Care Home: Wotton Rise Nursing Home

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What the care home does well This service`s pre admission process is thorough, helping to comprehensively identify peoples needs and ensure a smooth admission. The service`s main aim is to give individualised care and staff work hard to make sure that the care that is delivered is well planned and that it takes into account the individual person`s wishes. Peoples right to make choices and to be respected is a high priority for the staff. The service is open and welcoming of peoples rights to equality and diversity. Activities and social integration is viewed as being an important part of someone`s wellbeing and is well catered for in a way that recognises individual peoples capabilities and preferences. Staff are keen for the people who live in the home and for those that visit, to raise any concerns they may have so that they can be effectively and promptly dealt with. Staff are well supported, supervised and trained which benefits those that live in the home. The service is constantly re-evaluating standards of care and service provision and there are robust arrangements in place to recognise where improvement is required. There is strong and innovative management in place and the business is run in a manner that best suits the people who live in the home. What has improved since the last inspection? The pre admission process is now more robust. Care planning is far more person centred and has a real focus on peoples preferences and wishes. Staff training generally and the induction training has become more detailed and relevant. The home is aiming for best practice at all times and is supporting staff to achieve this. The management structure and quality assurance systems have become stronger and more effective. What the care home could do better: Make sure that any conflicting information given in employment documentation is thoroughly explored before people are employed. Key inspection report Care homes for older people Name: Address: Wotton Rise Nursing Home 140 London Road Gloucester Glos GL1 3PL     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Janice Patrick1     Date: 0 9 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Wotton Rise Nursing Home 140 London Road Gloucester Glos GL1 3PL Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Xin Zhao Type of registration: Number of places registered: care home 27 Wotton Rise Nursing Home Ltd Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 27. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age not falling within any other category (Code OP) Date of last inspection Brief description of the care home This care home provides nursing and personal care to a maximum of twenty seven, predominently older people. Admissions are only considered after a pre admission process has been completed but can be on a permanent basis, as an emergency or for a short period (respite care). Most people admitted have been referred to the service and are funded by the local County Council or Health Authority but their are some people who are funded from Care Homes for Older People Page 4 of 30 Over 65 27 0 Brief description of the care home other counties or who are funding their own care. The current fees range from six hundred pounds to seven hundred pounds per week. Hairdressing, Chiropody, Newspapers and toiletries are not included. The home is situated on a main road not far from Gloucester City center and is on a bus route, which means that the main bus station and railway station are accessible. It is close to a general convienence store, a church, a public house, the main hospital and not far from General Practitioner (GP) surgeries. Junction 11A on the M5 would be the nearest juction if travelling by moterway. The internal accommodation is on two levels and there is a passenger lift. All bedrooms have access to washing facilities but not necessarily private toilets. There are ample communal toilets and bathrooms. There is a lounge and separate dining area. Outside there is no parking to the front of the care home but some spaces can be located at the rear of the property; accessed by a small side road. There is stepped access to the front of the home but sopped access can be found at the back leading from the car park. There is also a small garden area at the back. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: We looked at all the information that we have received, or asked for since the last key inspection or annual service review. This included the most recent Annual Quality Assurance Assessment, AQAA that was sent to us by the service. The AQAA is a self assessment completed annually by the service and forwarded to the Commission. It tells how well the service feels it is meeting peoples needs. It also tells us of improvements made to the quality of the services provided and the plans the service has for the next twelve months. It also gives us some numerical information about the service. It has been referred to in this report also as the services information. We looked at any information that tells us how the service has managed any complaints, concerns and any staff investigations. What the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. Care Homes for Older People Page 6 of 30 We looked at the previous key inspection report and the results of any other visits that we have made to the service in the last 12 months. This included any outstanding requirements and how the service has told us how these have been met. We have considered any relevant information from other organisations. We then visited the service on one day between the hours of 1pm and 9.40pm. We looked in detail at the care of three people and observed interactions between several others and staff. We inspected additional care records, staff personnel files relating to their recruitment, supervision and training. We also inspected other records pertaining to the smooth running of the service and peoples health and safety. We looked at the arrangements for safeguarding people from abuse. We looked at the current arrangement for the management of the service, how the service measures the standards of its service provision and how it aims to improve this. We walked around the building, spoke to several service users and members of staff. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from being provided with information that is designed to help them make an informed decision about their future care; having their needs comprehensively assessed prior to their admission also helps towards achieving a successful and smooth admission. Evidence: This service will accept people on a planned and permanent basis, as emergencies and for respite care. People who make an initial enquiry are given an information pack. This gives details on the services provided along with information on financial arrangements. Additional and helpful information can also be found in the front hall. On admission, irrespective of how someones care fees are being met, everyone is provided with a residency contract. People who are entitled to Free Nursing Care Care Homes for Older People Page 10 of 30 Evidence: (FNC) are made aware of the assessment outcome. People who are planning to live at the home on a permanent basis are visited by the service unless this is geographically impractical. This is so that an in-depth assessment of the persons needs can be completed and so that staff can introduce themselves. Before any admission, the service will gather as much information as they can on the persons needs to be sure they can meet these. We saw the records of one such admission process. This person had very specific needs both from a care perspective and the physical environment that the Registered Manager had to be confident that the service could accommodate. This person required specialised equipment that needed consideration and organising before the admission and which would still need review after admission. In this case the service carried out their pre admission assessment with a Social Worker so that issues could be explored and agreed before admission, also enabling the service user to contribute to the process. In the event of an emergency admission the service will gather information from as many sources as possible. For one person this included talking to the person who had been caring for the individual in the community, a relative, obtaining a medical history summary from the General Practitioner and considering the information within the funding authorities Needs Assessment. This service has a high turn over of people being admitted for respite care and they tell us that the same rules apply. A judgment is made as to whether people are visited by the service before each new admission. This will depend on how long it has been since the persons last stay at the home and what the service is being told about their current needs. We spoke to three staff, one qualified nurse, one senior carer and a cook to see how involved they are with the pre admission and admission process. All confirmed that each potential admission is discussed by the services team collectively. We saw examples of information being communicated to staff before someones admission. The cook also confirmed that she is told of any particular dietary needs or cultural preferences in time to make preparations. Where relatives are involved and are key to the admission process, valuable information can be gathered from them and in particular, a personal history of the individual. This helps staff to be aware of some of the persons more important life events, their values and what helped shape them as an individual. Staff said this is particularly helpful in helping those who are confused to settle. The service have improved their pre admission process by ensuring that peoples cultural needs and preferences are explored in more detail. We discussed with staff Care Homes for Older People Page 11 of 30 Evidence: the specific needs in this sense of two previous people admitted for respite care. In one example the service linked up with the local Chinese community for support and also arranged for the persons main carer to prepare very specific dishes, which the home then stored and served to the person. In another example specific foods were purchased to accommodate some of the persons dietary preferences from the Caribbean. The Registered Manager explained that the pre admission process is now far more robust. We were told that this is not only because they wish to improve their own processes but because they do have a high turn over of people requiring respite care and have experienced a lack of or incomplete information being given to them by referring health care professionals or relatives. This has then led to complications and problems in managing peoples needs and unrealistic expectations at a later date, which the service wants to avoid. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a care home where there is staff continuity and where their health and social needs are considered and met in a very individual way. Evidence: We looked at the care records of three people in detail. We discussed some elements of one persons care with the person themselves. We spoke to the managers that devise the care plans and to some staff responsible for delivering the care. We made several observations during our visit, of staff interactions with service users and of some practical tasks being carried out. Staff were not always aware of being observed and we witnessed and heard a willingness from staff to help on each occasion. We spoke to three service users during our visit who said that the staff were very attentive. Two went on to say that they were very happy with their care and said the staff could not be more kind. We received thirteen service user questionnaires back; one was completed by a service user and the remaining were completed with the help of a relative or representative. Ten questionnaires confirmed that care and support was always given Care Homes for Older People Page 13 of 30 Evidence: when needed and two confirmed it is usually given. The same number of replies for each were received in response to whether medical care was made available when needed. Comments within the questionnaires included could not ask for better care, a very caring home, I would recommend Wotton Rise without any hesitation and they look after the residents well including their relatives and friends. Nine questionnaires confirmed that staff are always available to help them when needed and three said staff are usually available. One local health care professional said that peoples needs are usually monitored and met well. The services aim since the last inspection has been to make the care and care planning more individualised. By reading the care plans in two different files, completed several months apart, we could see a big improvement in this. If service users are able they are involved in this process if not, through lack of capacity their representative will be asked to contribute to the care planning. If a person simply does not wish to be involved in this then but has capacity the service will seek the persons permission before dicussing their care with a family member. One relative commented in their questionnaire any changes in condition are immediately relayed to me. We discussed one persons care where the relative has chosen not to accept an invitation to review their relatives care with the service. Staff explained that most relatives are keen to be involved and welcome the chance to discuss aspects of their relatives care. One care file contained specific instructions for staff, which would need to be followed in the event of a deterioration in one very specific area of this persons health. The Registered Manager had researched the condition and produced a summary in plain English for staff to read. There were also very specific instructions to staff as to what to do in the event of this emergency. One person had been within the home for a week and still did not have any recorded care plans. It was explained to us that the persons needs were still being assessed but once this process had been completed, care plans would be devised. Although, when we spoke to the care staff they had a good grasp of what this person needed help with, the Care Home Regulations do require care plans to be in place. The reason for this is so that all staff involved in someones care have clear information that tells Care Homes for Older People Page 14 of 30 Evidence: them how particular needs are to be met. We therefore suggest that the service decide on a time frame for certain required documents to be completed and that they formalise this. The Registered Manager explained that she is very aware that people have very different needs at night. She has therefore started to involve night staff more in care discussions and care plan development. To help maintain continuity in care accross the twenty four hours; night Key Workers as well as day Keyworkers are in place. The Key Workers responsibility is to have a much closer relationship with the service user and family alocated to them under the Keyworker System; to be more aware of their allocated service users wishes and preferences and to communicate these to the rest of the team. They are a specific point of contact for the family. Activities and social interaction is very much seen as a vital part of peoples daily care and so preferences and choices in this area are incorporated into the service users care planning. This is discussed in more detail in the next outcome of this report. From the care records and by talking to staff and people who use the service it is evident that the service liaises with many external health care professionals and specialist in different areas of health care. The service also has links with the Mental Health team. One questionnaire said staff anticipate needs well and provide appropriate care and equipment. Arrangements are in place to monitor peoples weight and manage any related nutritional risk. Risks related to pressure sores are also monitored and appropriate action taken. The medication system and its associated records are audited by the service on a monthly basis. We inspected a selection of medication administration records, which did not show any gaps or any other errors in recording that may cause concern. We observed one nurse administering some medications and this was carried out correctly and safely. People can self medicate if they are able to do so safely and if people are receiving respite care; and normally administer their own medication at home, then the service is keen to help the person retain these skills for when they return home. The Registered Manager usese information from external health care agencies to ensure she and the system are up to date with current legislation and schools of thought. The services aim is to meet peoples needs but at the same time recognise their rights to privacy. They also aim to maintain peoples dignity at all times so these topics are Care Homes for Older People Page 15 of 30 Evidence: discussed by the team and considered when devising the care plans. We did not observe any situation that would make us feel that peoples privacy and dignity were being compromised. We did witness one situation where one service user was accusing staff of opening and hiding their post. Staff dealt with this in a helpful and respectful manner and it was easily resolved. There was recognition in two questionnaires of how well staff maintained peoples dignity. When talking to staff it was very apparent that the service really want to provide good end of life care and that they are keen to enhance their skills in this area. Training has been delivered by a local Palliative Care Specialist and the service have purchased equipment that helps care for people at this stage of their lives. Although this service is not registered to care for people who predominantly suffer from dementia, some people in the home will either develop or already have a degree of shorterm and long term memory loss. Symptoms such as lack of concentration and general confusion also have to be managed by staff. The service have focused on improving staff knowledge and practice skills in this area of care. We spoke to one member of staff who acts as the dementia link worker on nights and one other person is soon to be this on days. These staff have completed specific training in knowing who to access for advice and act as a link to people who can keep the service updated in current best practices in dementia care. This stems from a government initiative for improving basic care and understanding towards those that suffer from dementia in care homes. Care Homes for Older People Page 16 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home where individual choices and preferences are respected and where social interaction and activities have a purpose. Evidence: We observed people making daily choices and some needed more support than others to do this. The right to make choices and the right to refuse is recognised when staff are delivering care and is an integral part of the care planning process. People can also choose to join in organised activities or they can choose not to. The majority of returned service user questionnaires said there are always or usually activities provided that they can join in with. Care staff provide the activities and encourage social integration. This can be ad hoc such as a sing a long to music, time spent chatting on a one to one basis or as a small group, or they can be more structured such as a planned group activity. Structured group activities are held twice a week and are chosen by the people who join in. Recently people have been making cards and decorations ready for Christmas. Some activities are actively encouraged for specific reasons such as one persons knitting because this encourages movement in the persons arthritic fingers and gives the person a sense of accomplishment. At weekends a volunteer specifically visits to provide social stimulation. Exercise to music Care Homes for Older People Page 17 of 30 Evidence: is organised by another external person who comes in specifically to do this. The service have tried to increase how many times external entertainers come in and they have managed to do this, but this is dictated by cost. One of the returned questionnaires from people using the service said staff create a very happy atmosphere. We observed people reading newspapers, books, watching the television and having access to table top games. Two staff have completed specific training in delivering activities to the older people and one person has completed the Sonas training. Sonas is a way of providing activities which links several senses; beneficial when working with people with dementia. Staff are encouraged and taught to communicate and pick up on communication that maybe in another form other than verbal. One carer described a very simple observation she had made about one service user. This person was able to indicate only through the use of their eyes that they were interested in a piece of fruit that another service user was eating. By picking up on this non- verbal communication the carer was able to provide the opportunity for this service user to enjoy a food that they could not verbally request. We felt that this demonstrated that the carer knew the service user well, was using her powers of observation and had time to spend with this person in order to enhance their quality of life, albeit in a very simple way in this case. Staff are trained to understand and manage challenging behaviour and one carer demonstrated to us that they understood that this maybe exhibited because the person is having problems expressing their feelings or preferences. Staff as a group understood that an agreed approach has to be taken when this happens and that more innovative ways of approaching things with a person maybe beneficial. Arrangements have been made in the past for service users to be able to express their preferences in their own language and to eat foods that they would culturally prefer. Staff are provided with training in equality and diversity. We observed mealtimes and noticed that although only one main dish is cooked for lunch there was evidence of several different options being provided. Some are for specific dietary reasons others were preferences. The cook explained that she takes the opportunity to add calories to foods that she knows people will eat and where she is aware they are at risk of losing weight. One person has extra cake and another will request ice cream at various times of the day and to provide this is not a problem. A Care Homes for Older People Page 18 of 30 Evidence: carer described one person as enjoying their breakfasts but then not eating much during the day so every effort is made to ensure a good breakfast is provided. In the warmer weather people go out and attend local events, there is a small garden for peoples use which can be reached via the lounge. One returned questionnaire said residents are out in the fresh air or on trips. Arrangements are made for people to practice and maintain their chosen faith, whatever that is. Particular arrangements were made for one very religious person to move to a bedroom that overlooked the church opposite and from which the person got some comfort. Another person had mentioned that she would like her bedroom painted a specific colour. When she went out for the day with her family this was done for her. Another person confirmed that they go to bed at a time that suits them. Visiting is unrestricted and people can go out with their visitors as and when they wish to or are able to do so. Care Homes for Older People Page 19 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a home where complaints and concerns are treated seriously and where there are robust arrangements in place to protect people from abuse or harm. Evidence: The service have a complaints policy and make the procedures for making a complaint accessible to those who live in the home and to those that visit. This procedure is in a large print format if needed. The service information tells us that an open door policy is adopted and that small concerns are resolved quickly. In order to successfully do this the service intends to continue to promote open and honest conversations with service users and their representatives about the quality of care. This open approach also helps to protect people from abuse and harm. The service has a clear policy with procedures on Safeguarding Adults from Abuse, which has been recently updated along with the Complaints Policy. The current management team have consistently demonstrated that there is a zero tolerance of any form of abuse and that robust action will be taken against staff who harm or abuse service users. In doing this the Commission are appropriately informed of any necessary action that is being taken by the service and consequently we know that the service liaises well with the local County Councils Safeguarding Team. Care Homes for Older People Page 20 of 30 Evidence: During our visit staff confirmed that they have had updates in their training on this subject. The services information tells us that training on abuse and safeguarding has been altered and made far more robust and staff confirmed that the Registered Manager makes reference to these issues on a regular basis. Care Homes for Older People Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is well maintained and where they are included in some decorative decisions. The home is kept clean and there are arrangements in place to reduce the risk of infection. Evidence: The service has an ongoing programme of redecoration and refurbishment. The general day to day maintenance is managed and dealt with by one of the Registered Providers but over the last year an additional person has been employed to help with an extensive redecoration programme. The service information tells us that people who live in the home have been able to choose the paint colour for their bedrooms. The services information also tells us that service users have been involved in choosing what colours would be used in the communal rooms. During our visit the environment looked well maintained. One returned questionnaire from a relative said the premises could be larger but apart from that they are doing a wonderful job. Some peoples rooms are very personalised some are more sparse. Everyone is able to take in with them items of personal value to help make their private space more homely. All rooms meet with the National Minimum Standards. Several electric profiling beds have been purchased making a stay in bed more comfortable and various moving an handling tasks easier for staff to carry out. Further Care Homes for Older People Page 22 of 30 Evidence: equipment for safe moving and handling has been purchased. Additional pieces of specialised equipment was seen and the service will source these when they are needed. The environment looked clean and there were no offensive odours when we visited. The service information tells us that various arrangements are in place to keep the environment clean and to ensure that good infection control practices are maintained. Staff confirmed that they have received infection control training and we observed them wearing protective clothing when preparing to carry out some care tasks; and when serving or helping people with their food. Infection control related policies and procedures are in place as are appropriate contracts for the disposal of certain wastes. Returned questionnaires from people who use the service said the home is always or usually kept clean. Care Homes for Older People Page 23 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from good staffing levels and staff are well trained and competent. More care is required in checking the contents of recruitment documentation. Evidence: During our visit the home was staffed with enough staff and with an appropriate skill mix. There was no evidence to suggest that this was not the case and we have not received any concerns regarding this. Many of the staff are employed from overseas but arrangements are in place to help these staff with their written and spoken English. We did not observe any situations where English not being someones first language, was causing a problem but the Registered Manager is aware of those that do need more support. Many staff employed from overseas are either qualified nurses in their own country or qualified in other health related disciplines. The Registered Provider views this as an asset to the service as staff come with skills that she feels enhance the services provided. The home will recruit locally when possible. All staff who need to are encouraged to study for the National Vocational Qualification, NVQ and all employees receive induction training. The service has recently reviewed its induction training so that all areas of practice now link in with the National Care Homes for Older People Page 24 of 30 Evidence: Common Induction Standards for Care. We saw an example of this which demonstrated that a comprehensive training takes place. All staff are made fully aware of their responsibilities in accordance with the General Social Care Councils Code of Practice. We inspected the recruitment files of two new staff. Each person had completed an application form but in both cases the dates of employment were only given in years; making any gaps in employment difficult to identify. One persons file demonstrated that a gap in employment had been explored with the member of staff during interview Another application form had conflicting dates of employment when it was cross referenced with references. This had not been picked up during the initial recruitment process. One member of staff was unable to remember their employment history when asked so asked the Managers to explore this further and to reassure themselves that everything was in oder. The Manager did explain that they had checked whether the staff member was studying at the college that they had put on their application. Both files contained Criminal Record Bureau (CRB) clearances; one clearance had been received back before the persons start date, but we were reassured that the person had not been working in the home but had been on their induction training. The service must ensure that a clear employment history can be demonstrated and that any gaps are explored. This therefore needs the service to be clear about exact employment dates and that what is written on the application form corresponds with the information given in the references. Care Homes for Older People Page 25 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is run in a manner that benefits them; where staff and systems are managed in such a way that keeps people safe and protected from harm. Evidence: This inspection has been carried out because the care home has become a Ltd Company and therefore needed to be newly registered with the Commission. As far as the day to running of the service is concerned there are no changes. The people who own the service are still very much involved and are very still very involved from day to day. The Registered Manager is still the same person and the Deputy Manager is undertaking further management training. A new addition to the service, over the last year, has been the administrator, who now provides valuable help with office related work to do with the running of the business. The managements expectations and goals are shared with all the staff, who in their returned questionnaires confirmed that communication and support within the service was very good. The services information tells us that there is a robust and effective quality assurance system in place. We saw evidence of several audits being regularly carried out and of the service Care Homes for Older People Page 26 of 30 Evidence: seeking the views of those that both live and visit the service. The views of the staff are also asked for in relation to the management of the service. The management style is very much one of continual self audit and a real desire to improve and enhance the quality of the services provided. The Registered Manager is well supported and has time to be innovative in her thinking and supportive to her team. Various external agencies acknowledge the services quality assurance system in checks and assessments that they also carry out. The Management team have a good awareness of equal opportunity issues and have well developed policies and procedures in place to help support the effective running of the business. Staff are made aware of these and of any constraints the care home may have, in relation to running as a viable business. Staff are encouraged to take ownership of their own part they play in the success of the service. The AQAA was very well completed and gave us comprehensive information about the service and its plans. The management were open to the inspection process and were able to demonstrate a clear understanding of areas that they wanted to improve. The management team have demonstrated in the past that they are able to be strong advocates for the people who live in the service. The senior staff have an awareness of the Deprivation of Liberty safeguards (DOLs) and have completed training on this provided by the local County Council. The services aim is now to help staff develop their awareness and demonstrate that peoples liberty is considered within the care planning. The service has no one currently referred under the DOLs. There is a sound and effective risk management system in place which also covers all aspects of health and safety. The service take advise from an external company on all aspects of health and safety as well as ensuring that staff are trained in all necessary subjects. The services information confirms that various checks and servicing contracts are in place for the utilities and equipment used. We are aware that the Fire Safety Officer has inspected the service in the last two years and that they are satisfied with the services current arrangements for fire safety. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 19 The Registered Person must 15/02/2010 be able to demonstrate that any gaps in employment have been explored and that information given during the recruitment process is correct. This is so that people using the service are protected from people who may cause them harm. 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 A protocol should be devised and timescales decided on for when certain care plans and assesments should be formally completed following the point of someones admission. Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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