Care Home: Boxtree Cottage

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Inspecting for better lives Key inspection report Care homes for older people Name: Address: Boxtree Cottage Way Lane Waterbeach Cambridgeshire CB25 9NQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Andy Green     Date: 0 3 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 25 Information about the care home Name of care home: Address: Boxtree Cottage Way Lane Waterbeach Cambridgeshire CB25 9NQ 01223860859 01223441861 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Jeffrey Robert Lloyd,Mrs Agnes Catherine Lloyd care home 14 Number of places (if applicable): Under 65 Over 65 14 14 dementia mental disorder, excluding learning disability or dementia Additional conditions: 0 14 Individuals in the category of Mental Disorder (MD) should not be under 40 years of age Date of last inspection Brief description of the care home Boxtree Cottage provides a comfortable home for 14 people over the age of forty who are diagnosed as mentally ill or have suffered organic impairment such as dementia. The cottage is approximately four hundred years old, and has been renovated and extended. There are three sitting rooms, three dining rooms and a room specifically for smokers. There is also a snack area available to residents. Twelve of the 14 bedrooms are for single occupancy and 4 have ensuite facilities. There is level access to the attractive cottage garden and patios, with a range of outdoor furniture and numerous flowering shrubs and planted tubs. Care Homes for Older People Page 4 of 25 Brief description of the care home The fees range from £548 to £573 per week Copies of CSCI reports are available to residents and their relatives upon request from the homes office. 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: We, the Care Quality Commission undertook an unannounced inspection of Boxtree Cottage on 3rd April 2009. We met with the manager, deputy manager, care staff, a relative and residents to gather their views regarding the services offered in the home. A number of records were inspected including care plans, training records, staff files, medication records and fire testing records. A tour of the building and grounds was also undertaken. The home completed an Annual Quality Assurance Assessment (AQAA) which is a self assessment document giving the home an opportunity to audit how they are meeting standards and regulations. Care Homes for Older People Page 6 of 25 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 set out 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. The home provides comprehensive information to residents and their relatives before they move in ensuring that they are aware of all the services provide. Evidence: The statement of purpose and service user guide have been reviewed since the last inspection to ensure that they remain up to date and accurately reflect the services that are provided. There were 14 residents living in the home. One of the residents is currently receiving treatment in hospital. Prospective residents continue make a number of visits prior to admission to ensure that they can make an informed decision about choosing to live in the home.The home receives a variety of pre-admission information from mental health professionals to ensure that the home can assess whether the persons needs can be appropriately met. There are currently four people visiting the home regarding Care Homes for Older People Page 10 of 25 Evidence: possible placements in the future. There have been no changes to the assessment procedure since the last inspection. The home does not provide intermediate care. 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. Residents are treated with dignity and respect and receive personal care and support to meet their assessed needs. Evidence: Two care plans were inspected and they indicated that support and healthcare needs are met. Care plans are presented in a person contained style with clear guidelines regarding the care and support needs of individual residents. There was evidence of monthly reviews and changes in care are recorded and updated as required. Care plan information included; an information sheet, assessment information, mental health support needs, personal care needs, aspirations and goals, family contact, communication needs and family contacts. Daily notes are recorded in individual residents diaries. Two were inspected and contained appropriate entries detailing each individuals day in their home. Residents spoken to indicated that personal care and support is given in a way that meets their needs and that the care staff were helpful, supportive and friendly. The home continues to have good contacts with mental health and health care Care Homes for Older People Page 12 of 25 Evidence: professionals including community psychiatric nurses, psychiatrists district nurses and GPs. There are separate records of appointments and visits from a variety of healthcare professionals including GPs and community psychiatric nurses. Residents privacy and dignity is clearly respected and staff were observed to speak to residents in a sensitive and friendly manner. One relative spoken to confirmed that the care and support in the home was always of a good standard and she was always made to feel welcome. She stated that she was kept well informed of any care and support changes. The home uses a monitored dosage system for the recording and administration and there is a medication policy in place. The records of the home were inspected and found to be accurate. However, it was noted that one resident is prescribed a controlled medication which is contained in a blister pack. This medication must be stored separately in a cabinet specifically designed for controlled medication. The deputy manager stated that she would action this immediately and contact the pharmacist regarding the supply of the controlled medication. Staff continue to receive training regarding the administration of medication and a local community psychiatric nurse also provides advice regarding medication used for mental health needs. 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. The staff provide appropriate support to ensure that residents can engage in activities appropriate to their needs. Evidence: There continues to be a daily morning meeting to discuss what people would like to do during the day and to make menu choices. Alternative choices and special diets are provided including meals for residents who are diabetic. Residents spoken to stated that the food provided was of good quality with choices available when required. The cook also seeks feedback from residents and staff to ensure that meals are varied, nutritious and new requests are accommodated as much as possible. Care staff continue to organise a range of activities including musical entertainers, quizzes, shopping trips, birthday parties, theatre and visits to the local pubs for meals. A programme of events is also displayed and day trips to local towns and coastal resorts continue to be arranged throughout the year. A number of residents attended the local village fetes. A number of residents have requested that the home has a vegetable garden and the deputy manager stated that plans are in place to develop this over the next few months. A computer has been installed in the main lounge Care Homes for Older People Page 14 of 25 Evidence: which gives residents access to e-mail and internet. Residents maintain contacts with family and friends as much as possible and also with the local village community. One relative confirmed that she visited regularly and was always made to feel welcome by the staff and residents. 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. The home has a satisfactory complaints process to make sure that residents and their representatives are able to raise concerns and have them dealt with appropriately. Evidence: The home has a clear complaints procedure, which is included in the residents guide. The home has not received any complaints since the last inspection and the Commission has not received any concerns or complaints regarding the home since the last inspection. The home has a safeguarding adults policy to guide staff when dealing with any incidents or allegations of abuse. Staff receive training in safeguarding, as part of the homes ongoing training programme. It was noted however that a number of staff had not received updates for three years and it is recommended that the home updates safeguarding training on an annual basis. The deputy manager stated that she would contact the local authority safeguarding trainer to seek advice regarding training updates. 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. The environment of the home provides residents with a safe, comfortable, clean place to live. Evidence: The premises and gardens are well maintained and the communal areas and bedrooms continue to be presented in a comfortable and homely manner.The home was clean and tidy and free from odours. Furnishings and fittings in the home are of good quality and rooms are bright and airy. Two of the lounges have had new furniture along with new carpets. Six bedrooms have been redecorated and new flooring has been laid in one bedroom. Residents continue to be encouraged to personalise their bedrooms. A new shower room has also been installed. The snack area has improved the lives of residents and is a successful addition to the home so that residents can be more independent. During the day it was observed that residents were happily making their own breakfasts, snacks and drinks. Plans are in place to add four further bedrooms, lounge and office space in the adjacent bungalow owned by the provider. Building work to adapt this space is underway and an application will be made to the Commission Care Homes for Older People Page 17 of 25 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. The homes recruitment policy and processes ensure that residents are protected from harm. Training is provided to make sure that care staff are competent to deliver personal care to the residents they support. Evidence: The home is sufficiently staffed and there were enough staff on duty during the inspection to meet the needs of the residents. The home is fully staffed at present. Satisfactory recruitment checks are in place including Criminal Records Bureau, POVA First checks and two written references and are in place prior to staff commencing their employment. There is an ongoing training programme to ensure that staff receive mandatory health & safety training including; first aid, fire, moving & handling and diabetes with updates and refreshers throughout the year. There is also training arranged to assist staff regarding mental health awareness and medication administration. New training regarding medication is now arranged through the local pharmacist. Mental Capacity training and Deprivation of Liberty training sessions have been organised. The home has also received information regarding the Mental Health Care Homes for Older People Page 19 of 25 Evidence: Recovery Star project which is national initiative regarding mental health rehabilitation. Sessions are being organised with staff and residents regarding this project. NVQ training is firmly in place and all care staff have achieved NVQ level 2 or 3. 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 well managed and the manager provides supportive leadership and guidance to staff. Evidence: The registered manager intends to retire in the next few months and it is anticipated that the deputy manager will become the manager of the home, The deputy manager has achieved NVQ level 4. Staff receive regular supervision to monitor their performance and development. Evidence of supervisions were seen during the inspection, Members of care staff spoken with confirmed that they felt well supported by the management and training provided in the home. A Quality assurance systems is in place including a questionnaire, which is given to residents, staff and health care professionals on a regular basis to audit all aspects of Care Homes for Older People Page 21 of 25 Evidence: the services provided. A copy of the last quality assurance audit in 2009 was seen. One of the providers continues to undertake monthly monitoring of the service and a copy of her report is forwarded to the Commission. The cook also stated that she has the delegated task of carrying out health and safety audits in the home and reports any issues to the manager. Fire records were accurately maintained and there are contracts in place regarding the servicing of equipment provided in the home. The home ensures that the Commission is regularly notified of any event occurring in the home as outlined in Regulation 37 of the Care Homes Regulations 2001. 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 1 9 13 Conmtrolled medication 30/06/2009 must be stored appropriately in the home To meet the required regulations. 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 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!