told us they are able to manage their own finances. One person said they are able to go to the bank independently, whilst others said family members and friends helped with this role. Lockable boxes are available in peoples rooms to store personal possessions and valuable items. Staff informed us they are not appointees for any people in the home, but do hold small amount of money for people to access for services such as foot care and hairdressing. This system was inspected. One person was selected but their file containing a small amount of cash could not be located. Six other files containing large amounts of money were located along with clear records of transactions performed. The manager gave assurances this file would be either be found or replaced with the necessary action being taken. Prior to writing the report the manager confirmed that relatives had said this small amount of money had been spent on hairdressing leaving the balance as zero. The storage envelope had been discarded, but receipts could not be located. The manager gave assurances that this system would be improved. Not all records in the home were well maintained, present or accurate. The statement of purpose and service user guide had not been updated and did not contain accurate information about the services provided at the home. No records were present to show that staff meetings had occurred. References within staff recruitment records had not been obtained or stored. Training records were also poorly maintained. There were no clear systems to show which staff were due which training. Records did not clearly show that all staff were up to date with their training. Records could not be found to show that staff had received mandatory training despite staff stating that they had received this. Discussion was held regarding the importance of accurate record keeping. The manager confirmed she was aware of the shortfall, but had declared she had been concentrating on the day to day management of the home. Staff, relatives and people living in the home were grateful for this daily effective presence. The manager confirmed it had been difficult to designate sufficient time to keep on top of records. Care Homes for Older People Page 29 of 34 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 30 of 34 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 29 19 Staff must not work at the 11/11/2009 home unless satisfactory checks have been performed. These must include obtaining two written references. This will show that the home have performed full pre employment checks on staff before they care for vulnerable adults. 2 35 13 Suitable systems must be in 12/11/2009 place to ensure secure systems and facilities are available for the safekeeping of money on behalf of people in the home. This will show that be storage facilities are secure, and will protect both people and staff at the home. 3 37 13 Evidence must be provided to show that: there is a qualified first aid on duty at all times, all staff have 16/11/2009 Care Homes for Older People Page 31 of 34 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 received moving and handling training, training in infection control, and training in food hygiene. This will show that staff have received the necessary training to be able to care for vulnerable people in a safe way. 4 37 23 Evidence must be provided to show that staff have received suitable training in fire prevention and the procedure to be followed in case of fire. This will show that staff have received the necessary training to be able to care for vulnerable people in a safe way. 11/11/2009 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 1 The manager should ensure the statement of purpose and service user guide are up to date and made available to people who use the service. Two signatures on hand written entries on the MAR sheet would minimise errors being made when transcribing prescriptions. Staff should have easy access to contact numbers and details for staff to use if they suspect abuse. 2 9 3 18 Care Homes for Older People Page 32 of 34 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 4 36 The manager should ensure systems are in place to ensure records kept at the home are secure, up to date, accurate and in good order to show that running of the business is efficient and effective. Care Homes for Older People Page 33 of 34 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). 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