Care Home: Winterbrook Nursing Home

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What the care home does well Comments given in the returned surveys in regard to what they do well: "Look after me and care for me." "Good care." "Look after us." From information obtained through this inspection the people who use the service can be confident that they will obtain a good standard of care and support. They will also be provided with the opportunity to continue to with their daily lives as they wish. They can be certain that their concerns will be listened to and that they will be protected from possible abuse or harm by the systems in place. The service provides a homely comfortable environment that is able to accommodate their needs and has the necessary equipment to do so. Staff are friendly welcoming and supportive and have be provided with the training and knowledge to care for them well. The service is run in the best interests of the people who live in the home. Information from the whole inspection process shows that the service is managed well and effectively. What has improved since the last inspection? They have ensured that the information given to prospective and current residents in the Statement of Purpose, Service User Guide and handy booklet is useful and helpful for them to know what the service can provide. A social care professional put; "As a frequent visitor to Winterbrook to review care I can see there is a marked improvement in the care provided. Clients are treated as individuals." The practices for the administration and storage of medications that the home manage on residents behalf, has improved and ensures that safe processes are in place. Residents, relatives and visiting professionals thought that the activities provided had improved during the last few months. What the care home could do better: The provider should ensure that they act swiftly to implement systems in place such as screening in shared bedrooms to protect the privacy and dignity of the people living in these rooms. They could develop the recorded chosen daily routine of how people like to live in better depth as to ensure that all staff can provide support in a consistent way.The meals and planned menu is not enjoyed by all and they should look at how they could improve the variety and choices they provide. Key inspection report Care homes for older people Name: Address: Winterbrook Nursing Home 18 Winterbrook Wallingford Oxfordshire OX10 9EF     The quality rating for this care home is:   two star good 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: Ruth Lough     Date: 0 3 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 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 30 Information about the care home Name of care home: Address: Winterbrook Nursing Home 18 Winterbrook Wallingford Oxfordshire OX10 9EF 01491833922 01491836166 winterbrookhome@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Harbhajan Surdur,Dr Ramnath Narayan Name of registered manager (if applicable) Mrs Elizabeth Lesley Collins Type of registration: Number of places registered: care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 26. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP). Date of last inspection Brief description of the care home Winterbrook Nursing Home is a care home owned by a partnership who have several other care services in the region. The home can provide nursing care and accommodation for twenty-six individuals and is set in about an acre of gardens, off a main road and bus route and about half a mile south of Wallingford town centre, Oxfordshire. The house was converted for use as a nursing home in 1990. The private Care Homes for Older People Page 4 of 30 Over 65 26 0 2 4 0 9 2 0 0 8 Brief description of the care home accommodation is arranged over two floors with a passenger lift and is a mixture of single and double rooms. Communal rooms include two sitting rooms and a dining room on the ground floor. The fees range from £550 to £750 weekly. 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: This was an unannounced key inspection process generated from the adequate findings identified at the last assessment of the quality of the service by the commission in September 2008. This inspection process included reviewing information provided by the service in the Annual Quality Assurance Assessment and any returned surveys to the commission before a one-day visit to the home. An annual quality assurance assessment (AQAA) is a self assessment and a dataset that is filled in once a year by all providers whatever their quality rating. It is one of the main ways that we will get information from providers about how they are meeting outcomes for people using their service. The AQAA from this service was returned within the required timescales and had been Care Homes for Older People Page 6 of 30 completed satisfactorily. The registered manager was present when we visited the service on 3rd September 2009, between 10:15 and 18:45. During the day the records for care planning, recruitment, and administration of the service were assessed. Five people using the service were involved with the inspection process. We met with four staff, eight relatives, and one visitor who were present in the home. The people who use the service and the staff who provide the support were also consulted about their opinion of what is provided, through surveys. Of the ten people who are in receipt of support that we contacted all had responded at the time of writing this report. Six staff were also contacted through surveys, of which two responded. Two professional who has been involved with purchasing services from and regularly visiting the home also returned surveys. From this visit it was found that all but one of the small number of requirements and recommendations that were made to improve the service during the last inspection process have been met. In regard to the outstanding requirement for improvements in screening in shared rooms we were provided with information that this would be rectified in the next few weeks. A number of good practice recommendations were given at the time of the inspection visit and can be found in the body of this report. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The provider should ensure that they act swiftly to implement systems in place such as screening in shared bedrooms to protect the privacy and dignity of the people living in these rooms. They could develop the recorded chosen daily routine of how people like to live in better depth as to ensure that all staff can provide support in a consistent way. Care Homes for Older People Page 8 of 30 The meals and planned menu is not enjoyed by all and they should look at how they could improve the variety and choices they provide. 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 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 people who use the service are given all the information in the Statement of Purpose and Service User Guide to make an informed choice to live in the home. They can also be assured that their needs will be assessed thoroughly before a decision is made that the home is able to support and care for them. Evidence: During the last inspection process of the service the information given to prospective and current residents about the home in the Statement of Purpose and Service User Guide was not up to date. Therefore they did not provide sufficient information for people to be able to make an informed choice to use the service. The Registered Manager provided a copy of the current documents and the information given to residents which they call a Welcome Pack. This included the formal Statement of Purpose and Service User Guide and a handy user friendly folder with the significant information that people living in the home will want to know. The Care Homes for Older People Page 11 of 30 Evidence: format of the information is easy to use and includes detail of the staff caring for them, times of meals, hairdresser and the activities available. Of the ten residents who responded to the survey from the commission, nine confirmed that they thought they had received sufficient information about the home before they came to live there. One stated that they did not. The processes for the assessment of individuals needs were reviewed as it was previously seen that it was not carried out in sufficient depth to establish that the home would be able provide the nursing and care support that they may need before they are admitted. The records for two people who have recently been admitted to the service were sampled to see if this has improved. The Registered Manager has reviewed the document tools and has implemented a detailed assessment process that looks at all aspects of an individuals needs. The records supported that information is obtained from any health or social care professional that may be involved in the persons care and uses any overview assessment from social services, care management or the discharge plan from hospital. The personal choices and wishes of the person concerned are requested about how they wish to live and there is a new area in the documents to note down the persons vision of their proposed stay in the home. Throughout the records that were reviewed it was evident that the person concerned was involved as much as possible in the information gathering and assessment of their needs. The home is able to offer trial visits or stays for one month for residents before an agreement and contract is made with them to stay permanently. 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. That individuals personal and health care needs are planned for and are met. The home has safe medication practices in place that protects the people who live in the home and ensures that they received their planned treatment and medications. Evidence: All of the residents who responded to the survey stated positively about receiving the care and support that they needed. Other comments made in regard to what they do well: Look after me and care for me. Good care. Look after us. A social care professional put; Care Homes for Older People Page 13 of 30 Evidence: As a frequent visitor to Winterbrook to review care I can see there is a marked improvement in the care provided. Clients are treated as individuals. The quality of the care plans seen at the last inspection identified that there were some weak recording practices in place. The care planning tools were not flexible enough and staff were having to use several different processes to record information and not all of the information was being used effectively for reviewing and ensuring that staff were able to meet the individuals needs. Since then the method of record keeping has been re-assessed and new tools have commenced to be implemented. A sample of three records were looked at, and it was evident that staff are now provided with information that is much more holistic and specific to the person concerned. Areas they are aware of that they wish to improve are those more focused on the persons chosen daily routine and expanding the recording and planning for their interests and activities they wish to continue with or participate in. The staff have several assessment tools in place for the continual monitoring of the individuals health and well being. These include their skin integrity, dependency level and nutritional status. Significant health issues are included in the information and any specialist nursing tasks planned for. The content in each section of the care plans are quite detailed and informative giving the nursing and care staff very clear instruction of how to support the individual and how they are going to achieve meeting their needs. It was also evident that the improved care planning information had encouraged staff to develop the detail in the daily records of the outcomes for the person concerned as these were comprehensive and holistic. One GP commented in a survey, Nursing staff are committed and treat the resident with dignity. The processes for the administration and safekeeping for medication were reviewed. We were informed that since the last inspection process the medication supply and delivery system has been reviewed and changes implemented. The home has ceased using a nomad system and has commenced using a Monitored Dosage System. The Deputy Manager also confirmed that the record keeping for the movement of medication in and out of the home and that for disposal has been improved. The records seen for this and the management of the controlled medications show that care is taken to ensure that all medication brought into the home is monitored closely and managed safely. In addition to the homes own checks carried out they are subject Care Homes for Older People Page 14 of 30 Evidence: to monitoring by the homes pharmacy supplier who audits records, storage and disposal of medications in the home. We looked at the systems they have for protecting the residents privacy and dignity in the shared bedrooms of the home during the last inspection process where is it was identified that this may have been compromised by the poor screening between beds. We reviewed this again during this inspection process and could see that this had not been rectified and that inadequate mobile screening was still in place. However, we were informed that this was scheduled work to be carried out and provided with information following the inspection visit to the service that this was occurring within the next few weeks. The Registered Manager provided information that there has been an improved approach to obtaining information about individuals choices of how they wish to be cared for at the end of their lives. The new care records include a summary of dos and donts in which the individuals choices can be noted for staff to follow. 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. The people who use the service are supported to continue with their interests and the social activities provided have improved. Meals and the planned menu is not always enjoyed by all the residents. Evidence: As previously identified the new assessment and care planning records offer greater flexibility to note personal choices of how people like to conduct their daily lives. The detail included in the key information of how support and nursing care is to be provided shows that the staff completing it spend time seeking the individuals opinion and ensure that their choices are noted. One area they could further improve is to record their chosen usual daily routine, such as rising in the morning, participation in events in the home, and time they like to retire to their room. Two residents put in their responses to the survey that the home did activities well. A visiting social care professional thought that both the internal and external activities provided to residents had improved. Two members of staff thought the activities provided to residents were very good. Care Homes for Older People Page 16 of 30 Evidence: From listening to residents and relatives during the day of the inspection there is a busy social activity programme, that all are encouraged to join in with and was found especially valuable to them. It was also apparent that members of the local community and relatives who no longer had someone living in the home return to participate and support events going on. In the past year there have been some very varied events organised which have included barbeques, cultural evening, strawberry tea and parties for special occasions. Local singers, musicians and schools visit the home and residents are supported to go out for short trips or to the local shops. Care was also seen to be given to assist those who wish to pay their respects and attend the funeral of a companion who had lived at the home. The photographs on display in the home also support that residents are given a schedule of activities that reflect particular calendar events, such as Valentines Day, Easter, and Christmas celebrations, and from what could be seen these were being enjoyed equally by the staff and relatives who were participating with them. The activities organiser has been working in the home for a number of years and has a programme of planned activities that appeal to the majority of the people living in the home. These are usually those of a practical nature such as knitting, painting, some to stimulate the mind such as quizzes and a little gentle exercise. A recent exploration into Reiki provided by a local practitioner was found to be enjoyed by a small group of residents who wished to participate. If they are able and want to continue residents are supported to maintain their usual activities in the community, such as attending day centres and clubs. Comments from residents about the meals provided were mixed. One person put, Food reasonable. Additional comments were in regard to what they could do better; Food could be better. Food Change of food. One member of staff expressed their concern that the actual planned menu for supper each day did not always reflect what was provided to residents. Care Homes for Older People Page 17 of 30 Evidence: A sample of the menu plan shows that there is only one main meal on offer each lunch time and it does not indicate if alternatives are available. The menu plan shows that it consists of mainly traditional English meals with a roast dinner on Sundays and a fish dish on Fridays. A meal time was not observed on this inspection visit. From what we were informed the residents can take their meals in the main dining room at the rear of the home or their rooms if they wish. Some residents use the small communal room in the middle of the home where staff can provide greater assistance should they need it. The meals are provided by specifically employed catering staff who work, according to the copies of the most recent duty rotas, from early morning till after midday each day. The evening meal is served and managed by the care and nursing staff on duty. This was expressed as a concern by a member of staff in a returned survey as it removed a member of staff from providing care and support to residents for a period of time to wash up and tidy the kitchen from the evening meal. Care Homes for Older People Page 18 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 can be confident that their concerns or complaints will be listened to and acted upon. The service has systems in place to protect the people living in the home from possible abuse or harm. Evidence: Residents are informed about the complaints process in the Statement of Purpose and Service User Guide which includes a flow chart so they can visibly see how a concern is managed. A copy of the policy and procedure is placed on display in the central hallway for all to see. The detail of the complaints process informs the reader of the timescales they can anticipate their concern will be investigated within and to whom, they can make their concern known to. The AQAA gave information that the home has received three complaints in the last twelve months, two of which were upheld. We reviewed the homes records for complaints management to see how they carried this out and what actions they took to rectify the concerns expressed. From what could be seen the concerns were investigated and acted upon appropriately although the method of recording them could be improved to ensure that confidential information is protected. Additionally it could be seen that they often do not note down minor concerns that are rectified immediately by staff, which done so would aid monitoring for trends of concerns. This observation was passed back to the Registered Manager during the inspection. Care Homes for Older People Page 19 of 30 Evidence: All of the people who responded to the survey confirmed that they knew who to speak to if they were no happy. One person added, Dont act on it. The home has the necessary information available to staff in regard to identifying and acting upon possible abuse or harm to the vulnerable group of people they support. Staff are provided with the basic information in the induction programme which is then followed through with further training within the training programme. Copies of the local interagency procedure for staff to refer to and follow should they be concerned, is left in the main office for staff to read. Care Homes for Older People Page 20 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. The home is maintained well and meets the needs of the people who live there. Evidence: The home is not purpose built and is a large family residence that has been adapted and extended over a period of time to provide accommodation to twenty-six residents. There are sixteen single and five double bedrooms over two floors, the majority of which have an en suite toilet and hand basin. One bedroom has recently been altered to provide a shower, wet room, facility that was completed the day before the inspection visit and not yet tried out by the resident staying in the room. The Registered Manager provided information in the AQAA that improvements have been made in some of the provision of furniture, fittings and decoration of the home since the last inspection process. This could be seen in some of the bedrooms, communal rooms and en suites. However, some of the cupboards in the communal bathrooms and the personal bathroom cabinets are looking tired and worn and should be included in the intended continual programme of refurbishment that is carried out. The main areas of concern observed were passed back to the Registered Manager during the day. We looked at the provision for the communal spaces available for residents to use and could see that seating in the main lounge had been replaced and the room slightly rearranged to accommodate wheel chair users. Neither of the two larger communal rooms are sufficiently large enough to provide space to all the residents at one time so some residents spend much of their time either in the dining room, their Care Homes for Older People Page 21 of 30 Evidence: own rooms or the smaller room in the centre of the home. During the day it could be seen that four residents specifically use this smaller room the majority of the time and staff have looked at providing furniture that is more recognisable as something that they would identify with from their past to make it more homely. However, the lighting and decoration in this room could be improved as the darker colour walls and poor light from the window gave insufficient brightness for residents to read by. The home has limited storage space internally for equipment and general household and clinical stores. Hoists, wheelchairs and residents own transport, are kept in various places such as bedrooms, communal bathrooms and hallways which therefore at times restricts access to facilities for residents and staff. The provider has ensured that external space is available for some of the items but it could be seen that care has not been taken at times to store excess furniture and fittings when not in use. An overspill of furniture had been recently left in close proximity to the home and had the potential to put residents at risk if they were using the garden and the overall fire safety of the home. Once informed, the provider took action during the day of the inspection to remove the redundant furniture from the garden. The Registered Manager has listened and acted upon the concerns identified at the last inspection about the control of infection practices in the home. They have obtained a copy of Department of Health, Infection Control Guidance for Care Homes and has ensured that staff are working to the guidelines and have had the necessary training. The concerns about the toiletries in the shared accommodation have been rectified by providing separate storage for each individuals items to reduce the opportunity for cross infection. The Registered Manager confirmed that the laundry area of the home is still under scrutiny as to continue to improve the facilities to minimise the spread of infection. The size and shape of the room does limit the space to manage soiled and clean linen in the same room. The home has gloves and disinfectant hand gel placed in various parts of the home for staff and visitors to use. They were advised to place a hand gel dispenser in the front hall of the home for people to use as they enter and leave the building to promote hand hygiene for visitors. The facilities of the sluice sink area on the first floor have been improved by a regular cleaning routine although the layout of the room with the equipment still means staff are unable to access the sink to wash their hands easily and therefore is still an area the should be re-assessed for improvement. The provider, during the day of the inspection visit stated that a mechanical sluice was the proposal to improve the facilities on the first floor for this. The home does have a mechanical sluice on the ground floor. Care Homes for Older People Page 22 of 30 Evidence: All of the people who returned surveys to the commission indicated that the home was kept fresh and clean. Two expressed that they thought that they did this well and one added, Very clean. The home has the benefit of larger than average garden areas that completely surround the building. To the front of the home the manager has implemented some small changes by the addition of seating and potted plants to enhance the facilities for residents. There have been no changes to the access from the rear of the building for residents to use or shelter provided for those who smoke to sit during wet or cold weather. These were both areas identified at the last inspection to make the experiences of the residents comfortable and the garden more accessible. The Registered Manager and provider confirmed that the proposed changes to the facilities and the accompanying building work were still going ahead and would possibly effect implementing permanent improvements in these areas. Care Homes for Older People Page 23 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 homes staffing levels meet the current needs of the people they support. The recruitment process is carried out appropriately and staff have had the necessary training they may require to carry out their roles. Evidence: The residents and relatives involved with this inspection visit, spoke very highly of the staff working in the home. They used words to describe them as: friendly, helpful, always smiling, and welcoming. A comment in a survey was, Staff very good. Some staff expressed in the returned surveys and during the day their concerns about staffing levels at times of peak activity particularly at residents suppertime when care staff have kitchen duties. One thought that there was not enough supervision of staff carried out. Copies of the staff rota for the previous week and current week of the day of inspection were reviewed to what staff are present in the home at peak activity times and during the night. From what was recorded a registered nurse was always on duty, and the small team of permanent nurses including the Deputy Manager, covered all Care Homes for Older People Page 24 of 30 Evidence: the required shifts very flexibly, moving to night or day duty to accommodate the needs of the service. Specific staff are employed for the kitchen and domestic needs of the home. Care staff continue with laundry duties as part of their general responsibilities and a member of staff is employed specifically to provide activities in the home, although this was not clearly indicated on the rota when these staff were away from providing personal care and support for the residents. The Registered Manager does not use the assessed dependency levels of the residents as a tool for staffing to determine the current staffing needs of the home. The Registered Manager provided information about the qualifications and training that staff have obtained during the last twelve months. She was able to inform that of the twelve care staff employed, five have obtained an NVQ 2 or above including two staff with a NVQ 3. A further two staff have recently have registered for NVQ training and the Registered Manager and Deputy Manager are in the process of completing their NVQ 4. The recruitment and employment records were reviewed for three staff to assess if their processes are robust and safe and protect the residents they support from inappropriate staff being employed. The records showed that the key information is obtained including the necessary references, full work history and the Criminal Records Bureau and Protection of Vulnerable Adults list checks are carried out before they commence working in the home. The manager stated that they were aware that their induction programme for staff was an area they needed to improve and have commenced using the Local Authorities programme as to ensure that the process meets current good practice guidelines. One area they will need to continue to develop is recording the shadowing, mentoring and close supervision of new staff as to support that these processes have been carried out appropriately. A new member of staff is given a probationary period which is indicated in their offer letter given to them with their contractual agreement for their role in the home. The employment records were organised and confidential information is separated from other documents. Staff were able to confirm that they are provided with a regular training programme, although one did comment that they thought they all could improve their practices by training in regard to caring for people with mental health needs. The employment records supported that staff had been provided with health and safety training including food hygiene, fire safety and infection control during the last twelve months. Medication training has been undertaken by the registered nurses to ensure that their skills and competencies are satisfactory. Care Homes for Older People Page 25 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. The home is run in the best interests of the people living there, and is managed effectively by a knowledgeable manager and provider. Evidence: Comments in the returned surveys in regard to what they do well included from a social care professional, They provide a safe and happy environment for clients. Visitors to the home during the inspection process emphasised how much the home had improved in the last few months and staff were happy and sociable and that it was a pleasure to see. The new manager registered with the commission several months ago having previous been the deputy in the home for at least two years before this. She is not a registered nurse but has had many years experience in the provision of care and support of the elderly. She is supported by a senior registered nurse who takes the lead in the planning and delivery of nursing care in the home. Since the last inspection process Care Homes for Older People Page 26 of 30 Evidence: both have spent time in improving and developing their skills and knowledge for the roles that they carry out by undertaking NVQ 4 level qualifications. They were also able to provide information of further plans to continue with their professional development The residents and visitors who participated in the inspection process spoke highly of the positive communication between themselves and the staff in the home. There is also more formal processes such as the individuals review of the planned care and surveys. There is not a planned programme of residents and relatives meetings in place, although this is an area that the manager is looking to develop. The manager has looked at the other processes for monitoring the quality of the services provided and has implemented checks for record keeping, medications and an infection control audit tool. Regular visits are made to the service every week by the providers, every month they complete an assessment of the service, Regulation 26, and sample random documents, facilities and consult with residents and staff. What could be seen was the content detail of these had improved and showed that the findings were being used to develop the service. The home keeps a small number of residents money that is used for purchasing hairdressing, chiropody and toiletries should they require it. They are also provided with lockable spaces in their rooms for their valuables. The records for the management of the monies were reviewed and it could be seen that that they record the transactions carried out and that the records are audited periodically. They were advised to look at the current method of holding this information improve the quality and audit processes. A sample of the safe working practices in the home, were reviewed to see what they have in place and if they protect the residents, staff and visitors. For fire safety the home continues to employ the service of a specialist consultant and it was evident that they had taken advice from them to improve the fire safety practices in the home. This has included ensuring specialist fire safety door closures, signage and equipment is in place. The records for water temperature testing and water outlets for show that they are carried out regularly. Care Homes for Older People Page 27 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 28 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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