Care Home: Attwoods Manor

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What the care home does well People were being supported by competent, stable staff team and relatives and people spoken with were complementary about the staff. The home provides care and support in an environment that is homely and well maintained. Service users spoken with were complementary about the facilities provided. Visiting arrangements continue to be flexible, with people being free to come and go as they please. Visitors spoken with said that they were always made welcome whenever they visited. People living in Atwood`s Manor spoke positively about the range of meals provided, which met their nutritional needs. What has improved since the last inspection? The home`s quality assurance process has been improved to enable the views of service users to be obtained. All staff are now receiving regular supervision. A range of stimulating activities are now being provided, some of which are as a direct response of requests received from service users. All staff have now received safeguarding training, to assist them in keeping people safe. A person has been appointed, and who is proposed to take on the role of registered manager. What the care home could do better: The provider should prioritise their application for the new manager to be registered with the Care Quality Commission. Key inspection report Care homes for older people Name: Address: Attwoods Manor Mount Hill Halstead Essex CO9 1SL     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: Neal Cranmer     Date: 1 5 0 4 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 25 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Attwoods Manor Mount Hill Halstead Essex CO9 1SL 01787476892 01787477769 attwoods.manor@virgin.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Golden Age Management Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 65 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 categories of service: Care Home with Nursing - N To service users of the following gender: Both Whose primary care needs on admission to the home are within the following categories: Old age not falling into any other category - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is: 65 The total number of service users accommodated in the home must not exceed 65 persons. Date of last inspection Brief description of the care home The owner of Attwoods Manor is Golden Age Management Limited and there is currently no registered manager. Attwoods Manor is situated approximately one mile from the town of Halstead. This is a large detached period property set within Care Homes for Older People Page 4 of 25 Over 65 0 65 65 0 0 4 0 6 2 0 0 9 Brief description of the care home approximately three acres of grounds. The home comprises of 59 bedrooms of which 3 are double rooms. The remaining rooms are all single and are mainly en-suite. There are 5 communal living rooms and a very large dining room/restaurant. There is ample car parking facilities at the front of the house. The grounds are well maintained and pathways around the home are designed for the use of wheelchairs and other mobility equipment. An attractive patio area at the front and side of the house is an ideal area for service users to use and to meet visitors. In October 2007 a large extension was registered, this compiled of 25 single en-suite bedrooms 4 large bathrooms, a large dining room and kitchen and sluice facilities. The home is registered for 65 older people who need residential care including 10 places for people who have dementia and nursing care needs. As at 4th June 2009, the Provider advised that the fees for accommodation ranged from £458.68 to £750.00 per week. Care Homes for Older People Page 5 of 25 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: The last inspection for this service was carried out on the 4th of June 2009. A range of evidence was looked at to enable us to compile this report. Documentary evidence was examined, such as care plans, rotas, menus and personnel files. The provider completed an Annual Quality Assurance Assessment (AQAA), which is required by law to be completed by the service, with information about the home and sent it to us at the Commission when requested. Throughout this report this document will be referred to as the AQAA. A visit to the home took place in April 2009 and included a tour of the premises, discussions with people living in the home and members of staff. Completed surveys were received from people living in the home, and members of staff. Observations of how members of staff interact and communicate with people living in the home have also been taken into account. Care Homes for Older People Page 6 of 25 On the day of the inspection we were given every assistance from the provider and the staff team. Care Homes for Older People Page 7 of 25 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 25 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 25 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 may use the service or their representatives are provided with a good level of information about the ability of the home home to meet their assessed needs. Evidence: The provider told us in the AQAA, We provide a six to eight week assessment period where we look at a trial period to ensure that the service given meets expectations. As at the last inspection records examined confirmed that there continues to be an assessment process in place. We examined four service users plans of care, and found that each contained an assessment of need covering a range of areas. Areas covered included daily life, personal care, mobility, communication, nutrition, medication, emotional support, sleeping, finance and death and dying. Through discussions the manager was able to explain how they assess the needs of any prospective service users to ensure they are able to meet those needs before the person is admitted to the home. Care Homes for Older People Page 10 of 25 Evidence: Initial plans of care are developed from the information obtained during the assessment process. All admissions to the home are on a six to eight week Trial Basis and following this trial period a review is held to determine whether or not the home is able to meet the needs of the service user. Care Homes for Older People Page 11 of 25 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 using the service can expect their personal and health care needs to be identified and to be provided with the support to ensure these needs are met as they would wish. Evidence: The provider told us in the AQAA, We carry out a thorough assessment process which assesses peoples physical and mental health, and which enables us to formulate a plan of care. A sample of four care plans were examined on the day of the inspection. The care plans identified the persons needs, the aim for the person and the actions to be taken to meet the identified need. Care plans were in place to support people with their communication, continence, daily life, mobility, nutrition and personal care needs. Records examined showed that care plans were being reviewed on a monthly basis. Since the last key inspection the care planning process has now moved to a fully computerised system. This system allows the manager and staff to track service users Care Homes for Older People Page 12 of 25 Evidence: care in a systematic way. Staff spoken with during the course of the inspection said that they were becoming much more proficient in the use of the system, and felt that it worked well. All staff had been provided with training in the use of the new system. All four care plans examined showed that risk assessments were in place and covered a range of areas including: Pressure care, nutritional screening, moving and handling, and falls assessments. All of the risk assessments were incorporated into the computerised care planning process. Observation of staff practice, as well as discussion with service users indicated that people received personal care in a way that protected their privacy and treated them in a dignified way. Service users requirng support with health care visits, spoke of having these needs met in a way that respected theri privacy and dignity. Registered nurses are on duty in the home throughout the day, this is a requirement of the homes registration because many of the service users now receiving care have nursing care needs. In addition to the support provided by the homes registered nurses, district nurses visit the home on a daily basis to administer insulin and carry out dressing changes to those service users who receive residential care. Records showed that a range of health care professionals were providing input into the home including GPs, district nurses, chiropodist and tissue viability nurses. One of the care plans that we examined contained a care plan relating to wound care, records seen relating to this persons care plan showed that the tissue viability nurse had been involved in the development of their care plan. The management of medication was found to be of a good standard with appropriate records in place regarding the ordering, administration and recording of medicines given by staff. All medication is only administered by qualified nurses or senior carers, who have been appropriately trained. The home does retain medcines of a controlled nature, and storage and record keeping relating to these medicines were found to be in order. The lunchtime medication round was discretely observed. Medication was only signed for once the person dispensing the medication had witnessed it being taken. People were seen to be well supported to take their medication. The homes medication administration practice was robust and protected service users. Care Homes for Older People Page 13 of 25 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. Overall people living in the home can expect to enjoy a lifestyle that meets their wishes, needs and interests. Evidence: The provider told us in the AQAA, Our activity area is always full of service users waiting to start the day. Since the last key inspection a full time activities co-ordinator has been appointed by the home. Service users spoken with said that a range of activities were being provided in the home including, sensory hand massages, board games, afternoon matinees, music and movement, arts and crafts, quizs and tai chi. Records examined in care plans showed that peoples preferences were recorded as part of the homes assessment process. The home provides access to a small library of books, videos and dvds, service users spoken with said that they did at times make use of this facility. On the day of our visit a number of service users were observed taking part in an arts and craft activity. Care Homes for Older People Page 14 of 25 Evidence: Service users spoken with said that they were able to receive visitors as and when they wished, they were also free to choose where to receive their visitors and there were a number of quiet areas around the home where service users could meet with their relatives in private. Relatives spoken with said that they were able to visit whenever they wished and were always made welcome. Service users spoken with said that the food provided in the home was very good, and they were always provided with a choice of at least two main meals. The lunchtime meal was discretely observed, and although there were a number of people eating together at the same time there was a relaxed atmosphere. People requiring assistance to eat were seen to be appropriately supported. Those requiring a soft diet were presented with an individual meal to preserve flavour and texture. The meal provided was displayed on the notice board in the dining room, and service users were informed the content of their meal when it was served to them. Care Homes for Older People Page 15 of 25 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 using the service can be confident that their concerns about how they are treated are listened to and acted upon as stated in the complaints and safeguarding procedures. Evidence: The provider told us in the AQAA, Our complaints procedure is displayed in the hallway for all to see, and we investigate all complaints made. The home has a complaints procedure which was on display in the homes foyer. The procedure was also included in the homes Statement of Purpose and Service users Guide. Since the last key inspection the home had received one complaint. Discussion with service users indicated that they knew who they should speak to if they wished to make a complaint. Since our last key inspection there have been no safeguarding referrals made in respect of the home. The home does have a safeguarding policy/procedure in place. Training records examined showed that all staff had received training in safeguarding, and staff spoken with were knowledgeable about the subject matte and were able to describe the types of abuse that might occur. Staff were also aware of their responsibilities around reporting incidences/allegations of abuse. Care Homes for Older People Page 16 of 25 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 enjoy living in an environment that suits their lifestyle and which is well maintained and clean. Evidence: The home was fit for its stated purpose, as set out in the homes Statement of Purpose, being set in extensive pleasant grounds. The home is spacious and provided a good level of communal space, with a range of areas available where people could choose to spend time. The lighting in the home was good, and provided service users with sufficient light to enable them to carry out various activities including reading and knitting. The furnishings and fittings in the home were of a good quality and were in keeping with the age and style of the property. The home is equipped with adequate toilet and bathing facilities to meet the needs of the numbers of service users living in the home, and these were situated in close proximity to all communal areas, to enable easy access. The homes laundry room was well equipped with all of the necessary equipment to enable the needs of service users to be met. Service users we met were appropriately dressed and their clothes looked to be well cared for. Cleaning materials used in the home were all safely and securely stored. On the day of our visit the home was found to be clean and tidy, and there was no Care Homes for Older People Page 17 of 25 Evidence: evidence of any unpleasant odours. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be confident of being cared for by a team of staff who are competent and who can meet their needs. Evidence: Examination of the homes duty rota showed that the home has eight staff on duty during the morning, and seven during the afternoon, with night time support provided by five carers. These staffing levels are made up of one qualified nurse, and one senior carer and the remainder direct care staff on each shift. A range of ancillary staff are provided in the home to ensure its effective running including chefs, waitress, kitchen assistants and domestic staff. Service users spoken with said that they felt that the staffing levels in the home had improved, and we noted that when call bells were activated staff were able to respond quickly. Staff spoken with said that they felt the staffing levels in the home were adequate to meet peoples needs. They also said that the use of agency staff to cover shifts had reduced. The home employs approximately forty care staff, of which thirty-two hold an National Vocational Qualification (NVQ) at level two or above, in addition to which a further three staff have just commenced their award. Care Homes for Older People Page 19 of 25 Evidence: The homes recruitment practice was examined through the viewing of four staff files. All contained evidence of all of the required information and checks necessary being carried out before people commenced employment in the home. These checks included references, proof of identity and criminal records bureau checks (CRB). Other information in peoples files included copies of employment application forms and job descriptions. Staff training records showed that staff had received training in fire safety, moving and handling, health and safety, safeguarding and the safe handling of medicines. Staff spoken with said that access to staff training was good. Care Homes for Older People Page 20 of 25 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 appropriately managed in the best interests of the people living there. Evidence: The home continues not to have a registered manager in post, although since the last key inspection an appointment of a person, who is proposed to be put forward for this role has been made. At the time of our inspection visit the home was continuing to be managed on a day to-day basis by the registered provider, supported by the newly appointed manager, a team of registered nurses and a full-time office manager. Staff spoken with during the course of our inspection said that they felt well supported by the management team, who they felt provided them with a clear sense of leadership and direction. The homes quality assurance process is based upon the use of surveys, which are used to gauge the opinions of service users. These are sent out bi-monthly by the homes activity co-ordinator. The surveys cover a range of areas such as comfort, Care Homes for Older People Page 21 of 25 Evidence: cleanliness/convenience, social activities, laundry services and food. The home continues to only manage money on behalf of one service user. everybody elses finances continues to be managed on their behalfs by family members. Records relating to finances were examined and were found to be in order. The homes safe working practices were eviewed and a range of safety certificates were seen, these included records relating to portable appliance tests, electrical installation certificate and environmental health report. All of which were current and up to date. Staff training files examined contained evidence that staff had received health and safety related training. Care Homes for Older People Page 22 of 25 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 23 of 25 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 Care Homes for Older People Page 24 of 25 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 25 of 25 - 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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