Care Home: Athorpe Lodge

What the care home does well The home provides a warm and friendly environment and staff were clear about their roles within a large team. The home is well managed and she delegates key responsibilities to ensure the smooth running of the home. The service is very good at providing a variety of activities to people who use the service. They employ a team of activity coordinators to ensure activities are available each day. People said they enjoyed joining in games of bingo and going on outings. Fund raising and an allowance from the organisation means that they are able to buy in entertainers for the people living at the home. They provide excellent opportunities for staff to attend training and they are good at providing service specific training to ensure staff have to skills to meet the needs of people who use the service. They have robust recruitment procedures to ensure the right staff are employed at the home and a excellent induction programme gives staff the right introduction to essential training. The home has good quality assurance systems to ensure people and other stakeholders have they say in the things that may need improving. People said they enjoyed living at the home and they felt safe and were able to tell staff if they had a problem. What has improved since the last inspection? The home continues to refurbish the environment including redecorating bedrooms and replacing the flooring in dining areas and peoples bedrooms. New furnitures and specialised equipment continue to be purchased for individual use. Medication procedures have improved to ensure there is a clear audit trail to confirm people receive their medication as prescribed. Assessments have improved and daily records show how staff had supported people with their personal care. What the care home could do better: Although medication procedures had improved there is a problem with the storage of controlled medicines. A second store on the ground floor would ensure that the medication can be stored correctly, and prevent overstocking. Key inspection report Care homes for older people Name: Address: Athorpe Lodge Off Falcon Way Dinnington Sheffield South Yorkshire S25 2NY     The quality rating for this care home is:   three star excellent 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: Valerie Hoyle     Date: 0 9 0 6 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 26 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 26 Information about the care home Name of care home: Address: Athorpe Lodge Off Falcon Way Dinnington Sheffield South Yorkshire S25 2NY 01909568307 01909563880 athorpelodge@exemplarhc.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Athorpe Health Care Limited care home 90 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 90 The registered person may provide the following category of service only: Care home with nursing - Code N, 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; Dementia - Code DE and Physical disability - Code PD Date of last inspection Brief description of the care home Athorpe Lodge is situated in the grounds of Dinnington Hall in the village of Dinnington. Athorpe Lodge is a purpose built home providing for 90 elderly people in need of care due to infirmity or dementia. The home provides personal and nursing care in five units with a separate unit for people who have dementia. All bedrooms are Care Homes for Older People Page 4 of 26 Over 65 0 90 0 90 0 90 1 2 0 3 2 0 0 9 Brief description of the care home for single occupancy with ensuite facilities. The home is constructed at ground and first floor levels; with a shaft lifts for ease of access for people. The home has its own garden; separated from Dinnington Hall by wooden fencing and gates and nearby car park. Local facilities are within easy access from the home. Information about the home and the Commission for Social Care latest inspection report dated 12th June 2007 is available to people from the home. Information gained during this inspection confirmed the current fees range from three hundred and sixty six pounds to five hundred and tewnty-eight pounds and thirty pence. Additional cost include hairdressing, private chiropody and newspapers. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent 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: The quality rating for this service is 3 star. This means that the people who use the service experience excellent quality outcomes. A random unannounced inspection was undertaken on the service on 12th March 2009 where we looked at medication procedures and the way activities were accessed by people. Two requirements were made at this inspection which was checked during this inspection. A annual service review was undertaken at this service on 17th June 2008 we looked at information contained in the AQAA and responses from surveys sent to people who use the service. As a result of this review we confirmed the service continue to provide good outcomes for people. This unannounced inspection took place over 9 hours starting at 09:00 finishing at Care Homes for Older People Page 6 of 26 18:00; this included a partial inspection of the home. Seven people who use the service, nine staff, the tissue viability nurse, a district nurses and four relatives were spoken to during this inspection;their views are included throughout the report. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use the service are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Occupancy at the home remains high with all beds occupied. Four peoples care plans were looked at. Policies relating to medication, complaints, protection of vulnerable adults and handling of peoples monies were looked at. Five staff recruitment and training records were looked at to assess how people were protected. Procedures and risk assessments relating to health and safety were looked at and discussed with the manager. The manager is Karen Radford; she has the required management qualifications, competencies and skills and is a registered nurse. The AQAA was sent to the home and was returned to us on time, which demonstrates responsiveness and cooperation. An Annual Quality Assurance Assessments is a selfassessment and a dataset that is filled in once a year by all providers whatever their quality rating. It is one of the main ways that we will get information from providers about how they are meeting outcomes for people using their service. The AQAA also provides us with statistical information about the individual service and trends and patterns in social care. The inspector would like to thank everyone who agreed to being interviewed as part of the inspection process, and the friendliness of staff. Care Homes for Older People Page 7 of 26 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 order line 0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service were assessed before moving into the home to ensure their needs can be met. Evidence: All new people receive a full comprehensive needs assessment before admission into the home. This is carried out by unit managers or nursing staff at the home depending on which unit they are going to be admitted onto. Staff undertaking the assessments have the required skills and competencies to ensure they can meet the persons needs. The service was highly efficient in obtaining a summary of any assessments undertaken by social services or the primary care trust. Staff confirmed the information contained in the assessment was essential to be able to meet a persons personal care needs. The assessments looked at were focused on achieving positive outcomes for people and they covered all essential areas of need. Before admission meetings take place Care Homes for Older People Page 10 of 26 Evidence: with family and the person social worker to consider the best interest of the individual. The procedures include trials at the home and people could visit before moving into the home. Relatives said they had looked around a number of homes before choosing Athorpe Lodge. They confirmed they were involved in the admission process and staff were warm, friendly and helpful. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans provides staff with sufficient information to enable them to meet the needs of people who use the service. Arrangements for dealing with health issues are met with support from health professionals. Medication policies and procedures were well managed ensuring the safe administration of medicines. Evidence: A number of care plans were looked at, they were well written and provided sufficient information to enable staff to meet the needs of people who use the service. The care plans include regular evaluations, and daily records assess the individuals progress. Comprehensive risk assessments had been developed to ensure people could maintain their independence while remaining safe. Risk assessments included how to move and handle people safely, nutrition and the condition of the persons skin. Consideration should be given to develop a risk assessment for one person who goes out with family and friends. This will ensure staff are clear about their roles and responsibilities if the person fails to return when expected. The home was able to demonstrate how they support people with their healthcare Care Homes for Older People Page 12 of 26 Evidence: needs. The manager said the local doctors visit the home weekly to see patients, they also have regular support from the district nurses and CPNs, for advise and guidance for people with dementia. The home works closely with the tissue viability nurse and we were able to speak to her during this inspection. She said staff were very good at contacting the service for early intervention to prevent pressure areas developing. She said the home purchases equipment where required to maintain the comfort of people. Relatives confirmed peoples healthcare needs were met, they said staff act swiftly if any people become ill. They said staff keep them informed of any concerns about the health of their relative. The manager said that qualified nursing staff and senior carers had responsibility for the administration of medication to people. An audit of some of the medication was undertaken. The records were clear and correct, although there was some over stocking of medication contained in the controlled drug cupboard. Consideration should be given to have a second control drug cupboard for the units on the ground floor. Senior staff have received training to safely administer medication and the pharmacist undertakes regular audits and gives advise where needed. Throughout the inspection staff were seen interacting with people in a kind manner, they spent time talking to people and were observed knocking on bedroom doors before entering. All people were referred to by their first name and this was agreed in the care plans looked at. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to socialise with family and friends and mealtimes were well managed. Evidence: There was a warm and friendly atmosphere on entering the home and a sense of calm on all of the units. Staff are commended for supporting people in a kind manner. Activities were arranged that were suitable for the people living at the home. The home employs three staff to the role of activity coordinators. The home had developed a activity plan which included the use of the organisations transport every Monday. The coordinator said they had arranged 3 barge trips to ensure those who wanted to go out had the opportunity. They had also arranged a coach trip to Skegness in July and other trips to local places of interests. The coordinators were given a budget for materials and buying in entertainment and there was evidence of monthly entertainers visiting the home. Arts, crafts and games were also available throughout the week. On the day of this inspection people enjoyed planting tubs of flowers outside. Fund-raising had enabled the home to purchase an activity centre which included strobe lighting and a sensory tank. The inspector was able to see it working and the coordinator said it was often used in bedrooms where Care Homes for Older People Page 14 of 26 Evidence: people spent time in their room. Consideration should be given to develop notice boards to advertise the forthcoming events and to publicise the good work undertaken at the home. A number of relatives were spoken with during this inspection and they confirmed that they were able to visit at any reasonable time. Most of the comments were positive although two relatives raised concerns over the staffing levels. This was discussed with the manager who provided evidence that the levels were sufficient. The cook gave examples of the menus provided and she said there was always alternatives if requested. Mealtimes were well managed by staff that had a good understanding of peoples dietary needs. The cook said nutritional assessments had been undertaken to ensure people receive additional supplements where needed. Staff were seen giving assistance in an unobtrusive way, and meals were served with a warm drink. The meals were served from heated cupboards which are transported from a central kitchen. The flooring in the kitchen was being prepared to be replaced and the manager said arrangements were being made to provide hot food while the kitchen was out of commission. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service were able to express their concerns, and have access to robust, effective complaints procedures, and were protected from abuse, and have their rights protected. Evidence: The home has robust complaints procedures which was seen on the notice board in the entrance of the home. The manager said people were given a copy of the policy when they were admitted into the home, and people confirmed they were aware about how to raise their concerns. The manager said she was responsible for investigating complaints and following the procedures which included informing the complainant of the outcome. The AQAA confirmed eight complaints had been received in the last twelve months and all had been investigated within the timescales stated in the procedure. The records were looked at and they included any action required by the home. There was a comprehensive safeguarding adults and whistleblowing policy and staff follow the procedures to those standards. The manager has responsibility for taking the required action including making referrals to the local safeguarding team in social services. Four referral had been made since the last inspection and they were discussed with the manager. Staff records confirmed that they had received training to keep people safe and relatives said they were confident that the manager would act Care Homes for Older People Page 16 of 26 Evidence: swiftly to deal with any concerns. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service were provided with a clean, comfortable environment. There was sufficient staff to maintain good hygiene standards. Evidence: The home meets the requirements of the Disability Act and the layout was suitable to meet the needs of people living at the home. The home is split into six separate units which provides care to people with various disabilities. Each unit has its own dining facilities and separate lounges. A tour of the premises found the home clean and fresh and bedrooms were personalised to individuals choice. A number of the bedrooms and bathrooms have been refurbished and the manager said they were continuing with the decoration programme. There was a choice of bathing facilities on each of the units and a number of toilets throughout the home. The home has sufficient equipment to ensure peoples safety whilst moving around the home including hoists, stand aids and wheelchairs. The manager purchases equipment as required to maintain peoples safety while in bed. The grounds are well maintained with seating areas and grassed areas to enable people to sit out. There was a safe garden for people with dementia and the staff had Care Homes for Older People Page 18 of 26 Evidence: added colourful plants to make the area more interesting. Throughout the inspection staff were seen interacting with people in a kind manner, they spent time talking to people and were observed knocking on bedroom doors before entering. All people were referred to by their first name and this was agreed in the care plans looked at. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff had the skills and competencies to fulfill their roles within the home; a stable staff group ensures continuity of care by staff that knows the people. Recruitment policies were followed ensuring the safety and protection of people who live at the home. Evidence: Training records were looked at and they confirm the staff have the required skills and competencies to meet the needs of people who use the service. The manager was able to show a training plan which flagged up when staff were due to receive refresher training. Staff confirmed they feel supported and the organisation invested in their development. The manager said there was a stable staff group with many of the staff working at the home for a good length of time. The AQAA confirmed that 14 staff out of a workforce of 76 had left employment in the last twelve months. There was a robust induction and probationary package for all new staff employed at the home, which includes a week spent at the organisation head office. The manager only confirms permanent employment when she is satisfied that they have reached the required standards. A new member of staff said she had been supported through her induction and spent time shadowing experienced members of staff. The AQAA confirmed that 23 care staff hold the NVQ Level 2 award in care and the Care Homes for Older People Page 20 of 26 Evidence: manager said although the levels do not meet the required 50 they were addressing the shortfall by getting more staff to be NVQ assessors. The home has robust recruitment and selection procedures that ensures people who use the service are safe and protected. A number of staff recruitment files were looked at and they included all the required employment checks including two references, application form, and Criminal Record Bureau Check. The files were very organised and could be easily audited. Staff rotas and observation during this inspection confirmed there was sufficient numbers of staff to meet the needs of people who use the service. The unit managers were responsible for completing rotas and staff tend to work specifically on each of the six units. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and the views of people are sought and any shortfalls were addressed. Systems were in place to protect the health and safety of the people and staff. Evidence: The registered manager has a wealth of experience and competencies to manage the home to a good standard. She had achieved the required management and care qualifications and she is a qualified nurse. She operates an open door policy to ensure she was accessible to staff and people that use the service. Relatives and staff spoke highly of the manager. She is supported in her role by a deputy manager and a team of administrative staff, who have specific roles within the home. Staff and group meetings ensure that staff were informed about training opportunities and the day to day running of the home. People who use the service were able to make decisions about how they want to Care Homes for Older People Page 22 of 26 Evidence: manage their personal money, although some choose to let the home manage their money due to their limited capacity. Records were looked at and they were a true reflection of the money kept in their savings. The organisation has developed good quality audits which the manager and her team have to complete. They also actively seek the views of people and other stakeholders, and surveys are sent out to people yearly. A selection of the outcomes from the last surveys were looked at, and they showed good satisfaction levels in most areas. The manager has responsibility for addressing areas requiring improvement. Accident and incident reports were analysed by the manager to ensure risk assessments are developed where required. Maintenance and service records were looked at and were up to date and current to the service provided. The manager has the required health and safety policies and procedures and displays the relevant notices. Fire safety procedures were in place and service records were looked at and were up to date. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The home must ensure they do not overstock on controlled drugs. To ensure it can be stored and administered safely 27/07/2009 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 9 The home should consider obtaining a second controlled drug cupboard for the ground floor to ensure the medication is stored safely. The organisation must continue to make a commitment to investing in NVQ awards in care. 2 28 Care Homes for Older People Page 25 of 26 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 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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