Inspection on 18/11/09 for Carey Lodge

This inspection was carried out on 18th November 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Key inspection report Care homes for older people Name: Address: Carey Lodge Carey Lodge Church Street Wing Leighton Buzzard Bedfordshire LU7 0NY     The quality rating for this care home is:   one star adequate 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: Chris Schwarz     Date: 1 9 1 1 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 35 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 35 Information about the care home Name of care home: Address: Carey Lodge Carey Lodge Church Street Wing Leighton Buzzard Bedfordshire LU7 0NY 01296689870 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.fremantletrust.org The Fremantle Trust Name of registered manager (if applicable) Mrs Sue Charlotte White Type of registration: Number of places registered: care home 75 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 75 The registered person may provide the following category of service only; Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Dementia (DE) Old age, not falling within any other category(OP) Date of last inspection Brief description of the care home Carey Lodge is located just off the Aylesbury to Leighton Buzzard road in the village of Wing. It is close to a church with local shops and pubs nearby. There is a health centre next to the service and another doctors surgery a short distance away. There are public transport links into nearby towns. The building is set back from the main road Care Homes for Older People Page 4 of 35 Over 65 0 75 75 0 Brief description of the care home and there is parking for staff and visitors. It is well sign posted. Accommodation for people using the service is spread across three floors in five houses. There is a passenger lift for access between floors, as well as the stairs. The two houses on the ground floor provide accommodation for people with dementia. All of the houses have single bedrooms with an en suite shower and toilet. Communal and individual rooms are spacious and designed to a high specification. There are garden areas which people can access. Information about the service is provided in a service users guide and statement of purpose. Fees at the time of this visit ranged from £617 to £720 per week. Thirty of the beds are block purchased by the local authority and the remaining forty five are for private referrals. Care Homes for Older People Page 5 of 35 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: one star adequate 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 unannounced key inspection was conducted over the course of two days and covered all of the key national minimum standards for older people. A pharmacy assessor was present on the first day. It was the services first inspection since registration in June this year. Prior to the visit, a detailed self-assessment questionnaire, the Annual Quality Assurance Assessment, was sent to the manager for completion. It was returned in good time and provided us with details and statistical information to help plan and assess quality of care at the service. Some elements of statistical information had not been completed but these were provided promptly when asked for. Surveys were sent to a selection of people living at the service, staff and visiting professionals. Completed surveys were received from five members of staff, sixteen service users and three health care professionals; these have helped to form judgements about the service. Information received by the Commission since registration was also taken into account. Care Homes for Older People Page 6 of 35 The inspection consisted of discussion with the manager and other staff, opportunities to meet with people using the service, observation of practice and a tour of the premises. Some of the required records were looked at such as care plans, medication records, staff recruitment records, training records, policies and procedures and health and safety checks. A key theme of the visit was how effectively the service meets needs arising from equality and diversity. Feedback on the inspection findings and areas needing improvement was given to the manager and external line manager at the end of the inspection. The manager, staff and people who use the service are thanked for their co-operation and hospitality during this unannounced visit. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: Advice has been given to review the admissions procedure to make sure it is up to date. The manager has also been advised to ensure that the mental health section on the pre-admission form is consistently completed when considering offering a placement to someone with dementia. Advice has been given to review sections of care plans where information has not been provided to make sure that peoples full range of needs are recorded. We would advise reviewing falls risk assessments regularly and rolling these out to all service users as good practice. Advice has been given to update the safeguarding procedure with the correct Care Quality Commission contact details. Advice has been given to use individual hoist slings for service users as a good infection control measure. The manager had notified us prior to the inspection of a service user with Clostridium difficile but this was not reflected in the care plan and measures to contain the Care Homes for Older People Page 8 of 35 infection were not recorded. A care plan needs to be written without delay when any service user develops a serious contagious condition, to outline how the person is to be cared for and the measures to be adopted to contain spread of infection. This is to promote good infection control practice. A requirement has been made to this effect. Intended actions from assessments were not consistently being carried out, such as weighing regularly and re-evaluating peoples risk of developing pressure damage. The manager needs to ensure that peoples changing health needs are properly monitored and reviewed and actions indicated in these assessments carried out accordingly. This is to ensure that people receive the support they require. A requirement has been made to this effect. Gaps were evident alongside prescribed dose times on some of the medication charts examined. Accurate records need to be maintained of medication administered to people using the service. This is to ensure there is a clear audit trail in place. Individual protocols are needed to guide staff on the use of as required medicines used to treat anxiety or agitation. This is to ensure that these medicines are only used when absolutely necessary. Requirements have been made to this effect. Advice is also given to improve medication practice by asking service users doctors to review as required medicines used to treat anxiety or agitation which are being used regularly, to see if they need to be prescribed for regular use, implementing a clear homely remedies policy, adopting the practice of writing no known allergies on medication charts (where this is applicable) and ensuring temperatures are checked daily for all fridges used for medicines. There was a period between staff shifts when no carers were working in one of the houses, leaving fifteen people with dementia without any supervision. A requirement has been made to ensure safe staffing levels are maintained at these times. 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 9 of 35 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 35 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 using the service are assessed prior to admission to make sure their needs are known. They are offered a trial period to test out life at the service and have a range of information to help them decide if the service is right for them. Evidence: Information provided in the Annual Quality Assurance Assessment showed that preadmission assessments are carried out by experienced senior staff to ascertain peoples needs. A trial period of four weeks is offered which can be extended if people feel they need more time to make a decision about moving in permanently. We were advised that people are provided with a contract which sets out the terms and conditions of residency and that people receive a welcome pack which includes the statement of purpose and service users guide. The majority of people who returned surveys said they has received enough information to help them decide if the service was the right place for them, before Care Homes for Older People Page 11 of 35 Evidence: they moved in. Most said they had been given written information about the terms and conditions. During the inspection we were able to see that the statement of purpose and service users guide were readily accessible to people in the foyer. Both documents gave a good outline of what people could expect from living at Carey Lodge such as the philosophy of care, a service users charter, the aims and objectives, photographs, names and qualifications of care staff and information about the fees, admissions process, meals, activities, telephone calls, laundry arrangements, visitors and access to health care as examples. Other useful information was also to hand in the foyer such as copies of the complaints procedure, local advocacy details, a leaflet from the Royal National Institute for the Blind, information about deprivation of liberty safeguards and copies of the providers in-house news magazine. The operations manual in the duty office contained a copy of the admissions procedure for the service. It had been produced some time ago and was in need of minor amendment to reflect the present head quarters for the provider and the name of the organisation regulating the service. The provider is advised to review the procedure to make sure it is up to date. Pre-admission assessments of two people with dementia were read. Both assessments followed a corporate format in line with the format used for care plans. Both outlined background information such as name, preferred form of address, where the person was living, next of kin, who their doctor was and the type of care needed. One provided a good range of information on areas such as communication, personal care and grooming, leisure, occupation and interests, mobility, physical health and health and well being. Information was provided about the persons mental health and emotional well being. The other assessment provided most of the information as above but did not give a good outline of their mental health needs; a tick was placed alongside Alzheimers but there was no other information about the persons dementia, what the symptoms were, how they are managed and any support or input the person was receiving or needs to receive. We would advise that this section is completed in full to make sure that needs are thoroughly identified. Both assessments had been signed to show who had undertaken them (senior staff) and had been dated. Intermediate care (short term rehabilitation) is not provided at this service Care Homes for Older People Page 12 of 35 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 adequate 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 good care plan format to record peoples diverse needs and a range of accompanying assessments are in place to supplement these and monitor peoples health needs. However, there are inconsistencies in following up actions from assessments which needs to be improved to promote health and well being. Some attention is needed to medication practice to ensure that medicines are handled safely and effectively to promote peoples well being. Evidence: We were advised in the Annual Quality Assurance Assessment that care plans were in place for each person, outlining their care needs. Risk assessments were said to be in place for moving and handling, falls and fractures, nutrition, likelihood of developing pressure damage and dependency levels. The manager advised that each fall is assessed, in line with the organisations procedures. Records were said to be in place of health care interventions and periodic weighing of service users. The manager advised that the service had a medication policy in place and that it uses a monitored dose system of medication administration. We were told that staff who handle medicines have been trained to do so. The manager told us that end of life care was Care Homes for Older People Page 13 of 35 Evidence: well developed and that the service is supported by district nurses and palliative care nurses. Staff who returned surveys said they are always given up to date information about the needs of people they support. A health care professional considered that peoples social and health care needs were always properly monitored, reviewed and met by staff and that advice was usually sought and acted on to meet peoples needs and improve their well being. They said the service usually supported people to administer their own medicines or managed it correctly where this was not possible. They commented that staff always respect peoples privacy and dignity and usually helped people to live the life they choose. They considered that the service usually responded to the diverse needs of people. Additional comments included caters for a diversity of mental health disorders and usually responds to their diverse needs. Seems to be equipped to meet the clients needs. Some junior staff could benefit from training in dementia care on a regular basis. A doctor who returned a survey said carers seem disorganised at many times. I am asked to visit patients who arent even registered. Often if one shift asks for a visit, when I get there the current shift have no idea why I have been called. As a GP we are asked to visit patients with minor health problems, e.g. a cold - staff need to be trained to take on more responsibility for minor/day to day medical complaints and should not involve the GPs. Another health care professional commented they are working positively with the nursing staff to improve the health and well being of the residents. We run twice weekly treatment rooms for as many residents as needed. The staff are able to refer residents to this at anytime. The person commented that internal communication needs to improve and added that this varied depending which senior member of staff was on duty at the time. People using the service said in surveys that they always receive the support and care they needed including medical care. One person said that one of the things the service does well was look after everyone. Seven care plans were read from three different houses and reflecting a range of care needs. All had been completed using a corporate format which covered areas such as communication, important relationships, personal care and grooming needs, leisure, occupation and interests, mobility and moving and handling, preferred routines, physical health, mental health and well being, skin care, continence management, diet and nutrition and a personal profile. All had a photograph of the person for easy identification. Essential information had been collated to record peoples name and preferred form of address (except in one case), their date of birth, key people in their lives (one did not identify the persons doctor) and there were spaces to record Care Homes for Older People Page 14 of 35 Evidence: gender, ethnic origin and religion. Significant areas of risk were identified and how family or key people wanted to be notified of changes to peoples health. In one file information had been noted for most areas but there were some gaps under leisure, occupation and interests, mobility and moving and handling, preferred routines, what comforts the person when they are anxious and under diet and nutrition (the person has diabetes, controlled by diet). Another file was also mostly completed but needed to be supplemented with some examples of what the person enjoys doing under the social activities section, so that staff could ensure the person was kept mentally stimulated. Under the food and drink section, some information to prompt staff on what a healthy diet is for a person with diabetes would be useful, so that they can ensure appropriate choices are offered at meal times. The third file had a good range of information about the persons care needs. It was noted that the persons night time care plan had been produced in September 2008 at the previous place of residence and may not still be relevant in the new setting. It would be advisable to review these sections and update as necessary. Three further files contained good accounts of peoples needs. In July this year the manager notified us that a service user had contracted the infectious condition, Clostridium difficile. The persons care plan was looked at during this visit and two of the carers on duty were spoken with. Carers gave a good account of the procedures they are following to keep this infection confined and described barrier nursing methods. Supplies of disposable items were in place in the persons room, there were alginate laundry bags to ensure washing was appropriately contained and they showed the inspector a supply of separate towels and flannels which were solely for the persons use. Separate clinical waste arrangements were also in place in the persons room. However, the care plan did not identify that the person had Clostridium difficile, nor did it indicate that there was a high contamination risk and the barrier nursing methods that need to be followed. A requirement is made to address this to ensure that staff have guidance on the infection control measures to be adopted to support the person with their personal care and control spread of infection. Personal emergency evacuation plans were in place and there were risk assessments for areas such as likelihood of developing pressure damage, moving and handling and nutritional needs. The manager was advised that one moving and handling assessment had not been reviewed since September last year. In the files of two people identified as being at high risk, staff were not following up actions highlighted as a result of pressure risk indicator assessments and nutritional assessments. For example, where re-assessment or weighing at a more frequent rate was indicated, records did not show that staff were carrying out the action, which could have an Care Homes for Older People Page 15 of 35 Evidence: affect on peoples overall health and well being. Staff were instructed via a note on the front of two care plan files to maintain records of food consumed and separate food charts were in place. In both cases it would be difficult to estimate daily calorific intake as not all meals were consistently being noted by staff. A requirement is made to ensure that peoples changing health care needs are properly monitored and reviewed to promote their well being. Records were being kept of health care interventions, such as visits from doctors, district nurses and hospital appointments. Dependency assessments were also seen on peoples files. A falls register was being maintained in the duty office. Where assessments were in place in care plan files for risk of fractures, these were dated 2007 and had not been reviewed. We would advise these assessments are kept under regular review; the manager may wish to consider putting these in place for all service users as a good practice. Peoples privacy and dignity were being respected. All personal care was carried out behind closed doors. The service also has a treatment room for people to see visiting medical personnel. Medication practice was looked at. The senior with main responsibility for medication was present and facilitated this part of the inspection. The service was using a monitored dose system of medication administration. Suitable arrangements were in place for storage and administration of controlled medications. Records were being kept of medication received into the service and returned to the pharmacy. There was a medication policy for staff to refer to, dated 2007 with a review date of 2008. It had not yet been reviewed. Medication audits had been carried out at the service for all of the houses during October this year. They reflected the findings of this inspection. Medication practice on two of the houses was looked at. In one house medication administration records were being kept up to date with no gaps alongside prescribed dose times. In the other there were gaps to four peoples medication records. A requirement is made to maintain accurate records of medication administered to people using the service, to ensure there is a clear audit trail in place. All medicines were within their expiry dates. Three peoples records that were looked at showed they are prescribed as required medication for anxiety or agitation. Records showed that these medicines had been administered on a regular basis and not on an as required, occasional, basis. Care plans for these service users did not identify any protocols staff needed to follow before resorting to administering the medicines, such as calming techniques. A Care Homes for Older People Page 16 of 35 Evidence: requirement is made to put individual protocols in place to guide staff on the use of these medicines and to ensure that they are only used when absolutely necessary. We would advise that the service users doctors are asked to review the medicines to see if they need to be prescribed for regular use. On two charts medicines had been handwritten but there were no names or initials to identify who had added these. One persons care plan showed that one of the handwritten medicines was to be given regularly, but this was not being done. We would advise that measures are put in place to address these issues by implementing a clear homely remedies protocol. It was noted that allergies were not noted on charts and in discussion with the manager she said that this information would only be recorded where an allergy was known about. We would advise that the service adopts the practice of recording no known allergies where applicable, as a good practice. The temperature of the medicines fridge on one of the houses was being monitored daily to make sure it was working within the correct temperature range; the fridge on the other house, which contained medicines, was not being monitored. We would advise that arrangements are put in place to make sure that all medicines fridges are checked daily. Staff training records showed that 59 of staff who have responsibility for handling medication were up to date with training. The manager had scheduled dates for those staff who need updates to be trained in the near future. Care Homes for Older People Page 17 of 35 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. Activities are available to people using the service to provide them with stimulation. Contact with family, friends, the community and an advocacy service is supported to maintain social links. Food is well prepared and presented attractively to make sure that nutritional needs are met and respecting peoples preferences choices. Evidence: Information in the Annual Quality Assurance Assessment showed us that the service has two activity co-ordinators, covering forty hours a week, who put together a programme of events for people using the service. We were advised that notices are displayed around the premises to inform people of what has been arranged. We were told that records are kept of activities and that photographs are displayed of events. One of the co-ordinators had achieved a National Vocational Qualification in activity and leisure. The manager advised us that service users are supported to keep in contact with their family and friends and that visitors are made welcome. We were advised that an Age Concern advocate visits on a regular basis and facilitates residents meetings; these meetings include discussion on activity provision and meals. The manager advised us that the premises has a cafe and shop. Menus were said to be available in each of the houses and the manager told us meals provided a wholesome and well balanced diet. Statistical information showed that nutritional Care Homes for Older People Page 18 of 35 Evidence: screening is carried out for each person admitted to the service and this is repeated where people are at risk of malnutrition. We were advised that there is a monthly multi denominational church service held at the home and holy communion is also provided; some people also attend local church services. Two staff who completed surveys identified activities as an area that the service does well. People using the service said in surveys that activities are always arranged that they can take part in if they want to. Most said they liked the meals provided for them; one person commented that there could be better lunches for people with diabetes. During the visit to the service, posters were seen in each house and in the entrance hall showing what activities had been arranged for people. The external line manager advised of a good size budget which had been provided for the service and commented that the provider organisation had recently held an activities conference for all of its services for older people. On the first day of the visit, a pianist was performing classical and popular tunes in the morning, which people said they enjoyed, and there was a gentle exercise class in the afternoon. On the second day a coffee morning took place, which was well attended, and there was a Songs of Praise service led by a local vicar. A remembering seaside sights and tastes event took place in the afternoon and one of the activity coordinators had been out to buy eels, cockles and prawns for this. The range of activities was good and included a weekly mobile shop, run by a volunteer, bingo, story telling, regular use of the cafe in the entrance area and seasonal events such as an autumn bazaar. A clothes sale was also advertised. The hairdressing salon was in popular use and the manager advised that three hairdressers visit Tuesday to Friday. Two gentleman had been enabled to go out to the local pub with the service taking them where they wanted to go and collecting them when they were ready to return home. Carey Lodge has two minibuses to transport people. Records were being kept of activities offered to people and there were photographs of events such as a Chinese evening and planting containers for the garden. People were seen around the building reading newspapers and there were magazines which local people had donated. One of the activity co-ordinators said local people had been particularly welcoming of the service and had donated CDs and DVDs and there was a box of old time periodicals in the office that someone had donated. The activity co-ordinators and manager spoke of positive input from the secondary school next door, with plans for them to help brighten the garden and produce art work. Care Homes for Older People Page 19 of 35 Evidence: One of the service users was being enabled to keep her dog, who was seen to be very popular around the building. In another lounge the service users had a budgie. Chickens were being kept in the garden. There were posters around the building advertising when the Age Concern advocate would be visiting, with his photograph on. He was met during the course of the inspection and said he attends once a month to talk with people. No concerns were identified. Arrangements for meals and meal times looked in good order. The chef manager considered the kitchen had been well designed and she had all the equipment she needed. A four week rotating menu was being used, with a copy in the foyer and daily menus written each day on notice boards outside each of the houses dining rooms. People can have a cooked breakfast if they wish, as well as options of toast and cereals. Lunch is the main meal of the day with two options consistently available, one a vegetarian option, plus a third option of a salad if people wish. On the first day of the inspection people had a choice of roast chicken or a vegetable burger, plus two vegetables and roast potatoes. On the second day there was a lamb casserole with vegetables and potatoes or a mushroom omelette. Tea time is a lighter meal such as sandwiches and cake. Food was served attractively and people said they had enjoyed their meals. The manager advised that staff had been encouraged to make meal times more relaxed by sitting down with people and saving the tidying up until everyone had finished. This was seen in practice and feedback was that it has been working well. Care Homes for Older People Page 20 of 35 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. Complaints and safeguarding are effectively managed to listen to views of people who live at the service and reducing the risk of harm to them. Evidence: Information in the Annual Quality Assurance Assessment advised us that the service had procedures in place to manage complaints and that people using the service and families and friends receive information on how to make a complaint in the welcome pack and through information around the building. The manager said that staff undertake customer care and safeguarding training. Thorough staff recruitment practices were described to protect service users. Two complaints and one safeguarding referral were identified in statistical information provided by the manager. We had been notified of the safeguarding issue before the inspection was being planned. Staff who returned surveys said they knew what to do if anyone raised any concerns about the service. People using the service said there was someone they could speak with informally if they were not happy. Most said they did not know how to make a formal complaint. The complaints procedure was accessible in the foyer and a copy was in the operations manual. A log was being maintained of compliments (of which there were many) and the complaints referred to in the Annual Quality Assurance Assessment. Records Care Homes for Older People Page 21 of 35 Evidence: showed that complaints are fully responded to. The operations manual also contained guidance on mental capacity assessments and a statement of working procedures for deprivation of liberty safeguards. The manager confirmed that she has attended training on deprivation of liberty. There was also a policy on safeguarding vulnerable adults. We would advise that the contact details of the Care Quality Commission be updated in this policy in order that staff have accurate information readily to hand when they need it. Training records showed that training is provided on safeguarding. Where staff were not up to date with safeguarding training, the manager had already identified a series of update courses to refresh skills. The induction of new staff includes input on safeguarding. The safeguarding matter that we had been notified of had been handled appropriately and the local authority had been informed. Recruitment practice at the service was seen to be robust enough to protect people from harm. Care Homes for Older People Page 22 of 35 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. The premises are new and purpose built to a high standard to provide comfortable accommodation for service users and adaptations are in place to meet the needs of people with disabilities. Evidence: We were advised in the Annual Quality Assurance Assessment that the service is a purpose built residential care home which has been designed to high standards. We were told that the premises are secure, warm, comfortable, bright and clean. Bedrooms were described as spacious with en suite facilities and the manager told us that people had been encouraged to personalise their rooms. We were advised that the kitchen and laundry had been equipped to a high standard and that the design of the building has allowed for creative use of space to provide points of interest around the building. A cafe and shop were mentioned in the information provided plus a modern hairdressing salon. The manager said the grounds are secure and that there is a courtyard garden with raised flower beds and a communal garden which can be accessed from the main hall. People using the service who completed surveys said the premises are always kept fresh and clean. Carey Lodge is located just off the Aylesbury to Leighton Buzzard road in the village of Care Homes for Older People Page 23 of 35 Evidence: Wing. It is close to a church with local shops and pubs nearby. There is a health centre next to the service and another doctors surgery a short distance away. There are public transport links into nearby towns. The building is set back from the main road and there is parking for staff and visitors. It is well sign posted. Entry to the building is via a doorbell or number coded door pad. The foyer contained books for staff and visitors to sign in and out and information about the service was available for people to look at as mentioned under the first section of this report. There is a spacious and bright entrance hall with plenty of comfortable seating areas and access to the garden. The managers, duty senior and administrators offices lead off from the entrance hall, as does the hairdressing salon. At one end of the entrance hall there is a cafe which had been equipped to provide drinks and snacks to people, and there are bistro tables for people to use. Bowls of snacks were placed around the entrance hall for people to nibble on. The kitchen and laundry areas are located off one corridor. Both had the necessary equipment for a large care service and were being kept clean and hygienic. Accommodation for people using the service is spread across three floors in five houses. There is a passenger lift for access between floors, as well as the stairs. The two houses on the ground floor provide accommodation for people with dementia. All of the houses have single bedrooms with an en suite shower and toilet. Where people need or prefer a commode, this was provided. People had personalised their rooms to different degrees. Each house had spacious, adapted bathrooms and toilets. Lounge and dining areas were attractively arranged with comfortable seating; dining chairs had gliders for easy manoeuvrability. The manager advised that fireplaces were to be fitted in the lounges. Dining rooms also contained kitchen areas with a plan to install ovens so that each house could do its own baking. Around the building there were areas which have been arranged to reflect themes, with items which people may find interesting. Each area had places to sit and be still. The manager said the aim would be to change the themes around to provide on-going points of interest. One area had been set aside to develop into a sensory area. One of the features of the building is that it has been designed with windows at the end of corridors to see outside and provide natural lighting, and chairs and occasional tables have been added so that people can make use of these areas. Three gentleman in one of the upstairs lounges were particularly enjoying sitting looking out over the open countryside. All parts of the building were clean, well decorated and designed to high specification. The building was kept comfortably warm. There was good odour control and appropriate sluicing and clinical waste arrangements were in place. Corridors were Care Homes for Older People Page 24 of 35 Evidence: wide and had natural as well as artificial light; sensory nodules had been fitted to grab rails to guide people with visual impairments. A smoking room had been provided on the top floor for service users. Care Homes for Older People Page 25 of 35 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. The service has thorough recruitment procedures, coupled with effective training to ensure staff have the right skills and competencies to support the people who live at Carey Lodge. Attention is needed to maintaining safe staffing levels at handover periods to make sure that people are appropriately supervised. Evidence: The manager advised us in the Annual Quality Assurance Assessment that staff are recruited in line with the regulations and that all of their recruitment checks and clearances were available on file. We were told that new workers undertake an induction in line with the Skills for Care common induction standards and that staff work in accordance with the General Social Care Council code of practice. We were advised that staffing levels are determined according to assessed care needs. The manager described the training programme as excellent and said that over 50 of the staff team had achieved National Vocational Qualification at level 2 or above. We were advised that National Vocational Qualification training had been extended to housekeeping staff as well. All staff were said to receive regular supervision and have an annual development review/appraisal. Staff who returned surveys said their employer had carried out checks before they started work and that their induction covered the areas they needed to know about very well. They said they receive training which is relevant to their role, helps them Care Homes for Older People Page 26 of 35 Evidence: understand and meet the individual needs of people and gives them enough knowledge about health care and medication. They said they often have support from their manager and meet with her to discuss how they are working. They considered the ways in which information is shared usually worked well and that there were usually enough staff to meet the individual needs of people. Staff said they feel they always/usually have enough support, experience and knowledge to meet different needs, such as those related to age, disability, gender, race, ethnicity, sexual orientation and faith. A health care professional said in a survey that staff and managers usually have the right skills and experience to support peoples social and health care needs. People using the service said in surveys that there are always/usually staff available when they need them and that they listen and act on what they say. During the visit to the service we were able to see that a rota was being maintained for care staff with cover across the 24 hour day. On each shift there was a senior member of staff to run and co-ordinate the shift. The managers hours are supernumerary to the rota. Separate rotas were in place for catering and housekeeping staff. The manager advised that no agency staff were being used to cover the service. Carers on one of the houses where people with dementia are cared for said that there are always three people on duty in that house to care for fifteen service users and that they considered this was sufficient. Staffing levels seemed to be sufficient on the houses that were visited as part of the inspection, apart from during the handover period between morning and afternoon shifts on one of the downstairs houses for people with dementia; no staff were working in the house during a six minute period when we were trying to find a carer to answer a query. A requirement is made to ensure safe staffing levels are maintained during handover periods to make sure that vulnerable people are appropriately supervised. Recruitment files for three new staff were looked at and found to be in good order. Each file contained an application form, two references, health clearance, proof of identification and an enhanced Criminal Records Bureau check. There was verification from staff in the personnel department that an overseas worker was entitled to work in the country. Terms and conditions of employment were also present in the files. Recruitment files for three volunteer workers were also in good order and they had been recruited using the same process as salaried staff. New staff undertake an induction over the course of six days which covers their mandatory training and includes input on dementia care. The induction is in line with the Skills for Care common induction standards. There is a well established training department and the service has its own trainers in some areas of practice, such as Care Homes for Older People Page 27 of 35 Evidence: safeguarding and dementia care. Training records of six staff were looked at. Training was largely up to date but where staff needed to attend courses the manager had already identified the gaps and had set aside a series of dates on which the training would be provided. Care Homes for Older People Page 28 of 35 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 management and administration of the service promote continuity and quality of care for the people who live there and ensure that risk is safely managed to reduce the likelihood of injury or harm. Evidence: The manager advised us in the Annual Quality Assurance Assessment that she is experienced in health and social care and business management and holds the registered managers award, National Vocational Qualification level 4 in health and social care and a diploma in management studies. She said she is also a National Vocational Qualification assessor and internal verifier. She advised us that the service has a dementia care manager who is also experienced and trained to a high standard and is a moving and handling assessor. She told us that both are trainers for safeguarding, food hygiene, infection control and dementia care. We were advised that there are two administrators for the service and that financial procedures are audited annually. Information reflected that there is monitoring by the provider to assess quality of care and internal and external audits. We were advised that policies and Care Homes for Older People Page 29 of 35 Evidence: procedures were in place to provide guidance to staff. Statistical information showed that staff receive training on health and safety related topics such as infection control and food hygiene and that the service had an action plan to deliver best practice in the prevention and control of infection. It also showed that written assessments were in place for the safe use of hazardous substances. A member of staff commented in a survey that there was a supportive manager. The service had a registered manager in place. Records showed that she has kept her training up to date. During the visit to the service we were able to see that the certificate of registration was being displayed in the foyer, as was a certificate of current employers liability insurance. The service was being run in line with the aims, objectives and principles in the statement of purpose. Regular monitoring visits were being carried out by the provider to assess quality of care and reports of these visits were available in the duty office. The provider has an established quality auditing system which involves an annual visit and stakeholder questionnaires; as the service had only been operating for a few months this was not scheduled to take place yet. Service users money was being managed using the providers residents savings scheme. The administrator advised that all of the people living at the service were using the scheme. Access to the computerised records was restricted and password protected. Receipts were being issued where people deposited money into their account or where valuables were deposited for safekeeping. Statements of accounts can be provided to those who wish for one to be printed off. Records showed that receipts and invoices were in place to verify spending on peoples behalf. There were financial policies and procedures available to administrative staff in their office as well as being able to telephone staff at head quarters if there are any queries. A financial audit by external auditors was due to take place shortly after this visit. An environmental health inspection took place in July this year with the service awarded a five staff certificate. A recommendation to put in place a risk assessment for Legionella had been addressed. The manager advised that the fire officer had also visited recently and advised adjustment to two fire doors which were not closing effectively; maintenance staff were addressing this. The operations manual contained policies and procedures on health and safety, infection control, food safety, first aid, moving and handling and control of substances hazardous to health. Accidents and incidents were being recorded and noted on Care Homes for Older People Page 30 of 35 Evidence: peoples care plan files. Staff were observed wearing disposable gloves and aprons and housekeeping staff made use of yellow hazard notices after cleaning floors. Staff were checking and recording bath temperatures. In discussion with the manager we advised that the service use individual hoist slings for each person, in line with Department of Health guidance. Thirteen staff (all of the senior team) were up to date with first aid training to ensure there was always someone qualified on duty at the service. Electrical testing, fire alarms, emergency lighting and the fire risk assessment were checked and satisfactory when the service was registered; as this was only a few months ago it was not necessary to look at these areas again on this occasion. Action needed to improve infection control practice is referred to under the health and personal care section of this report. Care Homes for Older People Page 31 of 35 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 32 of 35 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 7 13 A care plan is to be written 01/01/2010 without delay when any service user develops a serious contagious condition, to outline how the person is to be cared for and the measures to be adopted to contain spread of infection. This is to promote good infection control practice and to ensure that staff have guidance on how to support the person with their personal care needs. 2 8 12 Peoples changing health 01/02/2010 needs are to be properly monitored and reviewed and actions indicated in these assessments carried out accordingly. This is to ensure that people receive the support they require to promote their well being. Care Homes for Older People Page 33 of 35 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 3 9 13 Accurate records are to be 01/01/2010 maintained of medication administered to people using the service. This is to ensure there is a clear audit trail in place. 4 9 13 Individual protocols need to be in place to guide staff on the use of as required medicines used to treat anxiety or agitation. This is to ensure that these medicines are only used when absolutely necessary. 01/01/2010 5 27 18 Safe staffing levels are to be 01/01/2010 maintained during shift handover periods. This is to ensure that people are appropriately supervised. 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 34 of 35 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. 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