Care Home: Altham Care Home

What the care home does well People who use the service were treated with respect and personal care was carried out in private. One person said, "The staff are lovely I can`t grumble about them." Another person said, "The staff will do anything for me." One visitor explained how good the staff had been with her relative during a recent illness. A care worker explained how she promoted privacy and dignity for people using the service and said, "It`s their home so you have to treat them with respect." All the people asked said the daily routine was flexible and they could choose when to get and when to go to bed. One person said, "I choose my bed time." Training for all members of staff was actively encouraged. More than half of the care workers had National Vocational Qualifications in health and social care at level 2 or above. One care worker explained that when she had completed NVQ level 2 she was encouraged to do level 3. What has improved since the last inspection? To comply with the requirements made at the last key and random inspections the following action has been taken. Care plans identify the health and social care needs of each person using the service. They also provide directions for staff to follow so that they know what they need to do in order to fully meet the needs of each person using the service. Medication was managed correctly and clear records were kept to ensure all medicines could be fully accounted for. Members of staff responsible for the administration of medication were assessed to ensure they were competent. Medication was given in the correct dose and at the right time as prescribed by the doctor. Care plans provided information and guidance for staff to follow about medication prescribed to be taken `when required` to ensure this was given to people correctly. What the care home could do better: To ensure members of staff know what they need to do to look after a person suffering from an acute healthcare problem it is essential that a care plan giving clear directions is available. Key inspection report Care homes for older people Name: Address: Altham Care Home Burnley Road Clayton-le-moors Lancashire BB5 5TW     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: Susan Hargreaves     Date: 0 7 0 9 2 0 0 9 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 27 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 27 Information about the care home Name of care home: Address: Altham Care Home Burnley Road Clayton-le-moors Lancashire BB5 5TW 01254396015 01254871335 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Rajinder Singh care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category 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: Old age, not falling within any other category - Code OP (maximum number of places 13), Dementia - Code DE (maximum number of places 23). The maximum number of service users who can be accommodated is: 36. Date of last inspection Brief description of the care home Altham Care Home offers 24 hour personal care for up to 36 older people including 23 people with dementia. The property is purpose built with a car park and garden. It is located in Clayton-Le-Moors close to local amenities and public transport. Accommodation is provided on two levels in thirty single and three twin-bedded rooms. Twenty of these rooms have en-suite facilities. Communal rooms include two separate lounge areas with television, and two dining rooms. One dining room has a kitchenette for residents to make their own drinks and snacks. Toilets and bathrooms are Care Homes for Older People Page 4 of 27 Over 65 0 13 23 0 2 8 0 5 2 0 0 9 Brief description of the care home conveniently located close to communal rooms and bedrooms. The current fees charged at Altham Care Home are £366 to £465 per week. Additional charges are payable for hairdressing and newspapers. A statement of purpose and service user guide was available to prospective residents and their relatives on request. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: A key or main unannounced inspection, which included a visit to the home, was conducted at Altham Care Home on 7 September 2009. As part of the inspection process we looked at all the information we have received about Altham Care Home since the last key which took place on 2 October 2007. This included an Annual Service Review on 2 October 2008. The purpose of this was to assess if the quality of care provided to people living at the home had changed and to make sure the home was being properly managed. A random inspection was conducted 28 May 2009 by a specialist pharmacist inspector to look at how medication was managed. Information about the last key and random inspections and the Annual Service Review can be obtained from Altham Care Home or www.cqc.org.uk The manager completed an annual quality assurance assessment several weeks before this visit to the home. This document is a self-assessment that focuses on how well outcomes are being met for people who use the service. It also gives us some Care Homes for Older People Page 6 of 27 numerical information about the service. At the time of this visit twenty eight people were living at the home. A tour of the premises took place and we looked at staff files and care records. We also spoke to members of staff on duty and people who use the service. Discussions also took place with the provider and quality manager regarding issues raised during the inspection. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 Care Homes for Older People Page 8 of 27 order line 0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A thorough admission procedure ensured the health and personal care needs of people using the service were identified and met. Evidence: A copy of the statement of purpose and service user guide is available to people who are considering using the service and their relatives on request. These supply information about the care and facilities provided at the home. The quality manager or team leader visited people who were considering using the service in hospital or their own home before admission. The purpose of this visit is to assess the persons health and personal care needs to ensure they can be met at the home. We looked at the care records of two people using the service. Pre-admission assessments were seen both files. These assessments provided important information Care Homes for Older People Page 11 of 27 Evidence: for the development of their care plans. People considering using the service or their relatives received a letter confirming that their needs could be met at the home. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service were cared for in a manner which promoted their privacy and dignity. Medication was managed safely. Evidence: We looked at the care plans of three people who use the service. These plans usually identified the health and personal care of each person and provided directions for staff to follow to ensure their needs were met in the way they preferred. One of the care plans directed staff to give the person one item of clothing at a time so that they could dress themselves. The care plan also told members of staff to allow this person to choose the clothes they wanted to wear. Another care plan advised members of staff to speak clearly in order to enable the person to communicate effectively with them. One of the care plans we looked at stated the person had recently been seen by the doctor for an acute healthcare problem. Although a care plan was not in place Care Homes for Older People Page 13 of 27 Evidence: discussion with a member of staff confirmed that they were aware of this problem. The manager was advised to complete a care plan explaining exactly what members of staff needed to do to manage the problem and aid recovery. Appropriate risk assessments including ones for falls, nutrition and the development of pressure sores were in place. Guidance for staff to follow about how to manage identified risks was also included in the care plans. A written report about the care given to each person using the service was written during each shift. This ensured that all staff had up to date information about the condition of each person in order to ensure continuity of their care. Care plans and risk assessments were reviewed monthly and updated when the needs of the person changed. Where possible the person using the service or their relatives were involved in care planning and had signed the care plan to indicate their agreement with the care provided. One visitor said that she had seen her relatives care plan and been involved in care planning. This visitor also explained that she was kept informed if her relative was unwell and staff were always polite and willing to answer any questions. There were records of the involvement of GPs and other healthcare professionals including the chiropodist and district nurse in the care of people who use the service. As part of the visit a pharmacist inspector looked at how medicines were being handled because a previous visit had found some shortfalls. We found medicines stock and records to be well organised and securely stored. We found the records of medicines received into the home, given to people and disposed of were completed correctly and medicines were usually given to people at the right and best time. A clear system of stock control was in place that helped make sure medicines did not run out of stock and helped make sure they could be fully accounted for. Medicines were regularly checked and detailed records of this were made, any mistakes that were found were acted upon immediately to try and prevent them happening again. We gave some general advice about how to audit (check) liquid medicines and how to improve the general presentation of the records to help make further improvements. Staff had received regular medicines training and their competency in handling medicines had been formally assessed. Regular checks on medicines, relevant training and competency checks help make sure staff have the necessary skills to handle medicines safely. Care Homes for Older People Page 14 of 27 Evidence: We checked how controlled drugs (medicines that can be misused) were handled. The cupboard used for storage was secure and a special register was used for record keeping. Stock levels were correct and all entries were properly witnessed. Secure storage and witnessed records help make sure controlled drugs are not mishandled or misused. We looked at a sample of peoples care plans and found some good information about their medicines. Medicines prescribed as when required had clear guidance about when and how to give them including those used for pain, agitation and as laxatives and these were reviewed on a monthly basis. Having clear written care plans helps make sure medicines are given to people correctly. Personal care was carried out in the privacy of the persons own room or the bathroom. Members of staff were observed attending to people in a polite and friendly manner. One person using the service said, The staff are very good and they do as theyre asked. One member of staff said, Its their home so you have to treat them with respect. Care Homes for Older People Page 15 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples choices were respected and they were supported by members of staff to have a fulfilling lifestyle. Meals were wholesome and appetising and people enjoyed them. Evidence: Discussion with people using the service and members of staff confirmed that a variety of activities were organised in the home. These included board games, ball games, watching films, karaoke, sing alongs and manicures. An outside also entertainer visited the home every month. When the weather was nice people could sit outside or were taken for a walk by members of staff. During the morning of this visit people sitting in the lounge were listening to music and members of staff chatted to them when they were offered mid-morning drinks. This provided a pleasant and homely atmosphere for people using the service. A local Vicar regularly visited the home and offered communion to people who wished to practice their faith in that way. People using the service and members of staff said that visitors were welcomed into the home at anytime and offered refreshments. Care Homes for Older People Page 16 of 27 Evidence: The daily routine was flexible in order to meet the needs and preferences of people using the service. All the people asked said they could choose when to get up and go to bed. One person said, I choose when to get up and go to bed. The meal served at lunchtime looked wholesome and appetising. Members of staff were observed sitting and chatting with people using the service at lunchtime and assisting them with feeding when necessary. Lunch was unhurried allowing people time to socialise and enjoy their meal. All the people asked said the meals were good. Care Homes for Older People Page 17 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints were taken seriously and investigated. Members of staff had the training necessary to ensure people who use the service were protected from abuse. Evidence: A copy of the complaints procedure was included in the statement of purpose and service user guide and displayed in the home. One person using the service and the relative of a person using the service said that they would feel confident to make a complaint should it become necessary. The provider said he had investigated eight complaints in the last year. A record of these complaints, the investigation and the action taken were available for inspection. No complaints have been made directly to the Commission. We looked at the policies and procedures for safeguarding vulnerable adults. The procedure stated the action that members of staff must take if allegations of abuse are made. Notices were also displayed throughout the home advising people what to do if they suspected a person using the service was being abused. Discussion with three members of staff confirmed that they had received training in safeguarding vulnerable adults. They all said they would report any concerns immediately. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises are well maintained and provide a comfortable and homely environment for people who use the service. Evidence: A tour of the premises confirmed that the home was clean, tidy and generally well maintained. This provided a homely and comfortable environment for people using the service. Recent improvements to the lounge included a new carpet and chairs. People using the service were encouraged to bring personal items for their bedrooms to make them more homely. These included, ornaments, photographs, pictures for the walls and items of furniture. The grounds and gardens were well kept and accessible to people using the service if they wished to sit outside when the weather permitted. All the laundry was done at the home. A suitable equipped laundry room ensures clothes are washed promptly and returned to people using the service. Gloves and plastic aprons were available throughout the home for members of staff to use in order to protect themselves and people using the service from infection. Members of staff were also given training in how to prevent and control the spread of Care Homes for Older People Page 19 of 27 Evidence: infection. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Members of staff are encouraged to acquire the skills and knowledge necessary in order to meet the needs of people using the service. Recruitment procedures are thorough. Evidence: The duty rota provided details about the grades and number of staff on duty for each shift. One person using the service and a visitor told us that there was always staff about if they needed any help. We looked at the files of three members of staff appointed since the last inspection. These files indicated that all the required information had been obtained before these members of staff had started working at the home. This included two written references and a Criminal Records Bureau check. These checks ensure that people who use the service are protected from the employment of unsuitable staff. Discussion with the quality manager and members of staff confirmed that training was actively encouraged. This included induction training for new employees, moving and handling, basic food hygiene, health and safety, first aid, safeguarding, infection control, fire and dementia. In addition to this most of the care workers had National Vocational Qualifications at level 2 or above in health and social care. One member of staff explained that she had been encouraged by the management team to do NVQ Care Homes for Older People Page 21 of 27 Evidence: level 3 she said, They encourage you to better yourself. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The is effectively managed and the views of people using the service are considered when decisions about the care and facilities provided at the home are made. Evidence: The provider and quality manager are responsible for the day to day management of the home. They both have several years experience of caring for older people and people suffering from dementia. They keep up to date with current practice by attending relevant seminars, reading care journals and using the internet. The three members of staff interviewed said they liked working at Altham Care Home and found the management team to be helpful and supportive. One member of staff said, Its friendly everyone gets on well. Discussion with the provider confirmed that he was committed to running the home in the best interests of the people living there and had achieved the nationally accredited Investors in People Award. The people using the service and their relatives were asked to give their views about the home by completing anonymous satisfaction Care Homes for Older People Page 23 of 27 Evidence: questionnaires every year. The last one was done in December last year. An evaluation of the responses showed they were mainly positive. Meetings with people using the service were held about every two months to enable them to discuss any aspect of their life at the home. At the last meeting, a few days before this visit, leisure activities and trips out were discussed. The Annual Quality Assurance Assessment stated that as a result of listening to the views of people using the service menus are changed regularly to include their choice of meals. Policies and procedures for safe working practices were in place. These help to make sure the home is a safe place to live and work. We looked at the records of the weekly testing of the fire alarms and emergency lighting. An up to date fire risk assessment was in place and fire drills took place regularly. We looked at the records of routine servicing of equipment. These included up to date electrical installation and gas safety certificates and evidence that the testing of small electrical appliances was carried out annually. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 7 It is important for a care plan to be put in place which addresses any acute healthcare needs of people using the service. This will ensure that all care workers will know what they need to do in order to look after the person and promote their recovery. Care Homes for Older People Page 26 of 27 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. 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