Inspection on 11/03/09 for The Paddocks

This inspection was carried out on 11th March 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Paddocks 22/08/07

The Paddocks 20/03/07

The Paddocks 26/09/06

The Paddocks 29/11/05

The Paddocks 03/05/05

The Paddocks 01/11/04

The Paddocks 15/07/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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 Paddocks 45 Cley Road Swaffham Norfolk PE37 7NP     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Maggie Prettyman     Date: 1 1 0 3 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 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: The Paddocks 45 Cley Road Swaffham Norfolk PE37 7NP 01760723416 01760722420 lincolncare1@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Lincoln Care Homes Limited care home 100 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users that can be accomodated is: 100 The registered person may provide the following categories of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primay needs on admission to the home are within the following categories: Older people, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home The Paddocks is a residential home providing care for up to 100 elderly people. It is situated on Cley Road, and is within walking distance of the town centre of Swaffham. There are three separate wings, one of which is a Dementia Care Wing. In addition to the main buildings there is a separate block which houses the administrative offices and laundry. The home is set in pleasant gardens which are currently being re planted. Care Homes for Older People Page 4 of 27 Over 65 0 100 100 0 Brief description of the care home There is car parking at the rear of the home. Medical and nursing services are provided via the local G.P. service. (The Home has just been registered to provide nursing services, but has not yet recruited staff to enable this service to commence.) The Home currently charges between £414 and £550 per week according to peoples individual needs. 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Care services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out by using information from previous inspections, information from the provider and information from some residents as well as people who work at the home. We have also made a recent unannounced visit to the home. This report gives a brief overview of the service and current judgments for each outcome group. The unannounced inspection was conducted by two inspectors and took place over the course of 8 hours. Prior to the inspection records held by the Commission were read. During the inspection a tour of the premises was undertaken, staff practice was observed, records and files were read and checked and residents were consulted about their view of the homes facilities and services Care Homes for Older People Page 6 of 27 What the care home does well: What has improved since the last inspection? What they could do better: During this inspection we found some areas where the home could do better. The needs assessment undertaken before people come to live at the home should be more detailed, especially for people with special care needs such as Dementia or Nursing care. The plans of care that each person has were very variable, and some of them did not give enough information to make sure that new staff would know what Care Homes for Older People Page 7 of 27 someones personal and health care needs are. There are still a few things that need to be addressed to make the medication system work safely. The home could do more to make sure that activities always reflect peoples stated interests in their life histories. Some areas of the home would benefit from door sensors to ensure that people do not go into anothers private space uninvited. The standard of vetting of some staff was not good enough, and this means that residents could potentially be put at risk from unsuitable staff being employed at the home. A number of Health and Safety Issues were identified, which must be urgently addressed to ensure that the home is a safe environment to live and work in. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 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 9 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. People thinking about coming to live at the home are given good information to help them to make an informed choice. Basic needs assessments are undertaken, but these should be expanded to cover peoples more complex care needs. Evidence: The Home has improved its service to prospective residents by updating its Service User Guide and developing separate guides for each of the three wings. These guides are comprehensive and informative. The Manager showed us a photo book which is taken out to prospective residents who are unable to visit the Home before they come to stay there. This means that people get a good idea about the home and its facilities before they come to live there. There is currently no web site with detail about the Home and its facilities; the Home would improve its service if this was available to prospective residents and their families. A selection of sample files demonstrated that contracts setting out the financial agreement between the resident or their sponsor are in place for people living at the Care Homes for Older People Page 10 of 27 Evidence: home Pre admission needs assessments were found in place in all residents files inspected. These were sometimes supported by information provided by the Social Worker involved in the persons admission. The assessments completed by the Home were of varying quality. There was no special assessment for people with dementia care needs, and the Home has not yet developed a Nursing Needs assessment. This means that people coming to live at the home with these needs may not be adequately assessed, and the home must improve its needs assessment structure to ensure that this does not happen 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home needs to improve its personal and health care planning to ensure that peoples individual personal and health care needs are always fully met. The principles of respect, dignity and privacy are always maintained by staff for people who live at the home. Evidence: Examination of care plans from all three units at the home showed that they are of varying quality. Important areas of risk and support were sometimes not addressed. For example, one person had no risk assessment for bed rails being used, and care notes showed that there had been difficulties with using this equipment. There are new care plans being introduced and these tended to be richer in detail and more person centred. It is important that the home works to achieve more consistency and personalisation of care plans for everyone who lives there. We looked at how peoples health care needs were met and found again that there was variation across the home. Some care plans addressed peoples changing needs and others did not . Dementia care planning was in general good, but we did not find consistent evidence of information about how to support individual needs in some Care Homes for Older People Page 12 of 27 Evidence: aspects of care such as helping people to engage in purposeful activity when they become restless. There was, however, evidence to show that people are supported to access external professional health care support from people such as GPs, Continence Advisors, Dentists and Chiropodists. The medication administration system was checked and observed in all three units. Overall there has been good improvement since the last inspection, and staff have clearly worked hard to make sure that the system is properly operated and that the requirements from the last inspection have been addressed. Staff seen administering medicine did so in a careful and kindly way. Unfortunately we still found some shortfalls in the overall system. These included covert medication being administered to one person without a full procedure being followed and another person was being given As Required sedation without care planning instruction and support for staff. We also noticed that staff administering medication in one wing could be subject to interruption during their work. This was because the bunch of keys used for the drug trolley also opened the storage cupboard.This could cause distraction and errors, so the home should make sure that this does not happen. Observation of staff during the inspection demonstrated that people who live at the home are treated with respect and dignity. Training records showed that this area of practice is addressed during induction and ongoing training. Peoples personal possessions are looked after carefully and securely. Records and observations demonstrated that peoples name of choice is used when people are spoken to. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their lifestyle. Social and recreational activities meet peoples individual expectations. Evidence: People living at the home were interviewed during the inspection. They confirmed that the home generally meets their expectations and social needs. People said they get up and go to bed when they want, although one person said they have to put their pyjamas on too early in the evening. People living at the home also said that they choose what they want to eat, and that their daily routines are flexible. They confirmed that activities are offered, and that they can choose whether or not to participate. The dementia care unit team have clearly worked hard to provide appropriate personal activities, with memory boxes created containing photographs and mementos. Some residents at the home had detailed records of their life history and individual likes and dislikes about activities, but this was not the case for everyone. The home is in the process of appointing a replacement activity worker and it is hoped that this will rectify any current shortfalls. People living at the home said that their visitors can come whenever they wish and that they are welcomed by staff. They confirmed that their visitors are offered refreshment by staff and that they are always able to see their visitors in the privacy Care Homes for Older People Page 14 of 27 Evidence: of their own rooms. Evidence was seen in residents files that peoples likes and dislikes are recorded. This was particularly good in respect of peoples choices around food and drink, but less detailed in respect of daily living and activities. During the inspection we saw people given what they expressed a preference for, but we noticed that this choice was not always confirmed, and the home needs to make sure that expressed choices do not become set in stone. A tour of the kitchens demonstrated that a hardworking and professional team provide good food in a clean and efficient environment. Portion sizes were noted to be of a good size and liquidised diets were carefully presented from molds that represented the food itself. Peoples likes and dislikes are clearly displayed in the kitchen, and individual choices from the menu are recorded and food prepared accordingly. 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. People who use the service are able to express their concerns and have their complaints listened to. They are protected from abuse by a staff team trained in safeguarding policies and procedures Evidence: The home has received some complaints since the last inspection. These have been recorded by the home and reported appropriately to the Commission. Evidence was seen that action has been taken to address issues raised by a complaint that related to care of residents clothes. Residents confirmed that this service has now improved. It was noted in the Dementia Care wing that there is no assistive technology to monitor when residents enter another persons room, and this has been dealt with by rooms being locked with agreement by family members. The home could improve its service by using a door sensor system so that people are freely able to enter their own rooms. Training records and interviews with staff demonstrated that they are trained in safeguarding, and that staff are aware of their responsibilities to report any concerns if they have any. Care Homes for Older People Page 16 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 design, layout and maintenance of the home enables people to live in a clean, comfortable and homely atmosphere. Some infection control procedures could be improved. Evidence: A detailed tour of the premises was undertaken. The home is accessible and well maintained. It is clean and tidy and meets peoples needs in an attractive and homely way. Attractive gardens are being created, and residents were seen enjoying the outdoor environment despite it being a late winters day. Of particular note is the outdoor space available to people from the dementia care wing. There is a safe outdoor space as well as a walkway to enable them to walk outside and enjoy fresh air. Evidence of fire drills and maintenance of the fire alarm system was seen. The home was seen to be generally hygienic with infection control procedures in place. We saw that unmarked soaps and toiletries were left in communal bathrooms. These pose a risk of cross infection and the practice must be stopped. We also saw that opened undated food items were in a unit fridge and that uneaten food was placed on top of a hot tea urn. This could mean that residents might eat food that was not fit to be consumed. we also noticed that there is no disinfectant hand gel available to people when they enter units, this means that infection may be brought into units by visitors or staff coming from another part of the home. The laundry was inspected, and the staff working there were found to be professional Care Homes for Older People Page 17 of 27 Evidence: and concerned about the way that peoples clothes are looked after. This is an area of the home that has significantly improved its service since the last inspection, and staff are to be commended for their efforts. Care Homes for Older People Page 18 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff at the home are trained and skilled and in sufficient numbers to support the needs of people currently living there. Evidence: Observation of staffing levels on the day of inspection and staff rotas demonstrated that there were enough staff on duty to meet the needs of residents on that day. Staff observed were kindly and hardworking, and a good team atmosphere was apparent. The home has improved staff morale by allowing people to work in the unit of their choice as well as introducing a Carer of the Month award Training records demonstrated that an ongoing system of training is in place and that a good proportion of people at the home are undertaking NVQ qualification. Inspection of a sample of staff files demonstrated that the home needs to improve the standard of pre employment checks and validation it undertakes to ensure that people always have their full work history and personal background checked before they commence employment at the home. Care Homes for Older People Page 19 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 is run by a competent and experienced manager. Some aspects of the management of health and safety should be improved. Evidence: Throughout the inspection the homes manager demonstrated that she is an experienced, well trained, competent and caring person. There have been many changes and developments at the home as it has expanded over the past few years, and she has worked hard to maintain the homes practice. Shortfalls identified during the inspection were viewed and accepted positively, and good practice suggestions were met with interest and enthusiasm. A quality assurance survey has been undertaken, but the results have not yet been published. The manager is collating information under the various standards to provide evidence for compliance and self monitoring purposes. A selection of records relating to residents personal pocket money were checked and found to be in order. The tour of the premises demonstrated that there are some shortfalls in safe working Care Homes for Older People Page 20 of 27 Evidence: practices. These included cleaning products being left out in a toilet, a record of residents names being displayed on a wall, the key being left in the inner door of the controlled drugs cabinet, and a notice saying that a bath water temperature was dangerously high with no apparent action taken. These matters must all be addressed. We checked other safety records such as the Electrical Wiring Certificate, Boiler Servicing, Call System tests, COSHH Risk Assessments and the Environmental Health visitors report and found them to be satisfactory. Accidents are reported and recorded, and an audit of falls resulted in changes to a residents care plan to help them to live more safely. Care Homes for Older People Page 21 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 22 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 3 14 The home must ensure that detailed needs assessments are undertaken for people coming to live there. This is so that people with complex needs are properly assessed to ensure that the home will b e able to meet their needs. 05/06/2009 2 7 15 Everyone who lives at the 26/06/2009 Home must have a detailed and person centred care plan that fully identifies their care needs and addresses their individual risks This is so that peoples health and personal care needs are fully and safely met 3 8 15 Care plans must be further improved to ensure that detail of how each persons individual health care needs are to be met. 26/06/2009 Care Homes for Older People Page 23 of 27 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 This is so that all aspects of peoples health care needs are supported by the home. 4 9 13 The home must continue to improve its medication system in respect of covert and As required medication This is so that medication is always given appropriately when a person lacks capacity. 5 26 16 he home must make sure that unmarked soaps and toiletries are not left in communal bathrooms. This is to ensure that the risk of cross infection is reduced 6 26 16 Food items must be stored at all times in a safe place and date marked if opened. This is to ensure that food is not contaminated and is always fit for consumption. 7 29 19 The home must always thoroughly check peoples personal and working background before they commence employment at the home. 22/05/2009 22/05/2009 22/05/2009 22/05/2009 Care Homes for Older People Page 24 of 27 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 This is to protect service users from unsuitable members of staff that might potentially be employed. 8 38 13 The shortfalls in health and safety identified in this report must be addressed. This is so that all aspects of the home and its services are safe for both residents and staff. 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 22/05/2009 1 1 The home could improve access to information for prospective residents and their families, by developing a website detailing its facilities and services. The home should ensure that people administering medication are not subject to interruption which could cause errors to be made. Comprehensive records about peoples life history and personal interests and dislikes should be made by the home for all kept by the home for each resident. This would ensure that peoples individual choices are always accommodated. Staff should continue to check peoples food and drink preferences to ensure that expressed choice does not become Set in stone and that alternatives are always offered The home could improve its service and protection of residents by using door sensors to alert staff to people going into other peoples rooms when not invited to do so. 2 8 3 12 4 13 5 18 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 6 26 It is recommended that hand gels are available for visitors to the units to use when they enter to prevent infection being brought in. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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 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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