Care Home: Wemyss Lodge

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What the care home does well The information that is available about the home provides details of the service and its facilities but does need some updating. Placement in the home is only offered after a robust pre-admission assessment has been completed. Care planning processes ensure that people`s care and support needs will be identified and met in the way that they want. The monitoring of people`s health is good and medical care is arranged as necessary. We are assured that medication procedures remain safe and good practice guidelines are followed. There are opportunities for the people who live in Wemyss Lodge to participate in a wide range of social activities and the support of family and friends is encouraged and welcomed. People will be provided with a high standard of catering and meals are well balanced and nutritious. The home has a clear complaints procedure and any complaints people may have will be listened to and acted upon. Staff awareness of safeguarding issues will ensure that people are protected from being harmed. Wemyss Lodge Nursing Home is a well maintained, comfortable and fully equipped care home. It is kept clean, tidy and fresh smelling. The majority of bedrooms are for single occupancy and have en-suite facilities. All communal areas are well furnished and there is a programme of furniture replacement. The people who live in Wemyss Lodge will be cared for by staff who are skilled and competent and able to meet their specific care needs. Recruitment of new staff is in line with safe procedures, which means that only suitable staff will be employed to work in the home. This home is well managed and run in the best interests of the people who live there. Their views will be sought to ensure that people receive the care and support that meets their expectations. People`s health and safety will be promoted because of safe working practices. What has improved since the last inspection? Three requirements were made following the last key inspection. They were in respect of care planning processes, staff recruitment and staff training. We found that the necessary improvements have been made in all three areas, evidencing the services committments in meeting the national minimum standards and the relevant regulations of the Care Standards Act. What the care home could do better: We have not made any requirements as a result of this inspection. We have made four good practice recommendations 1. A separate moving and handling plan be prepared for each person. 2. All entries made on paper records should be legible 3. End of life care planning records must record decisions made and who involved. 4. Update the Complaints Procedure and the Abuse protection policy. Key inspection report Care homes for older people Name: Address: Wemyss Lodge Ermin Street Stratton St Margaret Swindon Wiltshire SN3 4LH     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: Vanessa Carter     Date: 1 7 1 2 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 28 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 28 Information about the care home Name of care home: Address: Wemyss Lodge Ermin Street Stratton St Margaret Swindon Wiltshire SN3 4LH 01793828227 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Wemyss Lodge Limited care home 60 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users requiring nursing care who may be accommodated is 22. The maximum number of service users who can be accommodated is 60. The registered person may provide the following category of service only: Care Home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Dementia (Code DE) - maximum number of places 6 Physical Disability (Code PD) - maximum number of places 2 Date of last inspection Brief description of the care home Wemyss Lodge is a purpose built care home situated in a residential area of Stratton St Margaret, Swindon. The accommodation spreads over 2 floors with en-suite facilities Care Homes for Older People Page 4 of 28 Over 65 0 60 0 6 0 2 Brief description of the care home provided in the majority of the rooms, double rooms are also available. Externally there is a pleasant, accessible garden and a car park to the front. The home is registered with the Care Quality Commission (CQC) to provide nursing care and support, and residential accommodation for up to 60 older people. The home has a full time registered manager, Mrs Kay Thompson and she is supported by an operations manager. There are registered nurses on duty at all times, supported by care assistants. Administration, catering, domestic, laundry and maintenance support services are also provided. Care Homes for Older People Page 5 of 28 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: We completed an unannounced inspection of Wemyss Lodge Nursing Home as part of our planned inspection programme. We were in the home for one day and spent a total of 7 hours there. The last inspection of this service was undertaken in January 2007 and our overall judgement about the quality of the service provided for the people who live in the home was that they received an excellent service. After that inspection we planned to visit again within three years (January 2010). We have completed service reviews in July 2008 and February 2009 and were of the opinion that people still received an excellent service. Prior to this inspection we asked the home manager to complete the annual quality assurance assessment (AQAA). This is a self assessment document that focuses on how well outcomes are being met. The assessment was not due back in time to be included as part of the pre-inspection planning process however the information in the AQAA was checked against what we found when we visited the service and has been Care Homes for Older People Page 6 of 28 used as evidence for this report. The assessment had been completed in detail and provided a clear overall view of the service. During the inspection we looked at records kept by the home, including care records and those that are kept in respect of the running of the home. We spoke to the home manager (matron), the operations manager and some of those staff on duty. We observed the interactions between staff and the people who they were looking after. We spoke to some of the people who live there and any visitors or relatives that were in the home. At the time of this report the fees for placement in the home range between 740 and 940 pounds per week. The fees payable will be determined following assessment and will be based on an individuals dependency needs. Additonal charges may be made for other services and these are detailed in the homes brochure. The home is currently fully occupied, a situation which is normal. They always hold a substantial waiting list of new people who wish to move to Wemyss Lodge. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: We have not made any requirements as a result of this inspection. We have made four good practice recommendations 1. A separate moving and handling plan be prepared for each person. 2. All entries made on paper records should be legible 3. End of life care planning records must record decisions made and who involved. 4. Update the Complaints Procedure and the Abuse protection policy. Care Homes for Older People Page 8 of 28 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 28 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 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information that is available about the home provides details of the service and its facilities but does need some updating. Placement in the home is only offered after a robust pre-admission assessment has been completed. Evidence: The Statement of Purpose, Service User Guide and Home Brochure are informative and provide a very clear picture about the home and what services and facilities it has to offer. They each need updating to reflect the changes in the Care Quality Commission details. Information must also be included about the Complaints procedure. A copy of the homes brochure is given to people who enquire about the home and those who have been assessed as appropriate for placement. we received six of our survey froms back from people who live in the home - they each said that they had received enough information about the home to enable them to make an informed decision. Because the necessary information is available people will know what to expect when they choose to live at Wemyss Lodge. We spoke to a number of Care Homes for Older People Page 11 of 28 Evidence: people about moving in to the home - my family arranged everything, I could not return home after a hospital stay and I came straight here and I knew about the home and I wanted to move here. We were also given information by relatives and those families who completed surveys for us - We had to look for a nursing home ten years ago and we chose Wemyss lodge. We had heard it was good and we have been very pleased and I was very impressed when I came to visit the home on behalf of my relative and I felt the manager had time for me, to explain everything. This same relative confirmed that a pre-admission assessment visit had been made to the hospital ward. Each person will be provided with a contract or a set of terms and conditions of stay. For those people who are part funded by the local authority, or funded by the primary care trust, a schedule of payments will be set up with the funding authority. Prior to any placement being offered, a pre-admission assessment will be completed. We looked at the documentation completed for one person who had recently moved in to the home. It was difficult to determine that the assessment had been completed prior to the admission date, but we were assured it had. The pre-admission documentation that is completed is comprehensive and will ensure that the home has the necessary facilities (nursing equipment) and the staff team have the necessary skills to meet peoples specific care needs. The assessment is recorded upon a comprehensive Dependency Assessment Rating Tool and covers all aspects of daily life skills, mental health and well being assessment, multi professional intervention, and social care needs. This assessment is then used as a basis of the care planning documentation. New placements will be arranged on an initial trial basis with a review of how things have gone being completed at the end of this time. This review will be undertaken with the funding authority where appropriate, the person if possible, any family or representatives, and home staff. This trial period can be extended if necessary. Care Homes for Older People Page 12 of 28 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. Care planning processes ensure that peoples care and support needs will be identified and met in the way that they want. The monitoring of peoples health is good and medical care is arranged as necessary. We are assured that medication procedures remain safe and good practice guidelines are followed. Evidence: Each person will have a care plan prepared that details their care and support, and where necessary, nursing needs. The plan will detail the actions that need to be taken by the care staff to meet those needs. We looked at a sample of four plans, one person who had recently been admitted, a second person with wound care needs and other medical conditions, and the other two, randomly selected. We found that each of the support plans had been well prepared and provided a very clear picture of how identified care needs were to be met. It was evident that the plans had been prepared in consultation with the person, and/or their family. The wound care planning documentation prepared for the one person that we looked at was clear, and detailed the medical products to be used and the frequency that dressings needed attending to. An evaluation was recorded each time the dressing was changed. The home has Care Homes for Older People Page 13 of 28 Evidence: very good relationships with the local tissue viability nurse who visits the home on a regular basis. The home are in the process of introducing new care planning documentation and this was shared with us. The layout of the forms was good, and enabled the information to flow in a logical manner. Care planning documentation includes a number of risk assessments. We saw risk assessments in respect of moving and handling procedures, nutrition, the likelihood of developing pressure sores (waterlow), and use of bed rails to maintain a persons safety. Information from the moving and handling risk assessment is included in the mobility care plan. we would recommend that a stand- alone care plan or moving and handling plan be devised for each person to record details about the specific equipment to be used and the numbers of staff required. When people need to be moved using a hoist, the sling size must be recorded. When the likelihood of developing a pressure sore is identified, appropriate equipment is provided and detailed in the plan of care. A record of care given is made on a daily basis. All plans and risk assessments are reviewed on a monthly basis however many of the recordings were unreadable. This has been referred to in the previous two inspection reports. All care records must be maintained accurately and legible. The registered person must remind those responsible for these records , of their responsibilities under the NMC Code of Conduct - You must ensure any entries you make in someones paper records are clear and legible, signed and dated. People will be registered with a GP practice of their choice or the GP practice that provides for most of the people who live in the home. People will be seen on a weekly basis if necessary and at other times when required and records are kept of all contacts with GPs and other healthcare professionals. We received three of our survey forms back from healthcare professionals who visit the home and they made the following comments - Wemyss Lodge continues to provide good care to all their residents, The nursing team are well managed and they liaise well with doctors both primary care and hospital, This is one of the best homes I visit in the area and peoples care needs are met well. Examples of other healthcare professional who may visit the home include chirpodists, dieticians, physiotherapists, opticians and dentists. We were told that medications systems are unchanged since the last inspection and remain safe. At the last inspection practice was shown to be good and we did not complete a full assessment on this occasion. We are still assured that all appropriate measures are in place and that standards remain good. During the time we spent in the home we observed the staff team interacting with the Care Homes for Older People Page 14 of 28 Evidence: people they were looking after and visitors, in a kind, thoughtful and professional manner. Staff were courteous and polite, but there was a lot of friendly banter, and fun being had. We were told by people we spoke with and relatives everyone is so friendly and helpful and this is a home from home. As part of the care planning process, end of life care needs will be discussed when necessary. We looked at the documentation that the home currently has to record decisions made about end of life matters. This process must include clinical decisions agreed by the GP as well as a record of who else involved in the decision. Where a decision could not be discussed with the person, an explanation should be recorded, so that it is obvious that others have had to make a best interest decision. In instances like this we will expect to see a clear record of who was involved in the discussions and signatures from the person where possible, family, member of staff from the home and the GP who is agreeing the clinical decision. Care Homes for Older People Page 15 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are opportunities for the people who live in Wemyss Lodge to participate in a wide range of social activities and the support of family and friends is encouraged and welcomed. People are provided with a high standard of catering and meals are well balanced and nutritious. Evidence: A variety of different activities are arranged throughout the week by a dedicated activities co-ordinator. Small and large group activities are arranged and these include exercise classes, live musical sessions, flower arranging and regular trips out in the homes minibus. Church services are held on a regular basis and people can receive visits from their own ministers as they wish - religious festivals are celebrated throughout the year. One visitor said there is always something going on in the home. My relative has a better social life than me. The six people who completed our survey forms said that there was usually (2) or always(4), something going on in the home that they could participate in. There are many entertainments and activities arranged - some appeal, others do not, I enjoy the trips out in the minibus for a pub meal and There is a wonderful light hearted atmosphere in the home. On the day of the inspection, preparations were underway for a Christmas party, and over a 100 friends and family were due to attend. A hairdresser visits the home on a daily basis. Care Homes for Older People Page 16 of 28 Evidence: In the main reception area there is a notice board displaying details about future events plus photographs displayed showing previous events and trips out. As already referred to the home has a minibus which is used for group outings. People are offered the choice to take part in activities and if they want, can stay in their own rooms and entertain themselves. For those people who are room bound, individual 1:1 time with be allocated if required. People are able to have visits from family and friends at any reasonable times. One visitor told us that they were regular visitors to the home, that they always found the staff very friendly and were offered refreshments. Our overall opinion because of observations made during the inspection visit and comments received were that people are encouraged to make their own decisions where possible. People are able to make choices about their daily rountine, where they want to spend their time and what they would like to eat. The home has a rolling four week menu plan and offers a comprehensive, varied and nutritionally well-balanced choice of meals. They can cater for specialised diets and will accomodate individual likes and dislikes. As part of the information gathering process about peoples needs, they will be asked about their dietary requirements. Alternatives meals will be provided at lunch and evening meal times, if the planned meals are not suitable. We were told that breakfast tends to be served in peoples own room but can be served in the dining room. The main meal tends to be served in the dining room. The midday meal served on the day of inspection was not the normal planned meal as preparations were underway for the Christmas party that evening and the buffett style catering. People who completed our survey forms said that the meals served were usually or always good - the food is good, and I look forward to the meals. Mid morning and in the afternoons, tea and coffee or cold drinks are served with biscuits. Evening snacks are provided. Care Homes for Older People Page 17 of 28 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 home has a clear complaints procedure and any complaints people may have will be listened to and acted upon. Staff awareness of safeguarding issues will ensure that people are protected from being harmed. Evidence: The homes Complaints Procedure is included in the Service User Guide and a copy is provided for each room. It is also displayed in the main reception area of the home. Those people who completed our survey forms each said they were aware of the homes complaints procedure. One relative told us Any concerns I have raised have always been dealt with promptly. I have not to make any formal complaints. The manager told us in the AQAA that they have dealt with five complaints in the last year and all had been resolved within their set timescales. They told us that two of the complaints were upheld. We have not received any complaints about this service. We are assured that the management of any complaints would be satisfactory , that people would be listened to and any necessary actions would be taken. The home has an Adult Protection and Prevention of Abuse Policy. The policy includes a flow chart for potential alerters plus contact telephone numbers of the local authority. This policy should be updated to ensure it has the correct details regarding the Care Quality Commission. Those staff spoken with during the course of the inspection demonstrated good awareness of safeguarding issues and of their responsibilities in protecting the people who live in the home. Staff will receive Care Homes for Older People Page 18 of 28 Evidence: safeguarding training as part of the induction training programme for new staff and regular mandatory training. Care Homes for Older People Page 19 of 28 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. Wemyss Lodge Nursing Home is a well maintained, comfortable and fully equipped care home. It is kept clean, tidy and fresh smelling. The majority of bedrooms are for single occupancy and have en-suite facilities. All communal areas are well furnished and there is a programme of furniture replacement. Evidence: Wemyss Lodge residential and Nursing Home is a purpose built three storey care home (the top floor is used by staff only), located in a quiet residential area of Swindon. It is well maintained and provides private and communal facilities on both floors. Car parking for visitors is to the front of the property and there is level access into the home. The entrance to the home is secure and during office hours, visitors are welcomed to the home by the administrator or office based staff. Access to the upper floor is via passenger lifts or via staircases, making the whole home fully accessible for people who have impaired mobility. All areas of the home are well decorated and appropriately furnished. There is access out in to the courtyard gardens. Wemyss Lodge Nursing Home is a well maintained, comfortable and fully equipped care home. It is kept clean, tidy and fresh smelling. There is an ongoing redecoration and refurbishment programme. Most of the bedrooms are for single occupancy and have en-suite facilities, but there are a number of shared rooms with privacy screening avavailble. Care Homes for Older People Page 20 of 28 Evidence: There is one large lounge and a dining room on the ground floor, plus a smaller quiet room, and a sitting area on the first floor with refreshment faciltities. All communal areas are furbished with a range of different arm chairs to meet different peoples needs. The corridors are wide and grab rails are installed. There is one area on the ground floor where the floor is not level and although there is appropriate signage warining of this, we discuused other ways to make the change in floor level more obvious. There are sufficient numbers of communal bathrooms located throughout the home fitted with either an assisted bath, or a level access shower facility. We were shown two bathrooms that have recently been refitted as a wet room. All bedrooms have ensuite faciltities of a toilet and wash handbasins. Toilets are also located near the lounges and dining rooms. There is a plentiful supply of hoists, stand aids and other types of equipment to assist with moving and handling tasks. There is a selection of different types of beds with some being specialist profiling nursing beds, some hospital type beds and a few remaining ordinary divan beds. There is rolling programme of replacement of the divan beds with more appropriate equipment. Specific items of equipment will be obtained for people with particular care needs as and when required. The home will provide different mattresses and alternating air mattresses dependent upon peoples individual needs. A nurse call bell system is installed throughout the home. There are 43 single bedrooms and five shared rooms. Privacy screening is available for the shared rooms. Each bedroom is fully furnished, with en-suite facilities and people are encouraged to personalise their rooms and to bring in any small items of furniture and other items. The home was nice and warm on the day of inspection and well lit. Most of the bedrooms were seen during the inspection. The home was clean throughout and fresh smelling. Those people who completed our survey forms said the home was always fresh and clean. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in Wemyss Lodge will be cared for by staff who are skilled and competent and able to meet their specific care needs. Recruitment of new staff is in line with safe procedures, which means that only suitable staff will be employed to work in the home. Evidence: A number of the staff who work in the home have done so for a number of years and there is an established team of registered nurses and care staff - staff turnover is generally low. Staffing levels are based upon the collective dependency needs of all people in residence and adjustments are made to the numbers of staff on duty when people develop higher dependency levels. On the day of inspection the staffing levels appeared to be appropriate (although there was extra staff in preparing for the evening party) and staff confirmed that the home is well staffed. Those staff spoken with said that although shifts are always busy, the staffing levels were correct. The home does not use agency staff and told us that they havent done so for three years. This means that people will be looked after by carers who are familiar with their specific needs and wishes. A team of housekeeping, laundry and catering, administrative staff, maintenance and activities staff, are also employed in sufficient numbers to provide support in meeting peoples daily living needs. All care staff have either already achieved at least a National Vocational Qualification Care Homes for Older People Page 22 of 28 Evidence: (NVQ)Level 2 in Care or are working towards NVQ level 2 at the present. Six staff have also achieved NVQ at Level 3. All new recruits are expected to undertake NVQ training after they have completed their initial training and probationary period. The home has a senior member of staff, who has NVQ level 3, is an NVQ Assessor and will support staff in completing the award. In addition to the care staff, catering and housekeeping staff are also encouraged to complete NVQ training. The committment to providing well trained staff is to be commended. We looked at six recuitment files to check the procedures that are followed before new staff are employed to work in the home. We found that safe and correct procedures are always followed. Applicants will complete an application form and attend for an interview and then the home will request two written references and complete CRB and POVA1st checks before employment starts. A personal training log is kept for each staff member and we looked at some of these. A senior training officer is employed to oversee and arrange the training for the whole staff team. All new recruits will complete an induction training programme and this consists of moving and handling, health and safety, fire, infection control, abuse awareness, first aid, food hygiene and a session about the home procedures and policies. Those staff spoekn with during the inspection confirmed that the training opportunities that are available for them are good, and that they feel suitably skilled and able to meet the diverse needs of people who live in the home. Care Homes for Older People Page 23 of 28 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. This home is well managed and run in the best interests of the people who live there. Their views will be sought to ensure that people receive the care and support that meets their expectations. Peoples health and safety will be promoted because of safe working practices. Evidence: The home manager Mrs Kay Thompson has worked at the home for many years. She is registered with the Care Quality Commission, is a registered nurse and has already completed the Registered Managers Award (RMA -NVQ Level 4). She is supported in the management of the home by an operations manager who also has the RMA, a deputy manager, administration staff and a team of registered nurses. In order to monitor the quality of the service that the home provides, regular meetings are held with the various staff teams and are minuted. There is an open door policy and residents and relatives have easy access to speak to either the home manager or the operations manager - one relative told us that the culture of the home Care Homes for Older People Page 24 of 28 Evidence: was that people were listened to and customer satisfaction was very important to the managers. Regular audits are undertaken in respect of health and safety and the environment are undertaken. Care planning processes are regularly reviewed to ensure that people receive the care and support that they need. The home looks after personal monies for people but we did not inspect the systems in place, to ensure that peoples money is protected. At the last inspection the system was found to be satisfactory - all transactions were recorded and signed. We have no reason to be concerned that this may still not be the case. Safe working practices ensure the safety of both the people who live in the home and the staff team. We recommend that clearer information is recorded in respect of manual handling risk assessments and safe systems of work. In the AQAA, a self assessment document submitted by the service prior to this inspection we were told that all the necessary environment and equipment checks are completed regularly by the maintenance man, that the fire safety risk assessment and fire log were all up to date. The home is well maintained throughout and no health and safety concerns have been raised as a result of this inspection. Care Homes for Older People Page 25 of 28 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 26 of 28 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 2 7 7 All care planning documentation must be kept accurately and the writing must be legible. Prepare a stand alone moving and handling plan for each person, that details specific equipment requirements and what procedures must be followed. Where end of life care decisions are being recorded, these must include an account of reasons why the individual themselves is unable to be included in the process. Update the Complaints Procedure and the Abuse Policy to include the correct details about the Care Quality Commission. 3 11 4 16 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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