Care Home: Witnesham Nursing Home

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What the care home does well Residents are provided with a personal care service that meets their care needs, and the home environment was comfortable, homely and clean. Relatives described the home as welcoming, and that their relatives are treated with dignity and respect by the staff. They described the staff as very supportive and caring. One relative said, `The care in this home is very very good. Nothing is too much trouble`, while another commented, `All, the staff are friendly, and approachable`. One relative told us,` Witnesham nursing home is excellent, and it is all down to the matron, Carol and her caring staff`. No relative who replied to the survey had ever needed to make a complaint about the service. One relative commented: `I know how to make a complaint, but I am happy to say that I have never had to complain about anything!`. People told us that staff were approachable, and one person said, `All staff are approachable and deal with any issues as it arises`. The home provides residents with opportunities which allow choice and control over their preferred lifestyle. This includes opportunities for the residents to join in on leisure activities and entertainment, and opportunities for contact with the local community. The home has community links through the `Friends of Witnesham Nursing Home` group, which supports the residents. Residents are supported by a professional, well trained, and a hard working staff group, who are qualified and able to meet their care and support needs. There is a commitment by management to provide residents with a quality service, which they showed by an appropriate management structure, the quality assurance systems they had in place to receive feedback, and a supportive staff group. The home showed us they have recruitment procedures which usually would protect the residents. What has improved since the last inspection? The previous requirement from the last inspection had been addressed by ensuring that a written record of the provider visits are now maintained at the home. Recommendations around providing a record of staff supervisions and improved storage for care plans had been addressed by ensuring that good records are maintained, and that care plans are secured in a locked cabinet. The home also told us of some of the positive changes at the home over the last year. This included the appointment of a deputy manager to support the management team. The `friends of Witnesham` group continue to provide strong links with the local community so supporting social activities and outings. A refurbishment programme continues to provide improvements to both the communal and private areas. To support the home`s health and safety policy, a `Fire officers grab pack` is now in place. Communication between staff and visitors has been improved by the introduction of a staff file of `Who is who`, which is available at the front entrance. What the care home could do better: The home showed us that they continue with the provision of a positive service that meets the needs of the residents. There were no requirements from this inspection. Recommendations included that the home should ensure that need assessments provide more details of each resident`s care needs on admission, to ensure that there is sufficient information to produce detailed care plans. Quality assurance surveys should be further developed, with more questions around the resident`s satisfaction with the service provision. This is to ensure that home can evidence the residents` satisfaction with the home`s wider service provision. Key inspection report Care homes for older people Name: Address: Witnesham Nursing Home Wearholme, The Street Witnesham Ipswich Suffolk IP6 9HG     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: Kevin Dally     Date: 1 5 0 5 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: Witnesham Nursing Home Wearholme, The Street Witnesham Ipswich Suffolk IP6 9HG 01473785828 01473785779 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Dibcan Limited care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Witnesham Nursing home is situated in the village of Witnesham on the northern outskirts of Ipswich. The home is registered as a care home with nursing for a maximum of 30 residents in the category of older people. The home has 2 lounges, a dining room with a small private sitting area adjoining and all bedrooms are adequately furnished and decorated with each resident being able to choose the colour scheme of their own room. Residents are encouraged to bring in personal possessions and small items of furniture for the rooms. Most of the rooms are of single occupancy. There is a nurse call system in place that is accessible to service users in all bedrooms, bathrooms and communal areas. A shaft lift allows access to the first floor and the home and its gardens are accessible to wheelchair users. The manager, referred to as Care Homes for Older People Page 4 of 30 Over 65 30 0 Brief description of the care home matron, leads a team of care staff who are trained to meet the needs of the residents. The fees charged are from £483 to £625 per week. 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 inspection visit was undertaken on the 15th May 2009 and we did not tell the home we were coming. Mrs Carol Glegg, the manager, was present throughout and provided us with information relevant to our assessment of the home. We toured the home and spoke with some of the residents and relatives, who told us what life at the home was like. We interviewed three staff, and observed the midday meal being served to the residents. We followed a medicine round with one of the nurses. We also checked a selection of residents records, care plans, staff records, maintenance records and training records. A questionnaire survey was sent out beforehand by the Commission to residents, and we received responses from fifteen residents. Most of the residents questionnaires had been completed with the support of relatives. Thirteen staff also responded. Their answers to the questions and any additional comments have been included in the Care Homes for Older People Page 6 of 30 appropriate sections of this report. The manager also provided us with the CQC annual quality assurance assessment form (AQAA). This enables the home to tell us how well they are meeting the national minimum standards, and allows them to say what they do well, what they could do better and any plans to improve the service. Some of the information from this document has been used in 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: Care Homes for Older People Page 8 of 30 The home showed us that they continue with the provision of a positive service that meets the needs of the residents. There were no requirements from this inspection. Recommendations included that the home should ensure that need assessments provide more details of each residents care needs on admission, to ensure that there is sufficient information to produce detailed care plans. Quality assurance surveys should be further developed, with more questions around the residents satisfaction with the service provision. This is to ensure that home can evidence the residents satisfaction with the homes wider service provision. 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. People can expect to receive detailed information about the service, and can be assured their care needs would be assessed, prior to moving into the home. Evidence: The home provides new residents with information about their service in a colourful brochure and within the statement of purpose. These included information for residents about the aims and type of service they can offer, the qualifications of the management and staff group, how the home is managed and how residents can make a complaint, if the service is not satisfactory. Surveys received from 15 residents said they had all received enough information about the home before they had moved in. The fee range charged per week was £483 to £625. The AQAA told us, Prior to admission to the home, the service user will have a detailed assessment done by a social worker and the manager to ensure that the home can meet their needs. Each service user or the relatives are given the Care Homes for Older People Page 11 of 30 Evidence: opportunity to visit the home, and spend time within the home before a decision is made. Two residents records we checked showed us that the home had completed a basic assessment of these residents care needs, to assess if they would be suitable for the home. The information provided had then been used to create a more detailed plan of care. (Please see next section) Information assessed included around 12 areas of care needs, which described each residents medical, nutritional, mobility, nutritional, social and physical needs, although some of the information was noted as quite brief. One assessment had been provided by social services, and this provided comprehensive information around the residents lifestyle choices and social interests. Feedback received from the residents surveys told us, We came to have a look and were very happy with the help we received, and, It was difficult to find a local home at short notice, but I was able to visit Witnesham, and receive information from the matron. The manager and staff showed us they had a good knowledge of the residents nursing care needs. The staff we spoke with and records checked showed us that staff had attended a range of training (please refer to the staff section) so that their knowledge and care skills would be suitable to meet the needs of people who live at the home. The home employs 7 part or full time trained nurses (there is always one nurse on each duty) who are qualified and registered to direct and provide nursing care for the residents. Information provided by the home told us that more than 50 of the support care staff had national vocational qualifications (NVQ) or higher. A number of the support staff are also adaptation nurses awaiting registration, so are highly qualified. Therefore the home could demonstrate that staff was trained and competent to support nursing staff to meet the residents care needs. Feedback from some of the residents surveys told us, The home was recommended, and I had heard many good reports. It was fortunate there was a vacancy at the home, or, The home was recommended to us, as no where else was suitable to meet my needs. 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. Residents will receive appropriately planned care, which meets their health care and support needs. Evidence: The AQAA said, To ensure the continuity of care, monitoring and an audit trail, documentation is provided such as dependency profiles, pressure sore risk assessments, falls risk assessments and a structured 24 hour nursing record. Additional monitoring records are used such as soft tissue and skin abnormality charts, which is a check list of exploring and identifying the underlying cause of the abnormality and injury. The care plans and care records for two of residents were checked which showed us that the home uses a person centred care planning approach. Individual problems are identified and the nursing care required by staff is fully recorded. The care plans provided detailed information around the residents medical history, current medicines, mobility needs, personal hygiene, pressure area needs, falls and safety, choices and abilities, and nutritional needs. Risk assessments included nutritional Care Homes for Older People Page 13 of 30 Evidence: assessments, pressure area and falls risk assessments, weight charts, moving and handling assessments, a dependency profile, and a social history profile. Body charts were maintained to evidence skin and soft tissue abnormalities. The care plans are updated monthly, and a record maintained of any changes to the plan. One resident who was at high risk of falls, their care was tracked. It was good to see that the care required to prevent falls had been recorded in their plan, alongside a falls risk assessment. An individual monthly monitoring record was also maintained on their records, of any falls experienced, and when and where the falls had occurred. The records showed us the number of falls they had experienced, and how the home had reviewed how they cared for them. The care plan had been agreed and signed by the residents family. The homes general accident records were also checked, and again these provided good evidence that any falls are regularly monitored and reviewed by the management team. A graph is maintained of all home falls for the previous year, and information is provided around the time and reason and location of any falls. One resident at risk of weight loss, their records showed that this was monitored on a monthly basis, and that they had gained weight over the last few month. There were records of visits by health care professionals, including the residents doctor. One resident told us that there was access to the chiropodist and dentist, when needed. End of life care needs were described in the care plans we checked. The staff records showed us that staff had received bereavement training and had attended a nutritional workshop. Feedback received from the residents directly or from their surveys, made the following comments about the care they received. I feel my relative is well looked after. They have taken a lot of trouble to sort their problems out, and their health has improved, since they have been here. The care and support at Witnesham is very good. The staff are very good and I always receive the care and support I need. The care in this home is very very good. Nothing is too much trouble for the residents. The matron Carol and her staff are all very kind. We observed residents were being treated with dignity and respect throughout the day Care Homes for Older People Page 14 of 30 Evidence: by the staff group. Staff were observed to be patient, kind and caring towards the residents they helped. The residents dignity was maintained during care sessions, and residents were positively included in conservations, and their needs were being met. Staff were seen knocking on the residents doors before entering, and respected their privacy. During care sessions staff asked the residents for permission to proceed with their care. A relative told us, The staff are friendly and helpful, and Our relative has received tender loving care throughout the years. The AQAA said, The home has a policy for the receipt, storage, handling, administration and disposal of medication, and a monthly audit. The home uses packet medicines and/or bottles that have been prescribed by the local dispensing GP surgery. Staff use a portable locked trolley to take the medicines to the residents, and this was found to be well organised, with separate trays for each resident. Only nursing staff administered medication. Bottles were seen to be dated on opening, and records were marked to indicate when the medicine was first opened. This helps with the auditing of the medicines. The medication administration record (MAR) sheets checked were completed with no gaps in the signatures. During the lunchtime medicine round a sample of 3 peoples medicines were checked to see if the tablets held matched with the records. Two of 3 medicine totals checked matched with the records, but 1 did not. For one medicine, there was 9 more tablets in the box, than indicated by the records. The manager investigated this and found that there had been a labelling error by the pharmacy, which had not been detected by staff. Taking this into account, 6 more tablets were able to be accounted for, leaving a shortfall of 3 tablets unaccounted for. Two further residents medicines checked, showed no further shortfalls. Shortly after the inspection the manager told us, Staff are now fully aware and after further discussion with the surgery they have agreed to change their practice and, from now on, they will cover the manufacturers label with their own label so there will be not be any discrepancies or confusion. I will personally be monitoring this situation very closely. Controlled drugs (CDs) were checked and found to be appropriately stored in a locked room and appropriate cabinet. A check of one residents CD records confirmed the number of controlled drugs held was correct and accurate, and two staff members had checked and signed the records. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will receive appropriately planned care, which meets their health care and support needs. Evidence: The home told us, We practice person centred care therefore the home will try to make the routines of daily living as flexible as possible. We have strong links with the community through the Friends of Witnesham Nursing Home, and personal contact with the village people. On arrival at the home, there was a calm and relaxed atmosphere with some of the residents being assisted to undertake their daily routines. During the later morning period the residents were seen in one of 2 lounges, reading papers, chatting with friends, watching a television programme or receiving assistance from some of the staff. All the residents were appropriately dressed and groomed and seated at various places in the day room. Drinks were readily available on the residents side tables. The home continues to be supported by an organisation called The Friends of Witnesham. This was made up of relatives and friends who raised money for nonmedical equipment and arranged outings and other activities for residents. The homes Care Homes for Older People Page 16 of 30 Evidence: forthcoming events programme showed us that friends of Witnesham can also join in with the residents. There was a weekly diary of events displayed in the hall for the week commencing 10/05/09, and included songs of praise, crowns and flags, a video, Holy Communion, darts and board games, a quiz, a sherry morning on Saturday, and bingo. Other options included watching deal or no deal on TV from 4:15 daily, or wheelchair walks around the garden, weather permitting. Some of the residents made the following comments about the activity programme at the home. They said, The activities are usually very good, or We have been out on the minibus to a beautician, and a garden centre for lunch. Another said, I attend regular meetings, entertainment, coffee mornings, parties and outings. A relative told us, My relative attended a carol service at Christmas, but does not participate in regular activities. They are content to watch other people doing things. The minutes from the last residents meeting in March 2009 was checked and 11 residents were asked about their views on the service. Many of the residents confirmed they were happy with the food or happy with the care they received. One person requested if they could sit in the garden in the evening, and this was agreed. Another complained that there was no choice for lunch, so the manager explained that they could always provide an alternative meal. The minutes provided good evidence that the home includes the residents views in the running of the service, and listens to their points of views. Family and friends are able to visit the home when they choose, and no restrictions are placed on visiting times. Visitors were seen calling on the residents throughout the day, and one relative told us, Our relative is well looked after. I have no worries about their care. Staff were seen to encourage and relate with the residents, and were courteous, friendly and supportive. Another residents relative told us, Our relative is well cared for, their clothes are clean, and the food is wonderful. The home provided a 2 week sample of the meal menus, and these showed us there was a good choice of two hot meal options each day. Examples of some of the weekly choices available included beef lasagne or vegetable Risotto, chicken & vegetable pie or leek and cheese bake, Chinese meatballs with sweet and sour sauce or potato and chick pea curry and rice, liver and bacon casserole or pasta bake, and roast lamb. The menu provided a varied and interesting diet, with something to meet all individual tastes. Care Homes for Older People Page 17 of 30 Evidence: The meal on the day of the inspection was a choice of fish pie and parsley sauce or steamed fish and lemon sauce. Some residents had ordered omelettes. The main meal was served simply but effectively with creamed potatoes, baked beans, and peas. Dessert was peach crumble and custard or ice cream. Meal portions were exactly sized, were attractively presented and so looked and smelt very appetising. The main chef has had considerable experience of running their own catering business, and this was apparent from the presented meals. We spoke with 5 residents during lunchtime, and they told us the meal was very good or I have had plenty or I am very satisfied. Residents were seated for lunch mainly in two lounges with chairs and side tables. The meal was unhurried, allowing residents the time to chat with friends. More poorly residents were fully assisted with their meal to ensure they received good nourishment. All residents who responded to our survey (15) when asked, do you like the meals at the home?, said usually or always. Comments from the residents or relatives about the meals included the following selection of views. The meals are very good and always look nice. The food at the home is first class, and we get a choice. On the whole the meals are good, especially the pancakes, and the porridge is the best I have ever tasted. There is lots of choice. Portion sizes are OK, which has assisted my relative with loosing weight, so improving their diabetes. 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. People can be assured that their concerns will be listened to and will be kept safe from abuse or harm. Evidence: The AQAA informed us, All service users are informed of the complaints procedure and would be fully supported by staff in making their complaint. All but 1 of the residents (15) who completed the survey said that they knew how to make a complaint, and knew who to speak to if they were not happy with the service. One said no. The complaint policy was outlined within the statement of purpose and this explained how a resident could refer their concerns to the management. Some of the residents we spoke with said that they felt able to speak to manager if they had any concerns. One resident said, If I ever have a complaint (and I have not) I am able to call by relative who will deal with it. Another resident told us, Yes I do know how to make a complaint, but I am happy to say that I have never needed to complain about anything. The homes complaints log was checked and contained one allegation around the way a residents healthcare problems had been managed by the home in October 2008. The safeguarding team referred this back to the home to which the manager fully responded. The alert was later closed. Care Homes for Older People Page 19 of 30 Evidence: The home had policies and procedures in place for keeping vulnerable people safe including how staff could report any concerns to the management. The home has access to the latest Suffolk inter-agency policy on the protection of vulnerable adults, updated November 2008. The manager was aware for her responsibilities in reporting any allegations of abuse to Social Services via customer first, for referral to the safeguarding team. Staff training records checked and feedback from staff members informed us that they had been provided with safeguarding training by the home, so they were aware of what do if they suspected any abuse of the residents. 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. People can expect to live in a home that is comfortable, well maintained and clean. Evidence: The home has two lounges, a dining room with a small private sitting area adjoining and all bedrooms are adequately furnished and decorated with each resident being able to choose the colour scheme of their own room. Residents are encouraged to bring in personal possessions and small items of furniture for the rooms. Most of the rooms are of single occupancy. There is a nurse call system in place that is accessible to residents in all bedrooms, bathrooms and communal areas. A shaft lift allows access to the first floor and the home and its gardens are accessible to wheelchair users. A tour of the home showed us that the home continues to be maintained and is kept safe for the residents. Lounges were well decorated with pictures, fixtures, fittings and carpet appropriate to the setting. Some of the corridor paint work was starting to show signs of wear, particularly on exposed corners, but the manager told us there is an ongoing maintenance programme, which would deal with this shortly. The home smelt fresh and clean and without any unpleasant odours, and there were cleaning staff available every day to ensure that standards are maintained. Care Homes for Older People Page 21 of 30 Evidence: The information provided by the home told us that a new security front door had been provided and a number of patio, bedroom and the kitchen windows had been replaced. The canopy fabric outside the sun lounge and a selection of new carpets and curtains in the communal areas had been replaced. Feedback received from the residents surveys(15) said the home was always (13) or usually (3) clean. Some of the residents commented, My room is cleaned everyday, or The home is very clean, bright and sunny, or A homely feel is created well. It is also very clean with daily cleaning carried out in all rooms and areas. A check of the homes health and safety documentation showed us that they have a fire risk assessment in place, and that weekly fire alarm testing continues. A check of the homes hot water outlet records showed us that hot water tap temperatures are checked monthly and are maintained within safety limits. Records checked showed us that there is a continual maintenance programme to ensure that lifts, electrical appliances, lifting equipment, gas, and fire equipment is routinely checked. The home also has an emergency evacuation plan, should this ever be required. Care Homes for Older People Page 22 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. People could expect sufficient numbers of staff who are well trained and supported to meet the residents care needs. Evidence: The AQAA told us, The staff has an appropriately qualified workforce with more than 50 percent staff delivering personal care holding an NVQ level 2 or above. A high proportion of staff delivering personal care are qualified nurses, some of whom are registered with the Nursing Midwifery Council (NMC). We checked the staff rosters for a 2 week period and received information from staff, relatives and residents about the staffing levels at the home. These confirmed that appropriate numbers of staff are maintained throughout the day, so are available to meet the care needs of the residents. People told us, There are always staff around the home to talk with and help. They are very good, or Sometimes if the toilet is needed, it can take a little while for 2 staff to become available at the same time, or The staff are very good. Some of the staff we spoke with confirmed that they were adaptation nurses working as carers in the home. One support worker told us they had nursing experience working in medical and intensive care wards in their own country. This experience would compliment the nursing care provided by the home. The staff records for a nurse and support worker were checked, and these confirmed Care Homes for Older People Page 23 of 30 Evidence: that the home have recruitment processes in place to check that staff are cleared to work with vulnerable adults. Both staff members paper work included Criminal Bureau Records (CRB) checks and Protection of Vulnerable Adults (POVA) checks. However the POVA 1st records showed us that one staff member had commenced their employment, before the POVA first check had been verified. The owners told us that this was due to an oversight where the homes registered body had incorrectly advised them that the person was cleared to work. When the error was realised, the appropriate paperwork was immediately obtained. There was a completed application form for each employee which provided a record of previous employment. Reference checks and proof of identity information had been obtained to show that they were suitable for the position. One nurses records checked showed us that verification of the nurses personal identification number (PIN) was held. Staff training records checked showed us that the home provided good support for staff to receive training relevant to their job roles. Witnesham provide in house training for staff when this is required. Induction training is provided for new staff based on the Skills for Care Common Induction Standards (CIS). Staff files checked showed us that they have attended training for safeguarding, fire, health and safety, moving and handling, skills development, and communication. Care Homes for Older People Page 24 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. People can expect a safe, well managed service which seeks the residents views on the quality of the service provision Evidence: The manager is registered with the Commission, and was a qualified nurse, and had completed the Registered Manager Award. She is up-to-date with good practice by attending internal and external training courses. People told us that the home was well run, and that the service matched with their expectations. Feedback from the resident surveys said, Witnesham nursing home is a very well run home, or Witnesham nursing home is excellent, and it is all down to the matron, Carol and her caring staff, or We have no complaints. The staff have been excellent. Staff told us that the home was well run and they were supported by the manager. Comments included All the staff and the manager work very well together, or There is good team work between all staff, and the management are very supportive, or, We maintain high standards of care, treating residents well and Care Homes for Older People Page 25 of 30 Evidence: maintaining respect and dignity at all times. Residents meetings are held to ensure feedback is received from the residents and to allow any concerns to be discussed. The minutes of one of the residents meetings were checked. Residents expressed their satisfaction with the service, for example one resident said, The care and food are good, and the entertainment is pretty good. There was a quality assurance programme in place to receive feedback from the residents and relatives around the service provision, with an annual quality survey last completed in November 2008. The home also undertakes regular telephone surveys and maintains a record of any comments made. The annual survey asked for the residents comments on the quality of the food provided, the care provision, the environment and the recreation opportunities available. The survey and questions were quite short but showed that most residents had listed the quality at the home as good or very good, under each of these questions. Some of the residents had asked for improvements, for example, more walks in the garden. The provider visits the home once a month and audits the home practice. Written reports about the visit are maintained at the office, and this was seen and checked. The home had also received a number of compliments about the service from relatives, and via their telephone survey, and the following is a selection of their views. Our relative is very happy and cannot fault the care. Thank you for the excellent care, we have no issues or problems. Please continue the good work. I would like to express my sincere thanks to you and all the staff for the excellent care you gave our relative. The home does not normally manage the financial affairs of any of the people living in the home. Where residents are unable to manage their own finances this is managed by their power of attorney or family. Residents can choose to have their personal allowances held in the office. Records are kept at the office in a register. Moneys held at the office were not checked on this occasion. Staff spoken with confirmed that they receive supervision training and support from the manager to do their job. Supervision records we checked showed us that regular sessions were taking place. The home showed us that there was a staff health and safety training programme in Care Homes for Older People Page 26 of 30 Evidence: place, which included fire, moving and handling, and health and safety training. Staff records we checked show us that staff receive this training. The homes maintenance records checked, including fire records, lift, hoist records, and hot water outlet records, showed us the home continues regular health and safety monitoring at the home. 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 1 2 Needs assessments should provide more detailed information about the residents care needs. This is to ensure that the home have sufficient pre admission information about new residents. The homes quality assurance survey should be further developed, with more questions around the residents satisfaction with the service provision. This is to ensure that home can evidence the residents satisfaction with the homes wider service provision. 2 33 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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