Inspection on 02/09/09 for George Hythe House

This inspection was carried out on 2nd September 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

George Hythe House 06/09/07

George Hythe House 03/05/06

George Hythe House 30/01/06

George Hythe House 13/12/05

George Hythe House 19/04/05

George Hythe House 06/10/04

George Hythe House 22/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: George Hythe House 1 Croft Road Beaumont Leys Leicester LE4 1HA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Linda Clarke     Date: 0 2 0 9 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 38 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 38 Information about the care home Name of care home: Address: George Hythe House 1 Croft Road Beaumont Leys Leicester LE4 1HA 01162350944 01162366560 georgehythehouse@lqha.co.uk www.leicesterquakerhousing.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Leicester Quaker Housing Association care home 41 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: No person to be admitted in categories MD(E) or DE(E) when 31 persons in total of these categories/combined categories are already accommodated. Date of last inspection Brief description of the care home George Hythe House provides accommodation and care for up to 41 older people, some of whom may have additional care needs which include a mental disorder, physical disability or dementia. The home was purpose built and is owned and Care Homes for Older People Page 4 of 38 Over 65 31 31 41 41 0 0 0 0 Brief description of the care home managed by the Leicester Quaker Housing Association. The home is located within a residential area. George Hythe House offers accommodation on the ground and first floor, each floor comprises of two wings, one wing provides secure accommodation for people with dementia. Each wing has its own kitchen/dining area, where meals are taken. The ground floor provides the main lounge in the home, with a smaller lounge being available on the first floor. The wing which supports people with dementia and is secure has a small seperate lounge. All bedrooms in the home are single and have ensuite facilities, in addition each wing has a bathroom which provides bathing or shower facilities. There is a car park to the front of the home, and a surrounding garden, which provides seating. Information is located on site detailing the range of services offered, which includes an information pack. George Hythe House has copies of recent inspection reports carried out by the Care Quality Commission and its predcessor the Commission for Social Care Inspection. Information regarding fees was provided on the day. People funded by Leicester City Council range from £345.00 to £399.00 per week. People funded by Leicestershire County Council range from £341.00 to £404.00 per week. People funded by Leicester City Council who receive care in the wing which provides secure accommodation for people with dementia range from £420.00 - £474.00 People who fund their own care range between £478.00 to £532.00 per week. People who fund their own care who receive care in the wing that provides secure accommodation for people with dementia range from £553.00 to £607.00 per week. Care Homes for Older People Page 5 of 38 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: We as it appears throughout the Inspection Report refers to the Care Quality Commission. The inspection process consisted of pre-planning the inspection, which included reviewing the Annual Quality Assurance Assessment (AQAA), which is a selfassessment tool completed by a representative of the service, reviewing previous Inspection Reports, and any information we have received. The unannounced site visit commence on 2nd September 2009, and took place between 09:30 and 16:30. The focus of the inspection is based upon the outcomes for people who use the service. The method of inspection was case tracking. This involved identifying people with varying levels of care needs and looking at how these are met by the staff at George Hythe House. Three people were chosen and discussions were held with some of them, Care Homes for Older People Page 6 of 38 along with other people who live at the home. Staff members were also spoken with. We sent surveys to people who live at George Hythe House, and their relatives. We also sent surveys to health and social care professionals who support people living at the home, along with staff who work at the home. We did this to find out the views of people. We did this Key Inspection with an Expert by Experience who spoke to people who are using this service. An Expert by Experience is a person who either has a shared experience of using services or understands how people in this service communicate. They visited the service with us to help us get a picture of what it is like to live in or use the service. This is important because the views and experiences of people who use services are central to helping us make a judgement about the quality of care. The Expert by Experience spoke with people living at the home, and observed the interaction between staff working at the home and the people that live their. They also looked at the environment, and how it impacts on the care people receive. What the care home does well: What has improved since the last inspection? Information provided by the Registered Manager told us that improvements in the last year have included the use of equipment to reduce the number of falls for those who are frail. Menus have been changed and now include a soft diet option. Care Homes for Older People Page 8 of 38 Environmental improvements have included new seating and carpet in the main lounge, and a new television which has been secured to the wall. 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 set out 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 38 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 38 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. George Hythe House enables people who require residential care to make an informed decision as to whether the home is appropriate to their needs by providing information about the services it provides and through its assessment process. Evidence: We wanted to look at the information provided to people who use the service to find out whether it was detailed and answered all their questions, and to find out how the service passed on the information. We looked at the information provided to people in the information pack which contained information about the service the home provides, and included information about fees. We sent surveys to people who use the service and their relatives, information within surveys told us that the information available had enabled them to make an informed decision about moving into the home. Information provided by the Registered Manager in the self assessment tool which we Care Homes for Older People Page 11 of 38 Evidence: looked at before visiting the home told us that everyones needs are comprehensively assessed, and that everyone completes a pre-entry assessment form. We spoke with people at George Hythe House about their views of moving into the home, one person told us that they had moved to the home from hospital and that they had visited before deciding to move in. Whilst someone else told us that they couldnt remember why they had moved into the home. We looked at the records of three people who live at George Hythe House, and found that some files contained an assessment which had been undertaken prior to moving into the home, the other assessments we were told had been archived as the person had lived at the home for sometime. We sent surveys to health and social care professionals, which asked them for their views about the assessment process for people moving into the home, and whether they are confident that peoples needs are met, answers reflected that the assessment process was sufficient in their view. The records that we looked at told us that a representative of Social Services had reviewed the persons needs, and that the review had included a representative from Social Services, the person in receipt of care, a relative and someone from the home and the review notes detailed the persons needs were being met. A survey from a social care professional did comment, that reviews of peoples needs could be more effective if the wing team leader and residents key worker were to attend the review meetings. Care Homes for Older People Page 12 of 38 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 privacy, dignity and personal care and support people receive is compromised by individuals lack of influence in the care they receive and by care plans which are not readily accessible and internal communication practices within the home. Evidence: We wanted to find out how the health and personal care needs of people living at the home were met. We spoke with people living at the home and observed the care and support provided by staff, we also looked at the care plans and records of three people. Information provided by the Registered Manager in the self assessment tool which we received prior to our visit contained very little information as to how peoples health and personal care needs were met, and provided no information as to how people living at the home or their relatives were involved in the development or reviewing of their care plans. There was no information as to how care plans ensured that the needs of people were met, or whether peoples views, and expectations of care were recorded. It stated that care plans are accurate and that staff at the home liaise with Care Homes for Older People Page 13 of 38 Evidence: medical professionals. It states that records held in care files are regularly updated. We found by looking at care plans that records were not in all instances updated or accurate. The care plans that we looked at, started by providing information about a persons life before they moved into the home, including information as to their employment, family, hobbies and interests, however we find no evidence in the care plan as to how this information was used to support a persons individual needs, including hobbies and activities. We found that the care plans of two people had recently been reviewed, but the third care plan had not been reviewed for nineteen months, and information that it contained was no longer relevant. We sat with the person and spoke with them about their care plan, whilst the historical information was accurate they were able to tell us that they no longer walk with a zimmer frame as detailed within their care plan, but now use a wheelchair. Care plans were not comprehensive and provided an outline as to a persons needs such as support with personal care, but didnt give staff clear guidance as to what support was required, or focus on what the person could do for themselves, promoting their independence. When we spoke to senior staff at the home they were not familiar with the term Person Centred Care or a Person Centred Approach to care. We spoke with staff who work at the home and asked them how they know what support people living at the home require, they told us that in most instances they have worked at the home for several years and therefore know the people well. They told us that they rarely read the care plans, in part this is due to where they are stored, which is in the main office, and if they work in an area of the home which they normally do not work, then their are notes and notices kept within the dining kitchen for them to refer to. We saw examples of this where notices were attached to the kitchen cupboards doors in the kitchen/dining room, where people living at the home eat their meals. Notices provided information such as the eating preferences of people in that wing, including their likes and dislikes, information as to who needed to have their food cut up and we saw one example where personal care information was recorded:Please can all staff ensure that... has a bath three times a week on a Monday, Wednesday and Friday. This has been requested by the District Nurse to ensure that....is kept clean. This evidences that the privacy and dignity of people living at the home is not always Care Homes for Older People Page 14 of 38 Evidence: considered and that staff do not use care plans to establish the needs of people living at the home. A survey completed by a health care professional when asked what they thought the service could do better wrote:Respect patients privacy and dignity better. Relatives in their surveys to the question what does the home do well wrote:Very patient, caring and understanding. Treat all with respect and good humor. We value the patient, understanding and friendly support given to ... and us her nearest relatives. We value the quiet and peaceful environment at George Hythe House. We asked to look at records for staff meetings. We found that each wing had a monthly meeting, and by reading the minutes of these meetings found that staff discuss each person living in the wing and any changes to care and support required. We found examples where the care recorded within the wing staff meeting minutes conflicted with that detailed in the care plan. We also found in wing minutes statements detailing that one person was not allowed to go to the main lounge as they were disruptive to others living at the home and visitors, this shows that the rights, choices and decisions of some living at the home may not be as they prefer or desire. We looked at the risk assessments of three people, which supported individual care plans. Risk assessments identified risks and what action needed to be taken by staff to reduce risks to people they care for and themselves. As with care plans some risk assessments had been regularly reviewed, whilst others had not. Many risk assessments stated ongoing but their was no indication as to how long they had been ongoing. Risk assessments can only be effective if they are regularly reviewed and are linked with a care plan which is accurate and regularly reviewed. Inaccurate or out of date risk assessments has the potential to put people at risk. By reading the care plans and records of people living at the home we found that health care professionals were involved in the care of people and that George Hythe House made referrals to appropriate professionals when a persons health deteriorated. Health care records showed that General Practitioners and District Nurses visited the home regularly. The Expert by Experience spent time with people living at the home, a majority of which was spent in the wing which was a secure area of the home providing care and support to people with advanced dementia. They wrote in their report:- Care Homes for Older People Page 15 of 38 Evidence: One resident stays mainly in his room. He knew and understood about his care plan. A relative of the person was visiting spoke with the Expert by Experience, and in their report they submitted wrote:She was very pleased with his treatment and care, this home caters for all his needs and look after him very well, including getting him Chinese meals which he loves. The Expert by Experience also spoke to people and made observations about the care people receive. In their report wrote:All the residents I saw were tidy and clean. I talked to a resident from each of the wings. One person said I cannot fault the staff. All site visits carried out by the Care Quality Commission as part of the inspection process are unannounced. We asked to look at the minutes of meetings for staff. In the minutes of the general meeting held in August 2009, the following entry was made:CQC will be coming to Inspect the home on 8th September 2009. Staff to ensure correct footwear worn, details can be found in staff handbook. Staff are to ensure that when residents are hoisted a blanket is placed over there legs and to ensure the brakes are used. Jeanette (the Manager) is to devise a list of 10 small reminders for staff to carry around with them. This suggests that practices in the home may not always be as they should be, and that staff were being reminded of how to provide personal care and support appropriately. The Expert by Experience in their report wrote about their observations where the care and support provided to someone during their lunchtime meal, potentially impacted on their quality of life. During lunch one of the residents who had been given painkillers for their back found it difficult to sit and asked for a cushion. A cushion was brought and put behind them. The chair was of such a design that the back did not come down to the seat and the cushion kept falling out of the hole with either another resident or carer picking it up dependent upon who was in the room at the time. Towards the very end of the meal one of the carers realised that there were ties on the cushion, which had been looped together and repositioned them so they could be tied to the chair. I did not feel that Care Homes for Older People Page 16 of 38 Evidence: even this was very successful and at this point the resident left the room. I was told repeatedly that this resident loved their food and always ate it up very fast. They had not really touched the food and I do not believe it was all because of the pain but because they could not be put in a position to eat where their back was properly supported. We looked at the medication and medication records of three people, and in addition the records of people who were prescribed a Controlled Drug. There was one instance whereby a person had not been given their medication in the morning of our visit, and a code had been recorded in the medication record stating they were asleep. There was no evidence to suggest that the person had been offered their medication at a later time when they had woken up. Medication records for the other two people and those of people in receipt of Controlled Drugs were in good order. We saw good practice with regards to the administration of medication. Both we and the Expert by Experience witnessed the person responsible for the administration of medication explaining to people what their medication was for, and asked people who were prescribed medication for the management of pain as and when it was needed, if they were in pain and would like pain relief medication. Care Homes for Older People Page 17 of 38 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities are available for people to engage in activities and go on outings, but stimulation for people is limited by the availability of staff and the range of activities available to those with specific needs. George House House provides a wholesome and varied diet. Evidence: We wanted to find out how people spend their day, and how the staff working at the home support people to make decisions and stay in contact with relatives and friends, we did this by observing people throughout the day, talking with people at the home and by looking at the care plans and records of three people. The care plans we looked at included information about a persons life prior to their moving into the home, including their occupation but did not detail how staff could support people to continue to pursue hobbies and interests. Care plans did state whether individuals liked participating in activities and outings. George Hythe House employs an Activities Organiser who encourages people to engage in a range of activities, a timetable of activities is displayed throughout the home. Activities on the day of our visit occurred as detailed within the activities timetable, we did note that six people took part in a game of skittles in the centre of the lounge in the afternoon, Care Homes for Older People Page 18 of 38 Evidence: whilst others sat around at the outskirts of the crescent shaped lounge. Our observations were that the Activities Organiser was not supported by care staff in supporting people to engage in activities. We sent surveys to health and social care professionals and when asked what does the home do well, one person wrote:Offer a wide range of activities and day trips. Surveys we receive from people who live at the home and their relatives told us:They arrange activities and outings well. Staff in the surveys we sent them also included additional comments about activities:There is a lot of activities for the residents, and all the carers take part as well. We saw visitors arriving throughout our visit, and were welcomed by staff at the home. We spoke with relatives and they told us that they were happy with the range of activities which took place. We also found by talking with people who live at the home, and their relatives and looking at records that there have been several outings and events that have take place recently. These have included visits to Ulvescroft Grange, boat trips, shopping trips, a day outing to Skegness, out for a pub lunches and in some instances a range of take away meals. We also found that entertainers visit the home who sing and play the piano. The Expert by Experience in their report wrote of their observations:In the main lounge there was a large television on the wall. The occupants, however, sat a long way away around the edge of the room and as the room was semi circular I would think it was difficult for some residents to see the TV as it would be at a strange angle. For a short time in the afternoon some residents played skittles whilst others just watched. After that they just sat many going to sleep and only a couple of them seemed to be looking at the TV. All the residents rooms that I visited had a television and a couple of rooms had a very large amount of books. Some said that they did not watch the TV others just selected programmes. The wing for people with advanced dementia has a small lounge with a television in it and they usually sat there in the morning and the afternoon. Although there was a wide range of activities published for September (games, bingo, scrabble, bowls) not many would be suitable for people with dementia unless they had a specific carer with them and there was not enough Care Homes for Older People Page 19 of 38 Evidence: staff for that. I gained the impression, however, that the carers working on the wing for people with advanced dementia provided most of the activities. I did not see any games in their lounge when I looked. After dinner people in the wing were all in their lounge with the television on but the two staff were mingling with them and talking to them. In the other wings at the home the residents I spoke to mainly stayed in their own rooms reading or watching television. As there was only one staff member per wing they obviously could not spend time talking to the residents. In the wing for people with advanced dementia there were two staff and one of them said she liked working on that wing because it gave her more time to talk and be with the residents. I spoke with a resident who said I cannot fault the staff. I do have a problem with everyone being so much older than I am and most do not join in the activities because they go to sleep and I do not join in. I enjoy going on the days out and to the pub meals, they take me in my wheelchair. When we arrived in the morning, we found some people were sat in the kitchen/diner of their respective wing eating breakfast, which was cereal and/or toast. The care staff on duty in each wing are responsible for preparing and providing the breakfast for people, and then clearing away afterward. When people had eaten their breakfast, they either returned to their bedroom or went to the main lounge on the ground floor. The lunchtime meal is provided by the catering staff, and taken to the individual wings in heated trolleys, the care staff and other staff which include the Activities Organiser helped to serve the lunchtime meal, and provide support to those who needed help with eating. The Expert by Experience wrote in their report of their observations:I sat in the dining room of the wing for people with advanced dementia whilst residents had their dinner. There were no serviettes provided. The residents had clean over aprons on. Two residents had their dinner in their rooms and a third was not feeling well so remained in their room. One resident knocked over their juice before the meal started and was upset, trying to clear it up themselves. One of the carers cleared it up and managed to assure the resident that they had not done anything wrong. A couple of the residents had their food cut smaller and one was using spork (combined spoon and fork). One resident was sitting so they looked out of the window but this meant they had their back to the rest of the room including the carers. A carer occasionally went and talked to them during their meal. Care Homes for Older People Page 20 of 38 Evidence: The meal consisted of pork with potatoes and vegetables and was served by the carers and looked appetising and nutritious. Only a couple of times did I hear one of the carers tell them what it was. I do not think the other carer ever said unless it was in response to a question. Sometimes the plates were put down without verbal or non verbal contact. One carer usually touched the resident affectionately and did say a word or two. At one point there were three staff in the dining room one of who was dealing with medicines. Eventually there was only one, the other staff member went to help feed the residents in their rooms. At times, however, there was no carer in the room for quite a few minutes. Whilst they were away one resident tried to give the remnants of their pudding to their neighbour stating it was not theirs as well as their cup of tea. One resident had finished her meal got up and went away. When a carer returned she poured tea/coffee for the missing resident. Then the other carer brought the resident back and noticed she had not had her putting so gave her her pudding. Care Homes for Older People Page 21 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at George Hythe House are able to express their concerns, and have access to a complaints procedure, and are cared for by staff who are aware of their responsibility to report situations which may affect the welfare and safety of people living at the home. Evidence: We wanted to find out how the staff at George Hythe House promote the safety and welfare of people who live at the home, written information supplied by the Registered Manager before our visit told us that the home has an open door policy so that staff and residents can discuss any issues at any time. They also wrote that complaints are dealt with immediately and sympathetically. We looked at the homes complaint records and found that any complaints or concerns had been recorded, and that the investigation process and information gathered had been recorded, and that the complainant had been given feedback. This shows that complaints are managed well, and enable people to be confident that their concerns will be responded to and acted upon. We sent surveys to people who live at George Hythe House and their relatives and asked them if they knew who to speak with if they were unhappy, and if they knew how to make a formal complaint. A majority of surveys told us that people knew who they could speak with and knew how to make a formal complaint. Care Homes for Older People Page 22 of 38 Evidence: A copy of the complaints procedure is included within a brochure which is part of the information pack provided to people when considering moving into George Hythe House. The complaints procedure is also displayed on the notice board within the entrance foyer of the home. We spoke with people living at the home and asked them if they knew who to speak with if they were unhappy, they told us:Id speak to my daughter, shed sort it out. Never had any reasons to complain. We wanted to find out how staff promote the welfare of people living at the home, those staff we spoke with told us that they had receiving training on Elder Abuse, which had told them about how vulnerable people are at risk, and the type of abuse they maybe exposed to. The understanding of staff on Elder Abuse differed between staff we spoke with, but all said that if they had any concerns they would report it to the Manager. Records for staff training were not available and we were told that they were kept at head office, we therefore could not determine whether all the staff had received training on Elder Abuse. We spoke with senior staff on duty who were not aware of the Mental Capacity Act, information provided by the Registered Manager in the self assessment tool, made no reference either to this legislation, all staff need to receive training in this to ensure that the rights or people living at the home are supported. Care Homes for Older People Page 23 of 38 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. George House House provides a good standard of accommodation, however improvements to the internal decor of the home could improve the quality of life and experiences for those with dementia. Evidence: We wanted to find out how the environment impacted on the day to day lives of people living at George Hythe House, and whether it met their needs and was well maintained. Information provided by the Registered Manager in the self assessment tool prior to our visit provided little information, but stated that the home was clean, safe, and well maintained with a homely environment. The information did tell us that carpets and armchairs in some communal rooms have been replaced, and that the wing for people with advanced dementia was having a walk in shower fitted. George Hythe House has a large entrance foyer, providing access to the office and the main central lounge. On the ground floor their are two wings, with a further two wings on the first floor. Each wing has a kitchen/diner where everyone eats their meals, and located within the wing are peoples bedrooms. All bedrooms at the home have an en-suite facility consisting of a wash hand basin and toilet, in addition on the ground floor en-suites also have a shower. Each wing has a bathroom, two housing a Parker bath, and two a walk-in-shower. On the first floor is a small lounge, however on the day of our visit we didnt see anyone using this room. The hairdressers salon is Care Homes for Older People Page 24 of 38 Evidence: also on the first floor. The wing which is secure and for people with dementia also has its own separate lounge. There is parking to the front of the home, and flat level access to the property. Their is a garden which surrounds the home, which is well maintained. The Expert by Experience made observations which were reflected in their report and wrote:The initial view of a well built purpose home was spoilt by the dead flowers in the hanging baskets. The main corridors were clean but could do with a coat of paint and many would have been brightened up with more pictures. There was no particular smell except in the wing for people with dementia. I believe that when I walked in there was a smell which may have been caused by the relaying of a floor during the alternation of a bathroom into a shower room. In this wing however there was a very strong urine smell at the end of the corridor. All the residents rooms that I visited were very individual to themselves with many family photographs and books, televisions and they all had a refrigerator in their room. At the entrance there were handing baskets and nearly all the plants in them were dead. I did not look around the gardens but could see them out of the windows and them seemed very pleasant. I did look at the secure garden made for people with dementia. I was told that the staff had brought in the coloured gnomes to help brighten up the garden for the residents. On good days these residents could go out in the garden although one of the residents said it was too far for them to walk. Inside at the entrance to each of the wings there was a notice board with the name a photograph of the Team Manager, the day and date and the names of all the staff who would be on that day. These were all up to date. All the corridors were in a neutral colour. Some of the corridors only had one painting which left them very bare. The main corridor at the entrance had several panels of photographs of residents on outings, which included a boat trip and a party. I thought these panels very good but copies on each wing would have been ideal. The wing for people with advanced dementia was a secure area. The corridor has many photographs of old fashioned commercial advertising. I though this could be quite a talking point with residents/carers/families as they were images that residents could remember. Care Homes for Older People Page 25 of 38 Evidence: The residents door usually had a number on them and a small written label with the residents name. On some doors there were photographs of the occupant at a slightly earlier age and A4 paper with their name on. When we arrived in the morning their was a odour of urine in the entrance foyer, which dissipated later in the morning once the cleaning had been undertaken. Communal areas were light and airy, and the home appeared well maintained. Improvements could be made to the environment to support the orientation of those with dementia by using colours more effectively within the home, along with signage. Surveys we received from people living at George Hythe House and their relatives told us:We value the quiet and peaceful environment at George Hythe House. We value the care for the environment and facilities. A social care professional within their survey wrote:Have good sized rooms with facilities for people to make their own hot drinks and fridge for snacks. Care Homes for Older People Page 26 of 38 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at George Hythe House are supported by staff who in many instances have a qualification in care, but staffing levels are not always sufficient to promote person centred care and enable people to live a lifestyle of their choosing. Evidence: We wanted to find out what the staffing arrangements were for George Hythe House, and whether these arrangements were able to provide the care and support people living at the home required and needed. We spoke with staff who work at the home and asked them about staffing levels. They told us that their should be two members of care staff on duty in the wing for people with dementia, and one member of staff working in each of the other three wings. The three wings should be supported in the morning by an additional member of staff who helps out across the other three wings as and when required. On duty at all times is a Shift Leader whose responsibilities include the day to day management of the home, the administering of medication, and dealing with any visitors. On the day of our visit, the Registered Manager was not on duty, and the home was being managed by a relief Shift Leader, working alongside them were five members of care staff, which meant two staff working in the wing for people with dementia, and one person in each of the three remaining wings, but no one to provide additional support. To facilitate the inspection, someone who was not rostered to work was Care Homes for Older People Page 27 of 38 Evidence: asked to come in, this shows that their is no capacity in the home to meet unexpected or unscheduled situations, without additional resources being requested. The three wings with one member of staff on duty accommodate between ten to twelve people, in addition to the member of staff being responsible for providing personal care and support they are also responsible for preparing and providing breakfast to each person, along with any support they may need to eat their meal. Our observations were that staff were very hurried and had little time, rushing from one situation to another, and were therefore task orientated as opposed to being able to support people to live a lifestyle of their choosing. One person we spoke with said I dont like to get up, I prefer to have a lie in bed, but you dont have a choice here.. Other records we read, which we reflected in the Health and Person Care section of this report, suggest that the home is run in some instances to support the staffing and administration of the home as opposed to the expectations and preferences of people living at the home, with directives as to what time people go to bed, and restrictions on someone accessing the lounge. Care plans in many instances do not include information as to how a person chooses to spend their day, i.e. what time they prefer to get up, what days they prefer to have a shower or bath, where they prefer to spend their day, such as in their bedroom or the lounge. Preferences for where they choose to eat their meals were not recorded and neither were their preferences for going to bed. We did find instances where limited information was recorded in care plans, however information in the minutes of wing minutes contradicted the information recorded in care plans. The Expert by Experience in the report of their observations noted where the lack of staffing impacted on the care and support provided. An example of this was as detailed within the section of the report Daily Life and Social Activities, where in some instances people were left unattended and someone offered the person sitting next to them the remnants of their pudding and hot drink. We observed in the afternoon that many people went to the lounge on the ground floor, with a few people engaging in the activity of skittles, with the remaining people sitting around the outskirts of the room. Once the activities had finished and the Activity Organiser went home, the Expert by Experience and I sat in the lounge. We noted that no staff entered the lounge for approximately twenty minutes, when the emergency door was activated by a resident opening the fire exit door into the garden, a number of staff came to the lounge to find out the cause of the emergency buzzer. Care Homes for Older People Page 28 of 38 Evidence: We spoke with senior staff who were on duty throughout the day, they told us that given the range of duties they were expected to undertake in a day, it left them little time to review and update paper work including care plans. Care staff told us that they felt staffing levels were not always sufficient, with the exception of the wing for people with dementia where their are two staff on duty, and fewer residents the number accommodated is nine. Survey completed by health and social care professionals provided the following information with reference to staff:Staff training and availability at times is at a low level. Surveys completed by relatives provided conflicting information: Theres always someone to watch over her as you could not leave her long. Surveys completed by people living at the home equally gave mixed views with some stating that staff only sometimes listen and act upon what they say, and are sometimes available when they need them. Whilst sitting in the lounge with people living at the home in the afternoon, we saw one lady taken to the toilet by a member of staff, when they returned the lady turned to the person on her left and said at least shes pleasant, some of them arent, as theyre so busy. Staff surveys also in the main indicated that additional staff in their view were needed. We spoke with staff who told us that they had received training in Elder Abuse, food hygiene, moving and handling and a one day course in dementia awareness. The information provided within the self assessment tool completed by the Registered Manager providing no information about staff training, other than staff receive certificates for training they attend, and that training is ongoing. There was no information as to what training staff undertook or how the training improved the quality of lives for people living at the home, but did tell us that 67 of staff have attained a National Vocational Qualification in Care. We asked to see the training records for staff, but were told these were kept by head office, and those facilitating the inspection were not aware of any training records kept at the home. We were therefore unable to determine the range of training staff receive. We wanted to find out how staff were recruited and whether the recruitment of staff promotes the health and well being of people who use the service. The recruitment of staff a George Hythe House is manged by head office. By looking at the files of three Care Homes for Older People Page 29 of 38 Evidence: staff who were on duty at the time of our visit was found that all had completed an application form, and had confirmation of their identification. Two written references had also been undertaken and their was proof that a Criminal Record Bureau (CRB) disclosure had been sought, which means staff have been vetted to ensure that they are suitable to work with vulnerable adults. Care Homes for Older People Page 30 of 38 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems for the management of information and record keeping need to be reviewed to ensure the efficient running of the home, and quality assurance processes should be used to influence the development of the home for the benefit of people to which it provides a service. Evidence: The Registered Manager was not at the home when we visited, and the inspection was facilitated by staff working at the home. Information provided by the Registered Manager in the self assessment tool was not comprehensive and providing minimal information as to how George Hythe House supports and cares for people well, how it manages the home on a day to day basis with consideration to the needs of people living at the home, and had limited information as to planned improvements. Planned improvements were identified as Ensure that the present standard is maintained. or To continue and be open to new ideas. Barriers to improvement were identified as a lack of funding, with Social Care Homes for Older People Page 31 of 38 Evidence: Services fees not meeting the cost of maintaining the level of service that the home provides, therefore the home seeks additional funding through fund raising which is time consuming and not always successful. The self assessment tool did not provide any information as to the training the Registered Manager has undertaken. George Hythe House does consult with people who live at the home and their relatives, they do this by sending out surveys to those living at the home and asking them to comment on the care and service they receive. The information detailed within the self assessment tool told us that as a result of consultation, improvements have been made to the menu, and now include ready meals for those requiring a soft diet. The opportunity for people to go out has increased, and their have been some environmental improvements. We saw the surveys returned to the home by its residents, but found no evidence that the surveys are collated with a report produced as to its findings. There is no evidence that those who take part in the process are advised as to the outcome, and know what changes are going to be made as a result of the consultation process. The Expert by Experience wrote in their report:I was given conflicting information about resident meetings, one resident said that they had none, another said yes that had them and a further resident said very occasionally. All the residents said they had no complaints and said if they did they went to Jeanette (the Manger), who would deal with it. George Hythe House also reviews the quality of care it provides by receiving visits from a person external to the home, who is employed by Leicester Quaker Housing Association, who visits every month and speaks with people who live at the home, visitors and staff. We read the reports of their visits, which were positive and included the views of people they had spoken with, we did find that they did not identify areas for improvement or areas that the home or staff needed to act upon. This supports information as detailed with the self assessment tool, that the home ensures residents standards are maintained, with no planned areas for improvement. We found that record keeping needed to be improved, care plans and risk assessments need to be regularly reviewed and updated, and be a working document which is referred to and used on a daily basis, by all staff, to ensure that the needs of people living at the home are met, as opposed to have personal information displayed on cupboard doors and accessible to all. The self assessment tool completed also had gaps in the information requested including maintenance schedules, which we looked at and found to be in good order, gaps were also identified in that policies and Care Homes for Older People Page 32 of 38 Evidence: procedures are stated as being reviewed but no date given as to when this took place. Staff have the opportunity to attend regular meetings, which include general staff meetings, and individual wing meetings which primarily focus on discussing the care and support of people living within that area of the home. Staff within the surveys made the following additional comments:The home runs very well it is like a little family. There is a lot of activities for the residents, and all the carers take part as well. We all work together as a team. I feel the home is run well. We spoke with staff who told us that they feel supported by the Management Team, and that they have opportunities to meet and discuss their work and training needs. Care Homes for Older People Page 33 of 38 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 34 of 38 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 12 The registered person to ensure that the health and welfare of service users is promoted by staff in a manner which respects their privacy and dignity. Privacy and dignity of service users to be maintained and promoted. 02/12/2009 2 7 15 The registered person to 02/12/2009 ensure that each person has a care plan, and that the care plan is kept under review, and is developed in consultation with the service user or their representative. To ensure that the care and support an individual requires is comprehensively documented. 3 18 13 The Registered Person to ensure that all staff receive training and gain an awarness of the Mental 02/12/2009 Care Homes for Older People Page 35 of 38 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 Capacity Act and Deprivation of Liberty Safeguards. To ensure that the welfare and rights of people who receive a service are acted upon and promoted. 4 27 18 The registered person to 03/11/2009 ensure that staffing levels are reviewed and kept under review. To ensure that people receive the care and support they need and expect. 5 30 18 The registered person to ensure that staff receive training and guidance as to the principles of person centred care. To support peoples individual lifestyle choices and preferences. 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 02/12/2009 1 2 7 9 Care plans are kept within each wing and are up to date and reflect the needs of people living at the home. The medication policy and procedure to be reviewed to ensure that where people are asleep, medication is reoffered at a later time when the person has woken up. The privacy and dignity of people should not be compromised. Information displayed on the doors of Page 36 of 38 3 10 Care Homes for Older People 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 kitchen cupboards as to peoples individual care and support to be removed, and such information kept within the persons care plan. 4 12 Care plans are developed which include activities and recreational pursuits, with particular reference to those people with dementia and communication difficulties, to ensure they receive a tailored and individual service reflective of their personal circumstances and preferences. George Hythe House to research how changes to the environment with reference to internal decor could improve the quality of life for people living at the home with dementia, and act upon the findings. A record as to the training staff have received, including planned training is available to view. The quality assurance process produces a report identifying the outcome of the consultation process, along with any actions the home intends to take to improve the service it provides, and that a copy of the report is made available to all. 5 19 6 7 30 33 Care Homes for Older People Page 37 of 38 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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