Care Home: Wolf House

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What the care home does well Residents live in a homely and clean environment with their private accommodation personalised to their individual preferences. Consistent feedback was received regarding the importance of the homely environment and the good standard of cleanliness with a resident commenting "the home always looks clean and never smells". The home is able to identify and meet the needs of the residents currently accommodated with residents clearly benefiting and enjoying the relaxed gentle lifestyle offered by the home. Without exception all persons consulted spoke positively about their experiences at the home. A sample of comments included "I looked at a number of homes before I chose Wolf house as I found it to be small and homely" " It has such a friendly homely atmosphere and the staff are very caring towards residents" "It is a really lovely homely place excellent really could not have found a better place" "we had two visits prior to mum moving in which was very reassuring, she is being looked after equally as well as I could myself" and "questions asked were answered I found the staff to be very welcoming and friendly and was informed I could view the last CSCI inspection on line". Links with families and friends are highly valued and supported by the home. A relative commented "I always visit unannounced I can pop in at any time and frequently do always made to feel welcome and offered refreshments". Consistent positive feedback was received on the good communication between the home and relatives with a relative commenting "I am always informed of any changes in care needed straight away it is a delight to visit, communication is first class". There is an effective complaints system with evidence that residents and relatives feel that their views would be listened to. A relative said "I have not had to address any problems at the home but if I did I knew I would be able to talk to senior staff on duty and be confident that It would be sorted out straight away and the home manager informed". Staff make a positive contribution in residents lives as residents benefit from a trained and enthusiastic staff team that know them and who are safely recruited and who are employed in sufficient numbers as is necessary to meet their needs. Comments about staff included "Staff always have the time to listen and help" "staff very helpful very nice" "I have every confidence in staff being able to look after my mum with care and compassion" and "the size of this home allows the staff to build up a relationship with all its residents I am very happy that my mother is in this care home". A health care professional feedback that "staff in charge always helpful and have a good understanding of the patients". Resident`s benefit from an experienced and established provider / manager who ensures a clear ethos and values of the home that enables staff to provide good quality care to residents. Consistent feedback was receive of how appreciable and resident focused the manager is. A staff commented "absolutely brilliant undoubtedly the best manager ever worked for supportive towards staff and expects a high standard".The health needs of residents are well met with evidence of regular input from a range of health care professionals. A Health care professionals said "District nurse team are called in if the home discovered any problems with patients ie wounds pressure sores and act on our advice, requests for visits are always appropriate". Resident`s lives are enriched by the home providing various opportunities for occupation and leisure. The meals are good offering both choice and variety with consistent feedback regarding the home cooked nature of meals. . What has improved since the last inspection? The ongoing maintenance, redecoration and refurbishment programme has involved the further refurbishment of some bedrooms and new furniture. All of the requirements made at the previous inspection have now been addressed. This has improved the managing and recording of individual risks faced and posed by residents. Staff have undergone some areas of specialist training to further enhance their understanding of the needs of residents with dementia and mental health conditions. Residents safety has improved through recommendations made following a fire risk assessment of the home being implemented. What the care home could do better: Further work needs to be undertaken to ensure care plans are person centred and provide the full range of guidance for staff on the personal, social and health care needs of residents to ensure that care can be provided in a consistent way. Not all of the routines of daily living currently enable residents to exercise choice and control over their lives this is with particular reference to times for rising. Infection control practices need to be improved in order to promote residents and staffs health and safety in reference to the use of a significant number of commodes at the home. The manager agreed to ensure that the garden was risk assessed to identify any areas of risks and the actions needed to promote the safe use of the rear garden. Any areas in need of redecoration or upgrade has been identified by the manager and action planned to address, with a helath care professional commenting "some of the rooms are a bit dark and gloomy but a feature of a property". Inspecting for better lives Key inspection report Care homes for older people Name: Address: Wolf House Wolf House Wolf`s Row Oxted Surrey RH8 0EB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jane Jewell     Date: 1 9 0 5 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: Wolf House Wolf`s Row Wolf House Oxted Surrey RH8 0EB 01883716627 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ms Yvonne B Gomes care home 13 Number of places (if applicable): Under 65 Over 65 0 13 mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 13 0 The maximum number of service users to be accommodated is 13 The registered person may provide the following category 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 category; Old age, not falling within any other category (OP) Mental disorder, excluding learning disability or dementia (MD) Date of last inspection Brief description of the care home Wolf House is a care home registered to provide care and accommodation for up to thirteen older people, including people who have dementia. The premises were originally converted from a domestic dwelling into a military convalescent home in the 1940s and then further converted in the mid 1980s to provide residential care accommodation. The home is located on the outskirts of Oxted Care Homes for Older People Page 4 of 31 Brief description of the care home town and is in a semi rural location with the village of Limpsfiled within walking distance . Accommodation is arranged across three levels with access provided to upper to the first floor via stairs and a stair lift. The top floor provides staff accommodation. Communal areas are on the ground floor, comprising of a lounge, interconnected dining room and small sun lounge. The majority of bedrooms provide single occupancy and two have en-suite facilities. There is a rear secure sloping garden which overlooks the country side and a front seating area providing level access. 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: 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: The information contained in this report has been comprised from an unannounced inspection undertaken over six and half hours and information gathered about the home before and after the inspection. The Provider / manager had completed an Annual Quality Assurance Assessment form and the information contained in this document has been used to inform the inspection process. The inspection was facilitated by the Mrs Gomes (Registered provider / Manager). The inspection consisted of a tour of the premises, examination of some of the homes documentation and observations of residents daily routines and in their interactions with staff. Four residents, two relatives and six staff were consulted as part of the inspection process. A group of eight residents were also observed in the lounge for a Care Homes for Older People Page 6 of 31 short time in their interactions with staff. Feedback surveys were sent to the home for distribution in order to obtain the views on the quality of the services and facilities being provided. Thirteen were returned in total, two from residents, two from health care professionals and eight were completed by relatives. Their feedback is included in this report. There were twelve residents living at the home at the time of the inspection. The focus of the inspection was to look at the experiences of life at the home for people living there. Signs of residents well-being/ill-being (terminology used for observing behaviour for people who do no use verbal communication) were observed in order to make judgements about their experiences and wellbeing. What the care home does well: Residents live in a homely and clean environment with their private accommodation personalised to their individual preferences. Consistent feedback was received regarding the importance of the homely environment and the good standard of cleanliness with a resident commenting the home always looks clean and never smells. The home is able to identify and meet the needs of the residents currently accommodated with residents clearly benefiting and enjoying the relaxed gentle lifestyle offered by the home. Without exception all persons consulted spoke positively about their experiences at the home. A sample of comments included I looked at a number of homes before I chose Wolf house as I found it to be small and homely It has such a friendly homely atmosphere and the staff are very caring towards residents It is a really lovely homely place excellent really could not have found a better place we had two visits prior to mum moving in which was very reassuring, she is being looked after equally as well as I could myself and questions asked were answered I found the staff to be very welcoming and friendly and was informed I could view the last CSCI inspection on line. Links with families and friends are highly valued and supported by the home. A relative commented I always visit unannounced I can pop in at any time and frequently do always made to feel welcome and offered refreshments. Consistent positive feedback was received on the good communication between the home and relatives with a relative commenting I am always informed of any changes in care needed straight away it is a delight to visit, communication is first class. There is an effective complaints system with evidence that residents and relatives feel that their views would be listened to. A relative said I have not had to address any problems at the home but if I did I knew I would be able to talk to senior staff on duty and be confident that It would be sorted out straight away and the home manager informed. Staff make a positive contribution in residents lives as residents benefit from a trained and enthusiastic staff team that know them and who are safely recruited and who are employed in sufficient numbers as is necessary to meet their needs. Comments about staff included Staff always have the time to listen and help staff very helpful very nice I have every confidence in staff being able to look after my mum with care and compassion and the size of this home allows the staff to build up a relationship with all its residents I am very happy that my mother is in this care home. A health care professional feedback that staff in charge always helpful and have a good understanding of the patients. Residents benefit from an experienced and established provider / manager who ensures a clear ethos and values of the home that enables staff to provide good quality care to residents. Consistent feedback was receive of how appreciable and resident focused the manager is. A staff commented absolutely brilliant undoubtedly the best manager ever worked for supportive towards staff and expects a high standard. Care Homes for Older People Page 8 of 31 The health needs of residents are well met with evidence of regular input from a range of health care professionals. A Health care professionals said District nurse team are called in if the home discovered any problems with patients ie wounds pressure sores and act on our advice, requests for visits are always appropriate. Residents lives are enriched by the home providing various opportunities for occupation and leisure. The meals are good offering both choice and variety with consistent feedback regarding the home cooked nature of meals. . 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 Care Homes for Older People Page 9 of 31 7535. Care Homes for Older People Page 10 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 11 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. The home provides both prospective and existing residents, with a wide range of information about what services are provided and what to expect when living at the home. The way in which prospective residents are assessed ensures that the home admits only those residents whos needs can be met by living at the home. The home is able to identify and meet the needs of the residents. Evidence: There is a range of well-documented information about the home and the services it provides, this includes a statement of purpose and service user guide which are available at the home and given to prospective residents, representatives and other Care Homes for Older People Page 12 of 31 Evidence: interested parties. A relative confirmed that they had received information about the home which they felt had been very helpful to them in deciding whether the home could meet their relatives needs. Residents are provided with a written contract of terms and conditions of residency with the home. This can be used with residents and their families to make explicit the placement arrangements and clarify mutual expectations around rights and responsibilities. Residents and relatives fedback that they had received their written contract soon after admission, which a relative said that they were pleased with the level of detail it contained. The home ensures that prospective residents are accommodated only following an assessment of their needs by the Manager or Social Services. Advice is sought during the assessment process from health care professionals and others who know and understand the needs of the prospective resident. The needs assessment then forms the basis of their initial care plan. This helps ensure that staff are aware of the recorded needs of new residents prior to them moving into the home. There is a range of needs being accommodated at the home this includes the majority of residents who have dementia including some who also have physical needs and mental health conditions. The majority of residents are assessed as having low to medium assessed needs. Through observation, looking at records and speaking to residents, staff and relatives, there was evidence that the home is meeting the needs of residents. All persons consulted regarding the home spoke positively about their experiences. A sample of their comments include I looked at a number of homes before I chose Wolf house as I found it to be small and homely It has such a friendly homely atmosphere and the staff are very caring towards residents and It is a really lovely homely place excellent really could not have found a better place. Residents and their relatives spoke of being provided with the opportunity to visit the home in advance to assess the quality, facilities and suitability of the home. Feedback from relatives included we had two visits prior to mum moving in which was very reassuring, she is being looked after equally as well as I could myself and questions asked were answered I found the staff to be very welcoming and friendly and was informed I could view the last CSCI inspection on line. Intermediate care is not offered at the home therefore this standard is not assessed. Care Homes for Older People Page 13 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are not person centred and do not always provide the full range of guidance for staff on the personal, social and health care needs of residents to ensure that care can be provided in a consistent way. The health needs of residents are well met with evidence of regular input from a range of health care professionals. Medication practices are well managed promoting good health. Personal support is offered in ways, which promotes and protect residents privacy and dignity. Evidence: Four individual plans of care were examined, staff spoke of the recent work that has been undertaken to start to make them more person centred. Currently however, not all care plans included the range of needs of residents, with particular reference to Care Homes for Older People Page 14 of 31 Evidence: social, behavioural and individual routines. This is necessary to ensure that staff have the appropriate guidance to be able to meet residents needs in a consistent way. Staff consulted with who have worked at the home for a number of years did however demonstrated a good understanding of residents individual needs and preferences, however this was not always recorded to ensure continuity. Daily notes are recorded on each resident, which largely recorded the actions and events that have occurred. These were written in a respectful and none judgmental style. However one example was noted whereby the notes did not accurately reflect the events that staff described and which lead to decisions being made by health care professionals to change medication. The manager agreed to ensure that this was rectified immediately through improved staff awareness of recording practices. In accordance with previous requirement improvements have been made in the recording of residents individual risk assessments, which also include any actions needed to manage identified risks. The manager confirmed that senior staff have also undergone training in risk assessing. Records of medical intervention showed that the home works closely with a range of health care professionals including GPs, district and specialist nurses, chiropodists, opticians and dentists to ensure residents receive a range of health care intervention. Residents consulted with said that when they have asked to see a Doctor then this has been sought promptly. A health care professional fed back that there was always good communication between the staff and themselves whenever they visited. Health care professionals also said District nurse team are called in if the home discovered any problems with patients ie wounds pressure sores and act on our advice, requests for visits are always appropriate . A relative commented they take great care of my mother she has put weight on looks really healthy and whenever she needs to see a Dr they call him very quickly. The system for the administration of medication was good with clear arrangements in place to ensure residents medication needs are able to be safely met. Staff consulted with showed a good understanding of good practices in preserving residents rights to privacy and dignity. Staff were able to give examples of how they promote these rights in their every day care practices. This was supported by the inspectors own observations of residents personal appearance, interactions between staff and residents and the experiences of a visiting health care professional. CCTV equipment was present in the foya, however the manager confirmed that this is no longer connected or used. Care Homes for Older People Page 15 of 31 Evidence: Staff spoke of the support they had received in the past from Health Care professionals during the care of residents who are receiving end of life care. Staff also spoke sensitively about the care and support provided to residents and their families when residents have become terminally ill. Care Homes for Older People Page 16 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. Not all of the routines of daily living currently enable residents to exercise choice and control over their lives. Links with families and friends are highly valued and supported by the home. Residents lives are enriched by the home providing various opportunities for occupation and leisure. The meals are good offering both choice and variety. Evidence: Residents views regarding activities varied between those who enjoy socialising and others who were not so interested, however all residents confirmed that their preference was respected by staff. Residents spoke of participating in a range of activities including memory games, gentle exercises and sing-alongs. Staff spoke of going for short local walks with a resident. As previously noted care plans needed to include the social needs of residents in order to help identify any further areas for occupation and stimulation, in particular for those residents who have dementia. Without exception all residents and visitors commented positively on how welcome they or their visitors were made to feel when visiting. A relative commented I always Care Homes for Older People Page 17 of 31 Evidence: visit unannounced I can pop in at any time and frequently do always made to feel welcome and offered refreshments. Consistent positive feedback was received on the good communication between the home and relatives with a relative commenting I am always informed of any changes in care needed straight ways the manager and staff are always very supportive to myself and mother. it is a delight to visit. communication is first class. During the inspection residents were observed to move around the home freely choosing which room to be in and what level of company they wanted to enjoy. It was clear that staff respect residents choices and preferences with regard to food and snacks, however it was not clear that residents individual preferences regarding time for rising was respected. Several residents commented that they were assisted to get up at 5am, which was confirmed by staff. This was in order to ensure night staff could assist all those residents who needed support to be ready to have breakfast at 8am in the dinning room, residents consulted said that they would prefer to get up later. As a consequence of this practice residents seated in the lounge were all noted to be asleep during the late morning. It has been required that the manager review the daily routines to ensure that they take into account residents individual preferences. The inspector observed part of the lunch time meal which was presented well with individual preferences respected, residents who required supported received discrete assistance from staff. The majority of residents eat their meals in a pleasantly decorated environment conduce to providing a relaxed environment which also helped to promote orientation for people who have dementia. Without exception all persons consulted spoke positively about the meals provided. A sample of comments included I am very impressed with the standard of cooking at the home the meals are all freshly cooked on the premises good home cooking and a good variety of meals and most meals are hand prepared and of a very high standard . The manager confirmed that menus are developed based on the likes and dislikes of residents and with input from a nutritionist. 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. There is an effective complaints system with evidence that residents and relatives feel that their views would be listened to. Staff have the guidance and training necessary to show them what to do if abuse is suspected. Evidence: There is an accessible complaints procedure for residents, their representatives, and staff to follow should they be unhappy with any aspect of the service. All residents and relatives consulted with said that they felt able to share any concerns they had with the manager. A relative said I have not had to address any problems at the home but if I did I knew I would be able to talk to senior staff on duty and be confident that It would be sorted out straight away and the home manager informed. The manager reported that there have been no formal complaints to the home since previous inspection. The home has written policies covering safeguarding adults and whistle blowing. These make clear the vulnerability of people in residential care, and the duty of staff to report any concerns they may have to a responsible authority for investigation. The majority of staff consulted with have received formal training in safeguarding adults and prevention of abuse and the staff consulted with showed a good understanding of Care Homes for Older People Page 19 of 31 Evidence: their roles and responsibilities under safeguarding adults guidelines. There has been no safeguarding referral made to social services since the previous inspection which have resulted in recommendations being required to improve practices at the home. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a homely and clean environment with their personal accommodation personalised to their individual preferences. Any areas in need of redecoration or upgrade has been identified by the manager and action planned to address. Infection control practices need to be improved in order to promote residents and staffs health and safety. Evidence: The home has been converted and extended over the years to provide various domestic and commercial residential accommodation. Much positive feedback was received regarding the homely environment and atmosphere at the home. Several residents and relatives sighted the importance of the homely atmosphere as the reason for choosing the home. All residents consulted with said that their bedrooms provided everything they needed. Residents bedrooms had been individualised with residents confirming that they are able to personalised their bedrooms. Standards of decor was generally good and those areas in need of further redecoration the manager was aware of and in the process of addressing. A health care professional commented some of the rooms are a bit dark and gloomy but a feature of a property. A relative commented that they do the best Care Homes for Older People Page 21 of 31 Evidence: they can with the building. Access to one of the ground floor bedrooms is through another bedroom which is not conducive to always maintaining privacy and dignity. The manager stated that residents or their representatives consent to occupy these rooms, with staff demonstrating how they try and promote good practices in preserving residents privacy Communal space consists of a dinning room, small sun lounge and lounge, which is decorated and furnished to a good standard. There is a rear secure slopped garden which overlooks woodlands and countryside, however due to the sloping nature of the garden and sunken pathways residents are currently unable to safely access this area independently. The manager confirmed that the rear garden is not used by residents and would risk assess the area as a matter of priority in readiness for the summer and any residents wishing to use it. The front and small side area are instead used which provides level access, seating and creates an attractive area in which residents can safely access with support from staff. There is sufficient number of toilets and bathrooms located around the home, including two bedrooms providing en-suite facilities and communal assisted bathing facilities. Fitted throughout the home are call points, which enable assistance to be summoned when pressed. Two residents confirmed that when they have used it staff have attend to them quickly. There is a range of individual aids and adaptations to assist residents mobility and independence, including stair lifts, raised toilet seats, walking aids, and grab rails. The home is not designed to offer a service to people with physical disabilities and the access arrangements within the home would make it unsuitable for residents with a significant permanent restricted mobility. The manager is mindful of this and residents mobility forms part of the admission criteria to the home. All areas inspected were observed to be cleaned to a good standard, consistent positive feedback was also received from residents and relatives which included the home is always clean and fresh and odour free and the home always looks clean and never smells. The majority of bedrooms are provided with commodes, the standard of which and cleanliness off were variable. It was not clear that there was a suitable system of infection control for managing this volume of commodes without the use of a sluice machine. In addition there was not always soap available for hand washing in toilets. It has been required that there are suitable infection control practices in the management of cleaning commodes and the disposal of human waste. This is necessary in order to ensure the health and safety of residents and staff. Care Homes for Older People Page 22 of 31 Care Homes for Older People Page 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff make a positive contribution in residents lives as residents benefit from a trained and enthusiastic staff team that know them and who are safely recruited and who are employed in sufficient numbers as is necessary to meet their needs. Evidence: Staff, relatives and residents felt that there was always sufficient numbers of staff on duty for staff to undertake their roles in a timely manner and for residents to receive the support they needed. There is a core group of staff who have worked at the home for a number of years and showed an in-depth knowledge of individual residents needs. All staff were observed to have a good rapport with residents and visitors which promoted a relaxed atmosphere in the home. A sample of comments about staff included Staff always have the time to listen and help staff very helpful very nice I have every confidence in staff being able to look after my mum with care and compassion staff friendly and seam very dedicated the size of this home allows the staff to build up a relationship with all its residents I am very happy that my mother is in this care home and the care staff are excellent my mother is very well cared for I am impressed by the attention to detail. exceptionally kind and caring. The staff are lovely and always helpful. Exceptionally kind and caring. A health care professional feedback that staff in charge always helpful and have a good understanding of the patients. Care Homes for Older People Page 24 of 31 Evidence: Several members of staff are directly recruited from overseas with a condition of their employment entitlement being to complete a national vocational qualification. The manager reported that all staff have completed or are in the process of completing a National Vocational Qualifications in care. Staff consulted with said that they had undertaken, or are in the process of completing, all of the mandatory training such as moving and handling, medication, first aid, food hygiene and fire safety in order to work safely with residents. In line with the previous requirements staff have undergone specialist training in dementia and mental health. The personal files of three staff were inspected and these showed that a robust recruitment process is followed which includes the use of an application form, interviews, Criminal Records Bureau (CRB) checks and written references prior to employment commencing to help ensure that only staff who are suitable to work with vulnerable people are employed. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from an experienced and established provider / manager who ensures a clear ethos and values of the home that enables staff to provide good quality care to residents. A range of regular health and safety checks helps to promote the health and safety of residents and staff. Evidence: The provider /manager has a significant number of years experience in managing and owning care service for older people. They originally trained as a nurse and reported that they have undertaken the recommended management qualifications. Without exception all persons spoke positively about the manager with particular reference to their approachability and resident focus. A sample of comments made about the manager included manager really cares and the deputy is really good also manager very good very understanding, she encourages us listens to us and is very supportive Care Homes for Older People Page 26 of 31 Evidence: and helpful and absolutely brilliant undoubtedly the best manager ever worked for supportive towards staff and expects a high standard. There are several mechanisms in place for the home to obtain feedback on the quality of the services provided and whether it is achieving its aims and objectives. This includes informal mechanisms such as direct discussion with residents, staff and stakeholders involved in residents care. It was evident that there is a good standard of communication between the manager, staff and stakeholders with residents consistently saying that they could tell the manager of anything they wanted to improve. Annual feedback surveys are also used which the manager reported has not highlighted any areas for service improvement. Residents are encouraged to retain control of their own finances for as long as they are able to do so and if unable then this responsibility is taken on by a relative or another responsible persons external to the home. Care staff spoke of receiving regular formal supervision and direct supervision when working with management and felt well supported by them to undertake their role. Written guidance is available on issues related to health and safety. Records submitted by the home prior to the inspection stated that all of the necessary servicing and testing of health and safety equipment has been undertaken. Systems are in place to support fire safety, which include regular fire alarms and emergency lighting checks, staff training and maintenance of fire equipment and fire drills were reported to have been undertaken. The manager reported that a fire risk assessment had been completed which records significant findings and the actions taken to ensure adequate fire safety precautions in the home. The manager confirmed that in line with previous requirement all works recommended to be undertaken following a fire risk assessment at the home have now been undertaken Care Homes for Older People Page 27 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 28 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 1 7 15 That care plans provide clear 22/07/2010 guidance for staff on all aspects of the health, personal and social care needs of service users and which make explicit the actions needed to meet these needs. To ensure that staff can provide continuity of care. 2 14 12 That care practices are conducted so as to enable service users to make decisions in respect of their care they are to receive, with particular reference to daily routines being flexible and varied to suit service users individual preferences and needs. To ensure that residents are able to exercise some choice over their daily lives. 22/07/2009 Care Homes for Older People Page 29 of 31 3 26 12 That there are suitable 22/07/2009 infection control practices in the management of cleaning commodes and the disposal of human waste. To ensure the health and safety of residents and staff. 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). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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