Care Home: Weston House

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What the care home does well We found that Weston House presents a high quality commitment to care with an open and highly personable approach. Staff are competent and friendly, and understand the needs of the people living here. People can feel confident they will be treated with respect and dignity at all times. We were told: "The service looks for the positive way forward, helps people live their lives, and respects everyone", which reflects the professionalism and homeliness of a confident relationship between carer, and those people using the service: "Dad`s health has improved since he was admitted to Weston House, he is content there, and very well looked after". "Weston House provides the best, all round care that I`ve seen anywhere, all the residents are treated as people, and as individuals in a loving environment". From our examination of care records we established that there was a thorough assessment, care planning and review of individual needs, which are meaningful and robust in formulating an excellent standard of care. When we discussed the quality of care with those people using the service, it was made clear that they appreciated this highly personable attitude and approach to care. The service`s Statement of Purpose states: "MHA`s care is person centred and holistic, with the individual and their preferences at the centre of our work", this we found to be true. We considered that the overall management style demonstrated a very positive approach in maintaining an environment conducive to the care of the elderly mental ill and people with dementia. There is a regular appraisal and review process of facilities and services, through a `Standards and Values Assessment`, conducted by the Providers, to maintain that environment by the senior care management and Providers. What has improved since the last inspection? We found that the home has addressed the issues raised in the last Inspection Report, with a review and streamlining of policies, procedures relating to medication administration, and a closer involvement of people who live in the Home, and their relatives in the planning and review of care. We acknowledge that the deployment of care staff in numbers and qualification are of a high quality and consistently pursued by the Registered Providers, providing a platform for the delivery of an excellent service. We recognise an improved, and comprehensive training process undertaken to ensure that staff are proficient and aware of changing needs of people, and of the care environment. We found that there has been a reinforcement of the impact that social activities play, that reflect the interests of the people in the Home at any one time. We have found a considerable improvement, and continuing development in the decor and physical presentation of the Home, to ensure that it remains a safe, comfortable and homely environment. The management of the Home has continued to maintain a solid professional management style, thoroughly implemented, to achieve high standards of set aims, objectives and care. What the care home could do better: The achievements in establishing an excellent standard of care have been recognised, areas of detail, outlined through recommendations, will continue to play a part in the ongoing development and maintenance of an excellent service. Key inspection report Care homes for older people Name: Address: Weston House Weston Road Stafford ST16 3TF     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: Keith Jones     Date: 0 1 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Weston House Weston Road Stafford ST16 3TF 01785228324 01785220815 home.weq@mha.org.uk www.mha.org.uk Methodist Homes for the Aged care home 48 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) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 48 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 48 Mental disorder, excluding learning disability or dementia (MD) 48 Date of last inspection Brief description of the care home Weston House is owned by the Methodist Homes for the Aged, which provides 24 hournursing care for 48 mentally infirm and mentally ill people. The home was first opened on 1st March 1993 and taken over by MHA in April 2005. MHA was created in 1943 and is a registered charity. The home is divided into four house groups, each house group provides a comfortable, homely atmosphere for people living in the home. Within each house group there is a fully fitted kitchenette where relatives and visitors are invited to help themselves to refreshments. The lounges were sensitively organised to allow people space, and choice of where to sit. The dining areas were also well arranged to allow a feeling of Care Homes for Older People Page 4 of 32 48 48 Over 65 0 0 Brief description of the care home space. Each person using the service have their own bedroom, which has en-suite facilities, and are encouraged to bring in their own personal possessions to personalise their bedrooms, which assists them to settle easily into their new home. Each bedroom has a TV aerial point, if the individual wishes to have their own TV and also a telephone socket too. Three hot meals are served daily, which were freshly prepared and cooked by the homes fully trained Chef and his assistants. Laundry services are also undertaken within the building. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We conducted this unannounced inspection with the Registered Care Manager, Deputy Care Manager, senior nursing and care staff on duty, whose input contributed to this report. Our inspection of the building allowed us free access to all areas and open discussion with people who use the service, relatives and staff. There were 46 people in residence on the day of our inspection. We looked at how care is being arranged and supported for a range of people with dementia and mental health care needs. To do this we looked at (case tracked) four peoples care records from pre-admission to the present time, and four staff records were examined. We also looked at other information such as complaints, events, other professional reports, and what the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. We took the opportunity to speak with a number of people who use the service, relatives and members of staff, who took an active role in the inspection process, and Care Homes for Older People Page 6 of 32 contributed to the subsequent report. We acknowledged receipt of the Annual Quality Assurance Assessment (AQAA), and two survey forms we received from those we issued to people who use the service some weeks before the inspection. The AQAA is a self-assessment that focuses on how well outcomes are being met for the people using the service. It also gave us some numerical information about the service. Relatives who were present were complimentary of the family approach to care, the freedom they enjoyed and the involvement that the Care Manager and her staff encouraged. It was evident that they were inclusive in the process of care. Everyone appeared comfortable and at ease with their surroundings. We inspected a sample review of administrative procedures, practices and records, confirming consistent good practice and effective management. There followed a report feedback, in which we offered an evaluation of the inspection, indicating those recommendations resulting from the inspection. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? We found that the home has addressed the issues raised in the last Inspection Report, with a review and streamlining of policies, procedures relating to medication administration, and a closer involvement of people who live in the Home, and their relatives in the planning and review of care. We acknowledge that the deployment of care staff in numbers and qualification are of a high quality and consistently pursued by the Registered Providers, providing a platform for the delivery of an excellent service. We recognise an improved, and comprehensive training process undertaken to ensure that staff are proficient and aware of changing needs of people, and of the care environment. We found that there has been a reinforcement of the impact that social activities play, that reflect the interests of the people in the Home at any one time. We have found a considerable improvement, and continuing development in the decor and physical presentation of the Home, to ensure that it remains a safe, comfortable and homely environment. The management of the Home has continued to maintain a solid professional management style, thoroughly implemented, to achieve high standards of set aims, objectives and care. Care Homes for Older People Page 8 of 32 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 32 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 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of people are appropriately assessed before they are offered a place. They and their relatives can be confident that the service will be able to meet their needs. Evidence: We examined the services comprehensive Statement of Purpose, and found it to provide an excellent, informative description of the homes aims, objectives, and the way it operated, although it needs to be updated to accommodate contact changes. The Service User Guide provides the basic details of the service which can be expanded and presented in a more robust style, and consideration be given to produced the document in large print, as and when necessary, and an audio version would help people with poor eyesight to make an informed choice. We acknowledged that the documents were presented to all enquirers, and that information concerning fees payable were not included in the Service User Guide. It is stated in the AQAA, and we recognise that the Statement of Purpose represents the basis on which the Home operates upon, offering those people who may use the service, and their Care Homes for Older People Page 11 of 32 Evidence: relatives, the opportunity to make an informed choice about where to live. Comments received from talking with people who use the service and visiting relatives: My sister had visited several times from her church and she thought it was suitable. We are very happy with the care given to us. The service looks for the positive way forward. Helps people live their lives, respects everyone. We received plenty of comments and descriptions from friends, and the information I received was very informative and helpful. Through our case tracking of four peoples care records we clearly identified that the Care Manager, or her Deputy, at the point of reference, conducted the pre-admission assessment. We found that the documentation identified a clear dependency assessment, forming a comprehensive foundation for care planning to meet needs, which included a copy of the care plan from Social Services, prior to admission. The objective is for this assessment to be produced with the full involvement of people who may use the service and their family, allowing them to influence the direction of care. We found this to be true, with each individual having a plan of care, which included a detailed care plan, daily care programme, risk assessments with goals and outcomes. Any special needs of the individual were discussed fully and documented, ensuring their personal needs would be met. During the course of our inspection we had opportunities to sit and talk with people who use the service, staff and a number of visitors. We found evidence that much care had been taken in involving people, and their families in the admission process. Social Services drew our attention when we were making enquiries, and we received plenty of comments and descriptions from our friends and people who knew of the Home, all being very complimentary, which we can now confirm. When we were visited by the manager the information we received was very informative and helpful, leaving us in no doubt as to the type of home Weston House is. We have been delighted with the result and the care dad gets. From our discussions it was clear that people are able to visit and assess the facilities and suitability of the Home at any reasonable time, and to meet with staff and management. Staff are aware of the special period of personal anxiety that people Care Homes for Older People Page 12 of 32 Evidence: have under those conditions, a point well illustrated when talking to people, and examining records on case tracking. No intermediate care took place in the Home. Care Homes for Older People Page 13 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care, which people receive, is based on meeting personal needs, with clear principles of respect, dignity and privacy put into practice. Medicine administration systems are safe and secure. Evidence: Those care records we examined, and case tracking provided clear evidence to show that the pre-admission assessment represented the foundation for a well considered, and detailed care planning process, in association with Social Services reports. The AQAA stated, and we verified that those people who use the service, families and friends are invited to participate in the care planning process, development of the plan, write up the personal profile, and sign the support plan to help establish monitoring systems, and evaluation of quality care plans. We found that the profile of each persons social, physical and psychological status offered an individual plan of care, based upon a Person Centred Support Care process of dependency assessment and activities of daily living, frequently reviewed in an individual plan of care that is reviewed monthly, to reflect their changing needs and adapting care profiles, supported with a substantial and very detailed daily progress report system, Care Homes for Older People Page 14 of 32 Evidence: disseminated within the support plan structure. Although accessible, the daily report lacks the continuity, with a night report, of a dynamic flow to assist clear communications and awareness. Nevertheless established monitoring systems follow a process of goals, care and evaluation of high quality care plans, appreciated by those people receiving care, and relatives alike. Risk assessments are carried out on an individual basis and reviewed as required, these include tissue viability, continence and nutrition. The strength of purposeful planned care lies within the frequency of the review process in monitoring and adapting care profiles. The person centred care plan has established a firm understanding of dementia care needs, and was found to be well maintained and accurate. Case tracking of four people living in the Home confirmed to us that specialist support and advice are sought as needed, with each person having access to appropriate professional services, including local Doctor, Dentist, Optician, Chiropodist, and Occupational Therapist as required. Our observations showed that generally people using the service appeared to be content, comfortable and happy with their lifestyle, complimentary regarding the quality of their lives and the care they were receiving. Comments we received during the course of inspection from people using the service, visitors and professionals: I have always found Weston House to be clean, and smells nice and fresh. The bedrooms and bathrooms are always clean and tidy. It has very good medical care, who come in regular and see to mum when she has been unwell, the staff are very approachable and friendly. Dads health has improved since he was admitted to Weston House, he is very content there, and very well looked after. We confirmed that the administration of medicines adhered to procedures to maximise protection for people who use the service. We found that the Care Manager is responsible for overseeing all matters relating to medicines, supported by her senior nursing staff. She has effected a well developed, and smooth process of ordering, receiving, storing, administering and disposing of medicines. Records were seen to be complete and easy to follow through, with no observed breaches in the system. Controlled Drug management was comprehensive, although requiring index updates. There was nobody self medicating at the time of inspection, although each person has the opportunity of their own lockable facility in their bedrooms on request. In our examination of care records, we established that as part of the completion of their care plan, people are asked about their end of life wishes, and are recorded. Care Homes for Older People Page 15 of 32 Evidence: Facilities are available to relatives or friends who wish to remain close, to meet individual needs, and were in place with the full knowledge of those who use the service and relatives. Our discussions with people confirmed that individual spiritual persuasions, and individual diversity was seen to be respected. It is stated in the services Statement of Purpose and the AQAA, that independence, privacy and dignity are encouraged, with the full involvement of family in all matters concerning the well being of people. This was confirmed in our discussions with people who use the service. visitors and staff. Issues of cultural, personal and ethnic diversity was discussed, reiterating an open policy on admissions, and consistency of care plans in respecting and celebrating diversity. Relatives and friends have freedom of visiting, emphasising the importance of maintaining social contact. We looked at bedrooms presented to facilitate privacy for the individual, which included medical examinations and personal care procedures being performed in private. We were impressed with the confidence and closeness within the Home and the mutual respect that prevailed. Care Homes for Older People Page 16 of 32 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. Peoples rights to live a meaningful life are promoted, and people are offered opportunities to exercise choice and control over their lives. People are offered a healthy, well balanced diet. Evidence: We found daily life to be flexible to accommodate peoples needs and capabilities, offering choices at meal times, and during personal and social activities, including recognition of varied religious needs. Our discussions with people who use the service and staff, identified a relaxed atmosphere in which peoples preferences were respected, with the security that there are familiar events to the day they could relate to. We acknowledge that Weston House employs an activity coordinator in social activities, who was seen to offer 1:1 and group activities, and to provide a diverse programme of activities and individual assessments of need. She is assisted by a Volunteer Support Group, who take an interest in individuals, as well as organised activities. The home has a full and varied activity programme running two group activities, seven days a week, drawn up after consultation with people living in the Care Homes for Older People Page 17 of 32 Evidence: Home and their families. We acknowledge that peoples social needs and interests are documented in individual support plans, and that peoples life histories are discussed, and used as a basis for individualised social care, offering choice and support. The Home boasts to celebrate residents special days and magic moments. We identified that the Home accommodates the needs of people with dementia in providing materials and activities to focus on reminiscence, encouraging people to reflect on their lives, families, and achievements. Our discussion with managers and staff identified a clear vision of care for people with dementia, and to participate in the process of change in environmental and social facilities. A member of staff has been trained in reflexology, and the Home has introduced elements of a natural community with plants, animals and children influencing aspects of life in the Home Families and friends are actively encouraged to participate in the daily life of the home, with no restriction being placed on visiting times. During the course of the inspection we saw staff and visitors interact with people in a positive and polite manner. Comments from visitors, one person who came every day were: The care that mum gets here is outstanding, the staff, all the staff, are committed to giving their best, for the residents benefit. Before she came in here she showed no interest in her surroundings, which has changed enormously over the past year, for the better. Weston House provides the best, all round care that Ive seen anywhere, all the residents are treated as people and as individuals, in a loving environment. It is stated in the Statement of Purpose and AQAA, that personal choice, dignity and self determination are respected in policy and action, which we found to be true. Those individuals rooms we inspected showed a very positive influence of personalisation in the inclusion of belongings, some furniture and general decor, demonstrated a high degree of expressed individuality. We found that the high standards of catering at Weston House continues, offering a very good service, to which all those people we spoke with being complimentary of all aspects of quality. A menu on a six weekly cycle offered a wholesome, varied and excellent choice. We confirmed that the catering manager knew each person using the service, and some of the relatives. We also discussed diversity with the manager, who indicated an awareness in meeting individual needs and preferences, who met with people to discuss their requirements, and confirmed that there were no special cultural needs at the time. A pleasant lunch of sausages, pizza and meals of choice were served during inspection, in tastefully furnished, and clean dining rooms. The choice of Care Homes for Older People Page 18 of 32 Evidence: dining room, lounge or bedroom was at the discretion of people in the home. Staff were seen to offer discreet assistance to those who required it. Snacks and drinks are available to people any time of day and night. People interviewed confirmed that that the quantity and quality food provided was nutritious, varied, well presented, and incorporating as much choice as possible following consultation with people at residents meetings. Care Homes for Older People Page 19 of 32 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. People are given opportunities to freely express any concerns, and these are quickly responded to. People are protected from abuse, and their human rights are promoted. Evidence: Through the course of inspection we confirmed that peoples legal rights are protected by the systems in place in the home to safeguard them, including the continual review and assessment of care planning, and policies in place, including the complaints procedure. The complaints policy and records of complaints dealt with were examined, which evidenced handling of peoples, and families concerns in a meaningful and effective manner. From our discussions with people who used the service it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. There were a few minor complaints, which we feel would be better dealt with through a record of Concerns, Complaints and Safeguarding, to record peoples, and their families concerns in a meaningful and effective manner. Comments we received from people living in the home and visitors, on the day of inspection : If Im not happy, I know I can ask the Manager, or a member of staff, who have always been attentive and responded well to suggestions made, to make mums life a Care Homes for Older People Page 20 of 32 Evidence: little better. I have absolutely no complaints to make, up to date. No formal complaints had been received by us since our last inspection. The overall policy of openness and transparency was acknowledged. We were informed that all the people who used the service had received information on the procedure to complain, including reference to us. This process was evidenced on examination, and case tracking, as previously reported upon. Discussion with the Care Manager confirmed that there continues to be a satisfactory protocol, and response to anyone who may report any form of abuse, to ensure effective handling of such an incident. The Annual Quality Assurance Assessment completed by the service prior to the inspection confirms all staff employed in the last twelve months have undertaken a satisfactory Criminal Records Bureau (CRB) check, confirmed by examining three staff files. It is positive that all staff have had training to highlight their responsibilities under the Mental Capacity Act. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home provides a safe, well-maintained, clean and comfortable environment for the people who use the service, which encourages independence. Evidence: External access is satisfactory for visitors, with adequate parking. The three patio gardens offer pleasant areas for fresh air and reflection, shared with the adjacent Queensway Care Home. The state of repair and maintenance is generally very good, offering a comfortable, homely yet secure environment. Visitors and people who use the service take advantage of the very attractive gardens and grounds; pathways were safe and recently attended to, the efforts in presenting the garden areas are recognised, and those comments we received were complimentary. On admission the Care Manager or her deputy assesses each individual persons needs for equipment and necessary adaptations. A letter confirming those arrangements was seen in each case file. Internal access was facilitated with ample fittings of hand and grab rails in well lit and airy corridors, facilitating wheelchair access throughout all areas of the home. It was noted that a comprehensive programme of redecoration and refitting has been completed since the last inspection, especially in meeting dementia care needs, in pathway recognition, reminiscence and familiar recognition. The Care Manager confirmed to us a willingness on the part of management to meet any reasonable demand for special needs. Care Homes for Older People Page 22 of 32 Evidence: All communal areas were seen to be of a high standard, providing four main lounge areas, well organized to provide areas for quiet reflection, socialization and activities. All were pleasantly decorated, providing good quality furnishings and items to provide comfortable areas where people were able to interact with their friends, or to entertain their guests. The dining areas offer clean and pleasant environments, each serviced with a kitchenette. At lunch time staff were observed to be assisting people with their meal, reinforcing contact and confidence. Our inspection of bedrooms found them well equipped and maintained to provide for peoples individual needs and preferences, personalised, with most displaying the personal furniture and belongings, all are en-suite and provide shower facilities. Efforts had been made to provide a homely atmosphere, and the decor was found to be of a good standard, with a development programme for continuing upgrading. We found that each bedroom has adequate space to assist with personal care and dressing assistance, and there are an appropriate number of variable height beds. We found the use of instruction notices in some bedrooms to be obtrusive, and need display in more discrete areas. The nurse call alarm system was satisfactorily tested, with a good response from staff on duty. Personal electrical equipment (PAT), that is televisions, radios, etc, where seen to be tested. Several people we spoke to expressed a sense of belonging and satisfaction in the quality and presentation of their living areas. The outcome is a comfortable and familiar private domain that reflects the peoples preferences. Bathrooms and toilets are fitted with appropriate aids and adaptations to meet the needs of people who use the service, and are of a high quality, clean, uncluttered and odour free. Adequate attention has been given to ensure maximum privacy within risk assessed boundaries. Toilets and bathrooms were located on both floors and were in close proximity to bedrooms and communal areas. We tested the water temperature and found it tepid for practical use at 37 degrees Centigrade following a busy morning. Sluice facilities have suitable arrangements to assist in control of infection. Notices regarding chemical handling in the areas that store chemicals are displayed. We discussed the high quality of the housekeeping and maintenance services in the Home with the Head of Hospitality, who demonstrated a commitment to offering a safe and comfortable environment. All those people spoken to remarked that they find the environment always very clean and fresh. Comments from people we met on the day, including visiting professionals: Care Homes for Older People Page 23 of 32 Evidence: Weston House is always clean and pleasantly presented, and smells nice. We have found that the bedrooms, toilets and bathrooms are always clean and tidy. The lounges and dining areas are great centres of activity, which mum enjoys, and the garden areas are lovely. I have been very impressed. The home achieves a high standard of cleanliness. We travel extensively and visit a number of similar homes, and we think that Weston House is an excellent nursing home. My brother who is a doctor, has always been very impressed with the service, and we both recognise that its nice that the residents, relatives and staff appear to like it too. Heating and ventilation were found to be satisfactory, and lighting was domestic in style. Aids, adaptations and equipment were available throughout the Home. Fire equipment was inspected and seen to be serviced and up to date. The treatment rooms were fit for purpose, including oxygen storage. The laundry was well organised and equipped to a good standard. Safe use and storage of chemicals regulations were clearly displayed, and relevant to solutions in use. The kitchen presentation showed good standards of cleanliness and evidence of sound food hygiene practices. All fridges and freezers were seen to be used in the appropriate manner, and were checked daily by the kitchen staff. A cleaning schedule was in place, up to date and comprehensive. We spoke with the cook who confirmed to us that he actively engages with people who use the service to determine their needs and likes and dislikes. He was aware of the issues of culture, ethnicity and age diversity, having had experience in dealing with a diverse population. The Annual Quality Assurance Assessment completed by the service prior to the inspection confirms that the building complies with the requirements of the local fire service and environmental health department, and records are kept accordingly. Care Homes for Older People Page 24 of 32 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. Staff in the Home are trained, skilled and in sufficient numbers to fulfill the aims of the unit and meet the changing needs of people using the service. Evidence: We confirmed that there were 46 people living in the home on the day of the inspection. Three weeks of staffing rotas showed to us a satisfactory balance between skills, experience and numbers to provide a good standard of care. The Registered Manager, who is supernumerary, is supported by a Deputy Manager and a satisfactory complement of Registered Nurses and care staff. Discussions with staff also confirmed their commitment to providing a quality service and their awareness of the principles of good practice. There are named nurses and key workers identified for each person living in the Home, providing personal care and support and ensuring personal needs are met. At the time of the inspection there were four Registered Nurses and ten care staff on duty, which represents a much improved provision, exceeding minimum recommendations. Average care staff coverage: Morning shift 3/4 Registered Nurses 10 Resident Support Workers Afternoon shift 2/3 Registered Nurses 9 Resident Support Workers Night duty 2 Registered Nurses 3 Resident Support Workers Care Homes for Older People Page 25 of 32 Evidence: The home has an full time Social Activities Co-ordinator, and a satisfactory complement of housekeeping, laundry, maintenance, administrative and catering staff. There are also a number of volunteers who reflect the partnership with the community. All of whom receive induction, training and ongoing supervision. A chaplain has a ministry within the Weston House/Queensway site, with a clear objective to support a person centred, good quality of life service, as indicated in the Statement of Purpose. We critically examined four staff files, and found them to be consistent and up to date. Staff are employed in accordance with the code of conduct and practice set by the General Social Care Council. We recognise that the management have established a comprehensive procedure for interview, selection and appointment of staff, reinforcing the policy that the thoroughness of staff selection has a significant effect upon the provision of care to ensure protection of people. We saw that all new team members receive a thorough induction programme, which meets prescribed standards, and an ongoing training and development plan for all staff. The records we examined showed that 70 of care staff are in receipt of National Vocational Qualification (NVQ) level II or level III, with a further 20 undertaking NVQ training at the time of inspection. Twelve members of staff have the certificate of first aid. Overall the evidence shows a substantial account of a meaningful schedule of training to meet mandatory and specific demand. Comments received from people we talked with on the day, and with staff on interview: I have found that all the senior staff, carers and other staff are very committed and dedicated. We have found the staff to be lovely people, very kind and very helpful, most of them have been at the home a long time, so they know the needs of the residents if there are any problems. The Manager is very supportive both personally and professionally, she sets the standards of good practice and behaviour, which we follow. The organisation is a great company to work for, always trying to improve and provide the best possible framework for staff to work with, and care for people. Records were available to demonstrate an on-going process of regular supervision and supervised practice, showing training sessions and appraisals to be a routine feature of staff development. Care Homes for Older People Page 26 of 32 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 can be assured that the home is run in their best interests. The ethos of the service is based on openness and respect. The care team, through good working practices, promote the health, safety and welfare of people who use this service. Evidence: We acknowledge that the Care Manager Janet Coulson has continued to demonstrate clear competence over the past fourteen years, four as Care Manager at Weston House, in establishing a solid professional management style that has been implemented, to achieve high standards of set aims, objectives and care. A Registered Mental Nurse who is presently undertaking an NVQ level 4 in Management, and has actively promoted, and enhanced the Key worker and Named Nurse team concept supporting a Person Centred Support Planning process. The Registered Providers have demonstrated a high profile and proficient involvement in the smooth running of the home, and are prepared to delegate a wide range of management responsibility to Care Homes for Older People Page 27 of 32 Evidence: good effect. We acknowledged the openness and confidence in the observed interactions of staff, relatives and people who live in the home. The relationships were seen to be of mutual trust and respect. Several comments made by people who live at Weston House, and visitors we spoke with, reinforced the strong foundation of confidence they had in the management leadership. Comments we received from people and staff interviewed on the day: All the staff treats the residents as individual people, the quality of loving care is very high from everyone who works at Weston House. Its so reassuring to know that mum is well looked after, and that she is so settled and comfortable. I have always found Janet Coulson to be warm, very approachable and fair, leading by example. This home has been a very positive time for me, in working with professional staff who really care. The manager is very good and gives us support, nothing is too much trouble. Its lovely having for the residents to have the minister for the Church with them all the time, its very comforting and reassuring. Our examination of records showed appropriate risk assessments are in place for people, through care planning and recording, staff selection and of the general environment, these are up to date and accurate. The services completed AQAA states that the Home has quality monitoring systems in place, and they also consult the people who use the service and their relatives about the service. We examined a Quality Development Plan for 2009/10, and found it an accurate reflection of a commitment on behalf of the Provider to maintain and improve facilities at Weston House. We recognise that the Providers, with the Care Manager, have developed a formal approach to monitoring quality across a wide range of activities. An examination of administrative, monitoring, planning and care records showed an organised and a professional attitude to effective record keeping. They were found to be well maintained, accurate and up to date, ensuring that peoples rights and best interests are safeguarded. We identified that small amounts of cash were efficiently handled by the administrator, through the Providers office. We acknowledge that the Providers audit the accounts on a six monthly basis, and the Care Manager inspects the records every three months. Evidence was secured to acknowledge achievements, ongoing and planned objectives. Involved within this process are the views of people using the service and relatives, confirmed at case tracking and informal discussion. There is strong evidence of Care Homes for Older People Page 28 of 32 Evidence: openness and honesty in receiving comments, and speaking with people living in the Home, relatives and staff, in which day to day events and episodes are freely discussed. Evidence was secured to confirm a quality monitoring system of Standards and Value Assessment, broad-based upon audit of standards, care plans and feed back from people living in the home and relatives. We acknowledged the outcome of the recent (March 2009) internal survey in which the results showed a clear indication that the home is run in those peoples best interests. Standards are discussed at staff meetings, daily reports, direct observation involvement and one to one staff meetings, held regularly in which staff are encouraged to participate fully in the management and direction within the home. The inspector observed at first hand the confident interrelationship that exist between management, staff, people who live at Weston House and their visitors. We made a random sample examination of the procedures manual, and found it to offer a very comprehensive reference. Policies on Missing Person, Safeguarding and managing abuse, confidentiality and medication were examined, and found to be accurate and informative. We found that the health and safety of people who use the service and staff, are promoted with safe storage of hazardous substances, regular electrical PAT, servicing of hoists, gas appliances, and regulation of the water system. The accident book was seen and found to be in order for staff and people using the service, with a three monthly analysis of trends and frequency undertaken by the manager. The Home has an open door policy and a commitment to equal opportunities. As previously mentioned there is a willingness to create a training environment, and a staff supervision policy and procedure is in place in the home. Cascading supervision programmes are established as part of the normal management/training process, with all care staff receive six sessions of individual formal supervision annually. Equality and diversity issues were also discussed covering a wide range of issues, including food, religion and staffing. We found the administration and management of the home is efficient, uncomplicated and sensitive to the needs of people living in the home. Care Homes for Older People Page 29 of 32 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 30 of 32 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 Service User Guide provided should be expanded and presented in a more robust style, and consideration be given to produced the document in large print, as and when necessary. An audio version would help people with poor eyesight to make an informed choice. The Provider is to consider a review of the daily report system, which lacks the continuity, with a night report, of a dynamic flow, to assist clear communications and awareness. Complaints would be better dealt with through a record of Concerns, Complaints and Safeguarding, to record peoples, and their families concerns in a meaningful and effective manner. That the use of instruction notices in some bedrooms cease to be obtrusive, and need display in more discrete areas. 2 7 3 16 4 24 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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