Care Home: Acorn Lodge Care Home

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What the care home does well The manager and staff who work at the home are friendly, professional and work hard to meet residents individual needs. Initial assessment completed by the current manager provides sufficient detail, to ensure that only people’s who’s needs can be met are admitted to the home. Care plans provide information to ensure people’s health and social needs are met. These are regularly updated when necessary. The home provides ample space, and has been refurbished to a good standard. Residents’ bedrooms are nicely decorated and personalised with many items Old Forge Care Home DS0000071782.V378380.R01.S.doc Version 5.2 such as pictures, electrical equipment, and furniture. Sky T.V has been installed in all bedrooms The manager and staff encourage relatives and friends to visit the home, and are arranging social events to try to increase outside involvement. What has improved since the last inspection? Since the last inspection in July 2009 the quality of the service provided to residents has improved considerably. Due to the current manager, systems have been put in place to ensure the well being and quality of care, to residents is properly monitored. This has included monitoring of fluid and food intake, and greater supervision of staff to ensure that any signs or change in health needs is recorded and where necessary community health professionals contacted i.e. district nurses, G.P’s etc. Five health professionals and two care managers were contacted to find out their views relating to the care currently provided in the home. All five responses were positive pointing to improvement in both health and personal care. The Statement of Purpose and Service User Guide has been updated since the last inspection, and now clearly outline the service provided i.e. residential care for people with dementia over the age of sixty-five. Both documents are together in one file for easy access and the manager provides prospective residents with a copy of this document The home/manager now liaises with new residents and families with regard to personal preferences on admission, which has made a significant different to the care people receive when they initially move into the home. The home has appointed a person to organise day activities within the home, five days per week from 10am to 2pm.This has improved interaction between residents and staff and this was observed to have lifted the overall atmosphere within the lounge area. The manager has a good understanding of safeguarding procedures and staff feels more confident to act within the home and local authority guidelines and procedures. What the care home could do better: All of the requirements made at the last inspection except for one have been met in a short timescale. On going concerns relating to the temperature in the home has not been fully resolved Two radiators were seen not to be working, one in the corridor near to room 4 and the other in the corridor, in the extension area of the home. The radiators are small in size in relation to the area that requires heating. The proprietor did state that the “boiler and radiators had been serviced at the end of October, but agreed to request they return to look at the heating. The windows in rooms 9, 14 and 15 do not closeOld Forge Care HomeDS0000071782.V378380.R01.S.doc Version 5.2 properly and were observed to let in a draft. With the onset of winter these repairs are urgent to enable people to live in a comfortable, warm environment. An application has not been received for the current manager to register with the Care Quality Commission. The home has not registered a manger since Eden care took over the management of the home in April 2008. This is a legal requirement. Some residents are wedging their doors to keep them open. A total of nine wedges were observed to be in use. A requirement has been made in regard to the use, and safety of this method of people keeping their doors open. Staff were not aware of the hours they would be working for the next week, and one week’s rota is being completed at a time. Staff working on shift must be planned in advance to ensure the well being and safety of the people who live in the home. Staff are also being requested by the proprietor to work split shifts, 7am to 10am and then return in the evening 5pm to 9pm. This is problematic for staff has the home is situated in a rural area and staff have to travel a fair distance to get there. Public transport is almost non existent. There is mixed opinions on the quality of the food served in the home. Some residents are pleased with the quality whilst others complain of variability in the food served. A four week menu is not in place, and stocks of the correct ingredients are not always delivered in time. The menu should be on display, and would benefit from being in pictorial format to enable people with dementia to recognise what is available, and enable wherever possible for them to choose. It is recommended that staff record on a separate record the residents comments of the food on each day, Key inspection report CARE HOMES FOR OLDER PEOPLE Old Forge Care Home Beazley End Braintree Essex CM7 5JH Lead Inspector June Humphreys Key Unannounced Inspection 9th November 2009 09:00 DS0000071782.V378380.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Old Forge Care Home DS0000071782.V378380.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Old Forge Care Home DS0000071782.V378380.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Old Forge Care Home Address Beazley End Braintree Essex CM7 5JH Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01371 850402 oldforgecarehome@btinternet.com Eden Health Care Manager post vacant Care Home 20 Category(ies) of Dementia (20), Old age, not falling within any registration, with number other category (20) of places Old Forge Care Home DS0000071782.V378380.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is 20 6th July 2009 2. Date of last inspection Brief Description of the Service: The Old forge is a purpose built home for older people, situated in the rural setting of Beazley End, Braintree Essex. The new owners, Eden care have extensively refurbished and converted the home to provide 24 hour care for 20 older people, who may also suffer from dementia. Accommodation is all on one level and all single rooms have ensuite facilities. There is parking to the front of the home, and a large secluded garden, with a patio area available, to allow easy access for wheelchairs, and people who are less mobile. The current scale of charges is between £440.00 to £600.00 per week, with additional charges for personal items (toiletries, hairdresser, newspapers, chiropody, etc.). Old Forge Care Home DS0000071782.V378380.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people who use this service experience adequate quality outcomes. This unannounced inspection visit took place on the 9th November 2009 and completed by two inspectors, June Humphreys, and Louise Bushell who spent seven hours at the home covering all the key national minimum standards. Because people with dementia are not always able to tell us about their experiences, we have used a formal way to observe people in this inspection to help us understand. We call this the ‘Short Observational Framework for Inspection (SOFI). This involved us observing 3 people who use services for 2 hours and recording their experiences at regular intervals. This included their state of well being, and how they interacted with staff members, other people who use services, and the environment. We also spoke to the manager, 3 staff members 3 people who live at the home, three health professionals, one social worker and three relatives. We also received 9 surveys from staff and relatives. A tour of the building was undertaken, looking at the facilities and the environment where residents live. A sample of documentation maintained in the home was looked at to ensure the health and safety of residents is considered at all times. This report also takes into account all the information CQC had received about The Old Forge since the last inspection including information provided by the service, stakeholders, professionals who have worked in the home, and also the people living at the home and their families. What the service does well: The manager and staff who work at the home are friendly, professional and work hard to meet residents individual needs. Initial assessment completed by the current manager provides sufficient detail, to ensure that only people’s who’s needs can be met are admitted to the home. Care plans provide information to ensure people’s health and social needs are met. These are regularly updated when necessary. The home provides ample space, and has been refurbished to a good standard. Residents’ bedrooms are nicely decorated and personalised with many items Old Forge Care Home DS0000071782.V378380.R01.S.doc Version 5.2 Page 6 such as pictures, electrical equipment, and furniture. Sky T.V has been installed in all bedrooms The manager and staff encourage relatives and friends to visit the home, and are arranging social events to try to increase outside involvement. What has improved since the last inspection? What they could do better: All of the requirements made at the last inspection except for one have been met in a short timescale. On going concerns relating to the temperature in the home has not been fully resolved Two radiators were seen not to be working, one in the corridor near to room 4 and the other in the corridor, in the extension area of the home. The radiators are small in size in relation to the area that requires heating. The proprietor did state that the “boiler and radiators had been serviced at the end of October, but agreed to request they return to look at the heating. The windows in rooms 9, 14 and 15 do not close Old Forge Care Home DS0000071782.V378380.R01.S.doc Version 5.2 Page 7 properly and were observed to let in a draft. With the onset of winter these repairs are urgent to enable people to live in a comfortable, warm environment. An application has not been received for the current manager to register with the Care Quality Commission. The home has not registered a manger since Eden care took over the management of the home in April 2008. This is a legal requirement. Some residents are wedging their doors to keep them open. A total of nine wedges were observed to be in use. A requirement has been made in regard to the use, and safety of this method of people keeping their doors open. Staff were not aware of the hours they would be working for the next week, and one week’s rota is being completed at a time. Staff working on shift must be planned in advance to ensure the well being and safety of the people who live in the home. Staff are also being requested by the proprietor to work split shifts, 7am to 10am and then return in the evening 5pm to 9pm. This is problematic for staff has the home is situated in a rural area and staff have to travel a fair distance to get there. Public transport is almost non existent. There is mixed opinions on the quality of the food served in the home. Some residents are pleased with the quality whilst others complain of variability in the food served. A four week menu is not in place, and stocks of the correct ingredients are not always delivered in time. The menu should be on display, and would benefit from being in pictorial format to enable people with dementia to recognise what is available, and enable wherever possible for them to choose. It is recommended that staff record on a separate record the residents comments of the food on each day, If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Old Forge Care Home DS0000071782.V378380.R01.S.doc Version 5.3 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Old Forge Care Home DS0000071782.V378380.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,5 and 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective Residents can be assured that a through assessment will be completed, and admission to the home will only be agreed if their needs can be fully met. EVIDENCE: The Statement of Purpose and Service User Guide has been updated since the last inspection, and now clearly outline the service provided i.e. residential care for people with dementia over the age of sixty-five. Both documents are together in one file for easy access and the manager provides prospective residents with a copy of this document, together with copies of the homes complaints procedure prior to admission. Because the service is aimed towards providing care to people with dementia the service user guide would benefit Old Forge Care Home DS0000071782.V378380.R01.S.doc Version 5.3 Page 10 from having pictures of the home so that perspective residents could see what the home looks like. One person has been admitted to the home since the last inspection in July 2009. This person’s assessment had been completed by the current manager and was found to provide sufficient detail to enable the home to decide if the person’s needs could be met, and devise a care plan to ensure the persons needs would be met. Residents and their families/representatives are encouraged to visit the home prior to admission, and there is a review of the trial period after six weeks. Old Forge Care Home DS0000071782.V378380.R01.S.doc Version 5.3 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 7,8,9 and 10 Care plans reflect individual need, and the health and well being of residents is appropriately monitored; this means residents can be assured of good quality outcomes. EVIDENCE: The manager and staff working at the home have worked hard to improve care plans, and ensure that people’s needs are clearly documented. The manager stated in the AQQA that the home has improved by “Adopting new and up to date procedures that help assess people, constant training of staff and improved staff observation skills.” Care plans are now regularly updated, and evidence of making changes when necessary was evident i.e. “prone to pressure sores, observe any redness of the skin when providing support with personal care”. Concern had been raised previously about the home/manager liaising with new residents and families with regard to personal preferences on admission. Old Forge Care Home DS0000071782.V378380.R01.S.doc Version 5.3 Page 12 Evidence of this now taking place was on file both on the care plan and also within the daily recordings. Relatives spoken to as part of this inspection confirmed that the manager has asked them about their relative’s preferences and in most cases were pleased with the contact they had with the manger and staff. One relative said “we talked together with the manager and I tried to ensure that the things he could not remember I told them”. Another person said “the staff are very good they usually write down anything you tell them, and I have observed that they do remember what you have said” One relative acknowledged that they had been spoken to, but did say that this was not when the resident was initially admitted to the home and this had raised concern. They said “the changes in staff have meant that what you tell them is not followed through”. This was feedback to the manager who advised that this was prior to her being appointed, and that has care plans were updated relatives were then met with. Three sets of daily records of people’s health needs were looked at Again improvement was seen. There was clear evidence of the district nurse service, and G.P having been consulted for advice and of the visits undertaken. As part of the inspection both a district nurse who visits the home daily, and the G.P were spoken to. Both stated that the current manager, and staff were meeting the health needs of the residents, and regular consultation with outside professionals was happening. The district nurse stated “Staff are working very hard to ensure that people are receiving the care that they need, and I have seen considerable improvement”. The G.P stated “The current manager has a good approach to ensuring people receive the care and support needed, and is in regular contact with the surgery when necessary”. The manager forwarded an updated copy of the home’s medication policy after the last inspection in July. The current policy allows one trained person to administer medication. There are currently five members of staff working in the home that have completed all necessary training including Boots MDS training. The five staff are senior members of staff, and had a clear understanding of the policy and procedures of the home. Medication is administered to each resident on an individual basis. Medication administration records (MAR) were viewed and were seen to be accurate. The lunchtime medication practice was observed, residents were offered medication before or with food dependent on their preference, and it was undertaken in a nice relaxed manner with residents not being hurried. At the time of inspection the manager had been of sick, and was ensuring that the deputy manager was aware of the procedure for ordering and returning medication in their absence. An auditing process is in place that is regularly completed by the current manager. Observation of the care staff at work showed that interaction with residents was positive, appropriate and in keeping with their needs. Old Forge Care Home DS0000071782.V378380.R01.S.doc Version 5.3 Page 13 Residents seen on the day of inspection were well cared for. Looked well presented physically, i.e. dressed in appropriate clothing for the temperature of the day, and were well groomed. Personal care was delivered discreetly and those residents spoken with who were able to express a view said that they were well-treated by the staff and felt that their privacy was respected, “I always receive the help I request, staff are very good.” Staff was observed working with a resident who was ‘quite challenging’, and staff were very skilled in moving the person out of the public area to their personal space to be assisted with personal care. Old Forge Care Home DS0000071782.V378380.R01.S.doc Version 5.3 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 12,13,14 and 15 The home provides flexible routines and a lifestyle that enables residents to make choices and to engage in their individual interests. EVIDENCE: The day activities available within the home were observed to have improved considerably since the last inspection in July. An activity co-ordinator has been employed who works in the home five days per week between 10am and 2pm. One inspector observed residents and staff over a period of two hours in the lounge area. We call this the ‘Short Observational Framework for Inspection (SOFI). This involved us observing 3 people who use services for 2 hours and recording their experiences at regular intervals. The feedback was very positive. A number of residents chose to join in playing skittles, but others were observed to watch, and be stimulated by the activity that was going on. Several other residents were talking to each other about the activity. The staff member leading the activity (activity co;0rdinator) worked hard to engage residents in the game, and praised those who did. The mood in the lounge was lifted, and residents generally seemed keen to interact. Old Forge Care Home DS0000071782.V378380.R01.S.doc Version 5.3 Page 15 The manager stated that the more frequently the activities occur the more confident residents are, and more people join in. The home has started to offer a good range of activities that includes some visits to the local garden centre and pub. The home now has transport to enable people to go out should they wish to. Residents spoken with said how they enjoyed the indoor activities which included board games, quizzes, sing-a-longs, manicures, cards, and bingo. Details of activities are placed on display in the lounge area. Residents’ spoke of the activities arranged for special occasions such as birthdays, Christmas and a recent Halloween party which everyone said ‘was such fun’. One resident said “We had a Halloween party; it was really good we got dressed up”. Another resident said “The staff were wonderful, I laughed so much”. Contact with relatives and friends is encouraged by the home and visitors made welcome. The home offers visitors the opportunity to share a meal with their relative should they wish to do so. The manager stated that “relatives are wherever possible encouraged to provide information about the person’s interests, family friends and social history. This is often helpful to staff when encouraging residents to talk and join in.” There has been mixed views in relation to the quality, and choice of food within the home. The main issues is that residents and relatives continue to state that there is inconsistency in the quality of food offered, and the option of choosing something different for the main meal of the day is not available, or limited. The manager did not discuss the menu or quality of food served within the home as part of the AQAA so it unclear what the services view is in relation to the quality of, and possible improvement. At this inspection there was again mixed views expressed. One relative said “you don’t always know who the cook is and generally food can only be described as adequate”. A resident said “We have sausages today or an omelette, but that’s not much choice”. But several residents were more positive and stated “I liked the dinner, it was a sought roast, and it was really nice”. Another person said I like the food here, I always eat it all”. There is a new cook since the last inspection, who said they had been in post about a month. On the day of inspection there was only one week’s menu prepared. I was advised that this was in the process of being updated. The meat order had not arrived and therefore the menu for Tuesday was cooked. This was sausages and mash with onion gravy and mixed vegetables. Rice pudding was served for dessert. The tables were nicely laid with table cloths, napkins, and salt and pepper. Staff wore blue aprons and served the food, which was well presented. Portions were of a good size. One inspector tasted the food, and the sausages and vegetables were soft and easy to chew. It was observed that one resident had a jacket potato instead of mash. Another resident had no carrots but requested extra peas and mash which was provided. The rice pudding was home made, and a selection of fruit was offered to people who were diabetic. Old Forge Care Home DS0000071782.V378380.R01.S.doc Version 5.3 Page 16 The service should produce a four week menu in consultation with the residents in the home. The ingredients to cook for each day must be ordered in advance. The menu should be on display, and would benefit from being in pictorial format to enable people with dementia to recognise what is available, and enable wherever possible for them to choose. It is recommended that staff record on a separate record the residents comments of the food on each day, this is particularly important with regard to the main meal of the day. Old Forge Care Home DS0000071782.V378380.R01.S.doc Version 5.3 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. 16 and 18 The staff who work at the old forge do listen and respond to concerns that residents raise, but they can not be assured that they will be appropriately recorded. EVIDENCE: A complaints procedure is in place within the home, and. staff spoken with had a basic awareness of the whistle blowing policy. Several residents were asked if they knew how to complain and they said they would tell ‘the manager’ or the relative who visited them. Several relatives also completed surveys and said that the home had made them aware of the complaints procedure as part of the admission procedure. At the last inspection verbal complaints were not recorded, and there was a concern that a high percentage of the current residents find difficulty in communicating and would therefore not be able to articulate their concerns, therefore being reliant on family, advocates or staff to raise their concerns. Instability within the staff team (Four care staff, plus the cook have left since July) is still an issue which means residents have not always been able to develop close relationships with staff, but this has improved. Old Forge Care Home DS0000071782.V378380.R01.S.doc Version 5.3 Page 18 The new activity co-ordinator has started to record any daily concerns that residents raise within activity sessions. It is also her role to organise monthly residents meetings. One meeting had been held to date. The manager has a file where complaints are kept, including the responses. One complaint had been received by the CQC and the inspector had received a response from the home. This communication was held in the file. It was recommended at the last inspection that a complaints log is held that clearly shows any verbal or written complaints, and the timescales and response. This as yet to be completed by the manager. The home has improved in the area of safeguarding; four care staff that was spoken to have attended safeguards training, and was able to explain how the local authority safeguarding procedures worked. Many of the staff team still remain dependent on the manager to report concerns on their behalf, and staff expressed a lack of confident in approaching either of the proprietors if an allegation or concern arose. The manager’s knowledge on safeguarding procedures has improved the home’s reporting of concerns, both to the CQC, but also to the local authority when necessary. The improvement in practice has also decreased the number of alerts needing to be reported. Some staff that had completed the safeguarding training has now left the home, and therefore there is a number of new staff who needs to once again complete the training. Old Forge Care Home DS0000071782.V378380.R01.S.doc Version 5.3 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,25 and 26 People using the 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 provides a safe, comfortable environment; which meets the needs of the residents who live there. EVIDENCE: The home was refurbished by the new owners, Eden care in April 2008, and offers residents a spacious and pleasant place to live. The lounge and dining room are smart and comfortable. Residents’ bedrooms seen were nicely decorated and personalised with many items such as pictures, electrical equipment, and furniture. Sky T.V has been installed in all bedrooms, and several residents were pleased that they could watch a range of sport, which they said they enjoyed. There is large plasma T.V in the lounge, which again is appropriate for older people whose vision or hearing may be impaired. Old Forge Care Home DS0000071782.V378380.R01.S.doc Version 5.3 Page 20 Five requirements were made at the inspection in July relating to repairs and maintenance of the building. All of these requirements were found to have been met, except for the on going concerns relating to the temperature in the home. Two radiators were seen not to be working, one in the corridor near to room 4. The other in the longer corridor, in the extension area of the home. The radiators are small in size in relation to the area that requires heating. The proprietor stated that the “boiler and radiators had been serviced at the end of October”. The windows in rooms 9, 14 and 15 do not close properly and were observed to let in a draft. With the onset of winter these repairs are urgent to enable people to live in a comfortable, warm environment. It was also observed that residents are wedging their doors, and that magnetic fire catches have not been fitted to the current doors that were being wedged. A total of nine wedges were observed to be in use. A requirement has been made in regard to the use and safety of this method of people keeping their doors open. Old Forge Care Home DS0000071782.V378380.R01.S.doc Version 5.3 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 People using the 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 Staff work hard to support residents’ and their individual needs. EVIDENCE: On the day of the inspection there were two carers, the deputy manager and the activity co-ordinator. One carer was on duty from 7am to 10am. This meant that when the activity co-ordinator came on duty at 10am, the carer went home, leaving three staff on duty. There are currently thirteen permanent residents and one person receiving respite. The deputy advised that there was an expectation that he would manage the shift and work along staff. Three staff to fourteen residents is an expectable number. Obviously some residents require two staff to assist with personal care due to the need to be hoisted. There was one weeks rota only (for the current week) completed. Staff were not aware of the hours they would be working for the next week. Staff said that this had been like this for the last month or so. They were also being requested by the proprietor to work split shifts, 7am to 10am and then return in the evening 5pm to 9pm. Old Forge Care Home DS0000071782.V378380.R01.S.doc Version 5.3 Page 22 This is problematic for staff has the home is situated in a rural area and staff have to travel a fair distance to get there. Public transport is almost non existent. There is currently eleven staff, and looking at the rota a number of staff are working long days i.e. both the am and pm shifts on several days. The proprietor stated that “due to the low number of residents, financially it was not possible for staff to work if not required. On the other hand the home wanted to keep good staff.” The home must plan the staff working on shift in advance to ensure the well being and safety of the people who live in the home. Four staff has left the home since the last inspection in July, but four new staff has started. Several were still completing induction. The manager has been off sick, but came in to participate in the inspection. Staff clearly demonstrated that they were pleased to see her return, and within a short time the manager became involved in directly working with residents. Communication within the staff team has improved. Staff reported that team/staff meetings are happening. Minutes were available for two meetings and a further was scheduled for November. There was a supervision schedule, but not all supervisions had taken place. The manager and deputy currently undertake supervision of staff. Most staff had received at least one supervision session and four staff had received two sessions. Staff stated that the manager has put systems in place which really has helped improve communication. One staff member said “we always have handovers which helps in ensuring that everyone is up-to-date”. Another staff member said “We have handovers, it’s time set aside to meet and talk, which we did not always have before”. There continues to be a number of staff who have been employed in the home for only a short period of time, and then leave. Within there time at the home they have undertaken induction training and a number of mandatory courses. When they leave in such a short time the home/residents do not benefit from the time, and cost of training that has been provided. There remains a shortfall in the number of staff who has completed training in dementia, which is a key area, as the home is registered to care for up to twenty people with dementia. The manager has organised a distance learning course for eight members of staff. The course should be completed by staff in April 2010. Two members of staff have also attended a three hour course relating to dementia. The main expertise is from the manager who has completed an accredited course in dementia care. Observation of staff working with residents over a period of two hours (SOFI observation) demonstrated that staff on shift had a good professional relationship with all the residents. Old Forge Care Home DS0000071782.V378380.R01.S.doc Version 5.3 Page 23 Staff was able to meet peoples individual care needs, and did respond, in a caring and supportive manner. The deputy manager did walk around the home and check regularly on residents who were in their bedroom. This included talking to them and checking they were o.k. Two sets of staff records were looked at. Application forms had been completed, interviews held, written references obtained, and criminal records checks undertaken. Copies of proof of ID and photographs were also on file. Old Forge Care Home DS0000071782.V378380.R01.S.doc Version 5.3 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35, 36 and 38 People using the 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 is run in the best interests of residents, and benefits from the knowledge and skills of the current manager. EVIDENCE: The new manager Joanne Newland joined the home at the beginning of July 2009, the amount and quality of the work she has completed is exceptional. The outcome for both staff and residents has improved. This is due to the systems that have been put in place, and daily supervision and support to staff. Old Forge Care Home DS0000071782.V378380.R01.S.doc Version 5.3 Page 25 Five health proffessionals, and two care managers were contacted to find out their views relating to the care currently provided in the home. All five responses were positive pointing to improvement in both health and personal care. The home has been without a registered manager, since the new owners Eden care was registered in April 2008. An application has not been received for the current manager to register with the Care Quality Commission Evidence collected as part of the service’s management review demonstrated that the home has improved, but does not always sustain the improvements made. An example of this is assessment and care plans, which are dependent on the manager to ensure these are completed, and updated when reviewed, or as necessary when changes in care are needed. The home continues to operate safe practices for looking after money on residents’ behalf. This is stored individually and securely, and clear individual records are maintained of all monies received or spent, with receipts kept and cross-referenced to the records. One person’s money and records were checked as part of this inspection, and the cash held balanced with records and receipts. The manager has demonstrated an active commitment to developing the home, and promptly met the requirements made at the last inspection. Fire procedures including evacuation procedures, were updated immediately after the last inspection. Risk assessments have been put in place, and staff spoken with, were clear on what was necessary in the case of fire. The walls in the laundry room have been repaired to stop possible infection, and chemicals were seen to be locked away to ensure residents do not have access. Foliage has been cut back and rails fitted to the side of the ramp of the patio outside room seven, and therefore no longer a hazard. Old Forge Care Home DS0000071782.V378380.R01.S.doc Version 5.3 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 2 x x x x x 2 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x x 2 Old Forge Care Home DS0000071782.V378380.R01.S.doc Version 5.3 Page 27 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP38 Regulation 13 Requirement The practice of Automatic door closures must be fitted to residents’ doors, instead of the using wedges to keep resident’s bedroom doors open should be reviewed in line with the home’s fire policy and procedure. This is to ensure the safety and protection of people living in the home. The windows that do not close properly in residents’ bedrooms must be repaired to ensure a constant adequate level of heat is maintained within people’s bedrooms. The radiators in the home should be repaired to ensure a constant adequate level of heat within the home Staff must receive training in a dementia care to ensure residents receive appropriate care. Timescale for action 01/12/09 2. OP19 23 01/12/09 3. OP19 23 01/12/09 4. OP30 19 (5) (b) 31/12/09 Old Forge Care Home DS0000071782.V378380.R01.S.doc Version 5.3 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP31 Good Practice Recommendations A permanent experienced manager should be appointed to review and develop the service. The manager should apply for registration with the commission Prospective residents with dementia would benefit from the service user guide having pictures of the home so that could see what the home looks like. The registered person shall ensure, that staff working at the home, receive regular 1 to 1 supervision sessions. Ensure that the complaints procedure for considering complaints, both written and verbal, made to any member of staff at the home by a service user or person acting on the service user’s behalf is documented effectively within the complaint record book/log. Staffing levels must be kept under review, and maintained so as to ensure that residents’ needs are met. 2. OP1 3. OP36 4. OP16 4. OP27 Old Forge Care Home DS0000071782.V378380.R01.S.doc Version 5.3 Page 29 Care Quality Commission Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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