Care Home: Willersley House

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What the care home does well People have a thorough care needs assessment prior to their admission to the home and information gathered at this time, along with other relevant information, is used to develop an individual support plan. People`s health care needs are met, including the safe administration of medication. Medication policies, procedures and practices at the home are robust, and this protects people from the risk of harm. People are encouraged and supported to live their chosen lifestyle. There is a varied activity programme for people to take part in if they choose and spiritual care is an important part of day to day life. People`s visitors are made welcome and they can have meals with their relative in a private area of the home if they wish to do so. The `dining experience` for people is one that respects their privacy and dignity. There is ample choice available at meal times and these are seen as social occasions. People are supported to be as independent as possible - everyone has a single en-suite bedroom and there is a post box outside all bedroom doors for receiving mail. The home has been refurbished and provides high quality accommodation and facilities for the people living there; there is good quality furniture and decor throughout. The home is well maintained and provides a safe place for people to live. It is clean, hygienic and there are no unpleasant odours. Laundry facilities are good. Staff are recruited via robust recruitment practices. They receive thorough induction training followed by mandatory and refresher training - this results in a staff group who have the skills and knowledge to meet the needs of the people living at the home, and who work well together as a team. The home is well managed - this includes quality assurance systems, the holding of service user monies and health and safety monitoring systems. Regular audits take place to check that these systems are working effectively. What has improved since the last inspection? The refurbishment of the home was completed approximately one year ago. The home now provides excellent quality accommodation for the people who live there, including improved bathing and showering facilities. What the care home could do better: Some minor improvements in the recruitment process would make the systems in use more robust, i.e. the retaining of letters to referees and the recording of staff supervision arrangements whilst waiting for their CRB check to arrive. Key inspection report Care homes for older people Name: Address: Willersley House 85 Main Street Willerby Hull East Yorkshire HU10 6BY     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: Diane Wilkinson     Date: 0 8 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 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: Willersley House 85 Main Street Willerby Hull East Yorkshire HU10 6BY 01482653353 01482659668 home.hull@mha.org.uk www.mha.org.uk Methodist Homes for the Aged care home 34 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 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Willersley House is owned by Methodist Homes for the Aged, a voluntary organisation specialising in the care of older people. The home is situated in the village of Willerby, in the East Riding of Yorkshire. Local amenities such as shops, public houses, banks, hairdressers and the post office are all within walking distance, and public transport is easily accessible. The home is a Victorian house with a modern extension that has recently undergone a refurbishment programme, but still retains some of its original features. It provides accommodation for thirty-four older people. All bedrooms are single and have en-suite facilities. The communal areas include a lounge, an attractive oak panelled quiet room and a Care Homes for Older People Page 4 of 32 Over 65 0 34 34 0 Brief description of the care home large dining room. All areas of the home are accessible to service users via the provision of a passenger lift and ramps. Outside there is a ramp into a well-maintained garden with numerous trees and bushes, and an enclosed courtyard. There is a small car parking area adjacent to Willersley House. 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: This inspection report is based on information gathered by the Care Quality Commission (CQC) since the last Key Inspection of the home on the 9th March 2007, including information gathered during a site visit to the home. The unannounced site visit was undertaken by one inspector over one day. It began at 10.30 am and ended at 3.30 pm. On the day of the site visit the inspector spoke on a one to one basis with the manager and deputy manager and chatted to people living at the home and other staff. Inspection of the premises and close examination of a range of documentation, including three care plans, were also undertaken. The registered manager submitted information about the service prior to the site visit by completing and returning an Annual Quality Assurance Assessment (AQAA) form. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. Care Homes for Older People Page 6 of 32 As part of the inspection process we sent survey forms to some of the people living at the home and staff; five were returned by people living at the home and six were returned by staff. Responses in surveys were positive, for example, the staff are lovely - I think a lot about them and although I am very independent, whenever I have need of any care, the staff help me. Other anonymised comments are included throughout the report. The manager told us that the current fee for residential care is from £441 to £557 per week. At the end of this site visit, feedback was given to the registered manager on our findings, including any requirements or recommendations that would be made in the key inspection report. We have reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Some minor improvements in the recruitment process would make the systems in use more robust, i.e. the retaining of letters to referees and the recording of staff supervision arrangements whilst waiting for their CRB check to arrive. Care Homes for Older People Page 8 of 32 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. We looked at outcomes for Standard 3. Standard 6 was not assessed on this occasion as there is no intermediate care provision at the home. People have a thorough care needs assessment prior to their admission to the home and are only offered a place if this evidences that their care needs can be met. Evidence: Five surveys were returned to us by people living at the home. Everyone who returned a survey told us that they had received enough information to help them decide if this was the right place for them and that they had been given a contract. We examined the care records for three people who live at the home. They all contained a document called a domiciliary pre-assessment that had been completed prior to the persons admission; we noted that these assessments were signed and dated by the person undertaking the assessment (usually the registered manager Care Homes for Older People Page 11 of 32 Evidence: and/or deputy manager). Information gathered at the time of the initial assessment is then recorded in more detail on an admission assessment summary form and includes information about areas such as nutrition, tissue viability, mobility (including the prevention of falls), spirituality, mental well-being and resting/sleeping. Each section is then expanded to record more specific information, such as likes early morning drink and glass of water near her bed and difficulty seeing food - may need assistance to identify different foods. Although none of the people whose files we examined on the day of the site visit were commissioned by a local authority, the manager told us that a copy of the community care assessment and care plan is obtained from care management when this is the case. This information would be used along with the information gathered by the home to begin to develop an individual plan of care. We noted that initial assessments are reviewed and updated every three months to ensure that staff are working with up to date information. Care Homes for Older People Page 12 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. We looked at outcomes for Standards 7, 8, 9 and 10. Staff support people with their social and health care needs in a way that respects their privacy and dignity, including the administration of medication. Medication policies and procedures are robust and this protects people from the risk of harm. Evidence: We examined the care records for three of the people living at the home; we noted that each care plan is accompanied by a photograph of the person concerned. A photograph is needed to assist new staff with identification and to help the emergency services should someone go missing from the home. We saw that each person had an individual support plan in place that was based on the information gathered at the time of admission; the areas recorded in the support plan mirror the information recorded in the initial assessment. The support plan sets out in detail the action which needs to be taken by staff to ensure that all aspects of a persons care needs are met. Care Homes for Older People Page 13 of 32 Evidence: Five people returned a survey to the Care Quality Commission (CQC) and they all told us that they receive the care and support they need, that staff listen to them and act on what they say and that staff are available when they need them. One person told us, good standard of care which is always available when I need it and another said, although I am very independent, whenever I have need of any care, the staff help me. We saw that care plans are reviewed on a regular basis and that changes are made to care plans as a result of these review meetings, such as, x. now needs assistance to dry her back and x. would like her keyworker to do her nails now. Six surveys were returned by staff and they all told us that they are given up to date information about the needs of the people they support or care for. When asked what the home does well, one carer told us, key worker system - special relationship between key worker and resident. There are assessments in place for nutrition, pressure care, moving and handling, continence and the risk of falls (accompanied by a falls diary), and these are accompanied by the appropriate risk assessment tools. In addition to this, there are invdividual risk assessments in place for areas of particular concern for each service user, such as receipt of breakfast tray and hot drinks, use of a hot water bottle and going out of the building for walks unescorted. All assessments and risk assessments are reviewed on a regular basis and any changes were seen to be clearly recorded. There is a record of all contact with health care professionals including the GP, district nurse and community psychiatric nurses and the outcome of these contacts is recorded. In addition to this, there is a separate sheet to record details of any medical investigatons or specimens taken and the outcome. All of the people living at the home who returned a survey told us that the home makes sure that they get the medical care they need. Any correspondence received from other health care services is held with care records. People have a single room so are able to see health care professionals in private, and there are also private areas of the home if people do not want to go to their bedroom. On the day of the site visit we examined medication administration records and inspected the arrangements in place for the storage of medication. The home has a medication room and the medication trolley that is used to take medication to bedrooms and other areas of the home is stored in this room when not in use. There is a medication fridge in use - we saw the records of daily temperature checks to ensure that medication is stored at the correct temperature. We also saw the storage arrangements for controlled drugs and noted that these are satisfactory. There is a Care Homes for Older People Page 14 of 32 Evidence: controlled drugs book in use and entries were seen to be accurate. We noted that the arrangements in place for returning unused or damaged medication to the pharmacist were satisfactory, including records held. We examined the medication records held for each person living at the home. In addition to a medication administration record (MAR) sheet there is a photograph of the person concerned, details of any allergies they have, a medical history and diagnosis, a protocol for the use of medication prescribed as as required and a clinical risk assessment form that is used to assess the risk of such things as keeping creams in their own room. We noted that there were no gaps in recording and that there were no handwritten entries on MAR sheets - staff told us that either the pharmacist supplies them with a spare label or they photocopy the existing label and attach it to the MAR sheet. We were told that staff know that it is a disciplinary offence should there be gaps in recording on MAR sheets at the time when they were responsible for that task. Staff record on the rear of MAR sheets the reason why people have declined as required medication so that they can monitor the use of medication prescribed by the GP. The assistant manager told us about the training requirements for staff. All staff undertake basic training on medication and only staff who have completed National Vocational Qualification (NVQ) Level 2 in Care are allowed to witness signatures where medication records require two signatures. Some staff go on to do advanced training - these are staff who will be responsible for the administration of medication. When staff have completed medication training, they are observed by the assistant manager and are not able to administer medication until they are considered competent; we were told that it can take a number of months for a staff member to be declared competent. This is good practice. There is a sample signature in place for each person who is responsible for the administration of medication or witnessing administration so that records can be checked for authenticity. In addition to this, there is a handover sheet that is signed at the end of each shift when the medication keys are handed from one senior member of staff to another. On the day of the site visit we saw that a persons privacy and dignity is respected. All bedrooms are single and have en-suite facilties so any assitance with personal care takes place in a persons own room. There is a sign in use to inform people not to enter the room whilst assistance with personal care is taking place. As part of the recent refurbishment programme a post box was fitted to the wall just Care Homes for Older People Page 15 of 32 Evidence: outside each persons bedroom door and some people have had their own telephone installed so that they are able to keep in touch with family and friends independently. Care plans record a persons preferred name and on the day of the site visit twe saw that these were used. We observed that staff do not take the medication trolley into the dining room at meal times; staff told us that they respect each individuals dining experience and feel that taking the trolley into the dining room does not promote privacy and dignity. Medication is taken to people in their bedrooms either before or after mealtimes, depending on how this has been prescribed by the GP. Similarly, staff do not take the homes telephone into the dining room as this could spoil the dining experience for the people living at the home. 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. We looked at outcomes for Standards 12, 13, 14 and 15. People are supported to take part in chosen activities and to retain their chosen lifestyle. Meal provision at the home promotes dignity and choice in a social setting. Evidence: Care plans include details about a persons previous lifestyle, including their life story one record that we saw had been signed by the person concerned and the member of staff making the entry. One area of the support plan is emotional well being and this records such things as, keeps in touch with family by telephone and visits and another is living, working and recreation - this includes such information as likes to attend activities, paper (Yorkshire Post) delivered daily Monday to Saturday, likes listening to the radio and watching TV. All support plans include an information sheet entitled Seize the day - this records any ambitions or wishes for the future people may have and is completed following a discussion with their key worker. We noted that routines at the home are flexible. People can spend time in their room Care Homes for Older People Page 17 of 32 Evidence: or in one of the lounges. On the day of the site visit it was evident that people are free to choose whether or not to take part in activities - those people who choose not to either stay in their room or sit in one of the other lounge areas. Five people living at the home returned a survey and they all told us that there are activities arranged at the home that they can take part in. One person added, activities three mornings and five afternoons per week and another told us, plenty of activities to stimulate people. The activities coordinator has done a twelve month course on reflexology (paid for by the organisation) and now offers reflexology to people living at the home, free of charge. Details about daily activities are displayed on the notice board. The activities coordinator spends one to one time with people who do not like joining in activities, and key workers also spend time with people to ensure that everyone has some social interaction. A member of staff told us that the home arranges activities to involve all residents regardless of their abilities. There is a hairdressing room at the home that is equipped like a hair salon - we were told that people enjoy visits to the hairdressing room and they like to sit chatting to each other whilst they are waiting for their appointment. The home is owned by the Methodist Homes for the Aged and many of the people living at the home enjoy attending a church service. The home now employs a chaplain for 10 hours each week and this ensures that church services can take place at a time to suit the people living at the home, and provides an extra visitor to the home. We noted that people had visitors throughout the day and that they were made welcome by staff. Some people have meals at the home so that they can spend quality time with their relative; there is a separate dining area for them to use. Because everyone has a single room it is possible for them to meet their visitors in private; there are also small kitchen areas where people and their visitors can make themselves a drink and snack. People are supported to remain part of the local community - they go to the local pub/restaurant for meals and go to the local doctors surgery rather than asking for a visit at the home whenever this is possible. Six staff returned a survey and when asked what the home does well, one staff member responded, residents are helped to take control of their everyday life, with choices of how they want to live. Excellent activities and excellent food and dining experience. Care Homes for Older People Page 18 of 32 Evidence: Information about advocacy services was displayed in the entrance hall; this enables people to access this information independently. People are encouraged to manage their own financial affairs for as long as possible. Bedrooms were seen to reflect the individual choices - people are able to bring small items of furniture, pictures and ornaments into the home so that rooms can be personalised. There is a menu displayed each day in a menu folder that is placed on dining tables this records the choices available as well as the main meal on offer. We noted that it also records the activities that will be taking place for that week. The manager told us that there is a breakfast club each Wednesday morning - people who attend have a cooked breakfast and they discuss the latest news. The dining room is well furnished and provides a pleasant environment for people to take their meals. People use this as a social time and linger after their meal to have a coffee and talk to their friends. We noted that staff offered appropriate assistance to anyone needing help with cutting up food, and that this was done discreetly. As previously recorded, staff at the home make every effort to ensure that meal times are undisturbed for people - they do not take the homes telephone into the dining room and medication is administered either before or after lunch, when people are having their coffee. 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. We looked at outcomes for Standards 16 and 18. People are protected by the arrangements in place for expressing concerns, making a complaint and safeguarding adults from all types of abuse. Evidence: The homes complaints procedure is displayed in the entrance hall and we noted that this had been updated to include the latest contact details for the Care Quality Commission. There is a suggestions/complaints/compliments folder placed at the front door and this includes a form that can be completed and placed in an envelope addressed to the manager. Some suggestions have been received but no complaints. We checked the complaints log and found that there were no entries. There are systems in place for any complaints received to be monitored and reviewed. The manager told us that people are asked at their six monthly review if they have any areas of concern and that they would be dealt with at that stage; this may be why they have not received any formal complaints. Five people living at the home returned a survey and they all told us that there is someone who they can speak to informally if they have any concerns and that they know how to make a formal complaint. The six staff who returned a survey told us that they know what to do if anyone expresses concerns about the home. Care Homes for Older People Page 20 of 32 Evidence: The registered manager, deputy manager and assistant manager have completed managers awareness training on safeguarding adults from abuse. The manager told us that, following this training, the homes policy on Abuse was adjusted. All staff have done training on this topic - it is considered to be mandatory training by the organisation. They use a DVD training programme that includes a question and answer sheet that is checked by senior staff to ensure that staff have understood the content of the training programme. In addition to safeguarding training, nineteen care staff have completed NVQ Level 2 in Care and abuse is one of the topics covered in this training programme. The home has made no safeguarding referrals to the local safeguarding adults teams, as there have been no observed or reported incidents or allegations of abuse. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. We looked at outcomes for Standards 19 and 26. The home is clean, well furnished and decorated and is maintained in a safe condition, providing a very pleasant environment for the people who live there. Evidence: The home underwent a major refurbishment programme approximately one year ago. At the time, people expressed concerns about how long the alterations were taking but we visited the home to undertake a random inspection and found that the organisation had done everything they could to reduce upheaval for the people living at the home and to make the home safe. The home now provides excellent accommodation - each person living at the home has a single en-suite room. Each floor has a small kitchen area so that people can make themselves or their visitors a drink or snack. A post box has been fitted outside each bedroom door so that people can receive their mail independently. Bathrooms and shower rooms have been upgraded and they all provide equipment to enable people to have a bath or shower safely, with ample space for mobility equipment to be used and for staff to assist (if needed). People have a choice of taking a bath or shower and facilities are decorated in a domestic style. Care Homes for Older People Page 22 of 32 Evidence: Communal and private areas of the home are well decorated and are domestic in nature, with good quality furniture and fittings being provided throughout. The home offers ample access to sunlight and the gardens are easily accessible and in good order. There is a full time handyman employed at the home and we saw evidence in the maintenance records that he undertakes various weekly checks, including fire safety, water temperature checks, cleaning of the laundry room and weekly grounds and external building inspections. This results in a home that is well maintained and provides safe accommodation for the people who live there. Five people living at the home returned a survey and they all told us that the home is fresh and clean. When asked what the home does well, one person told us, always clean and tidy - never unpleasant smells. Quality furnishings. Fresh flowers on all the dining tables and about the house. Another person said, It is clean - my room is lovely. A member of staff told us, It is like a hotel not a care home. On the day of the site visit we noted that there were no unpleasant odours in any area of the home. Laundry facilities at the home are good and people told us that they are happy with the laundry service offered by the home. We saw that staff follow good hygiene practices and that they undertake training on health and safety every three years, food hygiene every three years and the Control of Substances Hazardous to Health (COSHH) every year. Care Homes for Older People Page 23 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. We looked at outcomes for Standards 27, 28, 29 and 30. People are supported by a staff team who have been recruited safely and who receive the training that they need to carry out their role effectively. Evidence: We looked at the staff rotas - there is one rota for care staff and another rota for ancillary staff. Rotas record the role of each member of staff - ancillary staff include an activities coordinator, a maintenance person, an administrator, domestic staff, cooks, tea-time assistants and kitchen assistants. Since the last key inspection and annual service review a chaplain has been employed at the home for 10 hours per week. Due to the high number of ancillary staff employed, care staff are able to concentrate on personal and health care tasks for the people living at the home. A member of staff told us, all the staff work well as a team and are willing to come in at short notice. Six staff returned a survey and when asked if there are enough staff on duty to meet the needs of the people living at the home, two responded always, two responded usually and one responded sometimes. One of the people living at the home told us in a survey, The staff are lovely - I think a lot about them and another said, the staff are very caring - they try very well to meet peoples needs. Care Homes for Older People Page 24 of 32 Evidence: We looked at the recruitment records for two new employees. Both contained an application form that records the applicants employment history, the names of two referees, details of education and training and a criminal conviction declaration. We saw copies of letters sent to applicants to invite them to the home for interview and that copies of interview questions and responses are retained. Both applicants had Indepentent Safeguarding Authority (ISA) First checks in place prior to commencing work at the home and the manager told us that new employees shadow existing employees until they are deemed to be competent. The manager was reminded that, when people commence work prior to a Criminal Records Bureau (CRB) check being received, the supervision arrangements in place in the interim period need to be recorded. Two written references had been obtained for both new employees - some of these were not returned to the home on the form that had been sent to them by the home. The manager explained that the letter requesting a reference does tell people that they can return the reference in a different format; the manager was advised that they should keep a copy of this letter so that there is evidence that the reference they accept as proof of someone being suitable for their post has been requested by them. New employees receive a copy of the homes code of conduct and disciplinary procedure, and information about the control of substances hazardous to health (COSHH) - we saw evidence that staff had signed to say that they had read these documents. We also saw a form entitled, Food handlers agreement to report infection - this made it clear to staff that they had a responsibility to refrain from work should they have an illness that could spread to other staff and people living at the home. New staff undertake induction training and we noted that there was a specific induction pack for each staff role. The training and development plan evidences that staff undertake two levels of induction training - the Methodist Homes for the Aged induction training covers information about the home such as fire safety, routines, policies and procedures. A private training company runs an induction training programme that is specific to a persons job role and meets the Skills for Care requirements. All of the staff who returned a survey told us that their induction training covered what they needed to know before they commenced work. The organisation has identified some training programmes that are mandatory for staff - these are induction training, moving and handling, health and safety, food hygiene, COSHH, fire safety and safeguarding adults from abuse. The plan also Care Homes for Older People Page 25 of 32 Evidence: identifies when refresher training is due - most of the mandatory training courses have to be updated annually but health and safety and food hygiene are updated every three years. Some staff have undertaken other training programmes such as dementia care, values and medication. As previously recorded, when staff have completed medication training they are observed by the deputy manager and not allowed to administer medication until they are considered to be competent; this is good practice. All of the staff who returned a survey told us that they receive appropriate training. One person added, good opportunity for training. The training and development plan also records the number of staff who have achieved NVQ Level 2 in care. More that 50 of care staff have undertaken this training. In addition to this, domestic staff have undertaken NVQ Level 2 in Housekeeping and Cooks have undertaken an NVQ at either Level 2 or 3. The manager told us that staff get an enhanced rate of pay when they have achieved their NVQ award. We noted that there is a fun scheme in place to reward good practice within the staff group. Staff are split into teams and any identified good practice is awarded points. Each month, the winning team is awarded a prize. 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. We looked at outcomes for Standards 31, 33, 35 and 38. The home is well managed, including the monitoring of quality assurance systems and health and safety systems that protect people from the risk of harm. Evidence: When asked what the home does well, a member of staff told us, very, very high standards expected from senior team - residents well cared for and someone living at the home told us, the home is well managed. The manager has the skills and experience to manage the home and has recently updated her skills by attending training on the deprivation of liberty and safeguarding adults from abuse and refresher training on disciplinary and investigating. She attends a monthly management meeting with other managers from the organisation where they look at new initiatives and how improvements can be made; these meetings are held at a different care home each month. It is the policy of the Care Homes for Older People Page 27 of 32 Evidence: organisation that a member of staff goes to the home where the meeting is being held with the manager to work alongside the staff group there. In this way, new ideas and good practice are shared between homes. The manager undertakes a monthly audit that covers accident recording, care plans, nutritional tools, pressure care, personnel files and staff supervision. Other audits are undertaken periodically, some by other members of staff. These include audits on food safety, key working, housekeeping/cleaning, fire records and activities. All of this information feeds into the quality assurance system operated by the home. We saw minutes of the most recent staff meetings and resident meetings. Staff meetings are held monthly and topics such as health and safety, new policies, swine flu vaccinations and bed changes were discussed at the most recent meeting. Resident meetings are held approximately every two months and these minutes record that staff turnover, property work and the dining experience were discussed - we noted that new residents are welcomed. A private company is used by the organisation to undertake an annual satisfaction survey. Survey forms are distributed to people living at the home, relatives and other stakeholders. Initially, when responses are returned, the home receive some comments that are of interest or need to be dealt with, and in due course they get a full report of the collated results. In addition to this, Methodist Homes for the Aged undertake a Standards and Values assessment each year - this is a two day audit of all policies, procedures and practices within the home. An action plan is produced following the two day assessment and this gives very practical suggestions for improvement, such as, extended falls diary needs to trigger a review of the risk assessment and identify support plans more than 12 months old and put plan in place to re-write. These results are combined with the results of the quality surveys - the home received an overall score of 93.36 in 2009. The home hold some personal allowance monies on behalf of people living at the home. Each person has a book that records monies received, monies paid out and a running total. When money is handed over the the home by a relative, they and a member of staff sign the entry in the book to ensure accuracy. Receipts are received from the chiropidist, hairdresser and for taxis. Periodically the administrator checks these records and signs in red pen to evidence that records have been found to be accurate. The manager told us that they hold a small float of money so that they can cash a Care Homes for Older People Page 28 of 32 Evidence: cheque for someone living at the home and that some people hold small amounts of money in their purse or wallet. We checked a selection of health and safety documentation held at the home. There is a fire risk assessment in place and we noted that the fire alarm system, fire safety equipment and emergency lighting had been checked by a contractor within the last year and that fire drills take place every 3 months. Weekly in-house fire tests take place consistently - these are undertaken by the handyman. Records evidence that there is a gas safety certificate in place, that hoists and lifts have been serviced and that there is a current electrical installation certificate in place. Staff undertake training on health and safety topics, including health and safety, food hygiene, COSHH, fire safety and moving and handling and staff receive refresher training at identified intervals. Health and safety arrangements protect people living at the home and working in the home, as far as is possible, from the risk of harm. 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 29 When people start work after a ISA First check but before a CRB check has been received, the supervison arrangements in place should be recorded so that there is evidence that the person has not worked with vulnerable people unsupervised. A copy of the letter sent to referees requesting an employment reference should be retained so that there is evidence that references accepted by the home have been requested by them. 2 29 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. 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