Care Home: Windsor Care Home

What the care home does well The admission process included a thorough assessment of the resident`s needs, prior to them moving into the home. This enabled the registered person and prospective residents to determine whether or not their needs could be met within the home. New residents were also issued with a contract, which informed them about what they could expect from the service. All residents had a care plan based on their assessment of needs. The plans provided guidance for staff on how to meet people`s personal, health and social needs. Wherever practicable the residents and/or their relatives were involved in the care planning process, which meant that they had an influence on the level and type of care and support provided. The daily routines were flexible and designed to meet the needs and wishes of the residents. The residents spoken to felt they were well cared for and the staff respected their rights to privacy and dignity. One resident told us, "I am always made to feel very comfortable, I feel very at home here" and one relative commented in a questionnaire, "The staff are very caring, attentive and always ready to help. The owner is also very good and helpful. The home has a good friendly atmosphere, reflected in the quiet comfortable environment it imbues". Activities were arranged in line with the needs and choices of the residents. These included table top games such as dominoes; reminiscence sessions; discussions and sing-a-longs. Relatives and carers were invited to all planned activities, which included birthday parties and visits from professional singers. Varied and well balanced meals were served. All the residents spoken to made complimentary comments about the food. The residents were provided with clean comfortable bedrooms and which they could personalise with their own belongings. The sitting areas were decorated in a homely fashion, with a variety of armchairs, footstools, side tables, ornaments and pictures. A good percentage of staff had achieved NVQ (National Vocational Qualification) level 2. This qualification provided the staff with the necessary knowledge for their role within the home. The staff were well supported by the registered person and had the opportunity to regularly discuss their training needs and the care of the residents. Good arrangements were in place to promote health and safety, which included regular safety checks on appliances and installations. This ensured that the residents lived in a safe environment. What has improved since the last inspection? Since the last inspection, the keyworkers were adding more details to the monthly care plan reviews. This meant the staff had access to current information about the residents` health and well being at all times. The registered person had recently purchased a new resource from Stirling University called "Talking Mat", this was a communication resource using pictures and symbols tohelp people with a communication difficulty communicate more effectively. The registered person had discussed the residents` views in respect to activities using the symbols and hoped to incorporate the information into each resident`s care plan. Various improvements had been made to the premises to promote the comfort and safety of the residents. These included new wardrobes and drawers for two bedrooms, new garden furniture, new dining chairs and two new recliner chairs for the quiet lounge. Several areas had also been redecorated and new carpet had been fitted in two lounges and the stairs and landing. The home had been linked via a computer to the LWDP (Lancashire Workforce Development Plan), which is an internet data base. The system displayed a training record for each member of staff and highlighted when mandatory training was due. This enabled the registered person to plan future staff training effectively, in line with the needs of residents. The registered manager and deputy manager had completed a distance learning course on understanding the Mental Capacity Act and the registered person had attended a conference entitled "Best Interests, End of Life". The latter provided information about the end of life and how to support residents and their families and carers through this process. What the care home could do better: Some of the documentation provided to current and prospective residents required updating. This is to ensure the residents are provided with meaningful up to date information about the home. We found that some risks had been fully assessed and documented. The registered person must therefore ensure that all potential risks are recorded and risk management strategies are drawn up to manage and reduce any risks identified. This is to ensure staff respond to risks in a safe and consistent manner. The staff spoken to had not received recent training on the protection of vulnerable adults. Staff must therefore receive refresher training on the safeguarding of vulnerable adults. This is to ensure that staff are fully aware of how and where to report any safeguarding issues in the event of an alert. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Windsor Care Home Queen Street Padiham Lancashire BB12 8JW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Julie Playfer     Date: 2 8 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Windsor Care Home Queen Street Padiham Lancashire BB12 8JW 01282772799 F/P01282772799 sharonanica@aol.com 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) : Mrs Sharon Anita Han care home 20 Number of places (if applicable): Under 65 Over 65 0 dementia Additional conditions: 20 The registered person may provide the following category of service only: Care home only - Code PC To Service Users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia - Code DE The maximum number of service users who can be accommodated is: 20 Date of last inspection Brief description of the care home Windsor Care Home is registered to provide personal care and accommodation for 20 Older People with Dementia. The home is a detached property set in its own grounds. There is a well-maintained and attractive front garden, which is accessible to residents. Accommodation is provided on two floors in 8 single rooms and 6 double rooms. Access to the second floor is eased by a stair lift. Communal space is provided in two lounges, two dining rooms and one sitting/dining room. Written and pictorial signs had been placed on communal rooms to aid orientation around the home. At the time of the inspection, the fees were £396.50 per week. Additional charges were made for hairdressing, dry cleaning, personal newspapers and name tapes. Care Homes for Older People Page 4 of 30 Brief description of the care home Information was made available to prospective residents by means of a statement of purpose and service users guide. The guide was usually given to prospective residents and/or their relatives on viewing the home or at the point of assessment. Copies of previous inspection reports can be viewed in the home or obtained from the Commissions website at www.cqc.org.uk Care Homes for Older People Page 5 of 30 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: two star good 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: A key unannounced inspection, which included a visit to the home, was conducted at The Windsor Care Home on 28th April 2009. The inspection was carried out by one inspector, however, the report refers to we as it was written on behalf of the commission. We lasted visited this service 1st May 2007 and an annual service review was carried out on 1st May 2008. There have been no additional visits to the home since the last key inspection. At the time of the visit there were 18 residents accommodated in the home. During the inspection we spent time with the residents, looked round the home, read some of the residents care records and other documents and talked to the staff and the registered person. We also consulted our records about the service. As part of the inspection Care Homes for Older People Page 6 of 30 process we used case tracking as a means of gathering information. This process allows us to focus on a small group of people living at the home, to assess the quality of the service provided. Prior to the inspection, the registered person completed an Annual Quality Assurance Assessment known as AQAA, which is a detailed self assessment questionnaire covering all aspects of the management of the home. This provided us with useful information and evidence for the inspection. Satisfaction questionnaires were sent to the home for distribution to the staff and the residents. Four questionnaires were returned from the staff and twelve were received from the residents. Some of the residents relatives had also made comments on the questionnaires. The responses from the questionnaires were collated and used throughout the inspection process. What the care home does well: What has improved since the last inspection? Since the last inspection, the keyworkers were adding more details to the monthly care plan reviews. This meant the staff had access to current information about the residents health and well being at all times. The registered person had recently purchased a new resource from Stirling University called Talking Mat, this was a communication resource using pictures and symbols to Care Homes for Older People Page 8 of 30 help people with a communication difficulty communicate more effectively. The registered person had discussed the residents views in respect to activities using the symbols and hoped to incorporate the information into each residents care plan. Various improvements had been made to the premises to promote the comfort and safety of the residents. These included new wardrobes and drawers for two bedrooms, new garden furniture, new dining chairs and two new recliner chairs for the quiet lounge. Several areas had also been redecorated and new carpet had been fitted in two lounges and the stairs and landing. The home had been linked via a computer to the LWDP (Lancashire Workforce Development Plan), which is an internet data base. The system displayed a training record for each member of staff and highlighted when mandatory training was due. This enabled the registered person to plan future staff training effectively, in line with the needs of residents. The registered manager and deputy manager had completed a distance learning course on understanding the Mental Capacity Act and the registered person had attended a conference entitled Best Interests, End of Life. The latter provided information about the end of life and how to support residents and their families and carers through this process. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 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 30 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 admission and assessment procedures were well established and ensured the care needs of the residents were met. Evidence: Written information was available for residents in the form of a statement of purpose and service users guide. The service users guide had been issued and explained to all residents and their families. A brochure was also available which offered residents with an overview of the services and facilities. However, some of the documentation required general updating to ensure it contained current and up to date information. The majority of the residents who completed a questionnaire indicated they had received enough information prior to moving into the home. Full copies of the last inspection report were available for reference in the hallway. All residents had been issued with a contract. The contract was easy to read and was Care Homes for Older People Page 11 of 30 Evidence: presented in a clear format. This meant that residents and their relatives were aware of the terms and conditions of residence and knew what they could expect from the service. A blank copy of the contract was included in the service users guide. The case tracking process demonstrated that the residents had their needs assessed prior to admission by a social worker and/or the registered person or senior member of staff. The pre admission assessment was carried out at a convenient time and place for the prospective resident, to ensure they had the time and opportunity to participate in the assessment process. The preadmission assessments covered a range of individual needs including personal, social, health and cultural needs. The registered person confirmed that admissions were not made to the home in the absence of a full needs assessment. This meant the registered person could be confident that the staff had the necessary skills and knowledge to meet the assessed needs of prospective residents. Following the assessment of needs a letter was sent to prospective residents and their families to confirm that the residents needs could be met in the home. This meant residents could be assured that the home was a suitable place for them to live. The registered person said prospective residents were invited to spend as much time as they wished in the home prior to making the decision to move in. This enabled the person to meet other residents and staff and experience life in the home. One relative who made comments on a questionnaire wrote, I was shown round the home and shown the room which would be my mothers and was given details about activities. Following admission, the contract and the service users guide stated that a trial period of one month was offered to every new resident, so both parties could make sure the placement was successful and the residents individual needs could be met. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care received by residents was based on their individual needs. Care practice took full account of the residents privacy and dignity. Evidence: Three residents files were looked at in detail as part of the case tracking process. All three files seen contained a care plan, which was based on the residents assessment of needs. The plans were supported by records of personal care, which provided information about changing needs and any recurring difficulties. The records had been made on a daily basis, to ensure staff were provided with up to date details about the residents well being. The records were detailed and the residents needs were described in respectful and sensitive terms. Some of the files also contained a personal profile, which provided staff with details about the residents past life experiences and significant events. The care plans covered the residents personal, social, health and cultural needs and provided staff with guidance on how best to meet these needs. This meant staff had Care Homes for Older People Page 13 of 30 Evidence: up to date information about the residents needs and preferences. Staff who completed a questionnaire indicated that they were given up to date information about the needs of the residents. The residents and their families had been consulted wherever practicable during the development and review of their care plan. Written records seen on the personal files demonstrated that the care plans were reviewed each month by the residents keyworker and updated in line with changing needs. Since the last inspection, the keyworkers were adding more details to the monthly care plan reviews. This meant the staff had access to current information about the residents health and well being at all times. Healthcare needs were considered during the assessment process and there was a designated section within the care plan. Whilst, the registered person had a full understanding and knowledge of the residents healthcare needs, the written guidance for staff on how to monitor and respond to specific healthcare conditions was not always detailed. There was written evidence within the personal care notes to indicate that the residents accessed NHS services and received specialist support as necessary, for instance the District Nursing Team. All residents were registered with a Doctor and they were supported as necessary to attend medical appointments. Charts were maintained to monitor the residents weight, to ensure any fluctuations were noted and acted upon. Risk assessments had been carried out as necessary, in respect to moving and handling and falls. The risk assessments were supported by risk management strategies, which provided staff with guidance on how to manage and reduce any identified risks. Whilst the registered person and staff were aware of risk management techniques, it was noted that risk assessments had not always been carried out in regard to the management of challenging behaviours and specific individual risks. These are important so all staff manage risks in a safe and consistent manner. The residents spoken to felt the staff respected their rights to privacy and dignity and all made complimentary remarks about the staff, for instance one resident said Theyre very kind and considerate, they never make me feel embarrassed and another resident commented, They listen to what you say and try and do everything they can to help. The residents, who completed a questionnaire indicated that they received the care and support they needed. The staff were observed to interact with the residents in a positive manner and they referred to the residents in their preferred form of address. Discussions with staff demonstrated they had an awareness of treating people with respect and considering their dignity when providing personal care. Care Homes for Older People Page 14 of 30 Evidence: Policies and procedures were in place to cover the management of medicines and these were available for staff reference in the medication file. The home operated a monitored dosage system of medication, which was dispensed into blister packs by a local Pharmacist. Appropriate records were maintained in respect to the receipt, administration and disposal of medication. All staff designated to administer medication had received accredited training. Suitable arrangements were in place for the storage and administration of controlled drugs. Whilst, general procedures had been drawn up for the administration of medication prescribed as necessary, there were no person specific procedures seen. These procedures are important so staff are aware of the individual circumstances of when this type of medication should be given to the residents. Care Homes for Older People Page 15 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were able to exercise choice and control over their lives and were supported to maintain good contact with their family and friends. The residents were provided with a nutritious and varied diet. Evidence: The residents preferences in respect of social activities were recorded and considered as part of the assessment and care planning processes. A range of activities was planned and implemented by the registered person and staff. Activities were arranged on a daily basis and were usually spontaneous, depending on the choices and preferences of the residents. These included table top games such as dominoes, reminiscence sessions, discussions and sing-a-longs. The residents were encouraged and supported to participate in the activities as they wished. Residents spoken to during the inspection said they enjoyed participating in the various activities, one person said, I like sitting in the garden and I like playing dominoes. On the day of inspection, the residents were observed chatting to staff, watching television and singing and clapping to music. Family and friends were invited to all planned birthday parties and concerts by professional singers. Care Homes for Older People Page 16 of 30 Evidence: The registered person had recently purchased a new resource from Stirling University called Talking Mat, this was a communication resource using pictures and symbols to help people with communication difficulties communicate more effectively. The registered person had discussed the residents views in respect to activities using the symbols and hoped to incorporate the information into each residents care plan. The routines were flexible and were primarily designed to meet the needs of the residents. The residents spoken to said they had a choice in the times they got up and went to bed. One person said I just take my time in the morning and come down when I like and another person commented, I think there is a time for breakfast, but there is never any pressure. The staff were observed to seek the residents views throughout the inspection and the residents spoken to felt comfortable to comment on life in the home. The residents had the opportunity to develop and maintain important personal and family relationships. There were no restrictions placed on visiting times and residents were able to receive their guests in private, should they wish to do so. Refreshments were offered to visitors, to ensure they felt welcome in the home. All the residents spoken to said they liked the food provided. One resident said, The food is really delicious, you cant fault it at all. There was a choice of food each meal time and residents were asked prior to each meal what choice they wished to make. Further to this, one resident commented, They always take note of what you say and always find something to cater for your needs. The menu was displayed on white boards in the dining rooms, so residents were aware of the forthcoming meal. Residents were asked their opinion of the food on an ongoing basis and they could make suggestions for future meals. The meal served on the day of inspection was plentiful and well presented. Residents were given support to eat their meals. Drinks and snacks were served throughout the day and at other times on request. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were able to express their views and any concerns and had access to a clear complaints procedure. There were established ways of working to respond effectively to any suspicion or allegation of harmful practice. Evidence: Arrangements were in place to ensure the registered person and staff listened to and acted on the views and any concerns of the residents. This was achieved during daily conversation, one to one discussion, residents meetings and satisfaction questionnaires. The residents spoken to said they felt comfortable about expressing their views and were aware of whom to speak to in the event of a concern. Staff who completed a questionnaire also indicated they were aware of what to do if the residents or their families had a concern. This ensured systems were in place to ensure any problems could be promptly and readily rectified. The complaints procedure was included in the statement of purpose and service users guide. The residents had been issued a personal copy of the complaints procedure as part of the service users guide. The procedure contained the necessary information and included the relevant telephone numbers should a resident wish to raise a concern. The registered person had received one complaint, during the last twelve months. The Care Homes for Older People Page 18 of 30 Evidence: complaint concerned the furniture in one of the bedrooms. The registered person investigated the complaint under the homes complaints procedure and purchased some additional furniture in order to resolve the issues raised. The complaint was resolved within 28 days. The policies and procedures for safeguarding vulnerable adults were available and provided guidance for staff should they suspect or witness any harmful practice. However, the procedure did not include reference to the Commission and required some minor amendments. Issues relating to the protection of vulnerable adults were incorporated into the induction training and staff received specific tuition as part of mandatory and NVQ training. The staff also had access to a whistle blowing procedure. However, the staff spoken to had not received recent training on the protection of vulnerable adults. This is important so staff are fully aware of how and where to report any safeguarding issues in the event of an alert. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were provided with a clean, pleasant and well-maintained environment, which promoted their comfort and independence. Evidence: Windsor Care Home is a detached Victorian residence set in its own grounds. The home is located close to local shops, a park and churches of most denominations. Accommodation is provided in eight single bedrooms and six shared bedrooms. None of the bedrooms have an ensuite facility. The home also provides four bathrooms, one of which has a walk-in facility for the residents requiring assistance. Communal space is provided in two lounges, two dining rooms and one sitting/dining room. The residents had free movement around the home and were able to choose where they wished to spend their time. Established arrangements were in place to report repairs and routine maintenance and appropriate records were maintained of the work completed. A handyman was available to carry out day to day maintenance. This meant that any problems with the building were promptly rectified. It was evident from a partial tour of the building that the residents had personalised their rooms with their own belongings and decoration was a good standard throughout. Care Homes for Older People Page 20 of 30 Evidence: The registered person explained that residents were encouraged to bring small items of furniture and personal effects to stimulate communication and enhance memory. The residents said they liked their bedrooms. One person said, I really like my bedroom, its very comfortable. Since the last inspection, various improvements had been made to the premises to promote the comfort and safety of the residents. These included new wardrobes and drawers for two bedrooms, new garden furniture, new dining chairs and two new recliner chairs for the quiet lounge. Several areas had also been redecorated and a new carpet had been fitted in two lounges and the stairs and landing. Residents had been provided with aids and adaptations to assist their independence skills, these included grab rails, handrails and raised toilets. The stair lift eased access to the first floor accommodation and a ramp was installed at the front door to provide access for wheelchairs. The provision of specialist equipment was determined by the needs of the people living in the home. The residents were able to use the garden at the front of the property. The garden was well maintained and had views over the surrounding countryside. Further to this, a relative who made comments on a questionnaire wrote, The gardens are particularly nice and always well kept. The residents said they enjoyed sitting on the patio area in fine weather. Radiators were fitted with guards and all water outlets including baths and showers were fitted with preset valves to guarantee water was delivered at a safe temperature. The home was clean and odour free at the time of the inspection. The systems for maintaining hygiene included procedures for infection control. Plastic aprons and gloves were available for staff when undertaking care duties. There was a separate laundry room, which had sufficient and appropriate equipment to meet the needs of the residents. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents benefited from experienced, competent and well-trained staff. Evidence: A staff duty roster was drawn up in advance and provided a record of the number of hours worked by the staff in the home. The registered person confirmed all staff who provided personal care were aged over 18 and all staff left in charge of the building were aged over 21. Many of the staff had worked at the home for several years which meant they had a good knowledge of the needs of the residents. A recruitment and selection procedure was available, however, this needed updating to reflect current regulatory requirements. The files of two members of staff were looked at in detail. It was evident that both applicants had completed an application form and provided a full working history. CRB (Criminal Records Bureau) and POVA (Protection of Vulnerable Adults) checks had been obtained prior to the applicants commencing work in the home, along with two written references. This meant that the registered person had collated all records and checks in accordance with regulatory requirements. Arrangements were in place for all new employees to undertake induction training, which incorporated the Skills for Care standards. The latter provided underpinning knowledge for NVQ level 2. According to information supplied by the registered person, Care Homes for Older People Page 22 of 30 Evidence: 14 out of 18 care staff had achieved NVQ level 2, which equated to 78 of the overall staff team. In addition one member of staff was working towards this qualification. This meant a good majority of the staff team had achieved the necessary qualifications to enable them to carry out their role effectively. All staff who completed a questionnaire confirmed they received training relevant to their role and all commented that they were well supported by the management team with any training needs. Staff attended both internal and external training courses and had at least three paid days training a year. It was noted staff discussed their individual training needs during their supervision sessions and staff meetings. Since the last inspection, the home had been linked via a computer to the LWDP (Lancashire Workforce Development Plan), which is an internet data base. The system displayed a training record for each member of staff and highlighted when mandatory training was due. This enabled the registered person to plan future staff training effectively, in line with the needs of residents. Care Homes for Older People Page 23 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management and administration practices were effective in ensuring the home was run in the best interests of the residents. Evidence: The registered person had overall responsibility for the management of the home and had achieved the Registered Managers Award and NVQ level 4 in Care. The registered person is also a Registered General Nurse and an NVQ Assessor. The registered person had undertaken periodic training to update her knowledge and skills whilst managing the home. She is also an elected committee member of the Local Alzheimers Society and a longstanding member of East Lancashire Care Home Association. As such the registered person attends regular meetings which provide her with further knowledge of care practices and changes in the care sector. The registered manager and deputy manager had completed a distance learning course on understanding the Mental Capacity Act and the registered person had Care Homes for Older People Page 24 of 30 Evidence: attended a conference entitled Best Interests, End of Life. The latter provided information about the end of life and how residents and their families and carers can be best supported through this process. The management approach was consultative and there were established ways of working to consult the staff and residents on an ongoing basis. Relationships within the home were positive and staff spoke to and about the residents with respect. Further to this, a member of staff wrote in a questionnaire, Our service ensures that residents are cared for as individuals, to meet all their needs to a high standard and another member of staff commented, We provide a safe and happy home where residents have choices. There was a programme in place for staff supervision and the topics discussed during supervision were recorded on a suitable format. Staff received formal supervision six times a year with a designated line manager. This enabled the staff to identify any future training needs and discuss the care of the residents. In addition to supervision, staff were given the opportunity to attend regular staff meetings and handovers. This meant that the staff were able to share experiences and discuss future developments. The service was reaccredited with an Investors in People Award in March 2008. This is a professionally recognised quality assurance award. Satisfaction questionnaires had been distributed to residents and their residents in February 2009. The registered person explained that the results were due to be collated and residents and their relatives would be provided with feedback. The results of the 2008 survey had been collated and an annual development plan had been produced, which set out the objectives for the forthcoming year. This document linked with the AQAA questionnaire submitted to the Commission. All sections of the AQAA were completed and the information provided gave a clear picture of the current situation within the service and the planned areas for development. Appropriate arrangements were in place for handling money, which had been deposited with the home by or on behalf of a resident. A random check of the records and monies deposited on the premises was found to be correct. This meant the residents financial affairs were safeguarded. There was a set of health and safety policies and procedures, which included the safe storage of hazardous substances and infection control. Staff received health and safety training, which included moving and handling, food hygiene, first aid, fire safety and infection control. Documentation seen during the inspection and information supplied in the AQAA indicated the electrical, gas and fire systems were serviced at regular intervals. The fire log demonstrated that the staff had received instructions about the Care Homes for Older People Page 25 of 30 Evidence: fire procedures during their induction. Appropriate arrangements were in place to record accidents and incidents in the home. This ensured that the residents condition was closely monitored following an accident or incident. The Commission had also been notified as appropriate of any significant event in the home. Care Homes for Older People Page 26 of 30 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 27 of 30 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 1 1 5 The statement of purpose and service users guide required updating. This is to ensure the residents are provided with meaningful up to date information. 01/06/2009 2 8 13 All risks must be fully assessed and documented and supported by risk management strategies. This is to ensure staff respond and manage risks in a safe and consistent manner. 28/05/2009 3 18 13 Staff must receive refresher training on the safeguarding of vulnerable adults. This is to ensure that staff are fully aware of how and where to report any safeguarding issues in the event of an alert. 01/06/2009 Care Homes for Older People Page 28 of 30 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 8 The guidance for staff relating to the residents healthcare needs should be more detailed. This is to ensure the staff are fully aware of how best to monitor and respond to these needs. Specific procedures should be drawn up for the administration of medication prescribed as necessary. This is to ensure staff are aware of the individual circumstances of when this type of medication should be given to the residents. The safeguarding adults procedure should be updated to include reference to the commission alongside the other agencies in the event of suspicion or evidence of abuse or harm. This is to ensure an appropriate response is made by the agency to any safeguarding issues, as set out in No Secrets in Lancashire. 2 9 3 18 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!