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Care Home: Alphington Lodge Residential Home

  • 1 St Michaels Close Alphington Exeter Devon EX2 8XH
  • Tel: 01392216352
  • Fax:
  • Planned feature Advertise here!

  • Latitude: 50.700000762939
    Longitude: -3.5320000648499
  • Manager: Mrs Julie Ellen Smith
  • Price p/w: ~
  • UK
  • Total Capacity: 28
  • Type: Care home only
  • Provider: Anna Hitchcott,Nicola Hitchcott
  • Ownership: Private
  • Care Home ID: 1634
Residents Needs:
Old age, not falling within any other category

Latest Inspection

This is the latest available inspection report for this service, carried out on 8th January 2010. CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

For extracts, read the latest CQC inspection for Alphington Lodge Residential Home.

What the care home does well People who are offered a place at the home can be confident that the home is able to support and care for them, because their needs will have been assessed before they move in. They, or someone close to them, are offered various opportunities to get information about the home, so that they can decide if Alphington Lodge is the right place for them. People living at the home are treated with respect, and most receive the care or support they need. Their daily life is varied and they enjoy beneficial relationships, because of the recreational opportunities within the home and links with the community around it. They are offered an appetising, balanced diet that meets their preferences, and benefit from well-maintained, homely accommodation. The home is generally run in the best interests of those living there. People`s concerns and complaints are listened to, and action is taken to protect them from abuse. They currently get support from a caring staff team, who give a safe basic level of support. What has improved since the last inspection? Individuals living at the home, or someone close to them, are involved in the planning of the care they are to receive. Choice and decision-making is better promoted through this and other improvements made since our last visit. For example, there is better information about the activities provided by the home, so that people know what is planned for each day, and they are consulted about which of the regularly-provided activities they would like to do. Storage and administration of medicines has been improved. Food intended to be hot is served at the correct temperature, so people enjoy their meals. The front doorbell is answered more promptly, ensuring that visitors are welcomed, and their reason for visiting is checked in order to safeguard the people who live in the home. Cleanliness in general has improved. Records are completed to show that regular checks and maintenance of all fire safety equipment have been carried out in accordance with the local fire authority`s guidance. Staff receive regular updates on health and safety related topics. Better quality assurance systems are being developed. Anonymous completion of the home`s surveys is now possible. A record of all complaints received by the home is kept in the home, with evidence to show how the complaint was investigated, and any action consequently taken. Written reports of the monthly visits by the provider or their appointed representative (- Mr Beard, the Responsible Individual) are given to the manager. What the care home could do better: The home could find out more about each person as an individual before they move in, and make care plans more individualised, to ensure that people`s diverse needs are met if they go to live there. In line with this, people should be enabled to continue their previous interests or hobbies by ensuring the recreational opportunities offered by the home reflect people`s recorded interests. Assessments of people`s needs must also be reviewed regularly to ensure current care plans are based on people`s current needs. This all helps to ensure that everyone gets the appropriate, consistent care and support that they need or want. Although improvements have been made, further action is needed to ensure that people`s medication is dealt with safely, and in line with good practise, by all staff. People living at the home would benefit if staff received regular updates on topics relevant to the particular or more diverse needs of people living at the home, to ensure that all their needs - including changing needs - will be met. All care staff should receive formal supervision more regularly, covering their practise and development needs (including training needs). Also, ancillary staff should be informed about safeguarding, and all staff should be fully aware of the local authority`s procedures for reporting concerns about abuse to appropriate agencies outside the home. This is to protect people living at the home from harm or abuse as much as possible. Appropriate recruitment practises must be used consistently, so that people are protected from unsuitable staff. Reviews of staffing levels in the home (when occupancy levels change, etc.) should be such that people still receive assistance they need in a timely way, and to ensure there are sufficient staff to carry out cleaning tasks. More proactive management is needed to ensure the welfare and safety of those living at the home in the longer term. We must be informed if the registered provider or manager is to be absent for 28 days or more. The results of quality assurance surveys should be made available, to ensure people know that their views and comments have been listened to and acted upon. Evidence of systems for ensuring environmental risks are controlled (in relation to hot water, falls from windows, etc.) would assure people that their safety is promoted. Advice should be sought from appropriate professionals on the safest way of dealing with soiled laundry, to reduce cross-infection risks to staff. Key inspection report Care homes for older people Name: Address: Alphington Lodge Residential Home 1 St Michaels Close Alphington Exeter Devon EX2 8XH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Rachel Fleet     Date: 0 8 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 37 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: Alphington Lodge Residential Home 1 St Michaels Close Alphington Exeter Devon EX2 8XH 01392216352 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Anna Hitchcott,Nicola Hitchcott care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 28 The registered person may provide the following category of service only: Care Home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Alphington Lodge is registered to provide accommodation and personal care to up to 28 older people. It cannot accommodate anyone with nursing needs unless they are nursing needs that the community nursing service is able to meet. The home does not provide intermediate care. The home is a period property in the centre of Alphington, within short walking distance of local shops, church, pubs and a health centre. The accommodation comprises of the main building, and a separate cottage annexe with two ground floor Care Homes for Older People Page 4 of 37 Over 65 28 0 Brief description of the care home bedrooms and staff office rooms above. The main building has three floors, including a new extension, served by a passenger lift. All bedrooms are for single occupancy, 14 being en suite. The home has three pleasant lounge-dining areas, large level gardens, and an enclosed courtyard for the extension. Current fees are £450 - 500 per week, depending on the level of care required. Fees include activities, but do not include supply of automatic door-holder devices for individuals bedroom doors (required for fire safety purposes), hairdressing, chiropody or newspapers for individuals. Our latest inspection report on this home is available in the homes entrance hall. We last inspected the home in March 2009. Care Homes for Older People Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection took place as part of our usual inspection programme. The homes last key inspection was in March 2009. We carried out an unannounced visit to the home, as part of this key inspection, which lasted 10 hours on a week day. Julie Smith, the registered manager, and her staff freely assisted us through the day. We discussed our findings with her at the end of our visit. Before our visit, we sent 10 surveys to the home for people who were living there, with a survey for their relatives (or other advocate) if they wished to pass it to them. We also sent surveys to 9 health and social care professionals who support people living at the home. Surveys were returned from 9 people living at the home, 2 of who were helped to complete them by relatives, and 3 were helped by staff (who remained anonymous). Peoples relatives or friends returned 7 surveys, and 3 surveys were Care Homes for Older People Page 6 of 37 returned by healthcare professionals. While at the home, we spoke with at least 11 of the 19 people living there on that day. We looked into the care of 3 people in more detail, by speaking with them, checking their care records and related documentation, talking with staff and observing some of the support these people received from staff. We spoke with 4 care and ancillary staff. We looked at other records, including those relating to staff, health and safety, and quality assurance. Our tour of the building included the kitchen and laundry, as well as peoples bedrooms and shared areas. Julie Smith returned a questionnaire (the Annual Quality Assurance Assessment, or AQAA), about the service offered by Alphington Lodge and how it was being run. This gave us general information about people living at the home and the staff, some assessment of what the home does well, and any areas for improving the service. It was returned within the required timescale, although our visit took place before we had received it. Information from these sources, and from communication with or about the service since its last review, is included in this report. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? What they could do better: The home could find out more about each person as an individual before they move in, and make care plans more individualised, to ensure that peoples diverse needs are Care Homes for Older People Page 8 of 37 met if they go to live there. In line with this, people should be enabled to continue their previous interests or hobbies by ensuring the recreational opportunities offered by the home reflect peoples recorded interests. Assessments of peoples needs must also be reviewed regularly to ensure current care plans are based on peoples current needs. This all helps to ensure that everyone gets the appropriate, consistent care and support that they need or want. Although improvements have been made, further action is needed to ensure that peoples medication is dealt with safely, and in line with good practise, by all staff. People living at the home would benefit if staff received regular updates on topics relevant to the particular or more diverse needs of people living at the home, to ensure that all their needs - including changing needs - will be met. All care staff should receive formal supervision more regularly, covering their practise and development needs (including training needs). Also, ancillary staff should be informed about safeguarding, and all staff should be fully aware of the local authoritys procedures for reporting concerns about abuse to appropriate agencies outside the home. This is to protect people living at the home from harm or abuse as much as possible. Appropriate recruitment practises must be used consistently, so that people are protected from unsuitable staff. Reviews of staffing levels in the home (when occupancy levels change, etc.) should be such that people still receive assistance they need in a timely way, and to ensure there are sufficient staff to carry out cleaning tasks. More proactive management is needed to ensure the welfare and safety of those living at the home in the longer term. We must be informed if the registered provider or manager is to be absent for 28 days or more. The results of quality assurance surveys should be made available, to ensure people know that their views and comments have been listened to and acted upon. Evidence of systems for ensuring environmental risks are controlled (in relation to hot water, falls from windows, etc.) would assure people that their safety is promoted. Advice should be sought from appropriate professionals on the safest way of dealing with soiled laundry, to reduce cross-infection risks to staff. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 37 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 37 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 can be confident that the care home can support them if they are offered a place at the home. This is because their needs will be assessed before they move in, although more could be done by the home to find out about each person as an individual during such assessments. They, or someone close to them, are offered various opportunities to get information about the home, so that they can be decide if Alphington Lodge is the right place for them. The home does not provide intermediate care. Evidence: All except 1 survey from people living at the home said that they received enough information before they moved in to decide if the home was the right place for them. The manager encouraged people to visit the home as well as others, according to the AQAA, so that they could compare them. We also saw some people had the homes Service user guide in their bedroom, which would inform them about the home and Care Homes for Older People Page 11 of 37 Evidence: the service it offers. Five people surveyed confirmed they had been given written information such as a contract or terms and conditions, with 3 others saying No or Dont know. The AQAA stated that everyone had a written contract if privately funded, or a copy of the agreed arrangements if funded by a council or health trust. The manager showed us such documents when we requested to see them for people selected at random. Three healthcare professionals surveyed thought the homes assessment arrangements usually or always ensured that accurate information is gathered and that the right service is planned for people. Staff we spoke with felt people were admitted appropriately to the home in that their needs were similar to others living at the home and within the care category the home was registered for. We looked at pre-admission information about two people we met, who had moved into the home since our last visit. We saw that some information on peoples support needs had come from peoples previous carers, such as hospital staff. The AQAA stated that if individuals care was funded by a local authority, an assessment of the persons needs would be obtained from the persons care manager, as we had seen on our previous inspections. The AQAA also stated that everyone had a needs assessment/discussion to identify if the home could meet their needs. It was clear from records we read at the home that people or their relatives were involved in these pre-admission stages. We read assessments carried out by the manager. These were comprehensive, although they lacked individualised detail in places. It was positive to see that the assessment for one person included their interests or hobbies (with more information obtained about these after their admission also). For the other person, their preferred rising and bedtimes were not identified until after their admission. Whilst the general type of diet these people required was noted as part of the assessments (a special diet, soft, etc.), personal preferences were not recorded. Bathing was another consideration, but with no indication of how often they might wish to have a bath, although the manager said she would note here if people preferred a shower. Such details can be very relevant when the home is required to confirm it can meet someones needs before they move in. Care Homes for Older People Page 12 of 37 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are treated with respect and dignity. Most people receive the care or support they need, but some people may not get appropriate or consistent care for meeting their health and social needs. Although improvements have been made, further action is needed to ensure that peoples medication is handled safely. Evidence: A relative of someone at the home, when asked what the home does well, replied Looks after the differing day to day needs of (A). Another said Always popping in to see if (B) is OK. All surveys from people living at the home indicated they always or usually got the care and support they needed, including medical care. Relatives and other advocates who responded thought the home always or usually met the needs of the person living at the home, giving the support or care expected or agreed. Three healthcare professionals responded usually or always when asked if peoples social and health needs were properly monitored, reviewed and met by the home. They also said this when asked if the home sought advice and acted on it to improve peoples well-being. Care Homes for Older People Page 13 of 37 Evidence: Staff told us that they were given information on peoples current needs, and how to meet those needs, at hand-overs and from reading peoples care plans. We looked at the care plans and associated records for the 3 people we case-tracked. There was indication that these had been regularly reviewed, so should have provided up to date information about the individuals support needs. We saw that people - and/or their relatives/advocate if appropriate - were invited, in writing, to annual reviews of their care plan, and also if their care needs changed. The individual living at the home had signed these letters, as evidence of their involvement in the review. Records needed to be routinely dated, to make it clear how recently the information used for care planning and associated risk assessments had been obtained. Assessments of peoples needs that we read in their care file were not always updated or reviewed as care plans were. An undated assessment of someones needs indicated they managed independently to go to the toilet, but their daily routine information indicated staff were to attend to their catheter bag. In places, care plans lacked sufficient detail or guidance for staff on how peoples needs were to be met. For example, not everyones care plan included their preferred bedtime or rising time. It was identified that someone suffered pain, but without indication of where this pain was usually felt. Staff were to empty someones catheter bag regularly. When we asked staff what regularly meant in practise, we were given varying responses, which had varying risk of infection for the person. Thus better guidance was needed to ensure appropriate action by staff. An assessment of the needs of someone with impaired sight said that they liked the radio or watching television. When we asked staff what radio or television programmes the person liked, we were given very different responses. Although the person themselves was currently able to indicate their preferences, such detail is useful should the person in future not be able to express their choices so well. Information for staff about supporting people tended to be about individuals personal care needs, with less about meeting their health needs such as through routine eye tests or regular medication reviews, their dietary preferences (- important if trying to encourage someone to eat, as with one person we case-tracked), their social or psychological needs, their capacity to make decisions for themselves, and their wishes about their care in the event of a serious illness or sudden collapse, for example. It was very positive to see that the home had obtained peoples life histories, giving staff a better picture of each person as an individual. Care records also generally indicated peoples faith (by denomination), and if they still practised it. We also saw Care Homes for Older People Page 14 of 37 Evidence: very personalised care plans - indicating how long staff should leave someones breakfast tray with them before going to collect it, differences in an individuals daily routine on certain days of the week (such as assisting someone earlier on Sundays so they could go to church), and how often to check someone in the night, for example. It was not clear from someones care records or from staff whether the person still had a skin sore. Staff told us the person was now generally independent (which we observed during our visit) but they would check when assisting the person with their weekly bath. The persons care plan said they should have a particular mattress on their bed, but we found they just had an ordinary mattress. We discussed with the manager that further action was needed to ensure that sore areas were appropriately monitored. Peoples weight charts in the care records we looked at had not been completed since October 2009. We were told that a district nurse routinely visited the home weekly to discuss any concerns, etc., besides community nurses coming to see individuals as necessary. We met one who was positive about the home. Care records indicated people had received attention from a physiotherapist, chiropodists and opticians. People we spoke with, who lived at the home, felt staff were vigilant about their health and took appropriate action if someone appeared unwell or said they werent well. People looked well cared for. Most people were up, and able to talk with us. We noted that those resting on their beds received regular attention. Three healthcare professionals responded usually or always when asked if the home supported people to self-medicate, or managed it properly for them where this was not possible. Stocks received into the home were recorded, and staff showed us appropriate procedures for disposal of unwanted medication. There were suitable fixed and portable storage facilities for medication, including facilities in bedrooms for anyone who was self-medicating. It was positive to see risk assessments had been carried out when people wished to self-medicate. Further detail was needed on some of these, to show how identified risks were to be managed if to enable the person to self-medicate safely. Daily temperature records for the medication fridge suggested it was kept at the right temperature for correct storage, but we advised that minimum/maximum readings were also kept to monitor that items were not being frozen (which could alter their effectiveness). Care Homes for Older People Page 15 of 37 Evidence: The medication rounds were divided between 2 senior carers, to ensure people had their medication on time. There was a system for highlighting anyones allergies. Handwritten directions on medication administration sheets had not been signed by the writer, with no evidence that their accuracy had been verified by a second suitable person at the time of writing. We saw there were new procedures for recording the administration of peoples prescribed skin creams, although these needed monitoring to ensure staff completed the records. We looked at how controlled drugs were dealt with. We noted that although the homes medication policy said 2 staff should witness the giving of such medication, on 1 occasion there was only 1 signature recorded. Staff said this was because there was only 1 care assistant on duty at that time who had had medication training. We brought this to the managers attention. We noted some prescribed eye-drops and skin creams had not been dated on opening, so the shelf-life indicated by manufacturers could not be monitored. The medication policy that staff directed us to did not include guidance on this or certain other matters. The manager said she would look into this as the medication policy had just been revised and thus guidance should have been available. Two people we case-tracked were on medication only to be given when they needed it. There was no guidance in their notes as to when it should be given - for example, what signs they might show that indicated that they needed it. We were told that staff had had accredited training on medication, which staff reported as being useful to their work. However, the medication issues identified above indicates that staff competency and practise needs greater attention. Three healthcare professionals responded usually or always when asked if the service respected peoples privacy and dignity. People we spoke with who were assisted with personal care - such as washing or bathing - said they felt their privacy was respected as much as possible. Toilet and bedrooms doors had locks, should people wish to use them. Staff we spoke with were mindful of who liked their bedroom door open or shut when they were in their room, etc. We saw that staff were discrete when entering and leaving peoples rooms, talking in a respectful, friendly manner with people they went to or encountered throughout the day. We noted someones dignity was compromised because their catheter bag was visible. Staff told us that district nurses had tried to find ways of addressing this, without success; the manager agreed to seek further advice. Care Homes for Older People Page 16 of 37 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 daily life is varied and they enjoy beneficial relationships, because of the recreational opportunities within the home and links with the community around it. Choice is better promoted, although more could be done to enable people to continue their previous interests or hobbies. People are offered an appetising and balanced diet that meets their preferences. Evidence: All surveys from people living at the home indicated there were always or usually activities arranged by the home that they could take part in. When asked what the home could do better, however, comments include More activities and Own transport. We noted during our visit that people who lived at the home enjoyed conversations with each other, or enjoyed each others company, in one of the lounges. People we spoke with said they didnt get bored, or they could occupy themselves. Some said staff stopped to chat, or that they appreciated being able to have a laugh with staff. People we spoke with knew about activities arranged by the home. The weeks activities programme was displayed in both entrances to the home: Bingo, floor games, board games, discussing the past, manicures, the homes sweet trolley, a Care Homes for Older People Page 17 of 37 Evidence: drama workshop, and arts and crafts were currently offered. The care staff are responsible for offering activities or helping people to occupy their time generally, although the home arranges specialist sessions or events - such as Music for health and exercise sessions - which are led by people from outside the home. Staff were putting a new delivery of library books into one lounge during our visit. One person said they didnt go out, but nor did they want to. Another person told us there had been a trip to a pantomime, and occasional outings for a tea somewhere. Two people said that staff took people out to the local shops. It was not clear that peoples interests were used as the basis for planning activities or recreational opportunities offered at the home. Information about someone showed they had had a range of interests in their younger years, but these were not reflected in the activities offered to them. This included gardening, which had also been an interests of 2 other people we case-tracked. The manager said that activities taking place were in line with what people wanted to do in as much as that people could choose from what was offered generally, rather than keeping to the event scheduled for that day. Thus story-telling and Bingo took place more often than suggested by the planned programme, because people currently enjoyed these and chose them over other activities offered. A Bingo session took place during our visit. Staff described how someone continued links with their church (- something not reflected in the persons care plan). People who lived at the home told us that some people went to the near-by Anglican church, whilst others spoke about the services held at the home. All surveys from people living at the home indicated the staff always or usually listened and acted on what the person said. Relatives and healthcare professionals responded usually or always when asked if the home supported people to live the life they chose, whenever possible. When we asked someone who lived at the home if staff fitted in with residents and did what they wanted, they confirmed they did, describing themselves as fussy and explaining staff had learnt to do things as the person wanted them done. We observed the support and attention given by staff to someone with more diverse needs than others living at the home, including some communication difficulties. Staff made eye contact and touched them reassuringly, giving explanations until the person understood what was being said or discussed. Their responses were listened to Care Homes for Older People Page 18 of 37 Evidence: carefully, before staff continued. This person was thus kept involved with the happenings of the day, and given the same opportunities as their peers. Relatives/advocates indicated in their surveys that people were kept informed by the home, and that the home helped their relative/friend at the home keep in touch with them. People living at the home who we spoke with said their visitors were greeted and made welcome by staff on their arrival. We saw staff conversing cheerfully with peoples visitors. The days menu was displayed near dining areas. We were told that the cooks drew up the homes menus, rather than directly involving people who lived at the home in this. Most surveys from people living at the home indicated they usually liked the meals at the home, with 2 saying they always did. People we spoke with said their dietary preferences were met, they were asked what they wanted to eat and there was plenty of food provided. Some said the food was marvellous, one said there was too much sometimes, and two said it was variable. We spoke with people who ate in the dining rooms and in their bedrooms - all said the meals were hot enough (an improvement since our last visit). We did not find anyone needing a special diet. One person, asked what the home does well, said Home cooked meals. We saw home cooked cakes and scones in the kitchen, which were served at 3pm and teatime respectively. As it was a Friday, fried or poached fish was on the menu for lunch, with raspberry Pavlova for dessert. The day before lunch had been an all day breakfast, a salad or an omelette, with cheesecake for dessert. The chef confirmed all desserts and soups were homemade. Pasties or poached eggs had been offered at teatime. We noted there was nothing sweet on the teatime menus. We were told this was because cake was served in the afternoon and at supper-time (at 7pm), when sandwiches were also served. We also saw people helping themselves from a well-stocked fruit bowl available in a hallway. Care Homes for Older People Page 19 of 37 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 can be confident that their concerns and complaints will be listened to, and that action is taken to protect them from abuse. Evidence: All surveys from people living at the home indicated there was someone they could speak to if they were not happy, and all knew how to make a formal complaint. All but 1 relative/friend surveyed said they knew how to make a complaint about the care provided if necessary, with all but 1 saying the home always responded appropriately if they or the person living at the home raised any concerns. Surveys from professionals also said the home usually or always responded appropriately if they or someone else raised concerns about the service. People we spoke with said they felt able to make a complaint or say if something was not as they wished, including someone who otherwise declined to speak with us. One person said they only had to ring the bell if something were wrong, and staff would come. People felt they would be listened to, and action would be taken to address the matter. We found complaint forms were available by the Visitors signing-in book at the main entrance, should anyone wish to make a written complaint. The complaints procedure was displayed in both entrances to the home. A Complaints log was kept, although none were recorded since our last visit - as reflected in the AQAA, which said none Care Homes for Older People Page 20 of 37 Evidence: had been received. Staff receive training on safeguarding through an external training provider. Staff we spoke with knew what is considered abusive practise, and were clear that they would report any concern promptly, if they thought that abuse might have occurred. But they did not know the local authoritys procedures for reporting concerns to relevant agencies outside the home should this be necessary. We could not find this information in the policy manual that staff showed us. A chef we spoke with had not had safeguarding training. Care Homes for Older People Page 21 of 37 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 benefit from well-maintained, clean and homely accommodation. Evidence: Asked what the home does well, comments from those living at the home included Homely, Welcoming, had a good atmosphere, and that it was clean. A healthcare professional, asked what the home could do better, said Answer the door quicker - an issue raised at our last inspection. And when we first arrived, there was a delay in the doorbell being answered. Most people we subsequently spoke with said their visitors had no issues about this, although one said it was variable. People assumed staff were busy giving care if there was a delay, and the manager had put a notice up to this effect, outside the front door. There is a covered area at the front door, but as it is not enclosed people can be kept waiting in the cold. People we spoke with generally liked their room and its facilities, with some particularly liking the view from their window. We saw people had a call-bell within reach when necessary. Most people said lighting and heating were sufficient; one person said they would appreciate a brighter ceiling light, which the manager said she would address. The home felt warm and looked homely, as indicated by the surveys. Dining tables Care Homes for Older People Page 22 of 37 Evidence: were set with cloths, posies and table mats. Lounges had large fishtanks, as well as settees and armchairs of various heights, with footrests available, but carpets in some corridors and lounges were looking stained or tired. Bathrooms had coloured tiles, which made them bright and welcoming. There was one shower, which although it was not level access had a fitted seat. Grabrails or handrails were fitted in some toilets and bathrooms. People we spoke with who used walking aids told us they got around without problem - there were no tripping hazards such as rucked carpets or uneven floors. Most surveys from people living at the home said the home was always fresh and clean, with one saying this was usually the case. There were no malodours in the rooms or areas we visited. The home looked clean generally. We noted one bedroom carpet looked as though it hadnt been vacuumed, and were told it had last been vacuumed a few days previously, when the room had its routine thorough weekly clean (when furniture was moved, etc.). People spoke highly of the cleaner on duty, saying their rooms were usually vacuumed daily; they felt she had too much to do when responsible for cleaning the whole home on her shift. We looked at the fire log book to find out if the home checks its fire safety equipment, and found the weekly or monthly checks were up to date - showing fire doors with automatic closers and the emergency lighting would work when needed, for example. This was an improvement since our last visit. The fire safety system had been serviced in September 2009 by external contractors. Staff confirmed fire drills had been held, but there were no records available for these. The manager said the staff member responsible for recording the drills had them, but such records should be kept available at the home. The home told us in their AQAA that all staff have received infection control training, and that they have an action plan in place to deliver best practise in prevention and control of infection. We found liquid soap, paper towels, disposable gloves and aprons available throughout the home. Staff wore different colours of disposable aprons and gloves for care-giving and serving food. The kitchen areas looked clean and orderly, although we pointed out to the manager that a bin by the hand-wash area had to be opened by hand (rather than being a pedal bin), which is not good practise with regard to infection control. Staff described the different washing machine programmes they used for ensuring Care Homes for Older People Page 23 of 37 Evidence: linen, etc. was cleaned properly. We saw a hot wash was appropriately in use when we visited the laundry. However, staff told us they rinse soiled items by hand. This creates an infection risk to staff from aerosol inhalation, so advice should be sought from relevant professionals on more appropriate practises. Linen cupboards were well stocked, and smelt pleasant due to use of fabric softeners. Care Homes for Older People Page 24 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People get the support they want, from a caring staff team, who give a safe basic level of care. However, staff training and development does not at present ensure that all their needs - including changing needs - will be met. Recruitment practises are inconsistent, creating a risk that they may be looked after by unsuitable staff. Evidence: A relative, when asked what the home does well, said Friendly staff who genuinely seem to care about the residents. A healthcare professional described staff as very conscientious and caring. People we spoke with were also positive about the staff. When we arrived, the manager was on duty with 4 care assistants (3 of who were senior carers), a domestic and a chef, looking after 19 people. We also met the gardener, who is employed part-time, as is a handyman. Activities are led by care staff, and by individuals who run a specific session. No administrative staff were employed. All surveys from people living at the home indicated the staff were always or usually available when they needed them, although one also wrote that there were not enough staff, particularly at week-ends and holidays such as Christmas and New Year. Asked what the home could do better, a relative/friend replied A few extra staff would be lovely which was echoed by another relative. One person we spoke with thought Care Homes for Older People Page 25 of 37 Evidence: there had been a change in staffing, and that subsequently some planned events had not taken place as there were not enough staff. The manager thought this was actually activities cancelled due to recent heavy snow, however. Two people said staff levels had been a problem recently - they had been kept waiting for attention, for example. Other people told us staff had time to chat with them, or popped in at intervals to see if they were okay. We looked at staff rosters for Christmas, the new year period and the week of our visit. These showed that there had been 4-5 care staff on duty each morning (excluding the manager), 4 staff on duty in the afternoon until 6pm, then 3 care staff until 10pm, with 2 care staff on duty overnight. Annual leave and sickness absences were usually covered by other staff members, with a low use of agency staff in recent months shown by the AQAA. The manager had not recorded her work hours, and agreed to do so in future. She said she was at the home 5 days each week, and was on call when not at the home. During our visit, staff were occupied but did not rush people if physically assisting them or talking with them, etc. They were also helpful and friendly to visitors. Staff we spoke with felt staffing levels were currently sufficient, although some said teamworking and individuals ways of working could affect how smoothly a shift went. A relative observed that things werent quite the same if the manager was not on duty. Sickness absences were attributed to certain staff, and the manager said she was taking steps to address this. Relatives and professionals surveyed said the manager and staff usually had the right skills and experience to support peoples various needs, although one didnt know if the service responded to peoples more diverse needs. Someone living at the home, who had impaired sight, confirmed that staff were mindful of this and its effect on their daily life - they gave the person appropriate assistance with their meals, without being asked, for example. The AQAA stated that all staff employed in the last year had satisfactory employment checks. We looked the recruitment records of 3 staff employed since the last inspection. We found that most required checks had been carried out before these staff had started work. For example, full or initial police checks had been obtained before people started working at the home, and people had stated on their application forms why they had left their previous care-related jobs. However, there was only 1 reference available for 1 person, where there were 2 (as is required) for the other 2 staff. For another person, one of their references was not written specifically for the home, but was an undated personal reference addressed to Dear Sir/madam. There Care Homes for Older People Page 26 of 37 Evidence: was no evidence that this reference had been verified or discussed with the person who had signed it. One person had not included dates in the employment history they provided, so it was not clear if there had been any gaps in their employment, and there was no evidence that this had been explored with them. We found that applicants experience was assessed in detail during recruitment, identifying their suitability as well as further training needs should they be employed. We saw an induction book that the manager said was now given to new staff, as well as a briefer in-house introduction/induction sheet. The book was based on nationally recognised common induction standards. There were no new staff on duty for us to speak to about their induction, but the manager confirmed new staff keep their induction book, signing it off over time with their mentor (a named senior carer). senior carers who we spoke with also told us that they mentored new staff. Staff we spoke with had obtained a recognised care qualification, or were undertaking one. The AQAA stated that 11 of the 18 care staff employed at the home had a care qualification. Records and our conversations confirmed that staff had had training, since our last visit, on safe working practises (by an external training company). This included ancillary staff who we spoke with. Some had also had training on Equality and Diversity, or care of the dying, but little else relating to the needs of people they supported. We found staff had varying ideas on managing catheters, and some did not know much about how Parkinsons disease might affect people. This suggested that the staff team needed more training, although a senior carer said that they learnt about individuals needs from visiting nurses and GPs. Formal supervision arrangements were not sufficient to identify individuals training needs (see the next section of this report). Care Homes for Older People Page 27 of 37 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 generally run in the best interests of those living there, although more proactive management is needed to ensure their welfare and safety in the longer term. Evidence: The registered manager is undertaking a qualification for managers of care services (Leadership & Management for Care Services - Level 4, or LMC), hoping to complete this in April 2010. A relative commented Excellent manager - she is very caring and nothing is too much trouble for her. People we spoke with, who lived at the home, said they saw the manager sometimes, but knew who she was and indicated they got on well with her. One said she was willing to go to see people if they asked for her. Another said Shes lovely - she will do anything she can. All requirements made at our last inspection had largely been addressed. The AQAA was returned within the required timescale, gave much of the information required, and at times reflected the views of people using the service when assessing how good Care Homes for Older People Page 28 of 37 Evidence: a service the home was providing (which is excellent practise). Some areas were less well addressed - for example, there was no evidence in relation to Safe working practises (Standard 38) in the relevant section of the self-assessment, that electrical circuits have been checked within recommended timescales, or that the homes policies had been reviewed recently. The manager told us that the policies are all under review, and this will be completed within a year. There was little in parts of the self-assessment on how the service could improve in the next year, and information provided did not always link to the topics under consideration. There was no-one living at the home who was subject to a deprivation of liberty authorisation, and we did not find that anyone was having their liberty deprived without an authorisation. Typed reports were given to the manager following the monthly unannounced visits to the home made on behalf of the provider by their appointed representative, Mr Mike Beard. This is an improvement since our last visit, although the reports were very brief. The manager told us that people living at the home and staff were spoken with much more than the reports indicated. A staff member we spoke with confirmed that staff could contact Mr Beard and that he spoke with staff on his visits. The manager also told us that matters raised at one visit were followed up with her at the next. We learnt from these reports that the manager had been absent from the home for over 4 weeks, but we had not been notified at the time. No residents meetings were held. The manager said she instead ensures she speaks to everyone regularly, and especially if staff tell her someone is concerned about something. We discussed that at present there was no record kept of how often she spoke with each person, so no way of monitoring that everyone had equal opportunities for giving their views. The manager agreed to give this further consideration. We saw that the homes quality assurance surveys were available by the Visitors signing-in book, for anyone to complete (including visiting health professionals). Conversations with people living at the home indicated the home had given them surveys in recent weeks, and we saw a sample of those returned. These gave an opportunity for people to express views anonymously if they wished. Surveys were still to be analysed overall, but the manager had begun to address individual matters raised, with records seen of this. Staff did not act as appointees for anyone, but the home held personal monies for some people. Records we checked had two signatures to verify entries - which Care Homes for Older People Page 29 of 37 Evidence: indicated payments for hairdressing, chiropody, pharmacy sundries, in the records we looked at. Recorded totals matched the individual cash balances held. Receipts were generally available, but we noted that receipts provided by the chiropodist were not dated. The manager said she would ensure this was done in future. One person we spoke with had money held by the home, and they were satisfied with how this was managed. Staff meetings were held. Some staff said these took place when the manager thought a meeting should be held, although an agenda was drawn up which staff could add topics to, and that more meetings would be appreciated. Recent minutes showed matters were discussed that would promote peoples rights to choice, help to ensure that they received prompt attention, maintain cleanliness, and that clarified staff roles and responsibilities, for example. Although the AQAA stated that staff had bi-monthly supervision, we found that some staff had not had such recent or regular opportunity. The manager said that this was because the deputy manager, who had been responsible for holding supervision sessions, had left. Staff we spoke with felt they had a safe working environment, and that they had the equipment and facilities that they needed to look after people at the home properly. One carer added they would report any health and safety issues, and felt they would be listened to. We found that fixed hoists had been serviced but the homes mobile hoist had not. The manager said this was due to a misunderstanding with the engineers but the matter would be addressed by the end of the month. We checked 3 upper windows at random, and found one was unrestricted and able to be opened wide. No records were kept of routine safety checks - on window restrictors, bed-rails and water temperatures, for example - to evidence that risks to peoples welfare were being managed appropriately. We looked at accident forms, and noted in recent months that some people had had accidents more than once. We asked if falls were audited, which the manager confirmed. She gave an example of how this had highlighted someone who had not fallen before, so she asked their GP to visit them, and their medication had subsequently been changed with good effect. Leftovers in the kitchen fridge were covered and dated. Temperature records were kept of fridges, freezers, hot food, etc. Care Homes for Older People Page 30 of 37 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 31 of 37 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 7 12 Peoples care plans must be sufficiently detailed regarding their individual health and welfare needs, and how those needs are to be met, To ensure that people consistently receive the care and support they need to ensure their physical and mental wellbeing as an individual. 01/04/2010 2 7 14 The assessment of peoples needs must be kept under review To ensure individuals changing needs are identified and they receive appropriate care. 01/03/2010 3 9 13 You must ensure you have effective systems for the safe administration of medicines, including 1) Appropriate medication 01/03/2010 Care Homes for Older People Page 32 of 37 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 policies & procedures for staff to refer to and follow, that include guidance on Recording the administration of peoples prescribed skin creams, monitoring of the shelf-life indicated by manufacturers, use of prn or as required medication, verifying the accuracy of hand-written directions 2) That staff practise is monitored, to identify and speedily address any poor practise, and ensure they adhere to the homes policies and procedures for medication To avoid risks to peoples health and promote their wellbeing. 4 29 19 You must ensure that noone is employed to work at the care home unless you have obtained the information and documents specified in Schedule 2, including: Two satisfactory written references, which relate to the job for which the person is applying 01/03/2010 Care Homes for Older People Page 33 of 37 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 Sufficient information for identification of any gaps in employment, with evidence that any gaps have been explored To ensure that people living at the care home are looked after by suitable staff. 5 31 38 The registered provider 01/03/2010 must inform us if they or the registered manager is to be absent for 28 days or more, giving the information detailed in Regulation 38, & notify us of within 7 days once they return from absence To ensure that there are clear management arrangements, to safeguard people living at the home. 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 3 It is recommended that pre-admission assessments of prospective residents needs are sufficiently detailed to ensure that the home can meet each persons individual or diverse needs if they move into the home. It is recommended that all eye-drops, skin creams and lotions should be dated when opened to indicate when they should be discarded, in line with the manufacturers guidance of their shelf-life once opened. 2 9 Care Homes for Older People Page 34 of 37 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 3 9 There should be clear guidance for staff regarding medication prescribed for use when required or prn, to show when and how it is to be used for each individual, as part of their care plan in relation to their particular need(s). It is recommended that handwritten directions on medication administration sheets are signed by the writer, with evidence of effective systems in place to verify the accuracy of what has been written. The activities and recreational opportunities offered by the home should reflect peoples recorded interests. All staff who work at the home should have safeguarding training. Staff should be fully aware of the local authoritys safeguarding procedures, including those for reporting concerns about abuse to appropriate agencies outside the home. You should seek advice from appropriate professionals on the safest way of dealing with soiled laundry, rather than hand-rinsing it, to reduce cross-infection risks to staff from aerosol inhalation. Reviews of staffing levels in the home (when occupancy levels change, etc.) should be such that people still receive the assistance they need in a timely way, and to ensure there are sufficient staff to carry out cleaning tasks. Staff should receive regular updates on topics relevant to the particular needs of people living at the home - so that they are able to meet peoples needs, including any changing needs, and fulfil the aims of the home as indicated in the homes statement of purpose. The registered manager should complete the Leadership and Management Award by April 2010. The results of quality assurance surveys should be made available to current and prospective residents, their representatives and other interested parties - so that people know that their views and comments have been listened to and acted upon. Care staff should receive formal supervision at least 6 times a year, covering their practise and development needs (such as training needs). Page 35 of 37 4 9 5 6 7 12 18 18 8 26 9 27 10 30 11 12 31 33 13 36 Care Homes for Older People 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 14 38 It is recommended that you evidence effective environmental risk control measures are in place (in relation to risks from hot water, falls from windows, etc.), seeking guidance from the appropriate authority locally, as necessary. Care Homes for Older People Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 37 of 37 - 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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