Inspection on 19/08/09 for The Laurels and The Limes Care Home

This inspection was carried out on 19th August 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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

Key inspection report Care homes for older people Name: Address: Kersal Mount Care Home 115 Manchester Road S Yorkshire S10 5DN     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Shirley Samuels     Date: 1 9 0 8 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 27 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 27 Information about the care home Name of care home: Address: Kersal Mount Care Home 115 Manchester Road S Yorkshire S10 5DN 01142660202 01142661178 kersal.mount@hillcare.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hill Care Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 88 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only Care Home only - Code OP Care Home with Nursing Code N. To service users of the following gender - either whose primary care needs on admission to the home are within the following categories - Old age not falling within any other category Code OP Dementia Code DE The maximum number of users who can be accommodated is 88 Date of last inspection Brief description of the care home Hillcare Limited is registered to provide nursing care for up to 88 older people. The majority of bedrooms are single. A proportion of both single and double rooms are provided with en-suite facilities. The home provides a range of communal areas and bathing facilities. The home is within two separate buildings, close to one another. One is a stone building, which has been converted, the other a stone, purpose built Care Homes for Older People Page 4 of 27 Over 65 13 88 0 0 Brief description of the care home premise. The homes gardens are landscaped and well maintained. A car park is provided. The home is situated on the south side of Sheffield. Local amenities are a short walk away. Public transport passes the home. The manager told us that the current fee range was £355.00-£520.00. There are additional charges for chiropody, hairdressing, holidays, magazines, newspapers, toiletries and staff escorts for outings. Further information relating to these charges may be obtained from the homes manager. Information about the home is provided to people and their representatives in the form of a service user guide. Leaflets and other general written information are posted around the home and available at the homes reception. The inspection reports are displayed in the entrance to the home. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection carried out by Shirley Samuels on the 19/08/09 from 8:00am-6:00pm. This is a new service, registered with us in March 2009. As part of the visit we sought the views of the people using the service, their relatives and staff. Some people completed questionnaires before the inspection, others were spoken to on the day of the visit. We checked a selection of documents regarding peoples care and support, staff records and records that show evidence of compliance with regulations and standards. Before the inspection the manager completed an Annual Quality Assurance assessment (AQAA). This information provided by the manager, tells us how the service has developed and what is planned to further develop the service over the next 12 months. People who live in a care home and find it difficult to communicate with our inspectors Care Homes for Older People Page 6 of 27 will now get the chance thanks to a new observation technique. When visiting a home, inspectors will watch how people with dementia or a learning disability behave to find out what they think of the care they receive. The tool, called the Short Observation Framework for Inspections (SOFI), has been developed between us and the University of Bradford. This tool was used during this inspection. The inspector spent two hours in one of the lounges making observations of the care and interaction between staff and people using the service. This aids us in making a judgement about the standard of care and the outcomes for the people using the service. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: Some people felt that improvements made following the outcome of complaints were not maintained. A better level of supervision was needed, to make sure people took their medication. Staffing levels on the unit for people living with dementia should be increased. This would make sure people have the levels of supervision they need to promote their safety and wellbeing. Care Homes for Older People Page 8 of 27 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 27 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 27 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. Peoples needs were assessed. This made sure staff had the information they needed to make a judgement about whether or not they could meet peoples needs. Evidence: There was evidence on each of the three files checked, to show that people did not move into the home without having their needs assessed. Assessments were carried out by social workers. The home also carried out their own assessment. This made sure they had the information they needed. The manager told us the home did not provide intermediate care. Care Homes for Older People Page 11 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans were in place, peoples health care needs were met and their rights were upheld. This showed that peoples health and personal care needs were met. Evidence: Each person had a plan of care. People told us they were asked about what they liked and did not like and added that family members were consulted. The care plans seen detailed peoples needs, what help they needed and who from. The daily records detailed what action staff had taken, improvements and any deterioration. Care plans were reviewed and in the main reflected what had happened for people the previous month and any changes. This meant that peoples needs were detailed in a plan of care and reviewed at regular intervals. The records showed that appointments were made for people to see health care professionals. These included the, Dentist, Optician and Chiropodist. People told us that they were confident, if they were ill the staff would get the Doctor for them. They told us most staff are attentive, they work very hard. Care Homes for Older People Page 12 of 27 Evidence: The home had a medication policy. All staff responsible for administering medication were trained. Medication was administered by qualified nursing staff. Medication was stored appropriately. Records were kept of all medication received, administered and leaving the home. Some controlled drugs were administered. They were stored and recorded appropriately. There was evidence to show that medication reviews took place. People told us in the main they received their medication on time. Although they did say that on occasion when staffing levels were short, medication could be delayed. In the main the records of medication administered was good. There was however evidence that on one shift the nurse had not signed for a number of medications that had been given. This was pointed out to the manager at the time of the visit. People told us they were treated with respect and dignity. Some people told us it was usually the same member of staff who attended to their personal care needs. This they said, helped them to feel less embarrassed. Staff were able to tell us how on a daily basis they respected peoples rights and promoted privacy and dignity. The examples staff gave us included, sharing information, getting to know people, knocking on doors, offering choice, speaking to people in a respectful manner, being patient and treating people as they would want their relative to be treated. Some staff added, that they felt frustrated as they were often rushed, and felt they did not always have the time (they felt they needed) to spend with people. Care Homes for Older People Page 13 of 27 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. There were shortfalls in peoples overall experience of daily life and social activities. Evidence: People told us that opportunities to take part in social activities was not as good as it used to be. Staff told us that the person responsible for activities was off sick. This responsibility was delegated to another person but due to staff shortages this person was covering other duties. Staff told us, activities and opportunity for stimulation and interaction could be improved. During the inspection observations were made of staff interacting with people. We observed, staff playing board games, reading and quizzes. Staff also encouraged people to interact with each other. Groups of people were seen playing games and passing the time of day with each other. People using the service told us they were able to receive friends and relatives. Staff told us they felt it was important that contact with family and friends was encouraged. The home used to have a person on reception who greated visitors and who was able to give information. There is no longer a person on reception. people using the service and visitors to the home have commented that they missed having this person. They Care Homes for Older People Page 14 of 27 Evidence: felt it helped them to feel welcomed and informed. People told us, they were able to make choices about how they spent their day and who they spent their time with. They told us, they felt there were some restrictions due to staff time and the needs of other people. People told us there had been some improvement with the meals provided. They told us, some days are better that others, sometimes I just dont feel like eating, sometimes we dont get what is on the menu I think there could be a little more choice at teatime. Breakfast and lunch was observed. People who needed assistance and encouragement, were offered this appropriately in the unit for people living with dementia. We observed that there needed to be more supervision of people in the dining room on the Limes unit. Staff who brought people into the dining room made sure they had a drink and cereal. The member of staff on dining room duty was not always in the dining room. This meant that people were left unsupervised and some people did not receive the prompts they needed to eat the food that was given to them. Care Homes for Older People Page 15 of 27 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 allegations of abuse were taken seriously and investigated. This meant that people were protected from harm or abuse. Evidence: Records of complaints were kept and contained details of the complaint, the investigation and the outcome. People were always given the opportunity to discuss the outcome and add comments if they wished. Details of how to make a complaint was posted around the home. People received this information about how to make a complaint as part of the service user guide, given to them or their representative when they first came into the home. Following the inspection we spoke to some relatives over the phone. They told us that some improvements had been made since the new manager had stated. There were however current problems that they felt were not being addressed appropriately. Some of these problems related to the attitude of some staff when relatives made comments or raised concerns. Some relatives added there was failure to maintain improvements following action taken after a complaint. There had been four safeguarding referrals. Two had been accepted as safeguarding and investigated. The outcome was, there were shortfalls in the care provided and resulted in recommendations being made. The home had responsibility for investigating two other referrals, which were not taken into the safeguarding Care Homes for Older People Page 16 of 27 Evidence: procedures. This resulted in a staff member being dismissed and the implementation of improved and more robust practices. Although there were a high number of referrals, this indicated that the manager took allegations of abuse seriously and dealt with them appropriately. Care Homes for Older People Page 17 of 27 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 home was clean and well maintained. This made sure people lived in a comfortable environment. Evidence: Refurbishment and redecoration of some parts of the home had taken place. People told us they were happy with their bedrooms, they were able to bring items in with them to make them their own. The bedrooms were personalised and in some instances reflected peoples interests and hobbies. The grounds were well maintained, safe and attractive. Fencing had been erected to create an enclosed garden area with seating. People told us they enjoyed using this area when the weather was good. Staff told us they had the tools, equipment and materials they needed to carry out their domestic role and to make sure the home was kept clean. In the main the comments about the cleanliness of the home was positive. There were however some comments from staff and people using the service that indicated the standard of cleanliness needed to be consistent. Staff told us they had received training in infection control. They were able to tell us the steps they took to make sure good standards of general and personal hygiene Care Homes for Older People Page 18 of 27 Evidence: were maintained. They added, they were provided with gloves, aprons, hand wash and sanitisers. These were always available and stocks replenished. This showed the home was clean and well maintained. Care Homes for Older People Page 19 of 27 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. Although there were safe recruitment procedures and staff were trained to do their job, there was not always sufficient staff on duty to meet peoples needs. This may at times put people at risk. Evidence: People using the service told us, in the main staff came quickly when they rang the nurse call for assistance. We were told that there were times when there were not enough staff and people had to wait. We checked the rota for the four weeks before the inspection. These showed there were a number of shifts where agency staff were used. There were also some shifts where the minimum staffing levels had not been maintained. The use of agency staff can create inconsistency in the care provided to people and puts extra pressure on existing staff. However it did demonstrate that the home had taken steps to cover staffing shortfalls. There was some evidence that additional staffing was needed on the unit for people living with dementia. There were some behaviours displayed, that could place people at risk if there were insufficient levels of supervision. There was no evidence that people were being put at risk. The records showed that staff received ongoing training. This was to make sure they had the knowledge and skills needed to do their job. Care Homes for Older People Page 20 of 27 Evidence: The home had a recruitment policy. The three staff files checked, included all the information required. This included, application form, criminal record check, references, identification and Pin number for staff working as qualified nurses. This meant that people were protected by the homes recruitment procedures. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was well managed. There were procedures in place to ensure safe working practices. This showed that people benifited from a service that was run in their best interest. Evidence: The home had a new manager, who had several years experience in managing care homes. The home was well managed and the manager had good, sound knowledge of her role and the responsibilities regarding the Care Home Regulations and the National Minimum Standards. At the time of the visit the manager told us, she had not yet applied to register with us but added she was in the process of gathering the required information. Staff spoke positively about the manager they told us she was approachable and protective of staff. People using the service told us that she was doing a good job, things are improving. Care Homes for Older People Page 22 of 27 Evidence: People told us they were able to comment on the way the service was run. We saw a summary of comments made by people about the service. This was available in the entrance to the home. It gave people information about what people felt about the service and how things could be improved. The manager told us that comments received provided some direction for the future. This meant that people were able to contribute to the way the service was run. People told us they were happy with the arrangements in place for looking after their money. They told us they were able to access there money when they wanted it. This showed that peoples financial interest were safeguarded. Staff told us they had received health and safety, moving and handling and training on control of substances hazardous to health and fire safety training. We observed good practice regarding moving and handling. Staff communicated well with people, explained what they were going to do and offered reassurance. Staff were observed using gloves, aprons and washing hands. This meant that staff practiced good hygiene and safety procedures. Staff were able to tell us the steps they took on a daily basis to promote peoples health and safety. The records showed that regular checks were carried out on equipment, gas electricity and the fire system. This meant people were protected by the homes safety procedures. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 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 15 18 Action should be taken to make sure that people have the supervision and support they need to eat their meal. This is to make sure peoples needs are met. 02/10/2009 2 27 18 There must be sufficient staff at all times working at the home and people living at the home must be provided with the appropriate levels of supervision. 02/10/2009 This is to make sure peoples needs are met and they are protected from unnecessary risk of harm. Care Homes for Older People Page 25 of 27 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 12 16 Action should be taken to make sure there is a consistent opportunity for people to take part in social activities. Action should be taken to make sure, improvements/changes made following complaints are maintained. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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