Care Home: Woodend Nursing & Residential Centre

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What the care home does well The manager ensures that service users needs are fully assessed before they move to Woodend and people are able to spend time there before they move in. Comments included, "I came and looked round spoke to the manager and I decided it was the place for me". Woodend is a friendly, homely place and service users seemed happy and relaxed. The manager and staff know the residents well and treat them as individuals with different preferences and needs. Service users are encouraged to carry on with or resume activities and hobbies that they enjoy or have enjoyed in the past and staff try to look at what service users can do rather than what they can`t. Comments from service users included, " staff are very good and willing to help whenever you ask", " we get a wonderful service", " it is a truly wonderful place". " the quality of care given to us all is quite exceptional". The care service users need is well planned.The quality of health and personal care provided by staff at Woodend is to a good standard and people are treated with dignity and respect. The internal and external appearance of the home provides a clean, pleasant, comfortable environment for service users to live in.Service users liked their rooms and one service user said the home was "lovely and warm ". The home offers a varied menu and service users were mainly positive about the food provided. Everyone ate and enjoyed the lunch provided for them during the site visit. The meals are wholesome and service users enjoy mealtimes at Woodend. Care is taken to make sure that service users on special diets are still presented with food that is appetising and one relative said, "Even when x was too poorly to eats solid food they pureed it and it was still lovely". Well over 50 per cent of care staff are trained to at least NVQ (National Vocational Qualification) level 2 which means that staff have the skills and knowledge to deliver a high standard of care. Staff felt they worked well as a team and this had a good effect on the overall atmosphere of the home. The management style is approachable and leads the way in ensuring service users are cared for to a high standard. Staff feel supported and senior staff are very keen to provide them with enough training to do their job well. The environment is pleasant,clean and comfortable and well equipped and spacious. Staff training opportunities presented to staff are good. There is a high level of satisfaction amongst service users and their relatives about the service at Woodend. What has improved since the last inspection? The home has had a total refurbishment since we last visited. The house has been completely re-decorated and new carpets fitted. New light fittings have been installed and some bedrooms have had new furniture. New lounge and dining chairs have also been purchased. We recommended on the last inspection that nurses sign handwritten entries on the medication administration records and have these countersigned for accuracy by a second person. This has been introduced into the medication procedures. All handwritten medication records were seen to have two signatures. This makes sure that the entries are correct and are as prescribed by the service users doctor. A second recommendation on the last inspection was to make sure that all medication records are clearly recorded. We did see on this visit that a couple of medications had not been signed as having been administered. We have asked that the procedures are looked into and checked to make sure that all prescribed medication is recorded as administered as it should be. What the care home could do better: The registered manager has left his employment at Woodend to take up another position in the organisation. Initially that manager was overseeing the management of the home and a member of staff was acting up in the capacity of manager. In November 2008 a new manager was appointed. The manager had worked at Woodend for about eight years and has been promoted. All managers should to be put forward to the Commission for Social Care Inspection (CSCI) for consideration for registration. This needs to be arranged as currently Woodend is without a registered manager as required by the regulations. The manager should provide staff with additional guidance or training in the safe method of mobilising service users in their wheelchair ensuring the service users safety is promoted. To make sure that staff are following procedures for the administration of medication the manager should make sure that checks are in place of the records so if a mistake has been made and staff have forgotten to sign the record when administering medication that this is quickly highlighted. This should make sure service users get the medication they are prescribed at the right time and an accurate record is in place. To further support service users enjoyment of the meals when they are supported to eat by staff, additional attention should be made so staff speak more to the service user and ask them or let them know what they are eating. To ensure that all service users are given the option and opportunity to take part in activity review the activities provided to make sure everyones tastes are taken into account and look into the possibility of providing trips out to more service users irrespective of their health or mobility problems. To further promote infection control the manager should review the number of clinicalwaste bins the home has ensuring the bins are not overfilled and adequate space is available to dispose of waste safely and hygienically. To promote the safety of service users and staff make sure that items are not stored or retained at the bottom of the stairs. The manager should review the use of agency staff ensuring that the care and support provided to service users is provided by staff that know service users and their care and support needs. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Woodend Nursing & Residential Centre Bradgate Road Bowdon Cheshire WA14 4QU     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kath Oldham     Date: 2 0 0 1 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. the things that people have said are important to them: They reflect 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 33 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Woodend Nursing & Residential Centre Bradgate Road Bowdon Cheshire WA14 4QU 01619295127 01619295664 hooleyn@bupa.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) BUPA Care Homes (ANS) Ltd Type of registration: Number of places registered: care home 79 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: A maximum of 6 older people who require personal care only may be accommodated in the agreed designated area (lower ground floor). A further 9 service users who require personal care only may be accommodated in the main body of the home. A maximum of 64 service users will require nursing care. All service users will be aged 60 years or over. Minimum nursing staffing levels as specified in the Notice issued under Section 25(3) of the Registered Homes Act 1984 on 10 April 2000 shall be maintained. Date of last inspection Brief description of the care home Woodend Nursing and Residential centre is registered to provide nursing care and personal accommodation for a maximum of 79 older people. The home is divided into four designated units, each having a designated staff team. Dunham, six residential residents. Stanford, 23 residents. Tatton, and Arley, 25 residents respectively. Woodend Nursing and Residential Centre is owned by ANS Homes Ltd which is owned Care Homes for Older People Page 4 of 33 0 Over 65 79 Brief description of the care home by BUPA Care Services. The home is situated in the residential area of Bowden, a suburb of Altrincham and is South to the city of Manchester. There is ease of access to the Manchester ring road and the motorway system. Altrincham town centre is easily reached by car and there is access to the public transport system within walking distance of the home. The passenger lift provides access to each floor. The grounds to the front are pleasantly landscaped and there are well maintained gardens to the side and rear of property. There are two patio areas accessible to wheelchair users. There is ample parking within the grounds of the home. The weekly fees vary from 875 to 975 pounds (Personal care only to nursing care). Extra charges are made for hairdressing, chiropody and newspapers. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This visit was unannounced, which means that the manager, staff and service users were not told that we would be visiting, and took place on 20th January 2009 commencing at 09:40am. The manager was not available on the visit as she was attending training. The administrative manager provided us with a lot of detail, information and support during the visit in addition to the support from the nurse manager. The administrative manager has a wealth of knowledge about service users and the organistaion. The inspection of Woodend included a look at all available information received by the Commission for Social Care Inspection (CSCI) about the service since the last Care Homes for Older People Page 6 of 33 inspection. We also sent Woodend a form before this visit for them to complete and tell us what they thought they did well, and what they need to improve on. We considered the responses and information Woodend provided and have referred to this in the report. We call this form the Annual Quality Assurance Assessment (AQAA). Woodend was inspected against key standards that cover the support provided, daily routines and lifestyle, choices, complaints, comfort, how staff are employed and trained, and how the service is managed. Comment cards were sent prior to the inspection for distribution to people staying and working at Woodend the views expressed in returned comment cards and those given directly to the inspector are included in this report. We got our information at the visit by observing care practices, talking with people staying at Woodend talking with the administrative manager, nurse manager and staff. A tour of Woodend was also undertaken and a sample of care, employment and health and safety records seen. The main focus of the inspection was to understand how Woodend was meeting the needs of service users and how well the staff were themselves supported to make sure that they had the skills, training and supervision needed to meet the needs of residents. The care service provided to three service users was looked at in detail to help form an opinion of the quality of the care provided. The term preferred by people consulted during the visit was service users. This term is, therefore, used throughout the report when referring to people living at Woodend. A brief explanation of the inspection process was provided to the administrative manager at the beginning of the visit and time was spent at the end of the visit again with the administrative manager in part and the previous manager to provide verbal feedback. We have received no complaints about this service. The manager has referred a couple of matters to the safeguarding team for investigation this is in line with the local authority policies and procedures. What the care home does well: The manager ensures that service users needs are fully assessed before they move to Woodend and people are able to spend time there before they move in. Comments included, I came and looked round spoke to the manager and I decided it was the place for me. Woodend is a friendly, homely place and service users seemed happy and relaxed. The manager and staff know the residents well and treat them as individuals with different preferences and needs. Service users are encouraged to carry on with or resume activities and hobbies that they enjoy or have enjoyed in the past and staff try to look at what service users can do rather than what they cant. Comments from service users included, staff are very good and willing to help whenever you ask, we get a wonderful service, it is a truly wonderful place. the quality of care given to us all is quite exceptional. The care service users need is well planned.The quality of health and personal care provided by staff at Woodend is to a good standard and people are treated with dignity and respect. The internal and external appearance of the home provides a clean, pleasant, comfortable environment for service users to live in.Service users liked their rooms and one service user said the home was lovely and warm . The home offers a varied menu and service users were mainly positive about the food provided. Everyone ate and enjoyed the lunch provided for them during the site visit. The meals are wholesome and service users enjoy mealtimes at Woodend. Care is taken to make sure that service users on special diets are still presented with food that is appetising and one relative said, Even when x was too poorly to eats solid food they pureed it and it was still lovely. Well over 50 per cent of care staff are trained to at least NVQ (National Vocational Qualification) level 2 which means that staff have the skills and knowledge to deliver a high standard of care. Staff felt they worked well as a team and this had a good effect on the overall atmosphere of the home. The management style is approachable and leads the way in ensuring service users are cared for to a high standard. Staff feel supported and senior staff are very keen to provide them with enough training to do their job well. The environment is pleasant,clean and comfortable and well equipped and spacious. Staff training opportunities presented to staff are good. There is a high level of satisfaction amongst service users and their relatives about the service at Woodend. Care Homes for Older People Page 8 of 33 What has improved since the last inspection? What they could do better: The registered manager has left his employment at Woodend to take up another position in the organisation. Initially that manager was overseeing the management of the home and a member of staff was acting up in the capacity of manager. In November 2008 a new manager was appointed. The manager had worked at Woodend for about eight years and has been promoted. All managers should to be put forward to the Commission for Social Care Inspection (CSCI) for consideration for registration. This needs to be arranged as currently Woodend is without a registered manager as required by the regulations. The manager should provide staff with additional guidance or training in the safe method of mobilising service users in their wheelchair ensuring the service users safety is promoted. To make sure that staff are following procedures for the administration of medication the manager should make sure that checks are in place of the records so if a mistake has been made and staff have forgotten to sign the record when administering medication that this is quickly highlighted. This should make sure service users get the medication they are prescribed at the right time and an accurate record is in place. To further support service users enjoyment of the meals when they are supported to eat by staff, additional attention should be made so staff speak more to the service user and ask them or let them know what they are eating. To ensure that all service users are given the option and opportunity to take part in activity review the activities provided to make sure everyones tastes are taken into account and look into the possibility of providing trips out to more service users irrespective of their health or mobility problems. To further promote infection control the manager should review the number of clinical Care Homes for Older People Page 9 of 33 waste bins the home has ensuring the bins are not overfilled and adequate space is available to dispose of waste safely and hygienically. To promote the safety of service users and staff make sure that items are not stored or retained at the bottom of the stairs. The manager should review the use of agency staff ensuring that the care and support provided to service users is provided by staff that know service users and their care and support needs. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 33 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 33 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. Detailed assessments are undertaken of residents before their admission to the home, therefore residents can feel confident that their needs can be met. Evidence: Assessments had been obtained for all residents before they were admitted to the home. The manager had undertaken their own assessment which included all the information specified to meet the standard. As well as risk assessments each resident had also been assessed to determine what their strengths were in relation to a range of areas such as their values and beliefs, thinking and communication, contact and activities, maintaining independence. environmental factors and physical health. We found this a very positive way to gain more understanding about the needs of the residents as it focused on the things they were still able to do for themselves and did not identify only areas that were Care Homes for Older People Page 12 of 33 Evidence: problematic for them. Staff were very knowledgeable about the residents and were able to describe their daily routines and preferences. Residents said they felt that the staff understood their needs. One staff said are always given up to date info about the needs of people they support or care for. One staff responded, sometimes One staff said, they would like, better communication at handover time as we dont always get a proper handover. A service user told us, I had a couple of weeks of respite and liked the home, staff and manager they made me feel very welcome. A further service user said, Terms and conditions fully explained. Tour of home given. Another service users said, Woodend was inspected by myself and my husband on behalf of X. Care Homes for Older People Page 13 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A clear and consistent care planning system is in place that provides staff with the information they need to meet service users needs. The health needs of service users are well met with evidence of good multi disciplinary working taking place on a regular basis. Evidence: All service users had care plans that had been developed in relation to their assessment of needs. Care plans were person-centered and detailed and had been reviewed at least monthly to ensure that the information remained up to date.Service users said that staff were kind and treated them with respect. Personal support was provided in service users own rooms and there preferences in terms of the gender of staff caring for them were noted and taken into account where possible. Risk assessments had been undertaken for all service users in relation to pressure Care Homes for Older People Page 14 of 33 Evidence: areas, moving and handling and nutrition. The home has developed a care plan for the prevention of pressure ulcers that meets current best practice guidelines. The type of mattress and the pump setting needed for one service user was recorded so staff can check that the equipment is set and working correctly. A member of staff told us,I would be happy for my mum to come here, they are looked after properly. Service users said that their doctor was called out if they were ill and that people such as opticians, podiatrists and dentists were accessed for them. One service user said we get a wonderful service Records in their care files provided evidence of this. We did see one aspect of unacceptable practice that needs to be addressed. A member of staff mobilized a service user backwards in their wheelchair without the use of footrests. This practice is disrespectful to the individual and is dangerous. Footrests should be in place on wheelchairs when mobilising unless this would be a risk to the individual. Examination of a number of medicine administration charts showed that the correct policies were being followed to ensure that medicines were stored, administered and recorded properly. There were a couple of occasions when their were gaps in the recording of administration of medication to service users. This needs to be checked to ensure staff are administering medications correctly and following procedures for medication administration. Interaction between staff and service users was seen to be friendly, caring and helpful Service users said the staff were kind to them and treated them with respect. Staff said the importance of respecting residents privacy and dignity had been discussed with them and staff were able to give examples of ways in which they could do this such as making sure that curtains and doors were closed when delivering personal care to a service user. A service user told us I have had to visit hospital on quite a number of times. One of my carers stays with me which is very comforting being with someone you know during these visits. A relative said, X is content in the home her health has improved since being at Woodend. Care Homes for Older People Page 15 of 33 Care Homes for Older People Page 16 of 33 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home shows a strong commitment to providing opportunities for service users for social stimulation and interaction. Dietary needs of service users are well catered for with a selection of food available. Evidence: The home employs two activities coordinators who work full time covering seven days a week. This means that activities take place at weekends as well as during the week. Morning and afternoon activity sessions are arranged and on occasions these are arranged in the evenings. The activities co-ordinator was on duty on the day of the site visit. Service users knew who she was and said they enjoyed the events and activities that the two coordinators organised. A service user told us, We have activities everyday which I enjoy and take part in as many as I can. Activities are done by two lovely girls and always include everyone who is able to take part . A really good team. another service user commented, Full programme of activities arranged including trips out. A further service user commented, The activities are splendid and the girls are first class caring and sweet with everyone. So important to have stimulation no matter what condition people are Care Homes for Older People Page 17 of 33 Evidence: and this they do. We looked at the activities programme and usually up to ten service users take part in the organised activities. The big screen cinema interested twenty four of the service users. Trips out are arranged when the activities coordinator arranges some transport usually once a month to places that have included Suthport ,the science museum and shopping and garden centre trips. On occasions trips out are arranged twice a month. Six service users are able to go out on the trips out due to the size of the coach.Some service users said it is the select few that go out or the ones who are least problems or have less mobility difficulties. The manager must be mindful that activities are included that are diverse enough to be of interest and benefit to service users who are less mobile or vocal,experiencing memory loss and other limitations due to their condition. Service users told us about the regular coffee mornings and the breakfast and book club they took part in. Young people from a local school come to the Woodend regularly and visit and spend time talking with or providing some occupation with service users who are in bed due to their health difficulties. Service users said they liked the food provided by the home. Examination of the menu showed that a varied range of meals was offered in keeping with service users tastes. Menus were displayed in the dining room. One service user told us you get sick of fish The choice on the menu each day does include a fish meal. When we looked at the choices service users made for their meals a lot did choose fish. We were told by the catering staff that a lot of service users did eat fish as it was light and easy to digest. The catering staff did tell us that there were going to be changes in the menu again in consultation with service users. In addition to a review of the menu a range of starters are to be provided and the option of an alcoholic drink with the meal is being planned in forthcoming weeks. A relative said, Even when x was too poorly to eats solid food they pureed it and it was still lovely. Staff were seen providing support to some service users who needed assistance to eat this was done respectfully, staff taking time individual to the service user. In some cases staff were not always involved in conversation with the service user and the Care Homes for Older People Page 18 of 33 Evidence: meal was given with no comment about what the staff member was giving them or asking them if they wanted a particular item to eat next. Additional guidance to staff by management should support them with this. Care Homes for Older People Page 19 of 33 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. The home has an appropriate complaints procedure and those living in the home know any issue they raise will be listened to and acted upon. Residents are safeguarded at all times. Evidence: This is a clear and established complaint process that people and or their relatives friends or families can access. Information about how to make a complaint has been made available to service users. The complaints record was examined and this provided information confirming that complaints and concerns were dealt with fully,openly and fairly.It was also clear that people were informed about the outcome of any investigation into a complaint and the actions that would be taken to prevent a repeat of any incident if this was relevant. The comment cards returned to the CSCI told us that service users knew how to complain. This is good as it enables everyone to have a view and opinion and make sure that comments are taken on board. The home also has its own informal complaints process where service users can contact the staff or management team to discuss issues that they are not happy with or concerns that they have. The home will try to resolve any concerns directly or may Care Homes for Older People Page 20 of 33 Evidence: require the attention of the management team.The administrative manager said that they try to sort out any problems as soon as they arise to enable service users or their families to have piece of mind. All staff who completed comment cards said they know what to do if a service user or visitor has concerns about the home. A service user commented, We know how to make a complaint only verbal complaints we would not know who to contact at BUPA. The home follows the Local Authoritys Multi Agency Adult Protection Procedures. The staff team have access to a rolling programme of adult protection training. Staff spoken with understood and were able to describe clearly the procedures to follow in the event of an allegation or incident affecting service users. Care Homes for Older People Page 21 of 33 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 using this service benefit from a home that is well maintained, warm, comfortable and provides an environment they know will meet their expectations and needs. Evidence: Since the last inspection the whole home has undergone a total refurbishment which has included new lighting, total decoration in all the public areas and bedrooms and new lounge and dining furniture. Some of the bedrooms have also had new beds and furniture and carpeting has been replaced throughout the home. A service user told us, the home is constantly being cleaned throughout the day. Keeping it nice fresh and very welcoming to everyone. And added, It really is nice to be in such a well run home. All my visitors are surprised how they are made welcome, my daughter enjoys coming to see me in such a pleasant and relaxed home. We have a cup of tea in my room and a good chat or join in activities. Another service user said, high standard of cleanliness throughout.One service user did say, that the home was usually fresh and clean and added, Just occasionally certain areas of the home can be a bit smelly. Care Homes for Older People Page 22 of 33 Evidence: The home was clean, comfortable and tidy on our visit. Some service users had personalised their rooms with support from staff or their family or friends. We saw that some files had been stored or were awaiting storage in the stairwell these items need to be removed and the manager needs to be mindful that such items should be kept away from these areas. Such items stored here are a risk to service users and staff safety. The home has contracts in place for the collection of clinical waste. We saw that two of the bins were overflowing. The manager said that they were due to be collected the day after our visit. There is an obvious need for additional facilities to promote infection control. Care Homes for Older People Page 23 of 33 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. Service users care, social and emotional needs are promoted by trained care staff. Service users are protected by robust recruitment procedures that complies in full with the legislation. Evidence: All new staff have to submit an application form detailing all previous work history, proof of identity, names for references and confirm work status. The home keeps a copy of the interview, letters of acceptance, job description and contract of employment, which includes terms and conditions on file. The homes recruitment files viewed were seen to include all the information as required by the regulations. The home showed that its recruitment practice is sound and robust and meets the regulations. Staff spoken to described training events that they had attended over the last 12 months. Staff members did mention that they felt they had the right level of updates in moving and handling,administration of medication and food hygiene.Staff were confident that they would continue to be provided with opportunities to take part in training to ensure they can meet and support service users needs. A record of staff attending training events was kept and used to establish staff training and to help to arrange refresher training events. Care Homes for Older People Page 24 of 33 Evidence: In response to the question did your induction training cover everything you needed to know to do the job when you started one member of staff responded, partlyand one responded mostly Staff also told us,the training, keeps you up to date with new ways of working. Another staff said the training they had received kept them informed of new ways of working and helped them understand and meet the individual needs of service users. All staff who completed a comment card said sometimes in response to the question are there enough staff to meet the needs of all the people who use the service. One staff added, We try our very best to give the best care possible, sometimes, it seems difficult because of staff problems, and it can be stressful. Apart from this our home works well with 90 percent staff and the team spirit is good. They are professional and do their jobs to the best ability. In response to the question what could the service do better, one staff member said, provide more staff as we always have to struggle because of under staffing because of sickness and other things. It makes our job a lot harder some days, or should I say a lot of the time. Management told us that they always have at a minimum one member of staff on duty for every five service users in the day and at night there is one member of staff to every ten service users. That means at night there are eight staff on duty, three nurses and five carers. Staff said that they do have agency staff and it is very hard as the agency staff do not know the service users so permanent staff have to spend time explaining service users needs and support to the agency staff to make sure they provide the right level of care and support to service users. One member of staff said they felt there werent enough staff on duty. A service user told us, The staff are caring and helpful and support me very well. You never have to wait long even when staff are busy. They are very attentive to my needs. Another service users said,the majority of staff very attentive. Always an RGN on duty. The home employs ancillary staff who work as cleaners, cooks, laundry,gardener and maintenance staff. This enables care staff to spend time providing care and support to service users as opposed to carrying out other duties as well. Care Homes for Older People Page 25 of 33 Care Homes for Older People Page 26 of 33 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. Those who use this service benefit from a home that is well run by a competent, caring and experienced manger. Health and safety measures ensure the safety of all those living in the home. Evidence: On the site visit the manager was not available as she was on training. The administrative manager provided all the detail and information needed on the site visit and it was clear she had a good knowledge of service delivery and service users, staff and families. Feedback at the conclusion of the visit was provided in part to the administrative manager and in full to the previous manager of the home who had made himself available . The manager has been in this post for about two months, and will be submitting her application for consideration to become the registered manager. She has had 15 years of experience working in nursing care for older people. The manager has also Care Homes for Older People Page 27 of 33 Evidence: undertaken courses in the home and was on the visit undertaking her induction training with the organization. The processes that were examined showed that the home is well managed and the service continues to develop. Management hold regular monthly meetings to which service users and their families are invited. The AQAA that was completed by the acting manager showed that she is capable of identifying areas for improvement in most areas,even though development of the service is ongoing. The home has a formal quality assurance process. A questionnaire is sent out annually and information used to improve and develop the service provided.This provides service users and staff and relatives the opportunity to comment on the service they provide. The staff and service users had an obvious rapport and spoke freely and comfortably together. The admin manager certainly knew all the service users and families that visited. We asked staff in the comment cards if there manager meets with staff to give you support and discuss how you are working one staff said sometimes, one staff said often and one said, regularly. The AQAA, Annual Quality Assurance Assessment returned by the home evidenced that all maintenance checks are undertaken within the timescales of good practice and the maintenance certificates are in date. Training records evidenced that staff do undertake training in health and safety related courses, it is important that all those requiring a refresher are facilitated within good practice guidelines. Staff have received training and briefings in relation to good working practices and minimising infection control. Staff on duty were aware of the risks and consequences of poor practice. Safety equipment such as disposable gloves and aprons were stored around the house, facilities and information on safe hand-washing was available and all soiled linen and clothes were safely transferred to the laundry facilities. The way that service users money is accounted for was examined and checks showed Care Homes for Older People Page 28 of 33 Evidence: that an accurate record of expenditure and income was kept. This provides service users with peace of mind that there monies are safe. The fire safety records were examined and this showed that all checks were carried out each month.The information in the AQAA confirmed that all equipment,including gas appliances,lifts and hoists and electricity appliances had been serviced. This is a safeguard to service users and staff to know that everything is working properly and staff are up to date with fire drill training and practice so they will know what to do in an emergency situation. Care Homes for Older People Page 29 of 33 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 30 of 33 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 31 8 Propose a manager for 28/02/2009 consideration for registration to CSCI To give staff and service users confidence that the management are registered as fit to manage a care home 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 7 Provide staff with additional guidance or training in the safe method of mobilising service users in their wheelchair ensuring the service users safety is promoted. To make sure that staff are following procedures for the administration of medication make sure that checks are in place of the records so if a mistake has been made and staff have forgotten to sign the record when administering medication that this is quickly highlighted. This will make sure service users get the medication they are prescribed at the right time and an accurate record is in place.. To make sure that all service users are given the option and opportunity to take part in activity review the activities provided to make sure everyones tastes are taken into account and look into the possibility of providing trips out Page 31 of 33 2 9 3 12 Care Homes for Older People to more service users irrespective of their health or mobility problems. 4 15 To further support service users enjoyment of the meals when they are supported to eat by staff, additional attention should be made so staff speak more to the service user and ask them or let them know what they are eating. To further promote infection control review the number of clinical waste bins the home has ensuring the bins are not overfilled and adequate space is available to dispose of waste safely and hygienically. To promote the safety of service users and staff make sure that items are not stored or retained in the stairwells. Review the use of agency staff ensuring that the care and support provided to service users is provided by staff that know service users care and support needs. 5 26 6 7 26 28 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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