Care Home: Wenham Holt Nursing Home

What the care home does well The home provides full, detailed and up to date information to prospective clients and their representatives, and offers a minibus pick up service for visitors travelling by public transport to the local bus and train stations. In addition to the full nursing assessments, completed by registered nurses, and the involvement of specialist support to promote the health of the residents/patients, the care planning process explores individual`s social background, wishes and needs, to ensure an holistic approach to fulfilling their needs. A relative commented in a resident`s survey they had helped them to complete, `from my point of view, Wenham Holt is an excellent home, the staff are friendly and maintain a good standard of care`, and the resident wrote, `the standard of nursing is excellent.` The home offers a wide variety of activities and entertainment, including trips out in the minibus to places of interest and for shopping. On the day of the site visit a professional singer was entertaining the residents, and there was a great dealt of laughter, singing and dancing in the large lounge in the afternoon, confirming that the residents were enjoying this activity. Providing a nutritious diet with a good balance of fresh fruit and vegetables is considered by the manager as one of the most important elements of the service provided. Residents and their relatives commented, `I can only eat soft food and the meals are always nicely presented`, `meals are first class and a lot of care is taken over providing healthy meals for clients,` and `my relative is diabetic and a special diet is provided for her`. Staff comments on `what the home does well`, in the surveys they completed, included, `I have been employed at the home for many years and feel the support and care given to the clients and staff by the management is exemplary,` `staff are well supported and well rewarded,` `time is taken to get to know each new client well to address their individual needs, and the teamwork is good,` Residents and their relative`s comments included, `the staff are very caring`, ` I would not want my relative to be in any other home, the staff are wonderful`, and `the staff all show a friendly, caring and courteous attitude.` One healthcare professional commented, `the home provides an extremely high level of nursing care.` There was an open, positive and inclusive management approach at the home and staff spoken with felt valued. This home continues to be a family business and the manager stated, `our philosophy is, that Wenham Holt Nursing Home is, above all, a home for our residents`. What has improved since the last inspection? This service, Wenham Holt Nursing Home, is a newly registered service, but had provided a service for many years under the name of Wenham Holt Nursing and Residential Home, and had an excellent rating at its last Key Inspection of 20th February 2009. Some of the improvements made, as a result of listening to the people who use the service, over the first six months of the new registration included, introducing new person centered care plans and compiling lifestyle histories for the residents to ensure the service is delivered in an individual way, improving access to the garden, and building a new sun lounge off the main lounge for the enjoyment of the residents. Eight free range chickens had been introduced to the garden for residents to be involved in their care, and to collect and enjoy eating the eggs. The activities coordinator`s hours had been extended to provide more activities for the residents to engage in, and to include hand massage, aromatherapy and social interaction. New bedroom and garden furniture had been purchased to enhance the environment for the residents, and arrangements had been for more trips out in the home`s minibus, to use the hydrotherapy pool at the sister home of Eastfield, and for free wi-fi internet access to much of the main house for the entertainment of the residents. Menu choice cards had been introduced to promote the ability of residents with communication difficulties in making choices. What the care home could do better: This home ensures stakeholders are at the heart of its future developments, by consulting with them through annual quality assurance questionnaires, and producing a development plan from the collated outcomes. This service is committed to continuous improvement. Key inspection report Care homes for older people Name: Address: Wenham Holt Nursing Home Hill Brow Liss Hants GU33 7PD     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: Christine Bowman     Date: 2 2 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Wenham Holt Nursing Home Hill Brow Liss Hants GU33 7PD 01730895125 01730893782 wenham.holt@btconnect.com www.wenhamholt.co.uk Wenham Holt Nursing Home Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Rosemary Anne Gorvin Type of registration: Number of places registered: care home 50 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia learning disability old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 50 The registered person may provide the following category/ies of service only: Care home with nursing (N) to Service users of the following gender: either whose primary care needs on admission to the home are within the following categories Old age, not falling within any other category (OP) Dementia (DE) Date of last inspection Brief description of the care home Wenham Holt Nursing Home Ltd is a family run business located in a rural area near to the small village of Liss. It has been re-registered with the CQC as a new service Care Homes for Older People Page 4 of 34 Over 65 0 0 50 50 50 0 0 0 Brief description of the care home because the family wanted to set up a separate company due to differing plans for the future from its sister home Eastfied, which is situated nearby. The two homes have been provided under the same company name for many years. The home offers nursing care for up to fifty older people, who may have dementia, learning disabilities, or physical disabilities. Sixteen of the beds within the home are designated as continuing care and this is in partnership with the local primary care trust. This facility is linked but separate from the rest of the home. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: This inspection report includes information gathered since the re-registration of the service six months ago. A full and detailed Annual Quality Assurance Assessment (AQAA) was completed and returned in a timely way, giving up-to-date factual evidence about the running of the home and informing us of what they think they are doing well, how they have improved the service, and of their plans for further improvements. Residents completed ten service user surveys, some with support from their relatives and representatives, giving their views on the running of the home. Nine staff members and two healthcare professionals also completed surveys, giving their views on the care and support given to the residents. An unannounced site visit was conducted on 22nd January 2010, and was carried out over six hours commencing at 11:00 am to assess the outcomes of the key inspection standards for older people with respect to the residents living at the home. The registered manager, Mrs Rosemary Gorvin and the Responsible Individual, Mr Dan Gorvin, were interviewed and they assisted with the inspection process by making residents and staff files, maintenance Care Homes for Older People Page 6 of 34 certificates, quality assurance documentation, the service user guide, the statement of purpose, samples of policies and procedures and other documents and records available to be sampled. We sampled four residents bedrooms and the communal living areas of the home, spoke with five residents, a visiting trainer, the activities coordinator, and observed and spoke with several staff members as they carried out their duties. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? This service, Wenham Holt Nursing Home, is a newly registered service, but had provided a service for many years under the name of Wenham Holt Nursing and Residential Home, and had an excellent rating at its last Key Inspection of 20th February 2009. Some of the improvements made, as a result of listening to the people who use the service, over the first six months of the new registration included, introducing new person centered care plans and compiling lifestyle histories for the residents to ensure the service is delivered in an individual way, improving access to the garden, and Care Homes for Older People Page 8 of 34 building a new sun lounge off the main lounge for the enjoyment of the residents. Eight free range chickens had been introduced to the garden for residents to be involved in their care, and to collect and enjoy eating the eggs. The activities coordinators hours had been extended to provide more activities for the residents to engage in, and to include hand massage, aromatherapy and social interaction. New bedroom and garden furniture had been purchased to enhance the environment for the residents, and arrangements had been for more trips out in the homes minibus, to use the hydrotherapy pool at the sister home of Eastfield, and for free wi-fi internet access to much of the main house for the entertainment of the residents. Menu choice cards had been introduced to promote the ability of residents with communication difficulties in making choices. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Full and detailed information enables prospective clients and the representatives to decide if this home is able to meet their needs. A comprehensive needs assessment is carried out to ensure each individuals needs and aspirations are taken into consideration and planned for, and that they can be met at the home. Evidence: The home had produced a pack containing a statement of purpose, illustrated with colour photographs of the home, the garden and of the homes newest venture, free range chickens. All the required information was included and the homes philosophy of care promised, to treat everyone with respect and dignity. A patient guide had been produced for the Continuing Care Unit, which provides accommodation for sixteen patients in conjunction with the National Health Service (NHS). Essential nursing care is provided with support from Hampshire Primary Care Trust (PCT) specialist clinicians, providing clinical supervision for the nursing staff, and assessment Care Homes for Older People Page 11 of 34 Evidence: and advice on the provision of appropriate equipment for patients. The service user guide informed prospective clients of the homes mission statement of, putting people first and their aim, to care for our clients in a safe, warm, clean and pleasant environment, which promotes a sense of well-being and encourages each individual to feel as at home as possible. The pack also contained a newsletter, planned activities and events for the month, the previous CSCI report (the home was previously registered for many years with the Commission for Social Care Inspection and its predecessors as Wenham Holt Nursing and Residential Home), a copy of the homes Annual Development Plan, which included comments from current residents, patients and their relatives. And a welcome leaflet informing prospective clients and their representatives that a visitors minibus pick up service was offered for anyone travelling by public transport to the local bus and train stations. A map showing the location of the home in relation to local towns, public amenities and the main route between London and the south coast was also included. The AQAA recorded that the information pack is available in different formats and an electronic version is on the homes website. The ten residents/patients, who completed surveys, confirmed that they received enough information to help them to decide if this home was the right place for them, before they moved in. The homes website also provides prospective clients, their relatives and representatives with up to date information about the home. Residents files sampled, confirmed that a comprehensive needs assessment had been carried out. The manager stated that the assessor would usually be a qualified nurse or another highly qualified member of staff. The nursing home had a team of registered nurses who were experienced in assessing the needs of prospective residents. Assessment documentation explored the prospective residents state of wellbeing, their medical history and medication, personal care needs, mental state and cognition and history of challenging behaviour, communication needs including hearing and sight, mobility and history of falls, diet and food preferences, continence, social, religious and cultural needs. The AQAA recorded, we actively encourage other health professionals and relatives to be part of the assessment process and if a resident is coming to us from another establishment, and a care plan has been kept, we insist on receiving a copy of this before admission. Assessment documentation sampled, included information with respect to equality and diversity to ensure the resident would be treated as an individual and that their personal, social, cultural and spiritual needs and interests would be taken into consideration in drawing up their care plan. Care plans, which included risk assessments for any identified risks and measures to reduce them, had been signed by residents or their representatives to confirm their Care Homes for Older People Page 12 of 34 Evidence: acceptance. The AQAA recorded, good deal of time and effort is spent making admission to the home as easy as possible for both residents and their relatives. We are happy to show prospective residents and/or their representatives around the home at a time which is suitable to them and will answer any questions they might have at that time. The home does not provide intermediate care. Care Homes for Older People Page 13 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans address the residents health, personal and social care needs, and they and their representatives are involved in compiling them. Safe arrangements are in place for the handling of medication to protect the residents and the staff and the residents right to privacy is upheld and their dignity maintained. Evidence: Residents care plans sampled clearly recorded their personal and healthcare needs and detailed how they would be delivered. Care plans covered all the residents assessed needs including physical, social and psychological. A team of experienced registered nurses continuously assess the health of the residents, and the prevention of pressure sores, a continence assessment, psychological needs, physical needs, nutritional screening and risk assessment, all form part of this assessment process. Named key nurses offer consistency and continuity to the residents. Residents social background was included in the care plans viewed, to help the carers to understand them and to respond to them as individuals. A resident, who had been diagnosed with dementia, had a personalised care plan giving a history of their illness, describing the difficulties it causes them, how they communicate, and how they like to spend their Care Homes for Older People Page 14 of 34 Evidence: time. A daily statement was kept which including the individuals preferred time for getting up, food preferences, likes and dislikes with respect to their personal care and daily routines, and their abilities to carry out self-care activities independently or with support. Records confirmed that the care plans had been reviewed at least monthly, and the manager stated that the residents key registered nurse was responsible for ensuring this task was completed. The residents and their relatives or representatives were invited to contribute to the care planning process. A newsletter, of which four were produced annually, welcomed relatives and representatives to liaise with key nurses with respect to this involvement. Seven of the nine staff, who completed surveys, confirmed that they were always given up-to-date information about the needs of the people they support or care for, in their care plan, and two that they usually were. Nine of the ten residents, who returned surveys, recorded that they always received the care, support and medical care they needed, and one recorded that they usually did. A relative commented in a residents survey they had helped them to complete, from my point of view, Wenham Holt is an excellent home, the staff are friendly and maintain a good standard of care, and the resident wrote, the standard of nursing is excellent. The AQAA recorded that a local General Practitioner (GP) makes regular routine visits to the home, and additional visits when required, and that all the residents have a choice to be registered with their own GP. A chiropodist visits the home every six weeks, and the manager stated that local practitioners provide dental and optical services and that the home provides transport for attending appointments. The continuing care unit is supported by a consultant physician, who visits weekly, and a local GP, who can visit every day if required. A specialist team from Hampshire Primary Care Trust supports and offers clinical supervision to the nursing staff and assesses and advises on appropriate equipment for patients. The two healthcare professionals, who completed surveys, recorded that the care service always seeks advice and acts upon it to meet the residents social and health needs and improve their well-being, and that individuals social and health care needs are properly monitored, reviewed and met by the care service. One commented, extremely high level of nursing care. The manager wrote in the AQAA, we ensure continued access to all NHS services and the possibility of private healthcare services is maintained. Staff ensure that care is person led, is flexible, consistent and able to meet the changing needs of the residents. Medication administration records inspected had been completed in a satisfactory Care Homes for Older People Page 15 of 34 Evidence: manner, showing that residents had received the required dosage of their prescribed medication, as set out by their medical practitioners, and there were no unexplained gaps in the recordings. The nurses, who took responsibility for this task, had received training in the safe handling of medication, and their individual training and development logs confirmed this. The continuing care unit held a stock of controlled drugs at the time of the site visit, under license from the Home Office, supplied and monitored by a National Health Service pharmacist. This was to ensure that changes in prescribed doses of pain relieving drugs by GPs would be readily available, should residents require this treatment. A controlled drugs register was held to record this information. Observations of the staff throughout the day confirmed that they were respectful and polite in their interactions with the residents, who appeared to be relaxed and happy in their home. Records confirmed that new staff had completed the Skills for Care common induction standards, which provide an introduction to the caring role and promote the residents rights to be treated as an individual, with respect for their privacy and dignity. The nine staff members, who completed surveys recorded that they felt they always had the right support, experience and knowledge to meet the different needs of the residents with respect to equality and diversity issues. Two health care professionals confirmed that, the care service always respects individuals privacy and dignity. All the bedrooms in the continuing care unit were for single occupancy and enabled meetings with healthcare professionals to be private and confidential. The main house provided a number of shared rooms, which had been provided with screens to promote the residents privacy and dignity. The AQAA recorded that, as a result of listening to the people who use the service we are considering reducing the number of shared rooms by making them into en-suite singles. Care Homes for Older People Page 16 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are treated as individuals, who are supported to follow their personal interests, enjoy stimulating activities, both within the home and in the community, and to retain as much of their independence as possible. Contact with important people in their lives is promoted and nutritious and attractive meals are provided. Evidence: The homes activities coordinator, who was very enthusiastic about her role, was interviewed. She was a qualified EXTEND teacher (exercise for the elderly and disabled), and had undertaken specific dementia training to assist her in my work. She was also a member of NAPA (an organisation promoting activities for older people), She stated that she spent time with individuals getting to know them well and also interviewed relatives to build up a full picture of each residents life history and interests. Life history books, containing colour photographs of individuals, their relatives and friends over the years had been compiled, written in large print, for those with visual impairment, to support residents reminiscence. One to one time spent with residents was recorded and a record was also kept of residents participation in the group activities provided. The activities coordinator stated that, the staff also spent one to one time with the residents, and that sessions could include a chat, a manicure, a hand massage, a facial including cleanse tone and Care Homes for Older People Page 17 of 34 Evidence: moisturise, aromatherapy, hydrotherapy, or being read to. The AQAA recorded that one to one sessions are tailored to individuals needs and one included looking at paintings with a resident, who was a well-regarded artist, and exploring patchwork and craft items with a resident, who used to love to sew. The activities programme was displayed for all the residents to see and advertised in the newsletter. It included bingo, cookery, art/craft therapy, reminiscence quiz, music and entertainment, visiting PAT dog, keep fit, fun and games, poetry, and one to one social care therapy sessions with aromatherapy hand massage. The home had a minibus and trips were taken to local places of interest such as Buriton pond, Butser Hill, Cowdray Park, and shopping trips to local towns, for the enjoyment of the residents and to provide stimulation. A hairdresser visits the home weekly, and twice weekly, a professional singer entertains the residents. On the day of the site visit there was a great dealt of laughter, singing and dancing in the large lounge in the afternoon, confirming that the residents were enjoying their singing and dancing session. Some of the residents were dancing together and some with the staff and everyone looked happy. There had already been a visit from the PAT dog in the morning and an exercise session, the activities coordinator stated and she explained that these sessions used props such as parachutes, maracas, jumping frogs and beach balls to help the residents keep fit and have fun. The busy Chistmas programme of church services, carol singing, childrens Christmas party and other festive activities and celebrations, had culminated in the presentation by the staff of a pantomime for the enjoyment of the residents, the activities coordinator stated, and photographs of staff in costumes, included a pantomime cow, and laughing residents confirmed that a good time was had by all involved. The continuing care unit had its own programme of mainly individual sessions such as looking at the daily newspapers, reading short stories and poetry, hand massage and visits from the PAT dog. Patients from this unit were welcome to take part in the activity sessions in the residential part of the home, should they wish to do so, and one patient wrote, I have started to enjoy going into the main part of the home for activities. I am getting used to the people and I like to play bingo. Eight of the ten residents, who returned surveys, wrote that there were always activities arranged by the home that they could take part in, one that there usually were, and one wrote that they did not wish to take part. The AQAA recorded, we offer a varied choice of activities that go towards ensuring our residents are able to enjoy a full and stimulating lifestyle. Weekly luncheon club trips (Salvation Army), trips to local school events and religious services keep the Care Homes for Older People Page 18 of 34 Evidence: residents involved in the local community. Residents were encouraged to exercise choice in relation to all aspects of the home, and there was flexibility with respect to routines to allow for this. The homes philosophy of care encouraged a sense of homeliness and, as a consequence, there were no limitations on the visiting hours, except to ask visitors to warn the night staff if visiting at night. Relatives and friends of residents were encouraged to have meals with them, free of charge, and were also able to stay for the night if they wished. A visiting relative spoke about the monthly carers/relatives meeting, organised by the manager and, which relatives of former residents were also invited to attend. They stated that it was an excellent support group, and social occasion, and that excellent refreshment was provided. Residents and their families were able to use the homes minibus for individual trips out to their homes and/or family events. There were no restrictions on family pets visiting. In order to enhance the homeliness of residents bedrooms, the manager stated, they were advised on admission that they could bring personal items including furniture and pictures to make their new home more familiar to them. Providing a nutritious diet for the residents at the nursing home was considered one of the most important elements of the service provided. The manager stated that, the staff of the nursing home are trained to understand that nutrition contributes significantly to the physical, social and psychological care of the clients in the nursing home. The menus are designed to provide a balanced diet with daily fresh vegetables and fruit, and to be responsive to the needs and popular tastes of the clients. A high proportion of the residents required pureed food and consideration was given to the presentation of the food, so that all foods were liquidised separately. A resident commented, I can only eat soft food and the meals are always nicely presented. The AQAA recorded. During mealtimes residents have the opportunity to choose from the main dish being cooked or a selection of alternatives. We will endeavour to meet the wishes of everyone without exception and have a good supply of alternatives available; if we do not have them to hand we will go to the local supermarket to purchase them. Residents are assessed regularly and if they have difficulty eating, the staff will directly assist them. The majority of our residents require considerable assistance with feeding and are given this assistance in a discrete and sensitive manner. All residents are given the time they need to finish their meals comfortably. A recent visit from the Environmental Health officer had resulted in the home being awarded an excellent standard of hygiene by the local authority food inspector. Eight of the ten residents, who returned completed surveys, always liked the meals at the home and two usually did. Comments included, meals are first class and a lot of Care Homes for Older People Page 19 of 34 Evidence: care is taken over providing healthy meals for clients. My relative is diabetic and her special diet is provided, The two health care professionals, who completed surveys, confirmed that the care service always supports individuals to live the life they choose, and one commented, patients are encouraged to remain independent when appropriate. They also thought that the care service always respond to the different needs of individuals with respect to equality and diversity issues. Care Homes for Older People Page 20 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents, their relatives and representatives are confident they would be listened to, should they express concerns, and a satisfactory procedure was in place to deal with complaints, should they arise. Residents are protected from abuse by well-informed staff, who know how to protect them. Evidence: The complaints procedure was available in the service user guide and displayed in the home. It included a timescale by which the complainant could expect to receive a response to a complaint, and the contact details of the Care Quality Commission were included to inform the residents, their relatives and representatives. The AQAA recorded that this procedure was available in larger print on request, and could be provided in other formats, if required. All of the ten residents, whose surveys were returned, recorded that there was someone they could speak to informally if they were not happy, and eight knew how to make a formal complaint. One resident commented, I have never had the need to make a complaint and feel comfortable to discuss any matters with the staff. One of the two health care professionals, who completed surveys, confirmed that the care service always responded appropriately if concerns were raised about the person using the service, and the other that this question was not applicable because there had been no complaints. The AQAA recorded that there had been no complaints over the previous twelve months, but a number of compliments had been received, including, thank you for the Care Homes for Older People Page 21 of 34 Evidence: loving care and kindness shown to our relative, I just wanted to thank you for the lovely way that you looked after my mum. You were all so patient with her, and nothing was too much trouble for your staff to do. Your sense of humour was always spot on, and you made a difference at a very difficult time for me. The atmosphere at Wenham Holt was lovely, thank you so much for the loving care with which you looked after our relative in the final week of her life. You treated her with compassion and respected her dignity, and I am so grateful for everything you do for mum, and for the friendly welcome we always receive from your lovely staff. The home had an up to date copy of the local authority safeguarding procedures, and a local procedure based on this to clarify referral details for the staff. The staff training and development logs, sampled, confirmed that the staff had accessed Safeguarding Vulnerable Adults and the Mental Capacity Act training to ensure the residents best interests would be protected. The AQAA recorded that no safeguarding referrals had been made over the previous twelve months. Care Homes for Older People Page 22 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a homely, comfortable, safe and well-maintained home, which fulfils their needs and is clean, fresh and hygenic. Evidence: The home is located down a drive from the Petersfield to Liphook road and there is a dedicated parking area. The large and imposing three-storey country house is surrounded by its own, well-maintained landscaped gardens, covering an area of six and a half acres, and bordered by woodland. Attached to the home is a single story, continuing care unit, which had been tastefully designed to complement the original building. The home is a well-maintained and attractive place for the residents to live. Through the main entrance to the home, was a welcoming, carpeted, hall leading to a wide staircase, and a large and beautiful, stained glass window shed plenty of natural light into the area. Shared facilities included four dedicated lounges equipped with suitable seating and a relaxation/sensory room where some of the residents were enjoying sensory stimulation. The large lounge in the main part of the home had been recently extended by the addition of a conservatory, which was furnished with comfortable chairs, plants and domestic lamps to give it a homely feel. In a large lounge, in the main house, residents were taking part in a song and dance session with a visiting entertainer. Some of the residents were dancing with the staff and their animated Care Homes for Older People Page 23 of 34 Evidence: faces confirmed they were having a good time. Those who were watching were singing along and smiling. The continuing care unit was accessed through a keypad-operated door so that the residents, who were able to walk freely around the house, could not wander into the unit. The unit was self-contained and purpose built to cater for sixteen residents. There was a lounge/dining room with a kitchenette attached to enable relatives to make drinks and snacks, should they wish to do so. All the bedrooms in the unit were single occupancy and most had en-suite facilities. All the bedrooms had French windows, which could be fully opened in the warmer weather for access to the terraced areas outside, which had been provided with bird tables for the winter months. Residents are able to choose their own decor, fittings, and furnishings, the manager stated, and welcome to bring in their own furniture if they wish to do so. Bedrooms viewed in the main part of the home, had been appropriately personalised, according to the residents wishes, and throughout the home, necessary aids such as adjustable beds, pressure mattresses, grab rails, call bells, assisted baths, a lift and other specialist items to support the residents live as independently and comfortably as possible, had been supplied. In the main house there were twenty-eight single and twelve double bedrooms, some of which were being used as singles. The statement of purpose showed photographs of how beautiful the gardens looked in the summer months. Handrails and ramps were provided to make access easier for those with mobility needs. The free-range chickens provided year round interest and encouraged the residents involvement, and potted plants provided winter colour, for the enjoyment of the residents and their visitors. There was an on-going programme of maintenance, repair and the replacement of carpets and furniture, to keep up the good standard of accommodation offered at the home. The AQAA confirmed that a daily maintenance record was kept by the handyman and a book was kept for the staff to record required repairs. Plans were in place to investigate the feasibility of building a sun lounge or conservatory to the lounge in the continuing care unit, for the enjoyment of the patients. The home had an infection control policy and alcohol gel dispensers at entrance and exit doors and between the nursing home and the continuing care unit. The laundry room was clean and fresh, in keeping with the home as a whole. The home had invested in two commercial washing machines, which incorporate a sluice action cycle and commercial dryers, for washing and drying the residents clothes and bed linen. Hand-washing facilities were available to promote infection control and staff training Care Homes for Older People Page 24 of 34 Evidence: records confirmed that infection control training was included in the mandatory updates for all the staff. 100 of the residents, who completed surveys, thought the home was always clean and fresh. A relative wrote in a survey, something the home does well is that the patients are clean at all times and the home is always clean and well-aired. Care Homes for Older People Page 25 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents 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. Evidence: The AQAA recorded that forty-one care staff/registered nurses worked at the home, and that a further twenty staff were employed to undertake other roles including, an administrator, two cooks, kitchen assistants, cleaning and maintenance staff. The nine staff, who completed surveys, recorded that there were always enough staff to meet the individual needs of the residents. The care hours in the nursing home significantly exceeds the recommendations of the Residential Forum and are based on the managers nursing assessment of what is required to meet the care needs of residents at the time of calculating the staff rota, the AQAA recorded, and, if an admission is planned, additional staff are added to the rota to allow for this, which enables the resident to have specific individual attention on their first day. On the day of the site visit a training day was in progress and the manager was providing some hands on care to enable as many staff as possible to attend. An external training provider was delivering Dementia training and stated at the end of the day that, the staff group were very keen to learn and contributed and interacted well throughout the day. Care Homes for Older People Page 26 of 34 Evidence: The AQAA recorded that twenty eight of the forty-one care/nursing staff had either completed a National Vocational Qualification (NVQ) in Care or Health and Social Care at level 2 or above, were in the process of completing one, or were enrolled on a course waiting to start, to support them in their role. This exceeds the fifty percent target to be achieved by April 2008. The AQAA recorded, a number of our staff are undertaking NVQ 4 at various educational establishments, and we are considering offering this level through our own training company. Two staff, whose files were sampled, had been recruited in accordance with regulations, and all the necessary pre-employment checks had been carried out for the protection of the residents. Full employment histories, with gaps explained and reasons for leaving had been completed on application forms, and equal opportunities documentation had been completed to ensure the process was fairly conducted. The nine staff, who completed surveys, confirmed that their employer had carried out checks such as Criminal Record Bureau checks and references before they started work. New staff files sampled, contained an induction in line with the skills for care common induction standards, which provides an introduction to the caring role and promotes the residents rights to be treated as an individual, with respect to their equality and diversity issues. The AQAA confirmed that all the staff had received this training, and eight of the nine staff, who completed surveys, recorded that their induction covered everything they needed to know to do the job when they started, very well and one that it mostly did. A training programme, displayed on the office notice board included Mental Capacity Act, Health and Safety, Fire Safety, Infection Control, Moving and Handling, Safeguarding Vulnerable Adults, Dementia Care, Food Hygiene, First Aid, Risk Assessment, Communication, Dental Care, Managing Violence and Aggression, Activities and Pastimes and Person centred care. Staff training and development files sampled, contained certificates to confirm the staff had received mandatory training in a timely fashion and other certificates for the Administration of Medication, Tissue Viability, Nutritional Needs and Malnutrition, Palliative Care and Oral Health Awareness. The manager stated that the registered nurses were encouraged to keep up their professional development by attending courses and other relevant training identified in appraisal. 100 of the staff, who completed surveys, recorded that they were being given training that is relevant to their role, helps them to understand and meet the individual needs of the residents and keeps them up to date with new ways of working. Seven of the nine respondents confirmed that it also gives them enough knowledge about healthcare and medication. Care Homes for Older People Page 27 of 34 Evidence: All of the ten residents, who completed survey, either themselves or with support from their relatives, confirmed that they always receive the care and support they need, that the staff are always available when they need them, and that they always listen and act on what they say. Some comments included, the staff are very caring, I would not want my relative to be in any other home, the staff are wonderful, and the staff all show a friendly, caring and courteous attitude. Care Homes for Older People Page 28 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a well managed home, in which their opinions are sought and acted upon for the improvement and development of the service. Effective systems are in place to promote the residents health, safety and welfare creating a safe environment for them to live in. Evidence: The registered manager, who is a Registered General Nurse with a degree, and post graduate diplomas in social research, and in the management of community care for older people, had more than twenty years of experience of care home management. She had also received certificates for extended study courses involving the care of people with dementia, physical illnesses of old age, and care of the dying. She keeps herself up to date with current practice and the latest research, by membership of the English Community Care Association (ECCA), had attended a Conference on Dementia Care Mapping, completed the Mental Capacity Act training and updated her National Vocational Qualification (NVQ) Assessors Award. Care Homes for Older People Page 29 of 34 Evidence: There was an open, positive and inclusive management approach at the home and the staff spoken with felt valued. The AQAA recorded under what the home does well. due to the fact we are a family run business and use a person centered approach, everyone is an Individual and this is their home. We feel this is extended so everyone feels valued in the home and a strong sense of loyalty and belonging exists. Snow had caused transport problems the week prior to the site visit and the manager stated that staff had voluntarily stayed at the home to cover for staff, who were unable to travel to work to ensure the residents care was not affected and had created a very happy environment for all involved at a difficult time. Staff members commented in the surveys they completed, I have been employed at the home for many years and feel the support and care given to the clients and staff by the management is exemplary, staff are well supported and well rewarded, time is taken to get to know each new client well to address their individual needs, and the teamwork is good, and there is a real family feel in the home. The food is home-cooked, the residents make their own choices and are respected as individuals, the home is very clean and wellmaintained, there is a varied activity programme, offering something for everyone to enjoy, and I am very proud to be part of the staff team. The collated results of the annual quality assurance questionnaires completed by the residents, their relatives and representatives, confirmed satisfaction with the service provided. 83 of the respondents stated that they thought the service was very good and 17 good. Comments included, excellent care tailored to the needs of the individual, the normal very high standard of service had been maintained, the attention and care given to patients is wonderful at all times, friendly staff, and good service, good food and nursing care. An annual development plan had been produced following the return of the evaluation forms and in consultation with relatives, visiting professionals and staff, setting targets for the forthcoming year, and confirming the homes commitment to continuous improvement. Some of the plans for the forthcoming year included making improvements to the car park, further personalisation of the residents care plans in line with the homes person-centred philosophy of care, to investigate the feasibility of extending the lounge of the continuing care unit by building a sun lounge or conservatory, and to consider reducing the number of shared rooms by converting them to en-suite singles. Recent improvements made as a result of listening to the people who use the service included; providing a new walk in bath to first floor bathroom, a new toilet on the ground floor and new bedroom and garden furniture; erecting a new sun lounge as an extension to the main lounge; introduced free range chickens so that the residents can enjoy feeding them, collecting their eggs and eating them; increasing the hours worked by the activities coordinator and introducing new activities such as hand Care Homes for Older People Page 30 of 34 Evidence: massage, aromatherapy and social interaction; extending the minibus trips to include weekends; making arrangements for residents to use the hydrotherapy pool at the nearby sister home of Eastfield; introducing menu choice cards to make decisionmaking easier for residents with communication difficulties, and introduced personcentred care plans and updated residents lifestyle histories. The management of the home had no direct control on the personal finances of any of the residents of the nursing home and those who required financial support and assistance received this from relatives and advocates. There were facilities for the safe storage of valuable items both in the residents own rooms and in the office. Records were kept of valuables held in safekeeping for residents. The Registered manager is supported by the Responsible Individual, who is a qualified Environmental Health Officer and the AQAA recorded that he has used his expertise in this field to bring about changes to systems and processes, waste disposal, health and food safety and fire safety. The health, safety and welfare of the residents was promoted by regular staff training in moving and handling, fire safety, first aid, food hygiene and infection control. Certificates were viewed on staff personnel files to confirm this. The Annual Quality Assurance Assessment, completed by the Responsible Individual confirmed that policies and procedures with respect to health and safety were in place to keep the staff informed, and that the essential maintenance of equipment had been carried out according to manufacturers recommendations to ensure it was safe to use. A sample of certificates were seen on the day of the site visit confirming that maintenance checks had been carried out in a timely fashion. The AQAA records that health and safety within the home is given the highest priority, Staff are trained to be aware of their responsibilities for health and safety both to protect themselves and others. A culture of reporting potential problems is encouraged to ensure that where concerns are noted that they are passed on to management to risk assess and act. A risk assessment of the premises is regularly carried out, by the health and safety officer, but staff are aware that this is a shared responsibility. Care Homes for Older People Page 31 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 32 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. Care Homes for Older People Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!