Inspection on 10/07/09 for Ivelhurst Nursing Home

This is the latest available inspection report for this service, carried out on 10th July 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.

Other inspections for this house

Ivelhurst Nursing Home 22/02/07

Ivelhurst Nursing Home 06/10/06

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report Care homes for older people Name: Address: Ivelhurst Nursing Home Ivelhurst Nursing Home 27 Preston Road Yeovil Somerset BA21 3AD     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: Shelagh Laver     Date: 1 0 0 7 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 25 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 25 Information about the care home Name of care home: Address: Ivelhurst Nursing Home Ivelhurst Nursing Home 27 Preston Road Yeovil Somerset BA21 3AD 01935426777 01935415777 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Ivelhurst Nursing Home Ltd care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Elderly persons of either sex, not less than 60 years, who require general nursing care Up to two persons, of either sex, between the ages of 50-60 years, who require general nursing care Date of last inspection Brief description of the care home Ivelhurst is a well established care home providing both personal and nursing care for older people. The home can also provide nursing care to up to two younger people. The home was purchased in January 1988 by the current owners. There are arrangements to provide care for service users funded by both social and health services. It became a registered company in March 2006. The responsible individual for the company is Mrs Ada White who is also company director. Eight new rooms were commissioned in 2006 and fitted and furnished to a high standard. Ivelhurst is a large traditional building situated in a residential area in Yeovil. The home provides nursing for up to 34 service users and at least one trained nurse is always on duty. The accommodation consists of a large lounge that leads to a paved area and two smaller Care Homes for Older People Page 4 of 25 0 Over 65 34 Brief description of the care home communal areas . There are seven rooms in the old building that have en-suites. All eight single bedrooms in the extention have en-suites. Care Homes for Older People Page 5 of 25 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 requested an Annual Quality Assurance Assessment which gives us information about the achievements and challenges faced by the home in the previous year. It also gives us factual information about the people and staff in the home and outlines the plans that the home has for the coming year. We could see that the majority of the people who live in the home are over 80. The AQAA was completed in detail and received on time. We sent survey forms to the home to be completed by people who live there or relatives or friends. Ten surveys were returned. They indicated that people felt that they received the care and support that they needed. When asked what the home did well one relative had written They look after mum the way I wish I could. I have no worries about mum and feel I can rest assured that she is receiving the best care possible. All the carers I have met are kind caring people. We (CQC) visited the home for one day and were able to meet people who live in the home and some of the staff. Care Homes for Older People Page 6 of 25 The manager was on duty and gave us all assistance. We were supplied with all requested information promptly and efficiently. Care Homes for Older People Page 7 of 25 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. Care Homes for Older People Page 8 of 25 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 9 of 25 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 10 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides an interesting range of information for people who may be interested in coming to live in the home. The home undertakes a thorough assessment of peoples needs before they come to the home. Evidence: There is a range of information for people who are interested in coming to live at the home. People can read the summary of the last inspection report and information about the home in the professionally produced folder. There is a web site and people are welcome to visit. When a visit is arranged the name of the staff member who should be contacted on arrival is given in advance so that people and their families are assured of someones dedicated attention. Surveys received prior to inspection confirmed that people received enough information before they moved in. People coming to the home following hospital discharge and may not be well enough Care Homes for Older People Page 11 of 25 Evidence: to visit in advance. Families may visit and occasionally no one has an opportunity to visit. The manager or deputy manager will always undertake an assessment and this will usually involve a visit to see the person in hospital or at home. We saw examples of assessments and documentation from health and social care professionals that are used in making a decision about whether staff are able to meet peoples needs at the home. The nursing home provides care for people with a wide range of needs. Some people come into the home needing lots of care but recover sufficiently to move to residential care or to go home. Others are very unwell on admission and required skilled care at the end of their lives. This is a home that tries hard to provide nursing care for people when they need it and staff work very hard to put care plans together and swing into action quickly when a person has been admitted. Care Homes for Older People Page 12 of 25 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 receive a good standard of health and social care which meets their needs. People are treated with respect and kindness in the home. There is a system of medication storage and administration that is safe and accurate. Evidence: There is evidence that people in the home receive good health and personal care and that there are some areas of excellent practise. Four care plans were reviewed. They were clear and easy to read and gave detailed guidance of the needs of the person and the actions to be taken by staff. In one file there was information about Parkinsons disease and the care plan included guidance about the physical care required and also the importance of maintaining the dignity and independence of the person. There was also a record of a visit to a Parkinsons Disease consultant clinic. There was evidence that people receive regular support from a team of health care professionals. General Practitioners visit regularly and there were records of visits from chiropodists, opticians and nurse specialists. Care needs are reviewed both in house and by health and social care professionals. One person had been reviewed by a Care Homes for Older People Page 13 of 25 Evidence: Community Psychiatric Nurse and the Community Nurse. They had been delighted with progress made and staff were to be congratulated. People returning surveys said that medical care was always available when needed. There is monitoring of peoples weight and a clear guide of the actions to be taken. There was evidence that expressions of need or short term health requirements are followed up promptly. One person had asked for a hearing aid and the audiology appointment letter was seen in the file. A carer had made a note of a possible infection in the daily record. This had been followed up by the nurse, tests made and appropriate treatment arranged with the GP. There was evidence that people were encouraged to maintain their independence. Clear guidance was seen in one room encouraging and supporting Independence in personal care. The home continues to develop expertise in the care of people at the end of their lives. They are using the Liverpool Pathway system of recording care that aims to ensure that the comfort of people who are very ill is maintained. One file was examined and seen to be completed appropriately. Two very poorly people were seen to be resting peacefully and to be receiving all care at appropriate intervals. Medication storage and administration was seen to be safe and to comply with good practise. The home should review the approach to recording fluids and position changes of people who are not on the Liverpool Pathway. It was noted that recording was patchy with some shifts recording plenty of detail and another shift recording erratically with some gaps. The manager and nurses should decide the criteria for recording care and implement a robust and auditable system of ensuring that it takes place. For example a view that someone drinks well is a qualitative statement. What is the clinical trigger for recording and encouraging drinks? While personal choice is a major deciding factor in people staying in the lounge for long periods of time there will be people who need to actively encouraged to rest in the afternoon. Surveys received from people said that the majority always received the care and support they needed and that staff were available when they needed them. A small number said that they were usually available. Care Homes for Older People Page 14 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People enjoy a choice of appetising and nutritious meals in the home. There are a range of social activities offered to people including individual outings when possible. Evidence: People are encouraged to make choices about how they spend their day. People said that they enjoyed their meals in the home and benefit from having a good cook in the home. The menus are interesting and varied and include a mixture of old favourites with some newer additions for example fish and chips or white fish and smoked mackerel pie. Cakes and puddings are home made and included apricot crumble and pineapple sponge. We heard people being asked to make choices about their lunch. There is a choice of hot and cold puddings. People are encouraged to eat in one of the two dining rooms but some people chose to eat in their rooms. Tables are set attractively and assistance was seen to be given to people who needed it with kindness and respect. The activities co-coordinator is enthusiastic and there have been some interesting introductions in the home. The home has purchased home cinema equipment and there is a regular film slot. There is a catalogue of DVDs that can be accessed by people in their own room. Care Homes for Older People Page 15 of 25 Evidence: An aromatherapist visits the home and the dining room is transformed into a sensory room for the afternoon full of smells, soft music and lights. The home tries to offer individual opportunities for people too. One person had been out shopping on the morning of the inspection. There are some social events organised. The most recent was a cocktail party attended by relatives and friends. It appears that there is a real attempt to provide some interest in the day. People are encouraged to do exercises and the purchase of a WII exercise game harnesses new technology. The programme of activities for the week is displayed on the notice board and included a film, a quiz, games on WII and arts and crafts. Some activities are very simplesat on the patio and eat ice creams whilst others such as a visit from school volunteers have taken more planning. We discussed the possibility of having a home newsletter which each person could read. It is difficult for everyone to see the board that displays the activities programme and people would e able to see any special entertainments booked for that month. Visitors are welcomed into the home at all times and two visitors spoken to were very happy with the care received by their relatives. Care Homes for Older People Page 16 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are policies and procedures in place to keep people safe. Staff are kept up to date in the legislation and procedures needed to keep people safe. People who live in the home felt happy to raise concern and make complaints if they needed to. Evidence: There was evidence that staff in the home have received training and up-dates in safeguarding adults using a DVD. The manager has ensured copies of the Safeguarding Adults in Somerset policies and procedures are available in the staff room and duty room. Recruitment procedures were seen to be robust and designed to protect people. In one file there was an assessment of a persons ability to make decisions and actions to be taken to promote her wellbeing. People who returned surveys said that there was someone that they could speak to informally if they were not happy and knew how to make a formal complaint. Care Homes for Older People Page 17 of 25 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 benefit from living in a home that is clean and comfortable. Management and staff have worked together to maximise the positive aspects of the environment and have plans to improve the home still further. There are procedures in place to reduce the risk of infection. Evidence: On the day of the inspection the home was clean and free from all odours. Overall the home is tidy and well maintained. The housekeeper Marion Clarkson manages the cleaning of the home professionally ensuring that rooms are deep cleaned on a regular basis and that rooms attain a comfortable hotel standard of presentation. There has been considerable investment in the home over the past two years. Rooms have been redecorated and up-graded, furnishings have been replaced and the owners and management team have made the best of available space. Bathrooms have been up-graded and the newer rooms and en-suites have been maintained in excellent condition. On the day of the inspection it appeared that management and staff have worked together to create a very comfortable and pleasing environment. There are now plans to considerable improve the communal sitting areas of the home. This will reduce the rather crowded feeling that the main lounge can have when a large number of people congregate for coffee or activities. We discussed the importance of managing the effect of the building work on people who live in the home and the need to keep people informed and where necessary to enable change of Care Homes for Older People Page 18 of 25 Evidence: room to occur. The manager had a plan in place and agreed that at times it may be that some rooms would not be used for a short period. The home has maximised the access to outside space with a small sensory garden and this area will again be redeveloped with a new sun lounge. There is an opportunity here to create a pleasant covered sitting area with views to a small garden. There were staff hand wash facilities and waste disposal arrangements that encouraged good practise in infection control. Care Homes for Older People Page 19 of 25 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 in the home benefit from the care given by well trained and supervised staff. Evidence: A review of the off duty indicated that there are sufficient staff on duty including at least one trained nurse. We spoke to a new member of staff on his second day in the home. He confirmed that before being employed at the home he had had an interview and that references had been taken up and a Protection of Vulnerable Adults check had been made. As the Criminal Record Bureau check had not yet arrived the staff member was seen to be working closely with a senior carer. Three staff files reviewed showing that staff receive regular training. Manual handling and protection from abuse had been up-dated since the last inspection. The home has a selection of training material that can be used in house and staff can also access external training events. A nurse had undertaken a four day medication training and had accessed clinical updates on wound care and peg feeding. All training is recorded in staff files and there is a white board that gives an overview of all staff training. We discussed with the manager the importance of tracking training, up-dates and appraisals to ensure that these are completed according to NMS and the possibility that the administration of a spread sheet could be undertaken by a member of staff. Care Homes for Older People Page 20 of 25 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 in the home benefit from a professional and committed manager and management team. The manager has a clear vision of the high standards of care that she expects to be delivered in the home. There are systems in place in the home to ensure effective safeguarding and management of peoples money. Record keeping is of a good standard. The proprietors manager and staff are committed to running the home in the interests of people who live in the home. Evidence: The manager Cheryl Stratton is a qualified nurse with a masters degree and wide experience of managing care homes. She continues to actively develop both her clinical and management skills. Most recently she has been undertaking training to lead the home into the Gold Standard Framework for palliative care. She is currently undertaking an Oxford Brookes Leadership Qualification. She has a clear vision of the standards of care that are required in the home and the home does its best for all Care Homes for Older People Page 21 of 25 Evidence: people who come to the home whether it is for several years or a few days. The management team is composed of Mr and Mrs White who are closely involved in the home, the manager/matron and her deputy and the housekeeper. It is a strength of the home that each person is effective and committed to the standards within the home. The manager undertakes a series of audits which encourage the views of people who live in the home. We saw minutes of meetings held for care assistants, night staff and management meetings. Minutes of meetings are now more formally recorded. It would be good practise to have a meetings calendar to indicate when meetings were due and at what frequency as it is not clear from the minutes. Residents meetings are sometimes chaired by the activities co-ordination which has worked well. There are effective systems in place to safeguard peoples personal finances and there are administration systems that ensure record keeping is of a high standard. There are systems in the home to maintain the health and safety of people who live there and staff. The management and maintenance staff are aware of the need to have rigorous systems for serving equipment and making checks on fire and water systems. The home is prompt to respond to requirements for improvements and a recent visit from the Health and Safety Executive had resulted in prompt action. Care Homes for Older People Page 22 of 25 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 23 of 25 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 1 8 The home should review the system for deciding when fluid intake should be monitored and how the nurses can be assured that people are having sufficient drinks on each shift. Care Homes for Older People Page 24 of 25 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 25 of 25 - 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!