Inspection on 23/01/09 for The Keepings

This inspection was carried out on 23rd January 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

The Keepings 14/04/10

The Keepings 20/09/06

The Keepings 16/01/06

The Keepings 29/03/05

The Keepings 02/07/04

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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: The Keepings 12 Priory Road Dudley West Midlands DY1 4AD     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: Christine Lancashire     Date: 2 3 0 1 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 26 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 26 Information about the care home Name of care home: Address: The Keepings 12 Priory Road Dudley West Midlands DY1 4AD 01384253560 01384214726 gordonnuttall@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Gordon Nuttall care home 23 Number of places (if applicable): Under 65 Over 65 23 old age, not falling within any other category Additional conditions: 0 One service user identified in the variation report dated 6 September 2004 may be accommodated at the home in the category DE(E). This will remain until such time that the service users placement is terminated. Date of last inspection Brief description of the care home The Keepings is a large converted and extended domestic property located within easy reach by foot of Dudley Town centre, and therefore close to all public amenities. There is car parking to the front of the property and on the main road. To the rear there is a large garden which is well established with a variety of plants and a large patio area with a number of tables and chairs available. The home has 19 single and 2 shared rooms. Residents accommodation is on two floors, the upper floor accessed by a stair lift. The bedrooms are individually decorated and reflect peoples tastes and personalities. Residents can bring in their own furniture if they wish dependent on space requirements and following discussion with the provider. The home has a number of bathrooms with assisted bathing facilities on each floor. There is a large lounge with a conservatory. The dining area is situated on the ground floor. Communal Care Homes for Older People Page 4 of 26 Brief description of the care home areas are decorated and furnished to a high standard. Care Homes for Older People Page 5 of 26 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: We visited this home on a weekday without telling anyone that we would be arriving. The purpose of the visit was to see how the home is meeting key National Minimum Standards. Before the visit we had received information from the manager about the running of the home and the plans for development. At the inspection we spoke to the owner, the manager, staff and some people who live at the home. We looked round the building and into several bedrooms. We looked at the records which the home is required to keep and these include records about the peoples and preferences, safety, menus, staff rotas, medication, staff recruitment and training, complaints and minutes of meetings. We looked at the systems which the home has for monitoring its Care Homes for Older People Page 6 of 26 performance and at the results of questionnaires completed by poeple who live there. We used this information to write this report. What the care home does well: What has improved since the last inspection? What they could do better: The owner and manager need to reorganise some records so that all personal information is recorded in an individual way. The owner and manager need to reorganise the office so that it comtains only up to date, relevant informaiton, which is readily accessible. Staff need to make sure that they take care to record medication doses in a clear and accurate way. Care Homes for Older People Page 8 of 26 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 9 of 26 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 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering moving into this home are provided with the necessary information to make an informed choice. Assessments and visits to the home ensure that people know, before they move in, that their needs can be met by the home. Evidence: The manager carries out assessments of peoples needs so that she can be sure that the home can meet these, prior to offering a place. She went out to assess someone who was in hospital on the day of the inspection. We sampled files and found assessments by the manager and a range of professionals which had been carried out before the people concerned had been admitted. These included nutritional and moving and handling assessments. The manager told us that no one would be admitted without a full assessment of their needs. If the home can meet the persons needs, they are invited to visit prior to being Care Homes for Older People Page 11 of 26 Evidence: admitted so that they can meet the people who live there and sample the meals. We heard the manager speaking to relatives of someone who was planning to move in and she invited the person to stay for tea. Care Homes for Older People Page 12 of 26 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. Peoples health, personal and social needs are set out in a care plan so that they can be met by staff. People are treated with respect and their privacy and dignity are maintained. They are protected by the homes practices in relation to the storage and administration of medication, but care needs to be taken to make sure that all recordings are accurate. Evidence: The manager uses the information from the initial assessment to develop a care plan which helps the staff to know how to care for each person so that their needs are met and their preferences are respected. We sampled files and found details of each persons needs in various areas such as washing and dressing, mobilising and transferring, activities, sleeping pattern, hearing and understanding. The plans also contain information about peoples preferences in terms of activities, outings and food. People have signed to indicate their choices about the furniture and level of lighting in their room, whether or not they have a key to their room and their preferred funeral arrangements. There is information about access to personal information and people Care Homes for Older People Page 13 of 26 Evidence: have signed to say that their care plan has been read to them and they agree with the contents. We saw that the plans have been evaluated on a montly basis, reviewed with family and social worker input where relevant and updated as necessary. The plans contain details of peoples health needs, assessments of their dependency and the likelihood of them developing pressure sores. There is a record of visits to and from a variety of health professionals. We met a district nurse in the home on the day of the inspection. One person who lives in the home told us, oh yes, you can always see a doctor if you want to, you just tell the staff and they sort it out. There are suitable arrangements for storing the medication and staff are trained to administer it safely. We looked at the records of peoples doses and found that they were mostly completed correctly, but on the day of the inspection there were three recordings which could have led to confusion for the next person administering the medication. We pointed this out to the manager and the member of staff concerned. It is important that all staff take care to record in an accurate way. People told us that the staff treat them with respect and we saw staff showing great patience and understanding towards a person who was distressed. People are encouraged and enabled to maintain a dignified appearance. A hairdresser visits each week. Peoples privacy is respected and staff knock on doors before entering. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples lifestyles in the home match their preferences and suitable activities are arranged. They are encouraged to maintain significant relationships with people in the community and they receive a choice of nutritious meals which meet their needs and take account of their preferences. Evidence: We saw that the assessments and care plans contain details of peoples preferences in relation to activities. The manager told us that people enjoy a range of activities such as quizzes, bingo and music. An fitness instructor visits once a week and most people have visitors on a frequent basis. Some people go out regularly. There are monthly church services. Staff took part in a slimathon. There is a pantomime in the home twice a year. On the day of the inspection, some people were in their rooms, some were watching television, one was reading and another was knitting. People were sitting in the conservatory chatting and they told us that this is their favourite activity. Poeple told us that staff ask them about their preferences and give them choices in most areas of their lives. There are residents meetings at which they are encouraged to provide their views on the food, activities and other aspects of life in the home. The Care Homes for Older People Page 15 of 26 Evidence: records which we saw show that peoples choices are recorded and acted on and that changes have been made to the menus and activities as a result of people expressing their preferences. The menus show a variety of meals which meet peoples needs and allow for choice. People who live in the home told us that they enjoy the meals and have their personal favourites. Several people said that they particularly enjoyed the homemade soup and the egg custard. Another person said that she enjoyed the ice cream. Food is available throughout the day. We saw someone who came for breakfast late in the morning and asked for a bacon sandwich. Staff provided this with no difficulty. The cook maintains the kitchen in good order and keeps the required records to ensure good food hygiene. The last visit by the Environmental Health officer was in November 2008 and the home received three stars in relation to food hygiene and the cleanliness of the facility. Two small pieces of work that needed to be done have been completed. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good arrangements to ensure that people are protected, including the arrangements for handling complaints. Evidence: In addition to the formal complaints procedure, which is publicised on the notice board in the entrance to the home, there is a book in the foyer for comments, complaints and compliments, where anyone can write a comment. People who live in the home told us that they had confidence in staff or the manager sorting out any complaints which they may have. The complaints book is new and contains no details of complaints. The owner informed us that the old book went missing from the home and cannot be found. We received one anonymous complaint about the home during the past year. This was referred to the owner to investigate and a satisfactory response was received, explaining the elements of the allegations. All staff receive training in recognising possible signs of abuse. There are procedures in the home for reporting these events. The local safeguarding procedures are also in the office. People who live in the home told us that they feel safe. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely, clean and safe environment which meets their needs. Evidence: We toured the building and found all areas clean and well maintained. There were no unpleasant odours. The home has a well-maintained environment, which provides aids and equipment to meet the care needs of the people who live there. There is evidence of on-going work to maintain the environment. A maintenance worker is employed for 30 hours a week. He does decorating according to a plan which is drawn up on an annual basis. The owner told us that during the past year a substantial amount of patio furniture has been purchased and some bedrooms have been improved by new curtains, decoration, carpets and furniture. New settees and chairs have been provided in the lounge area. The home has a permanent contract with carpet cleaners, which also helps with infection control. There are plans to continue with decoration and to extend the managers office, which is currently very small. The shared areas provide a choice of communal space with opportunities to meet relatives and friends in privacy or in their own rooms. The garden was seen to be a pleasant and interesting area. People told us that they like to go out in the Summer, Care Homes for Older People Page 18 of 26 Evidence: but enjoy watching the wildlife from the conservatory in colder weather. We looked in some of the peoples bedrooms and these contained personal items. There is a choice of bathing facilities, both assisted and unassisted, showers and baths and there are a number of toilets around the home. There is plenty of hot water and the temperature in the home can be changed, on request, in peoples own rooms. There is an infection control policy and staff are trained to follow this. However, the practice of all staff doing laundry is not best practice in terms of infection control. We discussed with the manager the advantages of having one member of staff to undertake this task. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live in this home are cared for by sufficient numbers of staff who are well trained and competent to do their jobs. They are protected by the homes recruitment practices. Evidence: The rotas show that there is adequate cover in terms of care staff, although staff appeared to be very busy throughout the day. There is a cook, but no dedicated member of staff to undertake the laundry. There are no domestic cleaning staff during the weekends. The acting manager also undertakes care tasks, but the owner plans to ensure that she has a period without care tasks in the near future so that she can begin the necessary reorganisation of the office. Staff are recruited through a standard procedure and the files which we sampled contained relevant references and evidence of checks through the Criminal Records Bureau. We saw records of individual staff training in their files as well as in a communal record. The manager told us that all staff receive induction training to National Training Organisation standards within the first six weeks of their employment. We saw the relevant checklist on sampled files. New members of staff are mentored by a more Care Homes for Older People Page 20 of 26 Evidence: senior member of staff until they are considered able to meet peoples needs. The records show that all staff have achieved or are working towards NVQ level 2, sixty per cent of staff are working towards level 3 and 2 have achieved level 3. In addition, most of the staff have undertaken training in various areas such as medication, abuse, food hygiene, health and safety, first aid, manual handling and infection control. The manager and deputy have attended external training in dementia care, team leading and pressure area care. They have passed on relevant information to other staff. The owner informed us that staff competency and understanding of relevant areas is regualrly monitored through supervision and the completion of questionnaires. Care Homes for Older People Page 21 of 26 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 live in a well managed home which is run in their best interests and where there are good systems for maintaining the quality of care. Their financial nterests are safeguarded and their health, safety and welfare is promoted and protected. However, the owner and manager need to make sure that the office is better organised and that some records are kept in a more individual way. Evidence: There is currently no registered manager at this home. Since the last manager left, the home has been managed by the deputy manager who demonstrated a good level of committment to ensuring that home runs smoothly. However, she also undertakes care tasks and, like other staff at this home, appears to be very busy. The role of manager is a demanding one and we discussed with the owner, the need for the manager to have time to concentrate on making sure that the records are in good order, without having to carry out care tasks. Care Homes for Older People Page 22 of 26 Evidence: During the course of the inspection, we found that, although the records relating to individual people who live in the home and the staff were in good order, there were areas in which records needed to be updated or maintained in a different way. For example, the staff communication book contains many messages with personal details of individual people in the home. These should be recorded directly in the individual persons notes. The office contains many documents which are out of date, for example, old versions of the Statement of Purpose and old policies and procedures. We discussed this with the owner, who said that that there are plans to continue to extend and reorganise the office so that the up to date records can be accessed more easily. The owner informed us that the home as a substantial quality assurance system and the annual development plan for the home is based on the finding of surveys of people in the home and their representatives. We heard staff checking with people that they were satisfied with their meals. In the pre-inspection information the manager provided dates of the checks which are made on equipment in the home. We sampled these checks and found that these are regular. We also saw risk assessments relating to the building and various activities. These help to keep people safe. Care Homes for Older People Page 23 of 26 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 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 9 37 The manager should make sure that all staff record medication doses in a clear and accurate way. The owner and manager should make sure that all records are maintained in a way which separates personal informaiton about individual people in the home and ensures that the up to date versions of policies, procedures and other general information are readily available. Care Homes for Older People Page 25 of 26 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 26 of 26 - 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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