Care Home: Warren Park

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• Chirnside House
• Keer Sands Residential Home
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• Parkside
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What the care home does well Warren Park is situated in a pleasant residential area that provides residents with a peaceful environment. The service has been extended over the past few months but it does not impact on the pleasing surroundings for residents. The service is well maintained and provides residents with a comfortable environment. The garden grounds are well maintained and provide residents with many pleasant sitting out areas. One relative interviewed stated, "They have very nice surroundings and the grounds are excellent". Residents are able to make choices about how they live their lives. Although many of the residents are dependent on staff they are encouraged to make choices about how they spend their time. One resident interviewed stated, "Staff do help you get in and out of the bath, I feel confident with the staff, and I want to go to bed at 7pm and this is accommodated". A relative interviewed stated, "I think this place is fabulous, I really do, They give residents a choice, they see what....wants for tea, if she doesn`t want to get up in the morning, they accommodate this, she can go downstairs or come up, they ask her". Policies and procedures in the service ensure that residents are protected. Residents are provided with a well maintained, clean and very comfortable environment. One relative interviewed stated, "It`s lovely, really nice, the home is very, very clean". Warren Park provides sufficient supportive staff to ensure residents needs are fully met. Residents and relatives were complimentary about the staff. Relatives interviewed stated, "I am very happy with Warren Park, every time I come in there is someone with her, they are caring with her, staff have been great, they are gentle with her, staff are lovely with everyone". Staff create a pleasing atmosphere for the residents, it is not noisy but enables residents to live in a comfortable and peaceful environment. The service is run for the benefit of the residents. Their views are listened to, which enables them to have a say in how the service meets their needs. Residents are regularly canvassed for their views. The manager ensures she speaks with the residents regularly but does not intrude on their privacy. All necessary checks are carried out to ensure the safe running of the service with certificates and records evidencing this. What has improved since the last inspection? Pre admission assessments are now signed by the person carrying out the assessment. The service has been extended to provide an additional ground floor suite of 8 bedrooms with en-suite facilities, an extra shower room, sluice and additional office space for the nurses and mangers to use. The conservatory has been extended to provide more internal public space for residents.The garden grounds have been refurbished in the extension area to provide a courtyard and seating area for residents. The terrace has been extended to provide more seating for residents. Two areas of which give residents protection from the sun with an umbrella and gazebo. Staff application forms are more fully completed. Register provider visits are being carried out and reports have been made, one of which was viewed during the visit. What the care home could do better: The assessment area needs to be improved so that a clear picture is in place that shows full admission details are accessed prior to and on admission to the service. All care plans need to reflect the changing needs of the residents with resident agreement in place. Residents were unsure about the care plans. One of the relatives understood about care plans and confirmed they had been involved in the planning of care. One relative interviewed stated, "I discussed the care plan when ....first came". The body mapping document needs to evidence clearly what area of the body is affected. This will ensure that staff are familiar with an up to date record of the progress of any wound or rash. Risk assessments need to be fully completed so that staff are clear about what the risks are and how they are managed. Social assessments could be better completed to provide staff with a clearer understanding of a residents background and preferences therefore making it easier for prospective residents to settle into the service. The lunchtime menu should offer residents an alternative meal therefore providing more choice. The medication fridge record was showing too warm during the visit. The temperatures need to be monitored regularly to ensure prescribed medication is kept at the correct temperature. When references are received for prospective employees the date needs to be recorded and this will ensure authenticity. Up to date staff training needs to be evidence in staff training records, which will make it easier to ascertain staff training attended throughout the year. It would benefit the service to ensure all records are stored in such a way as to make it easier for people to find information as at present finding information can take up additional time. Key inspection report Care homes for older people Name: Address: Warren Park 66 Warren Road Blundellsands Liverpool Merseyside L23 6UG     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Margaret VanSchaick     Date: 3 0 0 6 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: Warren Park 66 Warren Road Blundellsands Liverpool Merseyside L23 6UG 01519320286 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: karl.lysaght@warrencare.co.uk Mr John Lysaght care home 38 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Maximum no. registered - 30, of which up to a maximum of 29 N (nursing) and up to a maximum of 1 PC (personal care). Service users to include 38 OP. The Manager to undertake NVQ Level 4 or equivalent by April 2005. Date of last inspection Brief description of the care home Warren Park is a Care Home with nursing which provides care for 38 residents. Warren Park is a converted building in a residential area. The service has four floors with lift access to three floors and stair access to the administrative area on the top floor. There are 27 single rooms. 7 rooms have en suite facilities and 2 double rooms have en suite facilities. A new ground floor extension provides a further 8 bedrooms with en-suite facilities. Bedrooms are situated on three floors with 1 lounge area, a dining room and conservatory available for use of service users on the ground floor Care Homes for Older People Page 4 of 31 Over 65 30 0 Brief description of the care home and a lounge dining area on the 1st floor. Adaptations are fitted throughout the service and a ramp accesses the front of the service and garden grounds. Manual handling equipment is in place for residents use. A call bell system is in place. There is parking to the front of the building and well established and maintained gardens and grounds surround Warren Park. There are public transport systems within 5 minutes walk. Weekly fees range from £520-£580. 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: A site visit took place as part of the unannounced key inspection. It was conducted over one day by one inspector and lasted approximately 8 hours. Thirty seven residents were accommodate at this time. As part of the inspection process most areas of the service were viewed including many of the residents bedrooms. Care records and other documentation was also viewed. Discussion took place with residents, their relatives and staff. The inspection was conducted with the registered manager Alison Gale, Karl Lysaght and Jonathan Lysaght both of home are directors. During the inspection three of the residents were case tracked (their care files were looked at and their views of the service were obtained). All of the key standards for older people were inspected. Previous recommendations were looked at and most were met. Satisfaction forms Have your say about..... were distributed to residents and their Care Homes for Older People Page 6 of 31 relatives on the day of the visit and to staff prior to the inspection. A number of comments included in this report are taken from interviews with residents, their relatives and staff. An AQAA (Annual Quality Assurance Assessment) has been completed. The AQAA comprises of two self assessment questionnaires that focus on the outcomes for people. The self assessment provides information as to how the manager and staff are meeting the needs of the current residents and a data set that gives basic facts and figures about the service including numbers and training. The service delayed returning this to the Commission due to problems with changing offices. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? Pre admission assessments are now signed by the person carrying out the assessment. The service has been extended to provide an additional ground floor suite of 8 bedrooms with en-suite facilities, an extra shower room, sluice and additional office space for the nurses and mangers to use. The conservatory has been extended to provide more internal public space for residents. Care Homes for Older People Page 8 of 31 The garden grounds have been refurbished in the extension area to provide a courtyard and seating area for residents. The terrace has been extended to provide more seating for residents. Two areas of which give residents protection from the sun with an umbrella and gazebo. Staff application forms are more fully completed. Register provider visits are being carried out and reports have been made, one of which was viewed during the visit. 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. Care Homes for Older People Page 9 of 31 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 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 11 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. This area needs to be improved so that a clear picture is in place that shows full admission details are accessed prior to and on admission to the service. Evidence: The Service User Guide has been updated and the draft version was viewed during the visit. It has been put together very well, is easy to follow and evidences the information needed to meet the standard. The registered manager usually carries out all pre admission assessments of prospective residents. The AQAA stated that prospective residents are offered trial visits and periods of respite prior to admission. Relatives confirmed this. Residents and families interviewed were happy that they chose Warren Park. Relatives interviewed stated, It was recommended by a friend whose relative was resident and I chose this one, it was recommended. The assessment documentation viewed evidence two prospective residents were assessed prior to admission. Another residents assessment Care Homes for Older People Page 12 of 31 Evidence: was not available to view although some information with regard to their present medication needs and previous medical history were identified. Residents and their families confirmed that the manager had met with them to assess and discuss their care needs prior to admission. Relatives interviewed stated, The manager came to the other home and assessed .... there and ....was in hospital and the manager came out to assess them. The assessments carried out covered many areas including previous medical history, medication, diet, mobility, sleep pattern, pain, personal care and falls. In one or two areas the assessment was blank or had insufficient detail, which would make it more difficult to identify the individual care needs that need to be highlighted so that they can be documented on the care plan. The date of admission was absent for one resident. The assessment documentation needs to improve to ensure all care needs are identified prior to admission. All assessments need to be signed and dated and the admission date to the service recorded. Care Homes for Older People Page 13 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. All care plans need to reflect the changing needs of the residents with resident agreement in place. Evidence: Three residents were case tracked. Care plans gave the staff sufficient information to care for the residents. Some of the residents health care needs were clearly identified and evidenced clear goals and effective management. Others were unclear in some areas and difficult to follow at times with missing dates. The care files have been set up individually and are sectioned for each area, which should make it easier to follow but in some instances it is difficult to access information. The care plan for one resident whose condition has changed evidences an updated plan of care for the residents specific needs. It is well written and provides staff with a full, easy to follow plan of care to meet this residents needs effectively. There is no documented evidence that care plans are discussed and agreed with the resident. Residents interviewed were unsure of care plans. One relative interviewed Care Homes for Older People Page 14 of 31 Evidence: confirmed they had seen the care plan and stated, I discussed the care plan when ...first came in and we discuss any changes. They discuss any problems with me and if they contact the Gp they inform me immediately, we are kept informed of progress. Risk assessments are in place with regard to many areas including falls, bed rails and bumpers, going out and scalds. Most of them were completed and reviewed but one with regard to falls was not completed. A body map is in place for residents and in one resident shows evidence of where the wound is. In another the date is recorded but there is no evidence of where the problem is. Other documentation showed there was a problem but the body map was otherwise blank. Relatives interviewed were very pleased with the care provided. Relatives interviewed stated, ....had a nasty pressure sore, which they treated but it has healed up. They change .... and turn her and are very careful when they do this and gentle, I think they look after my wife very well and ....has got better since she came in, they get a Dr at a moments notice. Nurses interviewed fully understood the care needs of the residents. All were knowledgeable and up to date with the residents particular needs. The daily evaluation records show clear information with regard to the residents individual care. Care documentation is written in respectful tones and promotes the residents dignity. Residents have access to specialist equipment where needed including hoists, beds and pressure relieving aids. A nutritional assessment tool and Waterlow scores (tool for measuring risk of developing pressure sores) are recorded regularly. Residents receive good support from other health professionals where needed, including chiropodists, Gps dietitians and opticians. All of the care documentation looked at evidenced this. A resident interviewed stated, I see the Dr if I ask and the chiropodist visits regularly. Medication storage showed it was well organised and there was good stock rotation. Four medication trolleys with secure locks and cupboard storage are in use. Medication is provided mainly in blister pack format. Medication records viewed at random, were clear and easy to follow. Photographs of the individual residents are in place on the medication folders for easier identification during medication rounds. One or two of the controlled medicines were audited at random and found to be correct The medication fridge was measuring warmer temperatures than medication should be stored at. The manager was aware of this and is trying to resolve the situation by moving the fridge and storage of medication to an alternative room, yet to be Care Homes for Older People Page 15 of 31 Evidence: identified but one that will give them more storage space. Residents confirmed that staff provided medication at the right times. One resident interviewed stated, Staff give me my medication on time. A contract is in place for all sharps, clinical waste and waste medication. One priority for the management and staff at Warren Park is to promote the dignity and comfort of the residents. All staff were noted to be consistently respectful to residents and their families. Friendly interaction was observed during the visit. Staff were not intrusive and respected residents privacy throughout the visit. Residents who were being nursed in their bed looked comfortable and well cared for. One relative stated, ....is always in clean clothes, staff are always gentle. Many resident have the use of their own telephone with others able to use the public phone or the office phone, which is portable for privacy. Care Homes for Older People Page 16 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to make choices about how they live their lives. Evidence: The service employs an activities coordinator who works two to three afternoons a week and is responsible for planning and arranging activities that are suitable for the residents. Activities organised include trips out, bingo, arts and crafts, pampering afternoons, singing, large card games, skittles and afternoon teas/sherry. One of the residents interviewed about the activities stated, There isnt much going on, they do have musical afternoons, my husband takes me out and I do like to go into the garden. Relatives interviewed confirmed there are occasional activities and stated, Every week, they have a sing a long and .... gets involved in that and ....goes down on Wednesdays and Fridays for sing a longs, the staff make sure residents go to this if they want to. The service also continue to publish the monthly newsletter for residents and the April issue from this year was looked at. This gives residents information of a newsy nature such as babies being born to staff, birthdays and upcoming events. Items of interest are also included such as crosswords, poems and short stories. Care Homes for Older People Page 17 of 31 Evidence: Residents are asked about their social interests prior to admission with some information well documented and others not so much information. During the visit the hairdresser was attending to some of the residents in the refurbished salon. Residents enjoyed the experience and were very pleased with the results. Residents are encouraged to retain as much independence as possible. Residents are able to make choices about how they live their lives and are encouraged to with staff supporting them where needed. Residents interviewed confirmed they could choose how to spend their day. One resident interviewed stated, I want to go to bed at 7pm and confirmed this is accommodated. Residents were happy with the support provided by staff. One resident interviewed stated, Staff do help you, I need help in and out of my bath, I feel confident with the staff. Families interviewed were happy with the care and support provided to their relatives. Families interviewed stated, I think this place is fabulous, I really do, they give the residents a choice, see what ... wants for tea, if .... doesnt want to get up in the morning, they enable her to stay in bed, .... can go downstairs if she wants to or come up, they ask her and ...is happy here and Mt wife decides when she wants to get up.. The service have open visiting and residents are able to see their visitors in their own room or one of the public rooms if wished. Relatives are encouraged to maintain contact with the service and visit as often as they wish to. Relatives interviewed confirmed they are made welcome when they visit. One relative stated, Staff make me feel welcome, I look forward to my coffee, the visiting times are flexible, you can come when you want to. Residents are encouraged to personalise their bedrooms as seen during the visit. Residents religious needs are met by the local churches offering Communion where wished. Residents and families were complimentary about the meals served at Warren Park. One resident interviewed stated, The food is average, we do get a choice, I have my breakfast, lunch and tea in my room or the dining room. Other residents eating their breakfast confirmed they enjoyed the meals served and said food was very nice. Relatives interviewed stated, We had an excellent lunch today, the meat broke up nicely and ....really likes the desserts. Meals are served in pleasant surroundings and residents have the choice of two dining areas. Residents meals looked appetising and were well presented. Care Homes for Older People Page 18 of 31 Evidence: The menu was viewed and showed a varied and nutritious selection of meals. Although there is no alternative main course printed on the menu for lunch, residents and their families confirmed that there was always a choice for residents. The cook told us that residents are asked what they would like for lunch the night before and if they dont want the main course they can have what they like. The cook stated, I just get what they fancy on the way into work that morning if I dont have what they want in stock. Care Homes for Older People Page 19 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. Policies and procedures in the service ensure that residents are protected. Evidence: Residents and their relatives have access to a complaints procedure that is easy to follow. Copies are made available for residents and their visitors and the procedure is included in the Service User Guide. Local advocacy contact details are also available for residents. None of the residents spoken with were familiar with the complaints procedure although all were confident that had they needed to make a complaint that it would be listened to and acted on. There have been no complaints since the last inspection. Most of the relatives interviewed were aware of the complaints procedure and stated, I have no need to make a complaint, No I have not made any complaints, I would go straight to Alison (the manager) or one of the qualified staff, No I have not made any complaints but I am aware I could see Alison and I have never had to make a complaint, Im not aware of a complaints procedure, not had any need to. The service has a niggles book, which is to be used to record any minor issues but it is empty. The manager told us she speaks to the residents on a daily basis and deals with any concerns then. The service has a copy of the local adult protection procedure. The policies and procedures set up in the service ensure that any allegations or incidents of abuse Care Homes for Older People Page 20 of 31 Evidence: would be referred, followed up and action taken. Staff have attended adult protection training provided by the service and by Sefton. The service have not had any adult protection issues. Care Homes for Older People Page 21 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with a well maintained, clean and very comfortable environment. Evidence: The service has a planned maintenance and refurbishment programme with routine maintenance carried out and records kept. A full time maintenance person is employed to carry out maintenance of the service. Warren Park looked very well maintained on the day of the inspection and the garden and grounds looked well cared for too. Residents interviewed with regard to the accommodation stated, As these places go, its pretty good, my bedroom is alright, they brought an electric fan in to make us more comfortable in this hot weather and I like my room. Relatives interviewed were complimentary about the accommodation and stated, Its lovely, really nice, the home is very, very clean, They have very nice surroundings, the grounds are excellent and I chose the home, the bedroom is lovely. Since the last inspection the service has had an eight bedroom extension added, which provides additional en-suite accommodation for residents. An additional sluice and shower room has been added also. Storage has been improved and the nurse manager office has been located on the ground floor therefore providing easier access for residents and visitors. The public accommodation has been increased to provide further space for the additional residents. The conservatory overlooking the garden Care Homes for Older People Page 22 of 31 Evidence: grounds has been enlarged. The service provides residents with a choice of public rooms. Some of the residents were observed to use some of this space with others preferring their own rooms. The service provides residents with a pleasant environment to live in. Residents bedrooms are nicely decorated with each room personalised with the individual residents belongings. Some of the residents bedrooms have been redecorated and new carpets fitted. Furnishings throughout the service are of good quality and provide residents with a comfortable environment. The garden grounds are easily accessed by residents and a courtyard outside the new extension has been refurbished. Residents are provided with many seated areas and mature gardens containing plenty of flowers and shrubs. Protection from the sun is provided for residents by the use of an umbrella and gazebo. Adaptations are fitted throughout the service to benefit the residents and a call bell system is in place. The hairdressing salon has been refurbished for the benefit of the residents. The kitchen is well organised and was clean and tidy during the visit. The cook told us she had sufficient equipment with which to run the kitchen. Fridge/freezer and hot food temperatures were in evidence. Fresh fruit and vegetables are delivered twice a week and home baking is provided. The environmental health visited the service earlier this year and commented, an excellent standard of cleanliness throughout the kitchen. The laundry was well organised and had sufficient equipment to run the service. A sluice facility, red plastic bags for soiled laundry and protective clothing was in evidence. There was hand washing facilities for staff and floors were impermeable and walls easy to clean. 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. Warren Park provides sufficient supportive staff to ensure residents needs are fully met. Evidence: The duty rota was viewed and evidences sufficient staff are employed to care for the residents. Additional staff are employed at weekends. Three staff files were examined. The staff files evidence that pre employment checks including police and reference checks were carried out prior to employment. Two of the references had no date therefore it is not known when the references were received. All three police checks came through prior to employment. Application forms and some of the staff training attended is evidenced on staff training files. Passport evidence is in place to confirm identity and trained nurse personal identification numbers (PIN) have been checked to ensure their registration is up to date. Residents and relatives interviewed were happy with staff support. Residents interviewed stated, staff were nice and helpful. Relatives interviewed stated, Staff are overworked, nice and kind, Staff are very good, I think the staff are lovely, its nice and reassuring, I am very happy with Warren Park, every time I come there is someone with her, they are caring with her, staff have been great and gentle with her, staff are lovely with everyone and Staff are nice and patient. Care Homes for Older People Page 24 of 31 Evidence: The service has a planned training programme that has been set up to ensure all staff attend mandatory training throughout the year. Staff training records evidence some of the training and induction courses attended during their employment. Further training information is held on computer records with dates of attendance. Staff training evidenced includes adult protection, induction, health and safety, infection control, manual handling, basic food hygiene and fire. The induction course is run over five days and all new staff attend this on commencement of employment. Many of the staff have attended NVQ training and 75 of staff have gained certificates in this qualification. Staff interviewed were happy with the training provided form the service. One staff stated, I had an induction and also attended all my mandatory training within two weeks of starting, which included fire, first aid, health and safety, pova (protection of vulnerable adults) manual handling and I also attended care of the dying training. Staff working in the service told us they enjoyed their work. Staff interviewed stated, Warren Park provides very good care and I do like it here, I get on well with staff, they are all willing to help you, residents have choices e.g. with clothes, meals going out, Im happy here. The care staff are good to the residents. Care Homes for Older People Page 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is run for the benefit of the residents. Their views are listened to, which enables them to have a say in how the service meets their needs. Evidence: The registered manager is a registered nurse and has the RMA (Registered Managers Award) qualification. The manager has managed the service for approximately 18 years. The manager has attended further training to keep herself up to date including all mandatory training, cardiac and respiratory nursing, deprivation of liberty, foot care, palliative care and medication. Staff were complimentary about how the service was run. Staff interviewed stated, Alison is very supportive and Yes, we get plenty of support. The service has been awarded an external quality assurance award again. The results of which were published and viewed and found to be very positive. Internal quality assurance is also carried out six monthly. The last one was in March this year and the Care Homes for Older People Page 26 of 31 Evidence: results of these were viewed. Responses were positive and the views of residents are taken into account in regard to how the service is run. Management told us that residents and staff meetings continue to be held twice yearly but none of the minutes of these was available to view during the visit as they were held on different computer records. One relative interviewed confirmed they had been asked for their views and stated, I have taken part in a survey. The manager sees the residents on a daily basis and discusses and resolves any concerns they may have on the day. The service is committed to consulting with the residents and their families. The manager also meets with the residents on a one to one basis regularly throughout the year and makes notes of any further concerns they may have. She also listens to any suggestions they may have or changes they would like to see. The notes made were viewed during the visit. The feedback from these discussions is used to inform the service how well they are meeting residents needs. This provides residents with the opportunity to discuss any ideas they may have with the manager in confidence. The service like to promote an open atmosphere where residents and their families feel they can approach management and discuss anything they wish. The registered provider visits are carried out regularly by one of the Directors and these evidence visits are carried out and comments recorded with regard to the running of the service. A sample was viewed during the visit. Policies and procedures are updated annually or sooner if needed. Last updated in January this year. Residents manage their own finances with help of their families were needed. The service do not hold any resident monies. Residents have a lockable facility for valuables. No valuables are held by the service. Accident records are completed and the manager is aware of RIDDOR (Reporting of Injuries, Disease and Dangerous Occurrences Regulations). First aid boxes are in place. The AQAA stated that all servicing and safety checks are in date and we viewed one or two at random during the visit. They were in date. Fire drills are carried out with the most recent in March this year. Care Homes for Older People Page 27 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 28 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 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 3 It is recommended that full information with regard to the admission process is better evidenced and health care needs are clearly identified. This will ensure the service has a clear picture of the needs of the prospective resident and admission details are recorded. It is recommended that all care plans should be agreed and signed by the resident so that they understand and agree with the planned care. It is recommended that the body mapping document should be used effectively as this will clearly identify the area where the resident has a problem. Care documentation should evidence completed risk assessments so that staff are clear about what the risks are and how they are managed. It is recommended that the fridge temperatures should be monitored regularly to ensure that prescribed medication is stored at the correct temperatures. It is recommended that all residents social assessments should provide more information so that staff are aware of the individual residents social needs. Page 29 of 31 2 7 3 8 4 8 5 9 6 12 Care Homes for Older People 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 7 15 It is recommended that the lunch time menu should evidence alternative meals so that residents see they have a choice. It is recommended that all references sought for new staff should evidence dates received to ensure authenticity. It is recommended that staff training should be evidenced in staff training files and not just on computer. It is recommended that record keeping should be improved so that information is easier to find. 8 9 10 29 30 37 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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