Care Home: Warmere Court

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What the care home does well The home is well maintained, clean and well furnished with homely furniture, fixtures and fittings. The home is well managed and in the main run in the best interest of the residents who live there, outcomes for residents are good. Residents are cared for by a well trained team of staff and the interaction between the staff and the residents is good. Residents told us that they are able to make choices about how they spend their day. Residents and relatives spoken to praised the staff and were complimentary about the service they receive. The medication policies and procedures used by the home are safe and robust. Residents are treated with dignity and respect and their right to privacy is protected. Prospective residents, advocates and families are invited to view the home and stay for lunch or tea. Trial stays are arranged enabling the resident to decide if the home would be right for them. Some comments included: "Staff are very caring towards residents and there is always an appropriate use of medical services". "I have the freedom to do what I like, to come and go as I please with no strict regimes". "Staff are very kind to me and the food is nice". "The staff are excellent". Makes me feel wanted and cared for". I am well cared for and the staff are always helpful". What has improved since the last inspection? This was the first inspection of the service. What the care home could do better: The health and wellbeing of all of the residents must be monitored at least monthly and any remedial action taken if problems are identified, such as referrals to other health professionals. Menus should be available in the units in a format suitable for all of the residents. Some comments from residents were: "More activities as I get bored during the day". "Slight change in menus and better access to a phone". Four residents told us in surveys that more staff was needed although on the day of the visit no one when asked expressed a concern about this. We are told in the AQAA that plans for the next twelve months include: Develop a menu that incorporates more preferences of the residents. (We are told in the AQAA that the cooks are already gaining feedback on likes and dislikes in order to devise better menus). Extend our activities program to include more specific choices and preferences of residents and recruit an activities co-ordinator by the end of October 2009. Develop greater links with the local community. Continue to train and develop staff. Key inspection report Care homes for older people Name: Address: Warmere Court Warmere Court Downview Way Yapton Arundel W Sussex BN18 0HN     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: Ann Peace     Date: 0 9 0 9 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 31 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 31 Information about the care home Name of care home: Address: Warmere Court Warmere Court Downview Way Yapton Arundel W Sussex BN18 0HN 0000 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Shaw Healthcare Ltd Name of registered manager (if applicable) Mrs Julie Levy Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 40 The registered person may provide the following category/ies of registration only: Care home only (PC) to service users of the following gender Either Whose primary care needs ion admission to the home are within the following categories Old age, not falling within any other category (OP) Dementia (DE) Date of last inspection Brief description of the care home Warmere Court is a modern purpose built, 40 bedded care home situated in the village of Yapton in West Sussex. The home is in close proximity of local shops. Warmere Court is registered to care for older people who need personal care and Care Homes for Older People Page 4 of 31 Over 65 0 40 40 0 Brief description of the care home support and dementia care. All bedrooms have en-suite facilities with a shower. The premises are owned by Shaw Health Care who have appointed Mrs Peter Nixey to be the Responsible Individual for the home. The registered manager is Mrs J Levy who is responsible for the day to day running of the home. Fees range from 600 pounds to 650 pounds per week. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: An unannounced visit was made to the home on 9th September 2009 and lasted six hours. Before the visit to the home we looked at all of the information we have received from the home. This included the Annual Quality Assurance Assessment (AQAA) which is a document completed by the home. The AQAA gives the home the opportunity to say what it does well and provide evidence of this. It also gives them the opportunity to say what they feel they could better and what their future plans for the home are. It tells us how they have dealt with complaints and concerns, any changes to how the home is run and how well they care for people. The AQAA also gives us some numerical information about the service. The AQAA had been completed in full and was clear and concise. We looked at twenty surveys that were returned to us from residents living at the Care Homes for Older People Page 6 of 31 home, three surveys from staff who work at the home and two surveys which were returned from health professionals who visit the home. During the visit we talked to residents who live at the home, the majority of the staff on duty, the registered manager and two visitors. We looked at information about the residents who live there and how well their needs are met. We looked at other records that must be kept and checked that staff had the skills knowledge and training to meet the needs of the residents they support and care for. We also looked around the building to make sure it was clean safe and comfortable. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 31 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 31 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 31 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. Pre admission procedures and assessments are carried out before admission to ensure identified needs can be met. Each resident is provided with a contract and terms and conditions so residents and their representatives are clear about their rights within the home. Intermediate care is not offered at the home but respite care is available. Evidence: We looked at the homes statement of purpose and service users guide and they both contain information that reflects most of the the services provided in the home. They do list some of the activities that they say are available that are not presently offered i.e. Gardening club, Tai Chi, Current affairs. Mrs Levy does need to point this out to prospective residents and alter the documentation to reflect what is presently offered. We also questioned one area where the statement of purpose stated the number of Care Homes for Older People Page 11 of 31 Evidence: staff that would be on duty which was not what was displayed on the duty rota, we were told that the staff numbers printed were for full occupancy of the home. The information can be made available in large print, Braille and audio. We received twenty surveys from residents living at the home, twelve said they had received enough information about the home to make a decision about whether the home would suit them, four said they had not and four did not know, fourteen said they had terms and conditions and the rest did not know. However we did see terms and conditions in all of the care records we examined. We looked at the pre admission assessments, assessments and care plans for five residents. The records confirmed that the relevant information had been gathered and the assessments carried out before residents were admitted to the home either from prospective residents or their family. Where possible assessments/care plans had been signed for by the residents or their representative. In the majority of cases when the assessments were tracked to the care planning and risk assessments they were appropriate. Staff told us that they are given enough information about residents to be able to look after them and that they are given regular training and support to be able to meet the needs of residents. Two health professionals who completed surveys told us that accurate assessments are carried out to ensure the home will be able to meet the needs of prospective residents. Warmere Court does not offer intermediate care but respite care is available. Care Homes for Older People Page 12 of 31 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. In the majority of cases, residents have up to date care plans which staff follow to meet identified needs. In the majority of cases residents health is monitored and changes in health and welfare acted on. Medication polices and procedures are safe and robust. People are treated with dignity and respect and their privacy is protected. Evidence: All residents living in the home have a care plan which has been developed from their assessments and risk assessments.The care plans of five residents were examined during our visit to see if the care plans reflected needs and how they were to be met and monitored. The care plans were detailed and in the majority of cases had been updated to show residents needs were being monitored. We did note some inconsistencies in three of the care records in relation to monitoring on going health problems which could adversely affect residents, these were discussed with the manager at the conclusion of the inspection and we were told that they would be investigated and any action Care Homes for Older People Page 13 of 31 Evidence: needed would be taken. One related to resident who was complaining of a problem with their mouth, when we asked staff, they said they knew about it but there was nothing written in the care plan and there was no evidence that this was being monitored or followed up with a referral to a dentist. In the majority of cases the care plans had been updated on a monthly basis. Daily records are maintained and any changes in residents condition reported to team leaders who exchange information at handover sessions between shifts. Individual risk assessments are in place and in the majority of cases where a risk to residents welfare has been identified and these are updated regularly. In surveys sent to us, ten residents told us that the staff always listen to them and act on what they say, nine said usually and one said sometimes. They all said their privacy and dignity is respected, care is given in the privacy of their own bedrooms and toilet and bathroom doors are kept closed while care being carried out. They told us they get the care and support they need, ten said there was always enough staff available to care for them and nine said there are usually enough staff. All said they get the medical care they need. Health professionals told us that residents health and social care needs are monitored reviewed and met and that the home always seeks advice and acts upon it. We spoke to a new member of staff who confirmed that they had the basic induction when they started and they were due to go on a more comprehensive one in the near future. Staff told us that they had up to date training to be able to look after the residents in their care. During our visit we did notice that staff were constantly on the go and very busy. On one unit a relative was trying to get a member of staffs attention to say the residents in one particular unit had not had their 11 0 clock drinks at 12.20 pm. The two members of care staff were busy taking a resident to the bathroom so that left no one to serve drinks although they were an hour late anyway. We did bring this to the attention of the team leaders who were on duty, we were told that they were not aware of this as one team leader was covering two floors the other team leader was undertaking a medication audit. Care Homes for Older People Page 14 of 31 Evidence: This did indicate that there was either not enough staff on duty or that they were not very well organised, we did discuss this with Mrs Levy at the conclusion of the inspection who assured us that there was sufficient staff on duty but did admit that residents should not have had to wait for their drinks, Mrs Levy told us this would be looked into. All residents we spoke with and their relatives were very complimentary about the staff and the way they look after them. There are medication policies and procedures which staff follow,we observed part of the medication round and could see that safe procedures are followed, the team leader we observed was very patient and sympathetic towards residents who showed they had a good relationship with her. All staff who administer medication have regular training and on the day of our visit a medication audit was being undertaken which indicates that the home are checking their own procedures on a regular basis. Through observation of the staff in their interactions with residents and by talking to residents and staff we concluded that is a resident was dying the staff would treat them and their family with care, sensitivity and respect. Staff told us that this area is covered in their induction. Care Homes for Older People Page 15 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some activities are offered but there needs to be more especially person centred activities. Residents are encouraged to maintain contact with their family and friends. Residents are offered well-balanced meals with alternatives always offered. Evidence: When we spoke to residents they told us the routines in the home are flexible they could get up and go to bed when they wanted to and although mealtimes are set they could eat at other times if they wished. One survey told us that: Freedom to do what I like, to come and go as I please, no strict regimes. The home is in the process of recruiting an activity co-ordinator so although there are activities offered they are minimal at present. The home is attached to a day centre and a member of staff from there does undertake some activities at present. On the day of our visit there was a cake making session planned which a number of residents took part in. Some comments were made in the surveys that residents would like more one to one activities as well as group activities. We were told that the home are in the process of compiling life histories and interests of residents so that activities can be planned to meet individual social needs. Once the Care Homes for Older People Page 16 of 31 Evidence: activity co-ordinator is in post then this will be extended. Seven residents who returned surveys told us that there were always enough activities for them to take part in, seven said there were usually enough activities, five said sometimes and one said there was never enough activities. We were told by Mrs Levy that activities, both group and individual will improve when the activities co-ordinator is in post. We were told that the home was due to take ownership of a minibus the week of our visit which will enable residents to go out on trips. External entertainers do visit on a regular basis and events are planned for Halloween and Christmas. Recent activities held at the home included a BBQ, a summer fete and a falconry display. There is a newsetter called The Warmere Warbler which is circulated around the home. We are told in the AQAA that plans for the next twelve months include residents being more involved in planning activities. There were copies of the residents meeting on the notice boards and we could see that residents are consulted about the running of the home and their comments are taken seriously. Surveys sent to us by residents about the meals told us that eight thought the meals were always good, eight said the meals were usually good and four said that they were sometimes good. We were told that the home had recognised there was a problem so residents had been invited to suggest meals for the menu, we were told by residents that the meals had improved since the surveys were sent. The menus were displayed, but in small print on the wall outside of the units. Residents told us that they would like copies of the menus on the tables. When we spoke to Mrs Levy she told us that the new menu holders had just been delivered to the home so the menus would soon be displayed in all units. Regular drinks are served but during our visit we were told by a relative that the residents on one unit were still waiting for their mid morning drinks at 12.20pm, although there did not seem to be a problem in other units. The possible reason for this is mentioned in the previous section related to staffing levels and if they are enough for the dependency of the residents accommodated. Care Homes for Older People Page 17 of 31 Evidence: Snacks are offered, there was fresh fruit available in all of the units. The dining room tables were nicely set with tablecloths, condiment sets etc. At lunchtime on the day of our visit residents were given the choice of spaghetti bolognaise or soya bolognaise, gammon, saute potatoes, ratatouille or salad. This was followed by rice pudding and ice cream. Soup, sandwiches, pasty and beans were on the menu for supper. We sampled the food and found it to be well balanced and tasty, in the majority of cases residents seemed to enjoy their meals and staff were on hand to help those who needed it. One resident told us that their mouth was sore and that staff were aware, but at lunchtime we saw they were given a meal that it was difficult for them to eat, when this was bought to the staffs attention they did say that they could order an alternative softer diet. We did question why a softer meal had not been pre ordered as the staff said they knew about the problem. When we looked at the care plan there was nothing to say that the problem had been recognised or that action was being taken to resolve the problem. When we bought this to the attention of Mrs Levy she said this would be immediately dealt with. We visited a number of residents rooms and could see that they are encouraged to personalise their rooms to make them more homely. Visitors told us they are always made welcome when they visit. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure enables residents and other people using the service to know that any complaints will be taken seriously and responded to. The homes safeguarding adults procedure and training for staff safeguards residents living at the home. Evidence: The home has a complaint procedure, which is outlined in the statement of purpose and displayed in the home. We looked at the complaint procedure and log and could see that complaints are taken seriously and acted on in a timely fashion. We asked residents in our survey whether they knew how to make a complaint, nineteen told us that that knew how to complain informally one said they did not. Fourteen said they knew how to complain formally six said they did not. Mrs Levy is advised to ensure that all residents are clear about the procedure. When we asked staff they all knew what procedure to follow if someone made a complaint. Shaw Health care also monitors complaints on a monthly basis. We looked at the homes procedures for safeguarding residents and from records could see that all staff have training in what constitutes abuse and are aware of how to raise an alert. Recruitment records also confirmed that appropriate checks and references are carried out before staff work in the home to ensure residents are safeguarded. During the visit we asked staff about what they would do they if they Care Homes for Older People Page 19 of 31 Evidence: suspected abuse and they could all tell us the correct procedure and said they would have no hesitation in reporting it. We asked six residents if they felt safe at the home and they all said they did. They thought staff were very kind and caring towards them. Information on advocacy services is displayed and is accessed if needed. Care Homes for Older People Page 20 of 31 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 well maintained, clean, bright and airy. The physical design and layout of the home provides residents who live there with a safe environment, communal areas of the home are well furnished and homely. Evidence: Warmere Court is a purpose built care home located in a quiet residential setting in the village of Yapton. The home has two floors there are two units on each floor providing accommodation in each unit for ten residents. All bedrooms are single with en-suite facilities which include shower rooms. Residents moving into the home are encouraged to bring in personal items to make their rooms more personalised and so will be more homely for them. All areas of the home are clean, bright, airy and decorated to a high standard. Communal lounges/diners are well decorated and furnished with supportive chairs, flowers ornaments and pictures. There are also televisions and music centres in all lounges. Assisted bathrooms and toilets are easily accessible and with appropriate signage and there are quiet rooms that residents or their relatives can go into. There were Care Homes for Older People Page 21 of 31 Evidence: numerous small tables, stools and pouffes around that residents can use to make themselves comfortable. Residents are free to wander into other units on their floor if they wish to socialise with other residents or take part in any activities going on. There are modern kitchen areas in all units where staff can prepare snacks and drinks as needed away from the main kitchen area. Staff have started to decorate the corridors with themed pictures and articles and Mrs Levy told us that they were still in the process of completing this. A key feature of the home is the indoor street which runs along the length of the home on both floors linking all units and facilities. Residents personal laundry is cleaned in a laundry situated on the first floor of the home this is large and contains up to date modern equipment. There is a reception area and administration offices on the ground floor near to the entrance to the home, there are also offices on each floor where care staff meet for hand overs and where records are stored. Medication storage rooms adjoin these offices. The kitchen is situated on the ground floor and is well equipped. Staff facilities are provided. Access to the building and to each floor is only possible through a key fob security system operated to ensure confused residents are safe and do not wander outside without care staff. Because the home is not yet fully accommodated, staff do go between floors to work when necessary but we were told that when the home is full, a staff team will be designated to each floor. Policies and procedures are in place for infection control and staff have training for infection control and health and safety. Records indicated that the temperature of the baths are taken before bathing residents to prevent risk of scalding. A call bell system is provided in every room so staff can attend to residents who need help. There is a large accessible safe garden planted with shrubs and flowers with suitable pathways and seating for residents to use. A number of residents were outside when we visited. The home is suitable for wheelchairs and passenger lifts are provided. Care Homes for Older People Page 22 of 31 Evidence: Maintenance logs are kept and we could see they are completed on a regular basis as required which means that the environment is kept safe and well maintained. In surveys residents returned to us, eighteen said the home is always clean and fresh, two said usually. Care Homes for Older People Page 23 of 31 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. Residents living at Warmere Court are protected by the recruitment procedures in the home and staff receive appropriate training so they can meet the needs of residents living at the home. Evidence: Recruitment policies and procedures are in place to ensure staff employed by the home have the necessary skills and experience to carry out their roles. Criminal record bureau checks and references were seen on file for four members of staff. This ensures that residents are protected. Induction is given to new members of staff and this was confirmed when speaking to a new staff member who had a basic induction and was waiting to go on a more comprehensive one. We were shown that a staff training program is in place and a matrix kept to ensure all staff are given regular up dates. We also saw that a supervision and appraisal system to support staff is in place. Over 50 of care staff have achieved a National Vocational Qualification of Level 2 and above. We asked people in our survey about whether they thought enough staff were available. Ten residents told us that there was always enough staff on duty to meet their needs, nine said usually and one said sometimes. Two health professionals told us the home usually had staff on duty with the right skills and experience. Two Care Homes for Older People Page 24 of 31 Evidence: members of staff told us that there is usually enough staff on duty to meet needs of residents but one member of staff told us that there are never enough staff on duty. Two said there is always enough staff on duty with the right support and experience , one said usually. Staff also told us that they were always supported and communication is usually good. During our visit we did question with Mrs Levy whether the the staffing levels of one team leader for both floors and four care workers plus one care worker on induction were enough for twenty nine residents especially as we could see one team leader rushing between both floors and on one unit residents not getting their mid morning drinks until 12.20pm. Mrs Levy told us that there was sufficient staff on duty to meet the needs of the residents presently accommodated but would look into what had happened, and that as more residents are admitted then staff numbers would increase. We said that staffing levels should not only meet numbers of residents accommodated but must be based on the dependency of the residents and of those being admitted. The home has been using agency staff which does not enhance consistency for residents but this use has decreased recently as more permanent staff have been recruited. We could see that the home checks any agency staff working in the home have had safety checks carried out and they ask for proof of suitability before they work at the home. Staff when spoken to knew about the residents and their individual needs and in the majority of cases their response was in line with care plan requirements. In addition to care staff the home employs domestic staff, laundry staff, a cook and catering staff, maintenance men and administration staff. Some of the comments about the staff from the surveys included: They look after us very well. They make me fell wanted and cared for. The staff are excellent.Staff individually very good but a poor system at mealtimes.Well cared for, all her needs are met and she is very happy and the staff are always helpful. Four residents made comments about the need for more staff they included:More staff would be beneficial to the running of the home.Employ more staff. Employ more staff so they dont have to run around so much and the residents have more one to one. Sometimes more help is needed. One member of staff said Need more Care Homes for Older People Page 25 of 31 Evidence: staffing levels to be able to carry out care and daily activities for individuals rather than groups. Care Homes for Older People Page 26 of 31 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 is well managed and in the majority of cases run in the best interests of the residents living there. Residents are kept safe by staff following correct health and safety policies and procedures. Evidence: Mrs J Levy is the registered manager for Warmere Court, Mrs Levy is an experienced manager who has achieved the Registered Managers Award. There is a clear and accountable management structure and a 24 hour manager-on-call system to support staff during unsociable hours. Mrs Levy completed the Annual Quality Assurance Assessment in good time and it contained clear relevant information which was supported by evidence. The AQAA told us about the changes the home had made and where they still want to make improvements. Mrs Levy is supported by an administrator who looks after some of the records related to the running of the home. Mrs Levy ensures regular audits are Care Homes for Older People Page 27 of 31 Evidence: undertaken in all areas of the running of the home including health and safety, fire safety, medication and care plans. We were told that in the week of our visit Shaw Healthcare had undertaken a full audit of the home, which indicates that a robust quality assurance system is in place. Regular residents and relatives meetings are held and the minutes of these were available with notice of any action taken as a result. Monthly unannounced visits are undertaken by the area manager and copies of these reports were available in the home for us to see. Those residents and relatives we spoke to told us that they found the managers at the home approachable and open. Records demonstrated that a staff supervision and appraisal system is operation in the home and staff told us they were well supported by senior staff. We examined records of the administrative systems at the home such as records of systems to keep residents safe and these were in order. The home does not manage the financial affairs of residents and does not handle large sums of money. Where small amounts of money is held, there are safe systems in place to ensure no resident is put at a disadvantage, these are audited on a regular basis. The home has access to professional business and financial advice and has all of the necessary insurance cover to enable it to fulfill any loss or liabilities. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 31 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 8 13 Residents health and well being should be monitored and appropriate remedial action taken when problems are identified. To minimise the risks to residents and promote health and wellbeing. 30/10/2009 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 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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