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Inspection on 23/06/09 for Hendra House

Also see our care home review for Hendra House for more information

This is the latest available inspection report for this service, carried out on 23rd June 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The manager and staff try to find out what people living in the home like to do and try to make sure that they can do it. They find out what they like to eat and try to make sure that is what they get. If a person is ill they make sure that they get the right treatment. If a person doesn`t like something they can complain to the manager and will be listened to. People say the staff are cheerful, friendly and helpful and encourage people to enjoy themselves but also try to make sure that they are safe and well looked after. The feedback from surveys conducted by the home indicates that Hendra House provides a friendly and supportive place where people are respected and well looked after. People feel they are `at home` and not `in a home` where the staff are approachable and caring. A letter from relatives about the care of a resident states `We know that xxxenjoyed being part of the Hendra family`. The service provides a supportive environment for the care staff and have individual training plans that allow them to develop their potential as well as meet mandatory regulations. The service promotes involvement from the residents in decision-making. The care plans are detailed, individual and reviewed regularly. They mainly focus on needs and preferences rather than problems.

What has improved since the last inspection?

The service has built upon its expertise of involving people who live at the home in shaping its development over the last three years. The financial success of the business has enabled the service to make investment to improve the structure and fabric of the premises for the benefit of residents, relatives and staff, such as, creating more single rooms and minimizing the risk of infection. The accessibility and safety for the garden has improved. Staff are valued as important members of the team and their development through training and supervision has enabled the home to improve its service to people. An example of this is the move to provide a palliative care approach to people towards the end of their life, so where feasible, they can remain at Hendra House.

What the care home could do better:

The management of this service has a good awareness and understanding of what they want to achieve and how to do this including involving people who use the service.

Key inspection report Care homes for older people Name: Address: Hendra House 15 Sandpits Road Ludlow Shropshire SY8 1HH     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: Pat Scott     Date: 2 3 0 6 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 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Hendra House 15 Sandpits Road Ludlow Shropshire SY8 1HH 01584873041 01584873075 vince@hendrahouse.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Hendra Healthcare (Ludlow) Ltd care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users that can be accommodated is 28. The registered person may provide the following category of service only: PC care home only To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age (OP) 28 Mental Disorder (MD) 3 Date of last inspection Brief description of the care home Hendra House is situated in Sandpits Road, an established residential area positioned on the northwest section of Ludlow town. The Home is owned by Hendra House Healthcare (Ludlow) Limited. Mr V Burmingham, director of the company also has day-to-day management responsibility for the Home. The building, originally a private residence, has had purpose built extensions added in its conversion to a residential home without detracting from its original character. The accommodation is provided on two floors accessed by a shaft lift. Residents are Care Homes for Older People Page 4 of 24 Over 65 0 28 3 0 Brief description of the care home able to enjoy planted out gardens and borders to the front of the building and a quiet enclosed garden and lawned area to the rear. The home makes their services known to prospective service users in: The Statement of Purpose, Service User Guide and web site which also contain their contact e mail address. The inspection report is mentioned in the statement of purpose and summarised in the service user guide. It is also on display in the entrance hall. Fees are reviewed annually and are dependant upon the type of room occupied and the dependency level of the resident. The range of fees is identified in the homes Statement of Purpose ( £430-£485) which is available to all potential service users, their families and/or their advocates. The only additional charges to service users are for hairdressing and newspapers. This is clearly laid out in the terms and conditions. Care Homes for Older People Page 5 of 24 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, the commission, looked at all the information that we have received, or asked for, since the last key inspection 10/07/06 or annual service reviews. This included: The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Surveys returned to us by people using the service who were able to and from other people with an interest in the service. Information we have about how the service has managed any complaints. What the service has told us about things that have happened in the service, these are called notification and are a legal requirement. Care Homes for Older People Page 6 of 24 The previous key inspection and the results of any other visits that we have made to the service in the last 12 months. Relevant information from other organisations. What other people have told us about the service. Care Homes for Older People Page 7 of 24 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 24 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 24 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. The provider understands the importance of having information about their service so that people can choose a home that will meet their needs and preferences. The assessment process is thorough so that all people are given consideration to their individual needs, concerns and anxieties before moving into care. Evidence: The provider acknowledges that people should have the opportunity to choose a home which will suit their needs and abilities. To facilitate choice the provider clearly tells people in its information, which includes a service user guide, statement of purpose and website, what services they can and cannot offer. It tells people that every person will have their needs assessed before a decision on admission is taken, so that people are reassured that any anxieties will be listened to. Frequently asked questions are also accessible on the website with testimonials from people who have used the service. The AQAA states that all people are visited prior to admission to assess their needs. Care Homes for Older People Page 10 of 24 Evidence: We looked at three care plans of people who had recently been admitted to the home. The care manager had obtained a summary of the assessment undertaken through care management arrangements, where appropriate. All people have a complete preadmission assessment taking into account wishes and preferences about their care. Assessments seen are very detailed, person centred and include assessing changes in capacity to make decisions. The way assessments are written and kept shows that significant time and effort is spent planning to make admission to the home personal and well managed. Information is gathered from a range of sources including that from other health professionals such as GPs, hospital staff, district nurses and family. Relatives spoken with stated that they had received written and verbal information and had been given the opportunity to visit and meet with residents before admission. Care Homes for Older People Page 11 of 24 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. Peoples care needs and risk assessments are set out in their individual plans of care which ensures that all care needs have been addressed and will be fully and safely met. The manager understands the need to comply with safe medication systems and staff training ensures that the homes procedures are complied with and that residents health matters are safely addressed. The actions of staff and their approach to care ensures that people are treated with respect and their right to privacy is upheld. Evidence: The AQAA provided us with information regarding processes in place to ensure personal and healthcare support using a person centred approach based on the individuals rights of dignity, equality and respect. People are encouraged to participate in the care planning process at a level comfortable to them. We looked at three care plans of the people recently admitted. Preferences relating to personal support needs are stated in the plans and the daily records show that these are adhered to. Records also show that health appointments are maintained. Care Care Homes for Older People Page 12 of 24 Evidence: plans are regularly reviewed with input from the person and their family or representative and signed where able. The AQAA states that peoples health needs are met through good care planning with access to local GPs, involvement of professionals such as district nurses. Details of visiting professionals contacts are seen in the daily records. Assessments for potential problems regarding dietary requirements have been implemented and recorded well. People have a named keyworker allocated to them. One person spoken with knew who her allocated carer is and commented that she has been helped to settle in very nicely by kind and helpful staff. Staff were seen to provide support to enable people to do things in their own time. Full assessments of the capacity of individuals are recorded. The service has not, so far, needed to apply for a deprivation of liberty authorisation to make sure that any person is safe in their treatment and care. Records show that all staff handling medication have had a competency check within the last 12 months and certificates are available in the personnel files. A full audit of medication procedures has been conducted and no shortfalls identified. Risk assessments are in place for those people wishing to self-administer any medication. People sign for receipt of the medication they wish to self administer and keep it in a lockable facility in their bedroom. Staff are trained to care for people who are approaching the end of their life. A letter seen expressed thanks for the way the staff managed the final days of a relatives life. The staff upheld the right of the person to die at home and enabled this to happen peacefully with support for the family, the care being sensitive, present and at hand but not intrusive. Another letter commented: the caring ethos of the home is a true reflection of the example you set, the high standards you expect of yourself and your staff. Some staff have assisted undertakers to understand how a deceased person in their care liked to present themselves, so providing dignity right to the end. Care Homes for Older People Page 13 of 24 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 are provided with social activity and can keep in contact with family and friends. Social, cultural and recreational activities meet peoples expectations through assessment, consultation and choice. People receive a healthy diet according to their assessed requirement and preference. Evidence: Care files seen show that individual assessments are carried out regarding preferred activities for each person taking into account, interests, capacity and diversity. Emphasis is placed on considering a person as an individual rather than a collection of symptoms, and discovering ways to work with, and alongside, the person to enhance their social quality of life. Care plans address maintaining important links and relationships. As a response to peoples wishes, visits from the clergy for religious services, from singers, concert organisers, hairdresser and rememberance service have been organised and provided. A varied programme of activities is provided by the home for people to enjoy with something happening most days. A very informative monthly newsletter is produced and delivered to each person and displayed on the website. There are regular resident meetings to discuss policy issues and other matters of interest. Dates for resident/next of kin meetings are included in this letter. Care Homes for Older People Page 14 of 24 Evidence: Residents were seen to enjoy a social chat in the garden and looked at ease in their surroundings. Relatives were seen to come and go and those spoken with stated that the home provides meaningful activities which people attend as and when they want to. Information for people and their relatives and friends on advocacy and support services is provided in the foyer. People bring in personal possessions where possible. The service offers a choice of menu and flexibility at meal times where possible. Hot and cold snacks are provided. Menu records seen show that individual preferences are taken into account. Specialised crockery and cutlery is provided where required and a choice of seating and meal times is available. To improve the meal provision further the service has gained the recognised award for healthy eating in care homes at platinum level. People spoken with praise the food highly. They are very happy with the quality of food and portion size. Care Homes for Older People Page 15 of 24 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. The service has a complaint procedure which is accessible so that people who use the service have information of how to make complaints about the home. Training is provided so that people are protected from abuse and have their legal rights protected. Evidence: The home has a complaints policy and procedure. People and their families are given information in the service user guide. There have been no formal complaints since the home started operation in 2002. All staff working at Hendra House have the relevant criminal record bureau (CRB) and protection of vulnerable adults (POVA) checks including references. Staff are provided with training on adult protection. Referrals and procedures are followed from the Multi-agency protection procedures issued by Shropshire Council. There have not been any recent referrals made through these procedures. People who live in the home tell us that the staff always listen to their point of view and any issues are dealt with immediately. Relatives tell us that the communication in the home is very good and allays any need for formal complaints but that they have information on how to do so if necessary. Staff constantly show concern and interest for individuals. Care Homes for Older People Page 16 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home has been carefully developed so that people live in a safe, well maintained and comfortable environment. Evidence: The service had identified in its AQAAs over the last three years that some improvements are planned and have been working towards this. A tour of the home showed that it is a safe, comfortable, immaculately presented place to live. There are comfortable sitting areas and a dining room. The garden is landscaped and accessible to all with garden seating. The buildings and grounds are in excellent condition. Appropriate washing and bathing facilities are provided to ensure accessibility to all residents. Each bedroom is for single occupancy and all but one has an ensuite toilet. Plans are in place to make this ensuite also. People have chosen their preferred colour scheme and bedding. People are encouraged to bring in personal possessions. A call system is provided and was responded to promptly. There are no odours and systems are in place to prevent the spread of infection. Care Homes for Older People Page 17 of 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff care roles and responsibilities are well defined so that they provide personalised care with good communication. Staff get access to training, supervision and support they need from the manager so that people receive planned care. Staff in the home are trained and recognise the importance of care planning so that peoples changing needs are identified and acted upon. Evidence: Discussion with the care manager identified that staffing numbers are maintained at an appropriate level to the assessed needs of the people who live in the home and to the upkeep of the home and its facilities. The service has a very high percentage of trained staff at national vocational qualification (NVQ) level 2. Senior staff are trained to NVQ level 3 and managers have all achieved NVQ level 4 plus the registered manager award. Staff files seen show that staff have POVA and CRB checks before being confirmed in employment. Inductions are provided within recommended time frames. All staff receive regular training as identified in their individual training plan. The service has invested considerably in training over the last 3 years, encouraging staff with NVQ and other learning courses such as insulin admisnistration, nutritional risk assesmsent and palliative care. People spoken with all stated that the carers are very kind and always at hand. An Care Homes for Older People Page 18 of 24 Evidence: excerpt from a complimentary letter reads: their care gave her dignity and every consideration. Our wishes were met and we were welcomed no matter what time of day we called. Care Homes for Older People Page 19 of 24 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. The management of the home is based on openness and respect. The service has quality assurance surveys in place so that people are assured that the overall conduct of the home is taking into account their views. Peoples opinions are central to how the home develops and reviews its practice, and the service is developing appropriate ways of making sure they get things right. So, people have confidence in the care home because it is run and managed well. Evidence: The service continues to have stability and consistency in its management structure of a registered manager and a care manager. The manager understands the need to have a plan for the business and to monitor the quality of care provision. The organisation monitors itself through quality audits and surveys to relatives and residents. The management finds out what people like by talking to them, involving them in their care and holding resident and relative meetings so that any issues can be discussed. The manager is aware of the importance of making people safe and without Care Homes for Older People Page 20 of 24 Evidence: unnecessarily restricting their freedom and has introduced the required assessments in order to do this. The AQAA contains clear information that is supported by evidence and informs us of changes to make improvements in line with the business plan. The care manager continues the concept of person centred thinking and includes residents to shape the delivery of the service. This is seen in the way care plans are written, the involvement of people in recording care delivery, surveys and staff supervision. There is regular training on all aspects of health and safety. Risk assessments are carried out both for individuals and for the environment. All equipment and systems are serviced and inspected as per legal requirements. The service ensures that any hazards that arise are rectified quickly. The service has invested in ongoing improvements since the last key inspection in 2006. The service is committed to continuously improving all aspects of the business with input from the people who live at Hendra House. Care Homes for Older People Page 21 of 24 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 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 24 of 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!