Care Home: Weston House

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What the care home does well Weston House is effectively managed on a day to day basis by a person who is open and approachable and clearly committed to providing a good standard of care and accommodation to the people living at the home. Comments from all people living working and visiting the home have been very complimentary in relation to how the home is managed. One person who recently moved into the home also told us, `The home is a very nice place. I love it here. I would recommend it to anyone.` Another person said, `When I was in hospital recently all I wanted to do was come home. This is my home now.` On this occasion Weston House more than met minimum standards we expect to see provided for a service of this type, especially with regard to making sure people keep themselves busy with regular pastimes they enjoy. We received lots of comments such as, `Having activities makes this a happy place and something to look forward to.` Low turnover of staff combined with good training and development of the Weston care team now means over 90% of the carers have the minimum expected care qualification. This means continuity of care and support is maintained at a consistently good standards by a team of staff who know the needs and preferences of the people living in the home. What has improved since the last inspection? The home has fully addressed the previous requirements and recommendations we made at our last inspection.As a result, the home refurbishment programme for its shared facilities has been completed, including making sure everyone has the facilities they prefer to keep their belongings safe and secure. The in house laundry facilities have also been upgraded. There are now plenty of suitable hand washing facilities around the home. The company who own the home have also introduced new menus to make sure they match the dietary needs and tastes of the people living at the home and to ensure they are offered a well balanced diet. Improved training offered to all staff including new starters and team members who have worked at the home for some time now means the home have excellent systems to safeguard people ensuring all compliments and concerns will be dealt with appropriately to ensure the best interests of anyone living at the home are a priority. What the care home could do better: It is considered that Weston House continues to raise its standards and is setting its own objectives for continual improvement with the full involvement of the people whouse it. However, as a result of our inspection findings a total of five good practice recommendations have been made in order to improve standards at the service, which will further benefit people living and working there. Some parts of the home were not as safe as they could be when we first visited, and urgent action had to be taken to improve matters during our visit. These included making sure the hot water temperature for the first floor shower could be regulated and that a portable radiator could be used safely. Some cleaning chemicals were also seen in unlabelled bottles. These issues indicate the home systems to audit the equipment it uses for the people living at the home needs to be further developd to make sure it is all being used in a safe manner. Medication management systems were seen to be in need of improvement to make sure the home could demonstrate all drugs were being stored safely and that all individuals received their medicines in a way that suited their needs in line with how the doctor expected them to have them. Although the health needs of the people living there are met and people get the care from other professionals they need, the quality of details in the care plans of people living there need to be expanded, so that staff know how to support them to meet their needs. Care paperwork lacked details about the specific levels of assistance required in relation to some medical conditions and moving them safely at all times, especially in the event of an accident. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Weston House Green End Whitchurch Shropshire SY13 1AJ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Janet Adams     Date: 1 9 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Weston House Green End Whitchurch Shropshire SY13 1AJ 01948663052 01948668030 weston.house@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Springcare (Weston) Limited care home 38 Number of places (if applicable): Under 65 Over 65 38 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is: 38 The registered person may provide the following category of service only: Care Home Only (Code PC); 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) 38 Date of last inspection Brief description of the care home Weston House is registered to provide personal care to 38 older people. Springcare (Weston), a company that operates a number of care homes both in the local area and nationally, owns Weston House. The home has been converted from a large three-storey building situated in the centre of Whitchurch. It is within easy walking distance of the local shops and other amenities. Accommodation is in either shared or single rooms, a number of which have en-suite facilities. There are 3 communal lounges, a conservatory and two dining rooms. The Care Homes for Older People Page 4 of 31 Brief description of the care home upper floors may be accessed via a shaft lift and there is a small garden to the rear of the property for the use of residents. Weekly fees were not listed in the Service User Guide we were given at the inspection.The reader is advised to contact the home for up to date prices. Information of the home and the provision of the service are available in the statement of purpose and service user guide, both documents have recently been revised and are readily available. Our reports for this service are available from the provider or can be obtained from www.cqc.org.uk Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last time this service was inspected was May 1st 2007. This report covers our latest inspection that was carried out by one inspector over two separate visits. This was to accommodate time to spend with people who asked to speak to us. Some time before the inspection, we wrote to the home to request some up to date information to assist with this process. This meant that although Weston House knew the inspection was imminent, they were not aware of the date or time the inspection would take place. The inspection included observing activity within the home, inspecting the premises, an in depth look at records for residents and staff, as well as Care Homes for Older People Page 6 of 31 observing, talking and listening to over half of the 28 people living there. The aim of the visit on the inspection days was to have a good look round the home, and to spend time observing people and getting their views about living there. Some of the staff on duty at the time of the inspection also shared their views about working at the care home. Discussions with people were carried out in private with people on their own, or together in groups in the lounges. Everyone was happy to share their comments, which are included in the main body of the report. As part of the inspection process we, the Commission circulated questionnaires and stamped addressed envelopes to people living visiting and working at the home, so their views and opinions could be included in this report. A total of 11 people using the service one staff member and one health professional returned their written comments about the service to us. Three people especially requested to speak to us in person. Everyone, including residents and staff, was very welcoming and helpful throughout the inspection. The Registered Manager and her deputy were thanked for the very useful information provided before the inspection and their assistance on the inspection days. Feedback about the conclusions of our findings was given at the end of the inspection. What the care home does well: What has improved since the last inspection? What they could do better: It is considered that Weston House continues to raise its standards and is setting its own objectives for continual improvement with the full involvement of the people who Care Homes for Older People Page 8 of 31 use it. However, as a result of our inspection findings a total of five good practice recommendations have been made in order to improve standards at the service, which will further benefit people living and working there. Some parts of the home were not as safe as they could be when we first visited, and urgent action had to be taken to improve matters during our visit. These included making sure the hot water temperature for the first floor shower could be regulated and that a portable radiator could be used safely. Some cleaning chemicals were also seen in unlabelled bottles. These issues indicate the home systems to audit the equipment it uses for the people living at the home needs to be further developd to make sure it is all being used in a safe manner. Medication management systems were seen to be in need of improvement to make sure the home could demonstrate all drugs were being stored safely and that all individuals received their medicines in a way that suited their needs in line with how the doctor expected them to have them. Although the health needs of the people living there are met and people get the care from other professionals they need, the quality of details in the care plans of people living there need to be expanded, so that staff know how to support them to meet their needs. Care paperwork lacked details about the specific levels of assistance required in relation to some medical conditions and moving them safely at all times, especially in the event of an accident. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service receive most of the necessary information to make a fully informed choice about what living at Weston House can offer. People have their needs assessed prior to moving in the home. This means they can be confident the home will be able to meet their needs. Evidence: The feedback we received from people who have recently moved into Weston House was very positive. One person told us. I decided to move in after the good experience I had when I stayed at the home for some respite care. Before our inspection the home sent us some information which told us, All information to make a decision is contained within our brochure.A visit is always made to a prospective service user and their family to meet them and ensure all needs Care Homes for Older People Page 11 of 31 Evidence: can be met. A pre-admission assessment is always completed. In order to confirm what they told us was accurate, we looked at a copy of the welcome pack the home supplies to people thinking about living at Weston House and the records of two people who had recently moved into the home. Springcare, the Registered Providers for the service, produce a corporate styled information folder for prospective residents, which contains the homes Statement of Purpose and Service User Guide, the information we require them to have by law. It contained clear information to help people understand what services the home can provide. However, when we looked at the version of this information produced for Weston House it was seen in need of an update. It told the reader that we, the Commission inspected the home at least twice a year, which has not been the case. It also contained our contact details to be one of our offices that has been closed for over 12 months. Examination of records the home keeps to show they can look after people properly if they decide to move in confirmed this had been done professionally.Paperwork showed that that the home management team obtain all the information they can from the person concerned, and the people who are close to them, including any professionals who have been involved in their well being.We also saw that the assessment form the home uses has also been updated to make sure a persons capacity to make decisions is accounted for. One persons records accounted for a home visit by an occupational therapist as well as a nurse to make sure Weston House was the right place for the individual to live. The home management team had also made sure they had obtained enough information about one person who had been admitted to Weston House as an emergency. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care needs and risk assessments are set out in their individual plans of care which ensures that all care needs have been addressed and will be fully met. The manager understands the need to comply with safe medication systems and staff training ensures that the homes procedures are complied with and that residents health matters are safely addressed. The actions of staff and their approach to care ensures that people are treated with respect and their right to privacy is upheld. Evidence: The people who live at the home and responded to our satisfaction survey all commented they received the right care and support, and that staff listened and acted upon what they said.One person wrote, I can honestly say Im very happy here.Im very well cared for. Other people stated, Care Homes for Older People Page 13 of 31 Evidence: If I was poorly I know I would get the help I needed. My medical needs are well organised. People we spoke to confirmed they are treated with dignity and respect.We saw staff knocking on peoples bedroom doors before they entered, and they were seen to approach the people they offered care and support to in a respectful manner. Before we carried out the inspection visit, the home told us that one of they things they did well was making sure all people living at the home had an individual care plan.This is put together with information taken from the person concerned, family, friends, and any professionals who have been supporting them such as social workers, their doctors and community nurses. In order to confirm this, the records of three of the people living at the home were looked at. Records showed that people had been involved in their care plan, and their records also included individual safety assessments that stated how staff are to support individuals to take risks in their dayto-day lives whilst ensuring that they can be as safe as possible. It was positive to see records to show how the home was monitoring a person who had lost weight before moving into the home, and how they were making sure the individual was getting the right things to eat to help her gain weight and feel better. Bedrail records also confirmed the home was carrying out all necessary checks to keep a person safe whilst they were in use. However, it was seen that other peoples care records did not have all the details they needed. In the records of one person who had been prone to falls before moving into Weston House, the information they contained did not account for how to move the person safely if she had another one. Likewise, the records of a person who had specific needs to control a diabetic condition to keep her well, lacked details about how to safely administer her insulin with the special equipment that had been provided for this matter. Although a variety of records were checked we could not find a valid source to confirm the dosage of insulin the person needed. These issues were raised during the first inspection day and immediate action was taken to improve records for this matter, although it could not be confirmed which staff had received the right training to use the equipment safely. We reviewed the medication management systems in the home with the assistance of a senior carer whose responsibility it was to administer medication on the inspection day. Although in general, satisfactory standards reported at previous inspections have Care Homes for Older People Page 14 of 31 Evidence: been maintained, some medication storage and recordkeeping issues were identified.They were acted upon immediately to ensure people were receiving their medication as safely as possible at all times. It was seen that the systems for the storage facilities for refrigerated drugs needed to be improved so the home could demonstrate they recorded the minimum and maximum temperatures of the drug fridge. This is necessary to monitor the storage of insulin people need. It was positive to be told the home have a good working relationship with the local pharmacy who supply their medicines and that they were more than happy to visit the home to talk to people about their medicines if this request was made. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with social activity and can keep in contact with family and friends. Social, cultural and recreational activities meet peoples expectations through assessment, consultation and choice. Residents receive a healthy diet according to their assessed requirement and preference. Evidence: Feedback from all of the residents who asked to speak to us and took part in our survey confirmed there are always activities planned that they can take part in. The home continue to have a good rapport with the visitors of the people who live there and they often help out with the regular social activities that are planned. Everyone commented they especially enjoyed going on the outings and the in house entertainment the home continues to arrange free of charge. Everyone was keen to tell us about the wonderful evening they had at a local concert during the week of the inspection. People also told us, I join in most activities organised. I love the activity coordinator coming. I enjoy the outings especially the craft workshop at another home and Care Homes for Older People Page 16 of 31 Evidence: shopping trips. I have rearranged my weekly hair appointment so I can join in the weekly outings. Photographs and records showed that individuals celebrate the cultural festivals relevant to their preferred lifestyle. The home have active open fellowship meetings where they choose to share their spiritual beliefs as a group. The clergy and congregation from the local parish church also visit Weston house regularly to make the Holy Communion ceremony a community pastime. The activity coordinator who has worked at the home for a long time has an excellent working knowledge of peoples likes and dislikes and makes sure any individuals who are too frail or have no wish to join in the group activities have one to one time with staff so they can continue to enjoy their own hobbies and interests. This is confirmed by the meticulous records this person keeps in a designated social activities folder which accounts for the social care interests of all of the people living at the home, and the activities they participate in on a day to day basis. Since the last inspection the introduction of regular weekend activities has proven to be popular, with people joining in computer games and opting for walks in to the nearby park or venturing on a shopping trip. The home have also purchased a range of relaxation and therapeutic equipment for people to enjoy in the comfort of their own room or as a group activity. Weston house also have the benefit of a resident representative who has volunteered to speak up on behalf of other people in the home to make sure everyone living there is involved in having their say about life at Weston House. She is currently discussing the timings people prefer to be offered their supper. People were very keen to tell us how good the meals were. Everyone including those in need of special diets was very complimentary about what they get to eat and drink.People commented, The meals are very good. I enjoy my meals very much. I have no grumbles about the food. Springcare the company who own the home have launched a new menu which makes sure the needs choices and preferences of the people living at Weston House are catered for in a nutritionally balanced way. The manager told us the residents had a meeting to discuss this to make sure what was being planned would suit their tastes. Observations we made at two different mealtimes confirmed staff on duty were Care Homes for Older People Page 17 of 31 Evidence: knowledgeable about peoples dietary needs, and the best way to serve their residents food so they can dine independently. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements ensure that the views of the people living at Weston House are listened to and acted on. Systems in place make sure people are protected from abuse so ensuring their well being. Evidence: All comments received from people living, visiting and working at the home were unanimous in that people knew what to do if they had to make a complaint. Springcare, the company who owns Weston House actively welcomes comments in order to improve the service they provide. The home complaints procedure on display in the entrance area to the home clearly describes what people have to do if they are not happy. This information is also contained in the Springcare resident information folder mentioned earlier in the report. The home has fully implemented the company monitoring systems for this matter and a company area manager checks these on a monthly basis. Auditing of this paperwork confirms the home has not received a complaint since 2005. Our records also confirm we also have not received any complaints about this service or had any referrals to the local safeguarding adults team since our last inspection in May 2007. Management improvements have continued to make sure people feel comfortable to raise any concerns they are unhappy about.The manager makes a point of welcoming informal comments and encourages people to be frank about how Weston House can be improved. Care Homes for Older People Page 19 of 31 Evidence: Up to date policies and procedures for safeguarding adults are freely available in the home for staff to refer to including robust money and valuable management of the people living at Weston House. Before our inspection the home shared details about their mandatory staff training programme for this sensitive issue. This makes sure all new and established team members including hotel services staff have the training and support they need to protect people as they work in the home on a day to day basis. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables people who use the service to live in a clean, well-maintained and comfortable environment, which encourages independence. Evidence: All individuals who made comments to us about the home were in agreement that the home is always, Beautifully fresh and had a welcoming, clean and tidy appearance. One person wrote that they change the beds often and another stated, The housekeepers are very good. The entrance to the home has a welcoming feel with pretty flower arrangements provided by the same florist the home uses to send flowers to its new residents as a moving in gift. A tour of the home was carried out with the manager, and over a dozen bedrooms were seen, including those of people who asked to speak to us and those who use special equipment to keep them safe. All were personalised, furnished and equipped to meet peoples needs. One newly admitted person told us how pleased she was with her bedroom. Completion of the upgrade of the communal areas means that the home now has improved laundry facilities,and the home now offers a variety of welcoming comfortable areas for its residents to congregate for activities and meetings Care Homes for Older People Page 21 of 31 Evidence: or just to relax in peace. Handwashing facilities have also been upgraded around and about the home giving people readily available access to this equipment. At the last inspection we made a requirement for the home to make sure people have the opportunity for locking storage facilities for personal effects in their room.One lady we spoke to had welcomed this facility to keep her momentoes safe.Although we saw some rooms did not have safekeeping facilities,all people living at the home were consulted about this and some opted not to be provided with this amenity. The home have been disappointed with the quality of armchairs bought as part of the home upgrade and the condition of some were already showing signs of wear and tear. The manager told us this matter is in hand and they are being returned to the manufacturers in rotation for repair. Random testing of hot water in the communal bathrooms established that the shower in the first floor bathroom required a safety device to make sure there was not a chance of anyone turning the hot water temperature up above 43 degrees Centigrade and hurting them.This was attended to immediately by the home handyman who was on site. An unprotected convector heater we saw in a persons bedroom was also fitted with a purpose built guard so it could also be used safely. Cleaning chemicals were also seen in unlabelled bottles on the housekeepers cleaning trolley. Although prompt remedial action was taken to rectify the above matters during this inspection, it is recommended the home improves its auditing systems to make sure they carry out regular health and safety checks of the equipment that is used on a day to day basis in the home. Externally the home appeared to be in good order, although a clinical waste bin had its contents made secure after it was noted that it was unlocked and some bags of waste had burst posing a vermin and infection control hazard. In the information we recieved before the inspection, Weston House told us, Our improved patio and garden area provides seating and space for activities and alfresco dining. People we spoke to said they they were looking forward to better weather to take advantage of these areas. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for staffing, their support and development ensure that the needs of the people living there are met. The recruitment practices help to ensure that the people living there are safeguarded from abuse. Evidence: Favourable comments received from people living at the home confirmed that they receive the care and support they require. One person commented, Im very happy and well cared for Staff look after me like my lovely family would. Comments we received from a local doctor also confirmed that the care team Work hard to keep people properly cared for at Weston House as their needs change. Examination of past, present and future rotas during the inspection confirmed the home is adequately staffed and takes into account the dependency needs and numbers of people living at the home. Staff told us if there is a trip planned an extra carer is always rostered on duty to help out. Comments from the care team confirmed they are clear regarding their role and what is expected of them. The home is proud there is a very low turnover of staff and this means they do not use agency carers. As a result people get looked after by a staff team that knows them at all times. Examination of the files for two recent new starters showed that suitable recruitment Care Homes for Older People Page 23 of 31 Evidence: procedures are in place. Each file was well-organised and contained references, proof of criminal record bureau disclosures and confirmation of identity and qualifications. Many aspects of staff training have also improved. Records show new starters get a proper introduction to working at Weston House and a training agreement is set up to make sure any development needs are attended to. 90 of the carers have the minimum expected care qualification. The home benefits from being able to access the services of two trainers the company employs which helps keep staff up to date with the skills and awareness they need to do their job properly. The files of two staff members who have worked at the home for some time confirmed they have received all necessary training which has also covered additional safety issues for bedrail use.Senior staff whose duties include medication management have all received appropriate training for this matter.Catering staff are also developing themselves to get an NVQ 3 qualification to demonstrate their committment to higher standards for meal provision in the home. One staff memeber told us, The company is supportive and offers training opportunities to help me improve my role. Good tracker systems have been set up by the manager so she has an at a glance picture of the training staff have had and what they need. This would benefit the addition of her own achievements to confirm the skills and talents of the whole care team are accounted for. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service receive a safe, consistent and good quality service. Thismeans they can be confident that their needs will be fully met. Evidence: Jo Barber is the Registered Manager of Weston House and has worked at the home for over four years. She has obtained the Registered Managers Award and NVQ 4 in Health Care. Since the last inspection she has undertaken any necessary courses appropriate to her role to keep her skills and knowledge up to date. Following recent training to supervise her staff team she is now in the process of ensuring an effective system is in place to monitor and develop this responsibility. People living at the home, staff and visiting relatives were very complimentary in relation to the registered manager and her leadership skills. Staff commented, The manager is available and is supportive of my role and offers advice and guidance when and if I need it. Another carer stated, She is interested in Care Homes for Older People Page 25 of 31 Evidence: my role and offers training courses which will be of benefit to me. Prior to our inspection, the manager submitted an excellent annual quality assurance assessment (AQAA) to tell us about Weston House .The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. The AQAA contained comprehensive information with a wide range of supporting evidence, some of which was seen during the inspection. The AQAA demonstrated a high level of understanding about the importance of equality and diversity and a range of evidence showing how they have listened to people who use the service and the staff team. Through this information the service have demonstrated self-awareness and identified the areas in which it still needs to improve. Discussions with the manager during the inspection gave evidence of how the improvements were to be achieved, including the issues we have recommended be prioritised in this report. There is an ongoing programme of monitoring and auditing the majority of all aspects of the service at Weston House, in line with the policies and procedures of Springcare the company who owns the home. Spot checks of reports completed by the area manager for the company after her monthly visits confirms issues like complaints, accidents and staff development are monitored. The home continues to get positive feedback from their annual satisfaction survey, and excellent comments about care practices and activities have been received in response to this. Safe working systems in the home have been maintained made to ensure good management of monies and valuables kept in safekeeping for people using the service. The home currently looks after monies for eight people who live there. Recordkeeping for this matter could be further improved by reference being made to this part of the service being carried out on their behalf in their care records. All service and maintenance records for essential equipment used in the home were seen to be up to date and complied with necessary health and safety legislation.However, we did advise the manager that it would be good practice to have an inventory of all the hoisting equipment used at the home to make sure it would all be included in the six monthly services it requires. Examination of the fire safety records confirmed all regular checks have been carried outIwas positive to be informed that the home fire risk assessment which had not been evaluated for over 12 months was already being acted upon. Care Homes for Older People Page 26 of 31 Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The Statement of Purpose and Service User Guide should contain information about the service as per Schedule 1 and its associated Regulations. People thinking about moving into Weston House must be provided with all the necessary information they need to help them to decide whether the home is right for them. Additional details specific to individual needs of people need to be considered for inclusion in care plan records,in order to ensure record keeping accounts for all actions staff take to keep people safe and well especially with regard to their moving and handling and medication needs.This will assure people in the home that the service is doing all it can to safeguard their well being. It is rcommended that the home has the necessary recordkeeping to show that staff who are expected to administer medication using specialist equipment have received apropriate training to confirm they are competent to do such a task.This will assure people in the home that the service is doing all it can to safeguard their well being. It is strongly advised the home management team further expand their monitoring systems to make sure the equipment people use on a day to day basis is safe to use 2 7 3 9 4 25 Care Homes for Older People Page 29 of 31 and free from any hazards,This will offer assurance to people living at the home that the service is doing all it can to keep them safe. 5 35 When the home holds any personal moinies in safekeeping for a person it is advised this is acknowledged in the care records of the individual concerned.This will demonstrate the home is doing all it can to inform people who is looking after their monies and demonstrate open and transparent management systems for this matter.This offers people assurance the service is doing all it can to safegurd the well being of people concerned. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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