Inspection on 19/02/09 for Nevetts

This inspection was carried out on 19th February 2009.

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

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

Other inspections for this house

Nevetts 12/02/07

Nevetts 12/01/06

Nevetts 05/05/05

Nevetts 02/12/04

Nevetts 11/08/04

Nevetts 18/03/04

Similar services:

Henrietta House

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Nevetts Bowling Green Lane Buntingford Hertfordshire SG9 9DF     The quality rating for this care home is:   two star good 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: Jeffrey Orange     Date: 1 9 0 2 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 25 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Nevetts Bowling Green Lane Buntingford Hertfordshire SG9 9DF 01763271737 01763275741 nevetts@quantumcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Quantum Care Limited Name of registered manager (if applicable) Mrs Ann Clay Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Nevetts is a care home that accommodates up to 41 residents who require care due to old age, dementia and physical disability. It also offers respite facility for up to one service user. It is a two-storey purpose built home that was constructed for the Hertfordshire County Council but has since transferred to the independent/voluntary sector and was completely refurbished at that time. The ground floor comprises an entrance lobby, two lounges, a kitchenette and dining room, the main kitchen, the laundry, two offices and two staff rooms. There are also seventeen single occupancy bedrooms, two assisted bathrooms and four toilets. The first floor is served by a passenger lift. This floor comprises a kitchenette and dining room, two lounges, twenty-four single occupancy bedrooms, three assisted bathrooms and six toilets. The Care Homes for Older People Page 4 of 25 care home 41 Over 65 41 41 41 0 0 0 Brief description of the care home home has ample off-road parking places at the front of the building and gardens at the back and side. It is located in a quiet residential area of Buntingford, and is within walking distance of the main shopping area and other amenities. The current fees range from £470 to £540 per week. Information about the home and the services it offers are contained in its Statement of Purpose and Service Users Guide and a copy of the latest report on the home by the Commission for Social Care Inspection (CSCI) is also available in the home. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: The last key inspection on this service was completed on 12th February 2007. We also carried out an annual service review of the service in February 2008. We do an annual service review when there has been no major inspection of the service (called a key inspection) in the last 12 months. It does not involve a visit to the service but is a summary of new information given to us or collected by us since the last key inspection. The current key inspection was conducted by one inspector, where this report refers to we it recognises that it is written on behalf of the CSCI. The inspection started early in the morning and enabled the morning routine of the home to be observed as people living there were getting ready for the day ahead. During this inspection we were able to observe and talk to people who live in the home, members of the care, administrative and ancillary staff team, together with visitors to the home Care Homes for Older People Page 6 of 25 and the manager and deputy manager. We were able to look at some key records, including those for staff recruitment, care planning and medication administration. We also received surveys from care staff, relatives of people living in the home and health professionals associated with the home. We have also made use of the information provided to us by the home in their annual quality assurance assessment or AQAA. The AQAA is a self-assessment document that assessed the care outcomes for people living in Nevetts, it also includes some useful statistical information, for example on complaints and staff training. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Anyone considering Nevetts as a home for themselves or someone they are responsible for can be assured that they will only be admitted once a thorough and detailed assessment process has established their needs can be appropriately met. They can also be confident that they will be provided with sufficient detailed information to enable them to make a well-informed decision about a prospective move into the home. Evidence: When we looked at the Personal Guide for the home, that is provided to anyone considering Nevetts as a home for themselves or someone they are responsible for we found that it included very comprehensive information about the home, including what is offered and what the terms and conditions that apply are, all in a very clear and accessible format. We were also told that this information is available on-line. This means that people have access to the clear and detailed information they need in Care Homes for Older People Page 10 of 25 Evidence: order to reach a well-informed decision about the home. When we spoke to the relative of someone in the process of moving into Nevetts, they told us that they had adequate information and also opportunities to visit the home before any decision was made. When we looked at pre-admission assessments for people who had recently been admitted to the home, we found that they contained the detailed information that care staff would require in order to both identify and meet their needs. It was confirmed by the home in the AQAA that pre-admission visits to the home are encouraged, so that people considering Nevetts as their home can have the opportunity to look round it, to meet key staff and people who are already living in the home in order to judge if it will meet their needs and be a place where they feel they could be happy. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Nevetts can be assured that they will receive the personal and health care support they need to maintain their well-being. They can also be confident that the basic standard of care planning and medication administration recording is satisfactory and provides care staff with the information they need to meet their personal and health care needs. Evidence: When health professionals responded to our surveys, they told us that the home always seeks advice appropriately and acts upon it to manage and improve the health care of people living in Nevetts. They also assessed that the health care needs of people living in the home are always met. When we looked at care plans we found that they included details of visit by a range of health care professionals to people living in the home. This confirms that they have access to the routine health care services that they need. When we looked at the care plans of some of the people that we met and talked to whilst in Nevetts, we found that they included the basic information to help staff Care Homes for Older People Page 12 of 25 Evidence: identify their care needs and how they were to be met, although the level of personal detail varied considerably and there were varying degrees of consistency in the way that care plans were completed. For example weights could sometimes be recorded in imperial measure and at others in metric, which could make comparison and monitoring more difficult than it needs to be. We saw evidence of a regular review process to make sure that any changes in care needs were identified and acted upon and we also saw that care plans included risk assessments to identify and eliminate or reduce risks where possible. It was however not always possible to confirm from care plan records that where a specific risk had been identified, action in line with Quantum Cares own guidance had been followed, although we were assured that it had been. In their AQAA the home identify the need to improve care plans and this process has already been started. Some features of care planning that we saw were very good, for example there is a very clear at a glance care plan summary that enables staff to quickly access the principle areas of need for people they have to provide care for and how they are to be met. In their AQAA the home again identify the need to improve the standard of recording for medication. When we looked at medication records we found a frequent system of checking was in place, and the storage and administration of controlled drugs was satisfactory.The recording system for those medications that are only taken from time to time was also satisfactory.There were some gaps found in medication administration records and whilst these had in most cases been identified, the action taken was not always clearly recorded. It is understood that since this inspection the pharmacy advisor from Quantum Care has visited the home and that, together with the manager they have addressed this concern. When we received comments from relatives of people who live in the home they told us Nevetts provides an exceptional level of care and devotion to the residents and The staff are kind and caring Throughout this inspection we saw care staff interacting with people who live in the home in ways that were appropriate and respectful and supported their dignity. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Nevetts can be confident that they will be given some opportunity to take part in meaningful and stimulating activities, such opportunities are limited by the level of resources available and may not be consistently available every day or in the evening. Evidence: When we asked relatives of people living in Nevetts about activities they told us that meeting the needs of the most dependent at the same time as the less dependent was a challenge and that in their view sometimes there was not enough stimulation for the more able. We were informed that the activities programme is not routinely available in the home and covers only four days with care staff having to provide stimulation and purposeful activities at other times, dependent upon their other care duties. This means that activities can be sporadic and people living in the home may not necessarily be aware of what is going on in advance. Care plans include space for records of activities but these are not always completed. The activity staff do attempt to give one to one time to the more dependent people that live in the home, this might include for example head massage. Care Homes for Older People Page 14 of 25 Evidence: We were told of special event that take place from time to time, such as pub afternoons, carpet bowls, darts, discussions and reminiscence sessions. Activity staff had also identified that a number of men in the home might benefit from some its a mans world sessions focusing on sport and other activities which might be thought to be most appropriate, although not necessarily exclusively, to men. When we observed lunch, we saw that there was an opportunity for people to sit in different areas to have their meals. when we spoke to some men who were sitting together in a small dining area, they told us; Men only in here! and added that The food is good. When we observed lunch in other areas we saw help being given when required in a sensitive way and we heard people being offered choices of what they wanted to eat and we also heard people being given the opportunity to have seconds if they wanted them. The home informed us in the AQAA that each resident has a food preference sheet in their care plan and that the chef manager is made aware of any special needs, preferences and dietary requirements.This should ensure that realistic individual choices can be exercised by people living in the home. People living in the home are consulted about the menu at residents meetings and the Chef Manager also makes efforts to speak to individual people living in the home about menu choices. When we spoke to people visiting the home they told us that they always felt welcome. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Nevetts and those responsible for them can be assured that they are protected from abuse and that their views are listened to, taken seriously and acted on appropriately. Evidence: When we spoke to members of the staff team they had a good understanding of what constitutes abuse and what to do if it is seen or suspected. When we looked at training records we could see that all staff receive training in safeguarding vulnerable adults and that their initial induction includes whistle blowing so that they are aware of how to raise any concerns they may have outside of the home if they feel unable to do so within. The home told us in their AQAA that only one complaint had been received in the last twelve months, that it had been resolved within 28 days and was not upheld. We saw that Nevetts has a complaints policy and procedure that is clearly written and easy to understand. It is available on request in a number of formats which means that anyone living in the home or responsible for them can readily make a complaint about the care outcomes and experience in the home if they need to do so. No issues or concerns about the home have been raised with the CSCI since the last key inspection of Nevetts in February 2007. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Nevetts provides a well-maintained, comfortable and safe environment for those people who live or work there. Evidence: When we spoke to people living in Nevetts they were, in general very positive about the cleanliness of the home. It is very comfortable here was one comment made. Since the last inspection action has been taken to address some of the concerns raised, including some new carpets, redecoration and refurbishment of some of the homes bathrooms and a reconfiguring of the front entrance to the home to provide additional communal seating. When we saw some bedrooms, with the permission of the people living there, we found that they were personalised to reflect their personal taste, interests and life history. Throughout this inspection we found the home to be clean, tidy and largely free from any unpleasant odours. We were aware of pressures on storage for wheelchairs and some ancillary items such as hoists, efforts have been made to minimise the effect of this on people who live in the home. Care Homes for Older People Page 17 of 25 Evidence: In their AQAA the home details work planned to further improve the environment, including new lighting in the entrance, redecoration of Beechwood lounge and ongoing redecoration of bedrooms throughout the home. This will further enhance the homes appearance and the comfort of people who live and work there. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Nevetts can be confident that they will receive care from wellqualified, trained and supported care staff, who have been subject to a rigorous process of recruitment to prevent unsuitable people being employed in the home. Evidence: All the staff that care for my mother have been very kind in sometimes trying circumstances, Staff are kind and caring are some of the very positive comments received about the care staff and the care experience in Nevetts either from people who live in the home or those who are responsible for them. When we spoke to care staff they told us that they felt well-supported with training and supervision and that there was a very open and supportive staff team; There is always someone to ask was a typical comment. When we looked at staff training and supervision records, they confirmed that staff are given the skills and support they need to provide a good standard of care to people living in the home. When we asked staff about staffing levels they responded that there was always or usually sufficient staff on duty. Staffing levels were not raised as an issue by people Care Homes for Older People Page 19 of 25 Evidence: who responded to our surveys on behalf of people who live in the home. Some care staff did recognise that the time available for one to one activities was sometimes limited by pressures on time required to meet other care needs, but as noted above, felt overall that staffing numbers were sufficient. When we looked at the recruitment records for recently recruited staff we found that there is a robust system of checks in place to ensure that unsuitable people are not recruited to provide care in the home. The manager indicated that the position of the home made it difficult to recruit staff sometimes, however they continue to recruit to fill any permanent vacancies and by positively supporting existing staff through supervision and training opportunities, have achieved good staff retention. People living in the home benefit from receiving care from a relatively consistent and settled staff team. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in Nevetts can be confident that the home is well-managed and that their needs and best interests are at the heart of its operation and routines. Evidence: When we spoke to people who work in the home, they told us that they felt wellsupported by the manager and that it was a Happy home to work in. We saw evidence that regular one to one supervision takes place as well as less formal systems and opportunities for staff to discuss relevant issues. The AQAA that the home submitted was well-completed and realistic and together with the system of quality assurance in place should mean that the home genuinely seeks to achieve a consistently good and improving standard of care for the people that live there. When we checked records of monies held by the home on behalf of people living there, we found that there was a robust system of accounting in place, that should protect their financial interests. We saw records of resident meetings and staff team meeting that suggest that people that live and work in the home are able to influence Care Homes for Older People Page 21 of 25 Evidence: the way that it is managed and run. We saw that there are risk assessments in place to support and protect people who live and work in the home and that there are records kept to ensure that routine maintenance and safety checks are carried out appropriately. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 24 of 25 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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. 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. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!