Inspection on 21/01/10 for Charnwood Country Residence

This is the latest available inspection report for this service, carried out on 21st January 2010.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Extracts from inspection reports are licensed from CQC, this page was updated on 16/05/2010.

Key inspection report Care homes for older people Name: Address: Charnwood Country Residence Much Dewchurch Hereford Herefordshire HR2 8DL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sarah Blake     Date: 2 1 0 1 2 0 1 0 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 26 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 26 Information about the care home Name of care home: Address: Charnwood Country Residence Much Dewchurch Hereford Herefordshire HR2 8DL 01953609280 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Miss Karen Rogers Name of registered manager (if applicable) Type of registration: Number of places registered: care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: 1 The registered person may provide the following categories of service only Care Home with personal care Code PC 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 2 The maximum number of service users who can be accommodated is 17 Date of last inspection Brief description of the care home Charnwood is a large detached house in a small village in South Herefordshire. It has been adapted and extended to provide a suitable environment for older people. It is registered to provide services for up to 17 people who may have care needs arising from the ageing process. There is a limited public transport service to the village. A schedule of fees is available from the home. A copy of this report can be viewed at the home. Care Homes for Older People Page 4 of 26 Over 65 17 0 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection. One inspector spent a day at the home, talking to the people who use the service and the staff, and looking at the records, which must be kept by the home to show that it is being run properly. These include records relating to the care of people who use the service. We looked in detail at the records for two people living at the home. The service had previously completed an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. Some of the comments from the AQAA have been included within this inspection report. We also received completed survey forms from people who use the service, their relatives and health professionals who work with the home. The information from these Care Homes for Older People Page 5 of 26 sources helps us understand how well the home is meeting the needs of the people using the service. Care Homes for Older People Page 6 of 26 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 7 of 26 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 8 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to written information to help them decide if they wish to move into Charnwood. A full assessment of each persons individual needs is carried out before they move in, so that the home can be sure that it can meet their needs. Evidence: The home provides a very detailed Service User Guide, which gives good information about what life is like at the home. A copy of the Service User Guide is given to everyone who moves into Charnwood and is available for anyone who is considering it as a place to live. We spoke to the relatives of someone who had moved into the home, and they told us that they had visited before their family member moved in, and that they had been invited to lunch. They commented on how quickly the person had settled in. The manager told us that she likes to spend time before someone moves in, chatting Care Homes for Older People Page 9 of 26 Evidence: with them to find out what they would like to achieve or any interests that they enjoy. This is in addition to the assessment of needs which is carried out before anyone moves into Charnwood. We looked at the records for someone who had moved in recently, and we saw that the manager had spent time finding out what the persons needs were and had written an assessment, so that staff would know the care that the person needed as soon as they moved in. The assessment was detailed and contained all the information that staff would need. In the AQAA, the manager told us On the day of admission the service user will be allocated a key worker to facilitate the smooth transition of moving into residential care they will assist the service user to settle in and support their needs for the first 24 hours. In addition they will be responsible for ensuring the service users room is ready with welcome card, flowers and furniture is arranged in a way to suit the needs of the service user. Care Homes for Older People Page 10 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their health and personal care needs will be met by skilled and caring staff. Medication is managed safely. Evidence: In our surveys, almost everyone told us that they always get the care and support that they need at the home. We looked in detail at the care records for two people who live at the home. We wanted to see if their needs had been fully assessed, and to make sure that instructions for staff were clear and informative. Records showed that, where the home has identified a risk to peoples health and wellbeing, a plan is in place to manage and reduce the risk as far as possible. For example, we saw that one person had been assessed as being at risk of falling. The care plan included information for staff on the importance of well-fitting footwear to help prevent falls. We saw that the person was wearing shoes whilst sitting in the lounge, and that staff made sure that the person used their walking aid when moving around the home. This helps to minimise the risk of the person falling and shows that staff are following the care plan. Care Homes for Older People Page 11 of 26 Evidence: We saw that care plans are reviewed monthly, and that people who live at the home are encouraged to take part in planning and reviewing their own care. Staff know that they must inform the manager of any changes to peoples needs. We saw that care plans are updated whenever someones needs change. For example, one person had become unsettled at night, and the staff thought that this might be due to the fact that they had recently moved into a downstairs bedroom. A care plan had been drawn up to address the persons needs associated with this, and records showed that staff were following the care plan and that the persons anxiety had reduced. We saw that one person had been assessed as being at risk of developing urinary tract infections. The care plan for continence showed a good understanding of these infections and also the possible adverse effects of not drinking enough. For example, the care plan included the instruction: encourage B (name of person) to drink plenty to avoid urine becoming concentrated and excoriating the skin. The care plan also included information for staff on the signs and symptoms of urinary tract infections, so that they would know how to observe the person. Records showed that the home makes sure that people receive the medical help they need. One local GP told us I found the staff helpful - presenting appropriate information and paperwork and residents are well respected, well cared for. Care plans showed that people are encouraged to make choices and to maintain their independence as far as possible. For example, one persons care plan stated C (name of person) usually likes to get up at varying times, so staff are to allow for natural waking times staff to encourage C to do as much as possible for herself. Records showed that people are asked if they would prefer their care to be provided by male or female carers. We checked the homes management of medication. Records were up to date and had been fully completed. An audit of some medication showed one very minor discrepancy, which the manager immediately undertook to investigate. In all other aspects, medication management was of an extremely high standard. During the inspection, we saw that staff were respectful and kind when they supported people, and that they made sure that peoples privacy and dignity were promoted. For example, when asking people if they needed to use the toilet before lunch, staff spoke quietly to each person, so that other people would not hear. When we arrived at the home, the manager took time to introduce us personally to Care Homes for Older People Page 12 of 26 Evidence: each person in the lounge and also checked with individual people if they were happy for the manager to show us their bedrooms. This shows that the home places great importance on peoples privacy and dignity. In the AQAA, the manager told us We have been promoting the relevant points of DOH Dignity in Care. Dignity in Care is a Department of Health initiative which aims to end tolerance of indignity in health and social care services through raising awareness and inspiring people to take action. Care Homes for Older People Page 13 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a limited range of social and leisure activities for people to join if they wish. Food is home-cooked and provides a nutritious and balanced diet, with plenty of choice. Evidence: The home provides a limited, but improving, range of activities for people to join in if they wish. One relative commented in a survey most times I visit residents all sitting in lounge watching TV. We saw that, on the day of the inspection, people were sitting round the edge of the lounge, and for most of time many of them did not appear to be engaged in any meaningful activity. The manager told us that every afternoon, care staff do activities such as a singalong or a quiz. One day a week, the activities coordinator from one of the groups other homes will visit to initiate some new ideas. We saw that staff were holding a quiz session after lunch and that several people were joining in. The manager told us that every Wednesday morning there is a Bible and hymn-singing session in the lounge, led by a local churchgoer. Although records showed that all the people who currently live in the home are Christians, the home should consider how Care Homes for Older People Page 14 of 26 Evidence: this activity could be managed if people of other faiths came to live in the home. This is because the only other communal room with comfortable seating is the conservatory, which is right next to the lounge. Records showed that some of the people who live at the home get involved in tasks such as folding laundry and peeling vegetables. This is good practice, as many people enjoy carrying out tasks which they have been used to doing for many years. Although the range of activities is fairly limited at present, the manager told us of her plans to improve this in the near future. We spoke to people living at the home and one person said I like doing my wordsearches, Im quite happy doing them; another told us theres a lot going on, always a quiz or something to do after lunch. Therefore the home is meeting the needs of at least some of the people who live there, in respect of the social and leisure opportunities offered. Visitors told us that they are always made welcome, and we saw that staff were friendly and chatty towards people visiting the home on the day of the inspection. People told us that they enjoy the food provided at the home. We saw that people were able to eat breakfast when and where they wished. The breakfast menu was displayed in the dining room, and offered a very varied choice, including a full cooked breakfast every day. The staff ask people for their lunch choices during the morning, and there is always a choice of main meal. We saw that lunch looked appetising and was extremely well presented, with gravy and sauce being offered by staff at the table. Lunchtime was a relaxed occasion, with staff being discreetly attentive to peoples needs. We saw that one person needed support with eating, and this was carried out sensitively and kindly. Records showed that people are asked about their food preferences when they move into Charnwood. One relative told us that the cook had prepared their mothers favourite dish especially for her. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that the manager will listen to any concerns or complaints, and will do her best to resolve them swiftly. Staff know how to protect people from the risk of neglect or abuse. Evidence: In our surveys, everyone who replied told us that they knew how to make a complaint or raise any issues of concern. We spoke to relatives of people living at Charnwood and they told us that they felt confident that any concerns would be listened to and resolved. We saw that each person living at the home has a copy of the complaints procedure, and that the procedure is clearly explained so that people know what will happen if they ever need to complain. The home keeps detailed records of any complaints or concerns, and we saw that the records showed that any concerns had been resolved within the appropriate timescales. We, the Commission, have not received any complaints about the home. We spoke to staff and they showed a good understanding of their role in helping to protect people from the risk of abuse or neglect. They knew how to report any concerns, and had received training in the local procedures for protecting vulnerable adults. Care Homes for Older People Page 16 of 26 Evidence: One of the ways in which the home can help to protect people is by making sure that only suitable staff are employed. We saw that all staff had Criminal Records Bureau (CRB) checks carried out before they started work at the home, but the homes procedures for obtaining references for new staff were not robust enough to make sure that staff were suitable. We say more about this in the section on Staffing. Care Homes for Older People Page 17 of 26 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. Charnwood provides a homely and comfortable environment, and there is an ongoing programme of redecoration and refurbishment to bring the environment up to a high standard. Staff know how to take precautions to limit the spread of infection. Evidence: Charnwood is a large detached house, situated in a small village in the South of Herefordshire. It has been adapted and extended to meet the needs of the people who live there, without losing its character. Since the new owner, Karen Rogers, bought the home last year, there have been many improvements to the environment, and these are ongoing. On the day of the inspection, the reception area was being redecorated. People told us that they appreciate the work that is going into making the home a more comfortable place to live. Everyone who lives at Charnwood has a key to their own bedroom. The bedrooms are comfortably furnished and people are encouraged to personalise their rooms with items of their own furniture and ornaments, if they wish. We saw that one person has a kettle in their bedroom so that their family can make drinks when they visit. The lounge is a comfortable room, with chairs arranged round the edge of the room Care Homes for Older People Page 18 of 26 Evidence: facing the television. There is a very spacious and light conservatory, but the manager told us that people do not use it much, although she hopes that this will change in the warmer weather. People told us that the home is always kept clean and fresh. We saw that there was hand gel available throughout the home for people to use. This helps to reduce the risk of any infection spreading. We saw that staff were using gloves and aprons whenever they were providing personal care to people. Staff knew the principles of infection control. We saw that bathrooms and toilets contained liquid hand wash and paper towels, which help to reduce the risk of cross-contamination. Care Homes for Older People Page 19 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough trained staff to meet the needs of the people who live at the home. Staff receive training which gives them the skills and knowledge they need to provide care which is of a high standard. The homes recruitment procedures do not always fully protect the people who live at the home. Evidence: We had previously visited the home and had found that only two staff were on duty. The manager assured us that this was a unique occurrence and would never happen again. Rotas showed that, on every other day, there were sufficient staff on duty. On the day of the inspection, we saw that there were four care staff on duty as well as the manager, although two of these staff were new staff who were shadowing more experienced staff. The manager told us that, when the numbers of people living at the home increases, the staffing levels will be higher to take into account peoples needs. People spoke very highly of the staff at the home, and one person described them as good, while another said all lovely, Ive never heard a cross word from anyone. The staff we spoke to were very appreciative of the amount of training which has been provided since the new owner bought the home. We saw that staff had received the training which they need to give them the skills and knowledge to care for the people who live at the home. Training records were clear and detailed and would enable the Care Homes for Older People Page 20 of 26 Evidence: manager to plan training according to staff needs. We checked to see if the home was recruiting staff safely, so that they can be sure that only suitable staff are employed. We saw that the home had received Criminal Records Bureau (CRB) checks before new staff started work. However, we found that the home had not requested a reference from the previous employer for one new member of staff. For another new member of staff, there was a record of a reference request to their previous employer, but no record of any response, and no evidence that this had been followed up. This means that the home has not fully carried out its responsibilities with regard to making sure that only suitable staff are employed. Since the inspection, the home has introduced more robust procedures to ensure that recruitment affords greater protection to people living at the home. Care Homes for Older People Page 21 of 26 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. The home is managed in the best interests of the people who live there, and the manager works hard to ensure that their views are included in the development of the service. Health and safety is managed effectively. Evidence: The home has been registered with the Commission under its new ownership since August 2009. In the AQAA the manager told us The new manager and provider actively promotes a culture of openness and transparency and staff and service users feel able to voice any concerns or comments. This was borne out at the inspection, as we received many positive comments about the change in culture since the new owner and manager have been in charge. Under the new owner, Karen Rogers, the home is part of a small local group of homes. The group employs a quality assurance manager, and on the day of the inspection, she was visiting the home to monitor standards at the home and to ensure that the home complies fully with the Care Home Regulations 2001. We saw that written Care Homes for Older People Page 22 of 26 Evidence: reports are made of these visits and any action points are followed up. This shows that the owner takes her responsibilities seriously. The manager told us that she is in the process of applying to be registered with the Commission. Although the home holds regular meetings for people who live there, there are no notes kept of these meetings, and so it is not easy to see whether or not any issues have been followed up. The manager told us that she intends to keep notes in the future. The home does not usually take responsibility for peoples personal money. Any incidental expenses are invoiced monthly. We saw that one person has some of their own money, some of which is kept in locked storage in their bedroom, and some in the office. Records showed that this money is carefully accounted for. We saw that accidents are recorded in detail, and action is taken to reduce the risk of any recurrence. Maintenance records are clear and up to date, and in the AQAA, the manager told us In addition to the managers ongoing assessment and evaluation the groups Quality Assurance Manager regularly reviews the safe working practices within the home. In the AQAA, the manager showed that she knows how the home can make improvements. The AQAA gave an accurate representation of the home, and gives us confidence that the owner and manager will continue to improve the service. Care Homes for Older People Page 23 of 26 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 24 of 26 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 (1)(b) You must obtain in 23/04/2010 respect of all persons employed at the home all of the relevant information and documents as required by Regulation 19(1)(b) and paragraphs 1 - 9 inclusive of Schedule 2 of the Care Homes Regulations 2001. This is so that people can be confident that only suitable staff are employed at the 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 12 You should review the way in which activities are planned and provided, so that they meet peoples individual needs and wishes. You should ensure that staffing levels are kept under review, to ensure that there are always enough staff on duty to meet peoples needs. 2 27 Care Homes for Older People Page 25 of 26 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). 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