Care Home: Wisteria Lodge

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What the care home does well Preadmission processes means people move into the home with the belief the home can meet their needs. Care planning processes and care practices means people living at the home receive the care and support they need in a way they like. People living at the home can chose to take part in meaningful activities. The home is well maintained and furnished to provide a pleasant and safe environment for people to live in. A good understanding about safeguarding issues means people living at the home are protected from the effects of abuse. Staffing levels for both carer and ancillary staff means there are always sufficient staff on duty at any one time to meet the needs of people living at the home. Excellent provision of training that includes over 50% of staff trained to a minimum of NVQ level 2 in care means people living at the home are cared and supported by staff who are skilled in the relevant care practices. The management of the home seeks ways to improve the service for people living there. This includes responding to the wishes of people living at the home, examples of which include changes made to the provision of activities. What has improved since the last inspection? Improvements have been made to the environment which include improved lighting in some areas of the home and improvements ot the garden areas. Successful completion of NVQ in care courses means that the home increased it`s compliment of NVQ trained staff to 81% having NVQ level 2 in care as a minimum. In response to staff requests an extra member of staff has been employed to ensure people living at the home have choices regarding their care provision in the mornings. The service has formalised it`s in house quality assurance processes by collating and producing a report in response to surveys. They also have achieved accreditation with two professional bodies to support the quality assurance of the service they provide. Staff supervision has been formalised with a structured plan in place to ensure all staff receive formal supervision. What the care home could do better: The inspection has identified no areas for improvement required to comply with the Care Home Regulations 2001. The service`s own monitoring and quality assurance programmes identifies areas for improvement to ultimately improve outcomes for people living at Wisteria Lodge. Areas the home has identified for improvement are detailed in the relevant sections of this report. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Wisteria Lodge 82 London Road Horndean Hampshire PO8 0BU     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Gina Pickering     Date: 1 8 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Wisteria Lodge 82 London Road Horndean Hampshire PO8 0BU 02392598074 02392643297 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Wisteria Lodge Ltd Name of registered manager (if applicable) Mrs Rose-Marie White Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 19. The registered person may provide the following category/ies of service only: Care home only ? (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Wisteria Lodge was newly registered with the Commission for Social Care Inspection on 15th July 2008 as a limited company having previously been registered with us with the homes present owners being the registered provider. With this new registration no Care Homes for Older People Page 4 of 31 care home 19 Over 65 0 0 19 19 19 0 Brief description of the care home changes have been made to the management structure at the home with one of the owners of the home Mrs Rosa White being the registered manager. The home is situated in a residential area close to shops and other amenities in Horndean. The home offers comfortable accomodation arranged over two floors with fifteen single bedrooms, twelve of which benefit from an en-suite facilty and a furthur two double bedrooms, one with en-suite facilty. Communal areas include a comfortable TV lounge, a quiet lounge, a seperate dining room, courtyard areas to the garden. There is a terraced garden at the rear of the property and provision of parking spaces at the front and to the side of the property. The registered manager told us that a current range of fees is provided to anybody who makes an enquiry about the home. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection considered information received about the home since our last key inspection in June 2007, which was prior to the homes change of registration as a limited company. This includes information provided to us in the form of the homes Annual Quality Assurance Assessment form in which the registered manager told us how the service has developed over the past twelve months and how they propose to continue to improve the service. A visit was made to the service on 18th March 2009. We looked at documentation relating to four people using the service. We toured the building looking at the communal areas, a sample of bedrooms, bathrooms and the laundry. We also had conversations with six people living at the home, two visitors at the home, four staff Care Homes for Older People Page 6 of 31 members, the registered manager and the office manager as well as looking at various documentation as part of the inspection process. What the care home does well: What has improved since the last inspection? 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 8 of 31 Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good pre-admission processes means that people moving into this service should be able to expect that all their needs will be identified and met. Evidence: The AQAA and registered manager told us that a comprehensive assessment procedure is completed before a person moves into the home. This includes information about the person wishing to move into the home from the person making the referral ( relative, advocate or social services), an assessment of the personal, health and social care needs of the person planning to move into the home and the offer of visits to the home before the decision is made as to whether the home is able to provide the support and care the person needs. We looked at care files for four people living at the home, all of which contained assessments of their needs completed before they moved into the home. Two visitors Care Homes for Older People Page 11 of 31 Evidence: told us about the processes that took place before their relative moved into the home. This included discussion with the registered manager about the services provided by the home and about the care they wanted for their relative, the manager visiting their relative before they moved into the home to assess their needs and being provided with written confirmation that the home will be able to provide care and support for their relative. One person living at the home told us she had visited the home before making the decision about whether she wanted to move into Wisteria Lodge or not. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Effective care planning processes mean people living at the home receive the care and support they need in the way they like. Medication practices at the home protect the welfare of people living at the home. Evidence: The AQAA told us that prior to a person moving into the home a basic care plan is developed from the pre admission assessment process so care staff know about the persons care needs before they move into the home. A full care plan is developed within a week of the person moving into the home. Of the four care files we looked at each of them had a completed care plan, with written evidence of the involvement of the person living at the home and evidence of the plans being reviewed monthly. Details in the care plans include the problem or need, the desired outcome, the action to be taken by care staff to meet that outcome and reviews as to whether the desired outcome is being met. Care plans contain precise detail about how a persons needs are to be met that includes the wishes and preferences of that person. For example whether a person prefers a bath or shower and at what time of day and how many Care Homes for Older People Page 13 of 31 Evidence: times a week, what type of clothing they like to wear, what assistance they need and what they can do for themselves when getting dressed and details of creams used on their skin. Detailed descriptions of action to be taken by care staff to maintain peoples skin integrity is included in the care plans. This includes the use of equipment such as pressure relieving cushions, pressure relieving mattresses and profiling beds and other actions for example to encourage to stand and have a short walk every 2 hours. Discussion with staff identified they have a good awareness of the needs of people using the service. They also confirmed that care plans are accessible to all staff and that as well as the information provided in staff handovers they use the information in the care plans to ensure they are providing the care and support to people at the home as they need and in the manner they like. The files also detail contact people living at the home have with the multidisciplinary health care team. This includes GP, District nurses, Community Psychiatric nurses, Chiropodists, opticians and dentist as well as hospital visits. Discussion with visitors and people living at the home indicated professional health care support is requested promptly when needed. Relevant details recorded in the health care professional notes are included in the care plans and on the Medication Administration Record (MAR) sheets. Staff are made aware of changes in a persons treatment by use of the care plans and in handover periods at the change of staff shifts. The home operates a monitored dosage system for the administration of medication that is supplied by a local pharmacist. Records detail that all staff who administer medications receive training about the safe management of medications at a local college followed by regular refresher sessions provided by the registered manager. Staff members confirmed to us in conversations that only those staff who have received training about the safe management and administration of medications administer medications to people living at the home. Procedures are in place for people living at the home to manage their own medication. Each person has a completed risk assessment of their ability to manage their own medications. At the time of our visit to the home nobody had been assessed as able to or wanted to manage their own medications. We looked a sample of the MAR (Medication Adminsitration Record) sheets that detailed the dosage, at what time and to who the medication must be administered. This includes the creams used in personal care as detailed in individuals care plans. The registered manager told us she audits the MAR charts to ensure medications administered are being signed for and assesses any concerns with the relevant staff member. At the time of our visit there was a signature missing from one of the MAR charts we looked at, the registered manager was made aware of this. The storage of medications is clean and orderly, with facilities for controlled medications to be stored Care Homes for Older People Page 14 of 31 Evidence: in a secure cupboard that meets the relevant legal requirements. Procedures are followed that allows for an audit trail of all medications in the home. People living in the home told us they are treated with respect, as did their visitors. Care plans detail actions to be taken to protect the privacy and dignity of people whilst receiving personal and health care. Shared bedrooms have ceiling hung curtains that are used to promote the privacy and dignity of people whilst receiving personal and health care. Observation of practices during the visit supports the view that the privacy and dignity of people living at the home is protected. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities, family contacts and meals are well managed, offering variety and choice based on the preferences of people living at the home. Evidence: The AQAA told us the home has a varied and comprehensive activity schedule with activities being added or taken off the schedule as a result of the wishes of people living at the home. Examples given of activities added as a result of peoples wishes include visits from a theatre company, pet therapy and regular visits from a violinist. People living at the home are informed of forthcoming activities by discussion with staff members and by details of forthcoming activities being posted on the activity board. This detailed activities including pet therapy, craft activities, quizzes, reminiscence sessions, visiting theatre productions musicians and aromatherapy hand massages. During the afternoon of our visit a quiz and reminiscence session was taking place in one of the lounges. People living at the home told us they can chose whether to join in with activities. Visitors to the home also told us their relatives are able to choose whether to join in with activities. The manager shared with us comments received during the last quality auditing survey completed by the home in Care Homes for Older People Page 16 of 31 Evidence: October 2008. There were positive comments received about the provision of activities including I have attended a few functions & the atmosphere is relaxed and hospitable and the atmosphere is excellent & all appeared to be having a good time. Details of a persons religious/spiritual needs are included in the care planning process. Peoples spiritual/religious needs are met by the provision of visiting Anglican or Roman catholic ministers. The manager told us they have nobody living at the home at the moment who is of any other religion. One son living at the home told us her religious needs are met by being able to pray with one of the staff members. Information provided to people moving into the home and their relatives detail that people can receive visitors at all times but to respect the privacy of people living at the home request people seek permission to visit before 8am and after 10pm. The visitor book detailed that visitors are received at various times of the day and people living at the home told us they can receive visitors when they wish. Two visitors we had conversations with told us they can visit their relative whenever they want. One person visits their relative twice a day and told us he is always made welcome. People living at the home told us they enjoy the meals provided at the home, though many were unable to remember what they had at the meal previous to our conversation. The choices for the evening meal were displayed on the board in the dining room, detailing a choice of cauliflower cheese, savoury pancakes with potato wedges or cheese sandwiches. We discussed the food provision with the cook on duty at the time of our visit who told us people living at the home always have a choice of meals for breakfast and in the evening. The lunch is a set menu, but alternatives are provided for people who do not like or do not want the planned meal. A menu diary detailed the planned menu for the forthcoming weeks and detailed what meals have been provided to people living at the home. This menu dairy confirmed that people are offered choice at breakfast and in the evening and that a suitable cooked alternative meal is provided for people who do not want the lunchtime menu. On the day of our visit lunch was roast beef with vegetables and jam sponge. The home employs five cooks. This means there is a cook available to prepare and serve the breakfast, lunch and evening meals. At lunch time most people living at the home gathered in the dining room to eat their lunch. We observed staff asking people where they wanted to take their lunch, some people chose to eat their lunch in their bedrooms. Staff support during the meal times was observed and was carried out in a sensitive and unhurried manner. Care Homes for Older People Page 17 of 31 Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home can be confident that complaints will be taken seriously and responded to promptly. People who use the service are protected from the effects of abuse by a staff team that has a good understanding about safeguarding procedures. Evidence: The AQAA told us the complaint procedure is detailed in written information provided to people when they move into the home and is displayed on the wall in the entrance hall to the home. People living at the home told us they would address any concerns or complaints to staff members or the registered manager. Visitors we had conversations with told us they have had no need to raise any complaints with the home and any concerns they have had have been responded to and dealt with promptly and appropriately. Because of this they believe any formal complaints would be managed promptly and appropriately. The AQAA told us the home has not received any complaints about the service it provides in the last twelve months. We looked at the complaints log book that detailed no complaints had been received. The organisation of the logbook indicated that complaints would be documented, investigated and responded to within the agreed timescale of 28 days. Staff told us if they were unable to resolve any issues raised to them they will refer the concern or complaint to either the registered manager or the general manager. CSCI have received no complaints about the service in the past twelve months. Care Homes for Older People Page 19 of 31 Evidence: Policies and procedures are in place about safeguarding vulnerable adults including the local authorities safeguarding procedures. Records detail that all staff have received training about safeguarding vulnerable people and discussion wit staff members evidences they are aware of the different types of abuse, how to recognise abuse and the actions to take to protect people should they suspect an act of abuse has occurred. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Wisteria Lodge benefit from living in an environment that is safe, well maintained and furnished to a high standard. Evidence: As part of the inspection tour was made of the environment looking at communal areas, a sample of bathrooms and bedrooms, the kitchen, laundry and the garden area. Communal areas consist of two lounges, one of which is a quiet area without a television, dining room and courtyard areas with seating in the gardens. All areas are clean, well decorated and comfortably furnished. Lounge areas had newspapers and magazines for people to read. We observed people choosing which areas of the communal areas ot sit in or whether to stay in their own bedrooms and people we had conversations with confirmed these are their decisions. Bedrooms that we looked at were of varying sizes, comfortably decorated and furnished and evidenced that people are able to personalise their bedrooms with small items of furniture, pictures and ornaments. Shared rooms have ceiling hung screening to provide privacy. There are sufficient bathrooms providing assisted baths and walk in showers for people to have choices with regard to their bathing. A stair ift allows people access to both floors of the home. Equipment such as mobilty aids, hoists, standaids and profiling beds are available to ensure peoples welfare is promoted Care Homes for Older People Page 21 of 31 Evidence: within the environment. The home has a planed programme for maintenance of the home which includes for next twelve months digital television upgrade, storage area for medical equipment and the ongoing decorating of the home. The AQAA told us of improvements made to the environment of the home in the past twelve months, some of which include new lighting to some of the communal areas, purchase of two profiling beds, additional emergency lighting outside the building and improvements to the garden areas with benches, plants and flowers to the front garden. Procedures are in place for the reporting of maintenance issues. The reporting log book details the maintenance issue and the maintenance man signs and dates this once the issue has been resolved. This book detailed that most maintenance issues are resolved within five days. Dedicated housekeeping staff are employed to maintain the cleanliness of the home with two cleaners being on duty each day. On the day of our visit to the home the house was spotlessly clean and free from malodours. The laundry is situated on the ground floor. Good laundering procedures reduce risks of cross contamination from soiled linen. Records detail that all staff have received training about the control of infection. Protective equipment such as gloves and aprons are available for all staff and hand gels are available to supplement hand washing practices. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff development and training provision means people living at the home are cared and supported by a highly skilled and knowledgeable workforce in suitable numbers. Robust recruitment procedures mean people living at the home are supported and cared for by people suitable to work in the care industry. Evidence: The AQAA told us the service provides a professional complement of staff who have the knowledge and skills to support people living at the home. A staff rota diary details the planned shift pattern for the forthcoming year. The registered manager told us staff have a set rota, so they know what shifts they are working for the forthcoming year. We were told and the staff rota confirmed that in the morning there are four care on duty, in the afternoon there are three care staff on duty and at night there are two waking staff on duty. The registered and general managers are on duty during the day hours during weekdays and they told us one of them is available at all times for advice and support. There is a cook on duty to prepare and serve breakfast, lunch and the evening meal, a person ot wash up in the kitchen for two hours a day, two cleaners on duty each day and maintenance staff available daily. This excellent provision of ancillary staff means people living at the home have their care and support provided by a staff team whose role is solely to Care Homes for Older People Page 23 of 31 Evidence: provide care and support. One improvement made to the staffing of the home in the past year includes the employment of extra member of staff between the hours of 8am to 12 noon every day to ensure peoples needs are met at a time they want them to be met in the morning. We were told that as part of the plans to improve the service in the next twelve months the service is looking to employ an extra member of staff between the hours of 6pm to 9pm to support peoples choice about the time they want to go to bed. Staff we had conversations with told us there is sufficient staff on duty to meet the needs of people living at the home. We noted that call bells were answered promptly and staff had time to chat with people living at the home, all indicating there were sufficient staff on duty on the day of our visit to the home. People living at the home told us call bells are answered promptly and visitors we spoke with did not express any concerns about the number of staff on duty at any one time. We looked at four staff files to evidence the recruitment process. This detailed all recruitment checks including checks against the Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) list and two satisfactory written references are received prior to a person commencing employment at the home, This means the service has taken appropriate action to ensure people living at the home are receiving care and support fomr people who are suitable to work in the care industry. The AQAA told us the home is proactive in the training and development of staff. Staff told us they receive training throughout the year to provide them with the skills and knowledge to provide the care and support for people living at the home. The managers maintain a matrix for all staff that details their role, start date, hours worked and training the home views as essential depending on their role that they have undertaken such as moving and handling, first aid, health and safety, food hygiene, NVQ qualifications, management of medications, protection of vulnerable people and infection control. The AQAA and staff at the home told us that extra training is provided for staff so they can meet specific needs of people living at the home. Examples of this include training about dementia, Parkinsons disease and the use of MUST (a nutrition assessment tool). Staff files contain copies of the certificates for courses attended and framed certificates are on display in the entrance hall to the home. A plan for training courses is displayed in the kitchen area and the main office. This details all the training planned for the forthcoming year and the names of staff members who have booked themselves on these courses. The cook told us that although the ancillary staffing, including the cooks, do not deliver care, they attend courses such as dementia and the mental capacity act so they can understand the illness and conditions of people living at the home and the effect it has on their well being. Care Homes for Older People Page 24 of 31 Evidence: We spoke with a recently recruited member of staff at the home. She told us she is in the process of working thought an induction programme with the support of a staff member as well as undertaking all the other training provided by the home. We looked at one of the induction booklets evidencing that the induction programme complies with the the induction guidelines set by Skills for Care. The business plan the manager showed us detailed the home is striving to achieve 95 of care staff with NVQ level 2 or above in care. At present 81 of the care staff have NVQ level 2 or above, which is above the required standard of 50 of care staff with NVQ level 2 in care. Discussion with staff identified they have a good understanding of individuals needs and the overall aims of the service. They confirmed to us that the management will provide any identified training that is needed to meet the needs of an individual or all the people living at the home. They told us their training needs are discussed in appraisals and at formal supervision sessions.Their conversations made it evident that the management operate an open door policy and are always available for guidance. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Wisteria Lodge benefit from an open and transparent management ethos that takes their and their relatives opinions into account regarding the day to day running of the home. Good supervision and support of staff by the manager means people living at the home receive the correct support and care. The health and safety of people is prptected. Evidence: The registered manager, Mrs Rosa White, has a nurse qualification and the registered managers Award ( RMA) and regularly updates her training. Her records detail training attended for clinical and managerial aspects of her role. These include training to enable her to train staff in moving and handling, nutritional assessment training, falls awareness and business management training. The registered manager is supported by an office manager who has the responsibility for the administrative side of the care home. It is evident through improvements made to the environment, the provision of appropriate equipment, changes to activity schedules and the excellent provision of Care Homes for Older People Page 26 of 31 Evidence: staff training that the manager continually strives to improve the service at the home with the aim of improving outcomes for people living at Wisteria Lodge. The AQAA told us the managers have an open door policy to minimise barriers between staff, management, service users and their families Through conversations we had with people living at the home, visitors and staff it is evident that the management are approachable and are supportive with personal and work issues. We observed staff, visitors and people living at the home having conversations with ease with both the registered manager and the general manager. The staff and managers told us regular staff meetings are held allowing for staff to be informed about the running of the home and for staff members to make suggestions about the running of the home. Meetings held include departmental meetings as well as full main staff meetings. Minutes are kept of these meetings and a process of staff signing to signal they have read the minutes ensure all staff are kept up to date about the information discussed at staff meetings. Changes made as a result of input from staff members include the recruitment of an extra member of staff between the hours of 8am to 12 noon. A plan for all main staff meetings for the forthcoming year is on display so all staff know in advance about the dates and times of such meetings. Quality Assurance of the service is completed with the use of relative surveys, reviews of care plans a other documentation and discussion with people living at the home. We looked at the collated results for the last relatives survey in October 2008. The results indicated a high level of satisfaction with the service provided at Wisteria Lodge. Comments included I am happy with the level of communication and generally get a fast response to any query I may have and It is a joy to know mum is in a clean and loving environment. Examples of changes made as a result of listening to the views of people living at the home have been detailed in the Daily Life and Social Activities section of this report. The home has achieved ISO 9000 ( a professional quality audit) quality assurance certificate. The annual business plan also contributes to the quality assurance of the home. We looked at the business plan for the year 2009/2010. This contained a review of the achievements of the previous year and set out improvements planned for the forthcoming year. Supervision of staff has been formalised since the last key inspection that was completed before the service was registered as a Limited company. A plan is in place for staff to have formal supervision sessions six times a year and records of these sessions are documented. In keeping with the service culture of the developing staff, senior staff are now taking on the roles of doing supervision sessions after having recieved relevant training. Care Homes for Older People Page 27 of 31 Evidence: Some people living at Wisteria Lodge they like the home to look after small amounts of their money. This money is stored in a secure area of the home and accurate records are kept of each persons money handed over to the home for safekeeping. There is lockable storage space in each persons bedroom where they can store money or valuables of they wish. Records were seen that demonstrated the home provides safe working environment and practices to protect people who use the service, staff and visitors. Fire alarm test certificates and gas safety inspection records were up to date. The fire log book evidenced that maintenance and internal testing had been undertaken at intervals as required by the Fire ands rescue services. But entries were not available for February 2009. This was pointed out to the managers, who explained that the usual person who completes these tests had been on sick leave. They confirmed that the tests had been completed and told us they would get the relevant person to sign for the tests and will put process in place to ensure this does not happen again. A comprehensive fire risk assessment has been completed that details risks for each individual room and the action that must be taken to reduce identified risks. Records detail staff receive as a minimum two sessions of fore safety training each year. A recent food hygiene inspection carried out by the local authority resulted in the home achieving a gold rating and no requirements. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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). 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