Care Home: Buchan House

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What the care home does well We received a number of positive comments about the home and its staff. One resident told us: ` I am well looked after and like living here`, another: `most of the staff are the nicest people you could meet`. One relative commented: `my mother has only been in Buchan House since Nov, after 11 days respite at another home. The differences in the homes are unbelievable and I can only speak very highly of Buchan House after what Ive seen`. Another reported: `Buchan House provides a warm friendly relaxing and secure environment for my father with advanced dementia. The staff are superb in their caring and supportive roles`. The home`s recruitment practices are excellent, ensuring that only the right people are employed to work and residents are protected. The home works hard at actively consulting the people that use its services: there are residents` and relatives` meetings; satisfaction surveys are regularly sent out and systems at the home are audited frequently by senior staff at Excelcare to ensure standards are maintained. What has improved since the last inspection? Suitable references are now obtained for all prospective employees so that only the right people are employed to look after vulnerable adults. Staff now receive regular supervision to ensure they are looking after residents properly and so that they feel supported. A new permanent manager has been appointed who should bring experience, stability and leadership to the home. What the care home could do better: Medication records must be completed contemporaneously so that they are an accurate and timely record of what people have received. The amount of fluids received by residents at risk of dehydration must be added up daily to ensure they receive enough. More objects of stimulation and interest for residents should be available especially on the dementia care unit. Long corridors could be made more interesting and better signage would help residents and visitors find their way around the home more easily. Both staff and relatives felt that although there were some activities much more time needed to be spent talking with residents on a one to one basis Key inspection report Care homes for older people Name: Address: Buchan House Buchan Street Kings Hedges Road Cambridge CB4 2XF     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: Janie Buchanan     Date: 0 3 0 3 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 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 27 Information about the care home Name of care home: Address: Buchan House Buchan Street Kings Hedges Road Cambridge CB4 2XF 01223712111 01223712113 sue.carter@excelcareholdings.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Buchan Healthcare Ltd care home 66 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: One named service user with category PD under the age of 65, to be accommodated for the duration of their residency. Date of last inspection Brief description of the care home Buchan House is a purpose built home for older people, built on two floors and is registered to accommodate up to 66 persons. The home is divided into three units, Snowdrop Sunflower and Iris. Snowdrop and Sunflower are on the ground floor and respectively accommodate 18 and 33 people. Sunflower is the part of the home where residents with dementia care related need are looked after. Iris is located on the upper floor and is a smaller area for 13 people. All rooms are single occupancy and all have en-suite facilities of toilet and washing facilities. Stairs and a passenger lift provide access to the upper floor. The home has two Care Homes for Older People Page 4 of 27 Over 65 33 65 0 0 0 1 Brief description of the care home enclosed gardens and a visitors car park, and offers a dedicated and safe facility for residents with dementia. The home is located close to the King Hedges residential area of Cambridge on the outskirts of north side of Cambridge City. The home is accessible by car from the A14 Histon turnoff and can be reached by a city bus service. At the time of the inspection the fees charged ranged from £394to £484 per person per week. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: For this inspection we, (The Care Quality Commission), visited the home and talked with residents, staff, two district nurses, a visiting GP and the manager. We had lunch with the residents so that we could watch how staff supported them and also check on the choice and quality of food. We undertook a tour of the premises to check on health and safety and checked a sample of residents medication administration records. We received 26 surveys ( a good response) completed by residents, their relatives and staff asking them for their opinion of the service. We undertook a specialist observation called SOFI (Short Observational Framework for Inspectors) of care practices on the dementia care unit. As part of this we observed four residents for a period of two hours and recorded their experiences at regular intervals. This included their state of well being, how they interacted with staff, other residents and their environment, and what they engaged with. The findings of this observation are included in this report Care Homes for Older People Page 6 of 27 Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 8 of 27 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive good information about the home before they move in so they can decide if it is where they want to live. Evidence: There is a Statement of Purpose and Service User Guide that give good information about the home, its staff and the facilities on offer. Each resident is also issued with contract that clearly states the terms and conditions of their stay at the home and the fees payable. Prospective residents are able to visit the home and the most recently admitted person had lunch there and stayed for a couple of hours so they had the chance to assess its facilities before moving in. Residents who completed our survey told us they had received enough information about the home to decide if it was the right place for them. The manager or her deputy complete all pre-admission assessments to ensure peoples needs can be adequately met at the home and we viewed detailed preCare Homes for Older People Page 11 of 27 Evidence: admission assessments on the files that we viewed. Most residents we talked to told us that their admission to the home was smooth however we received one complaint from a relative that staff were unaware when her husband arrived to be admitted to the home due to a break down of staff communication between shifts. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health care needs are monitored well at the home. Evidence: We viewed the care plans for three residents. These were generally good with detailed information about residents needs and what staff must do to meet them. The plans had been reviewed every month ensuring that any changes in residents needs were picked up quickly. We sat with another resident and went though his care plan with him to check its accuracy. He told us the information in it was mostly correct although the plan stated that he needed assistance with showering when he actually had a bath twice a week as he didnt like showers. The information about this residents past life and history was very Spartan in detail, despite him being able to talk at length about his past experiences. There was also little evidence in the plan that he had been actively involved in its monthly review. The plans showed us that peoples health was monitored closely. Their dependency levels, Waterlow Scores and falls risk assessments had been reviewed monthly as had their weights (weights for these residents were very stable over a many months). Care Homes for Older People Page 13 of 27 Evidence: However we noted that for two residents their fluid intake was not added up daily making it impossible for staff to know if they were actually receiving enough. Residents we spoke to reported that the home met their health needs well: however one resident told us she sometimes had to remind staff to give her ear drops otherwise this wouldnt get done. We spoke to two district nurses who visit to give insulin injections and also dress a number of residents leg ulcers. They told us that they received appropriate referrals, that staff communicated well with them about residents and there was only one resident with a very small pressure sore at the home currently. A visiting GP told us she had no concerns about the quality of the care at the home and that the homes manager attends a monthly meeting with the practice manager at the local surgery. We checked medication storage and recording on Iris and Sunflower units. Storage was safe and medication administration records (MAR) were generally good with clear records kept of what medicines residents had received. However we viewed a member of staff signing off all the MAR sheets together at 10.45am for medicines some of which were given much earlier in the morning. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities are available to help stimulate residents and mealtimes are relaxed and sociable. Evidence: The home has recently appointed a new activities co-ordinator who will start working in a few weeks. She is currently undertaking a specialist course in meaningful activities for people with dementia. There is a daily program of events advertised around the home. On the day we visited there a number of activities available to residents in the afternoon: a hand bag sale and quiz on Snowdrop unit; manicures and hand massages on Sunflower, and crafts on Iris unit. Despite this however, we received comments from both staff and relatives that there should be more activities available for residents. One relative told us: more one to one contact is essential. I often visit with my father and he is mostly sitting alone. He is unable to read and have normal conversation so it is vital he has regular stimulation. One relative felt residents should have access to digital TV as so many watch a lot of television. One resident told us she does get very bored and that many of the activities put on by the home were of no interest to her. We undertook a SOFI observation (short observational framework for inspection) on Care Homes for Older People Page 15 of 27 Evidence: Sunflower unit and closely watched 4 residents for a period of two hours. All residents we observed showed a good mood state and signs of well being when they were awake. The quality of staff interactions with them was positive, personal and caring. We observed good examples of individualised care e.g. when one resident went into the garden staff got her a cardigan quickly to keep her warm; one staff member was able to speak with two Polish residents in their native language; when another resident began to undress in the lounge staff responded sensitively and respectfully and one member of staff spent time with another resident helping them wind up their watch. However, for one resident the only interaction she had with staff over the two hour period was when staff gave her a cup of tea on one occasion, and touched her lightly on the shoulder on another. We observed two instances of residents being transferred by hoist. The first instance was good with staff explaining clearly to the resident what was happening and calming her when she became distressed. The other transfer was less good with staff failing to explain what they were doing and the residents trousers falling down exposing his underwear. What our SOFI observation showed that, although residents showed many signs of well being and staff interaction was positive, there was a real lack of objects for residents to engage with naturally such as magazines, picture books, newspapers, puzzles and dolls to help keep them stimulated. We took lunch on the Iris unit which consisted of a choice of meatballs and pasta, poached fish or salad, followed by stewed fruits or yoghurts. Residents were offered genuine in choice in what they ate and we observed one carer showing each resident the menu and asking them what they would like to eat. We noted that extra cheese was available to add to potatoes in order to build up residents calorie intake. One relative commented on their survey:the efforts made for Christmas were outstanding. The Christmas Day Lunch was on a par with a four star hotel. One resident told us she often enjoyed a bacon sandwich for her breakfast Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have access to a complaints procedure and their concerns are taken seriously. Evidence: Details of how to complain are available in the homes statement of purpose and service user guide which are given to all residents. We viewed copies of the homes complaints procedure in all bedrooms and in the entranceway to the home, giving residents easy access to it. The home keeps a record of all the complaints it receives and recent ones concerning inter-resident aggression, staffing levels and missing jewellery had all been recorded and fully investigated within acceptable timescales. Most had been resolved satisfactorily. There is information about the homes adult protection policy and local contract numbers in the entranceway and staff receive training in this important topic. There has been one safeguarding issue in the last year concerning the care of one resident at the home. Although not all the allegations were upheld, some were highlighting shortcomings in the homes practices. The manager has already started work to address the issues raised. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a clean and well maintained home. Evidence: We undertook a tour of the premises. There was excellent information for residents and visitors in the homes entranceway giving them details about the Mental Capacity Act and paying for care home fees. There was also minutes of the most recent relatives meeting, a copy of the homes newsletter and information about Excelcares senior management members. We have received one complaint about the standards of cleanliness in the Sunflower Unit. However on the day we visited the home was generally clean and hygienic and we only noted a slight smell of stale urine in the corridor outside rooms 3 and 4 on this unit. Corridors on Snow drop were a little dark making it difficult for residents with visual impairments to see. One resident on this unit told us she had fallen recently and could not reach her buzzer where she fell. She shouted for staff but was unable to be heard as her bedroom was at the end of a long corridor. Orientation aids around the home could be improved and one visiting nurse told us she sometimes had trouble finding residents bedrooms because of the poor signage around the home. Care Homes for Older People Page 18 of 27 Evidence: The homes has been awarded 5 stars (excellent) for cleanliness and hygiene in its kitchen, ensuring that resident receive food that has been stored and prepared hygienically. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are looked after by well trained staff, who have been recruited safely. Evidence: On Sunflower Unit there is one team leader and 4 care staff to meet the needs of 30 residents: on Snow Drop one team leader and 2 care staff to meet the needs of 17 residents and on Iris unit one carer (plus an additional member of staff who floats between two units) to meet the needs of 7 residents. We received a mixed response about the adequacy of staffing levels. Most residents we spoke to told us that staff were around when they needed them and they rarely waited long for help. Two staff told us they felt there were enough of them to meet residents needs and they had enough time to complete their tasks and talk to residents. However, another staff member told us that Sunflower Unit was frequently short-staffed and that sometimes there were not enough staff around to supervise the residents at bedtime. Two relatives told us they felt staff did not have the time to sit and talk with residents. 50 of staff have an NVQ level 2 in care and more are due to complete this award at the end of March 2010. We checked the training files for night staff which showed us they had received a good range of training relevant to their role and were up to date with all their mandatory training. We checked the personnel files for two recently employed members of staff. Each Care Homes for Older People Page 20 of 27 Evidence: contained appropriate application forms, job descriptions, contracts and interview notes for the employee. Suitable references had been obtained (and followed up verbally to check their authenticity) as had CRB checks. Where an employee had begun work whilst awaiting their CRB a risk assessment had been completed to ensure residents were protected. This is excellent practice Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a well manged home, where their views about the service they receive are actively sought. Evidence: Management of the home has not been stable in the last year but a new permanent manager has recently been appointed. She has previous experience of managing homes for older people and has advanced qualifications in management and care. She is currently working towards a Masters Degree specialising in Safeguarding Vulnerable Adults and Leadership. We received mostly positive comments about her. One staff member reported:I have seen at least 6 managers come and go over the last 7 years. Since having Sam with us there have been changes for the better. Its great to have support again. One visiting GP told us: Sam has given the team leaders more confidence and has a clear vision of how she wants the home to be. She is strict with staff and thats good. Staff who completed our survey told us that they received good support from their Care Homes for Older People Page 22 of 27 Evidence: managers and met with them regularly to discuss how they were working. Staff files we viewed also confirmed this, with detailed records kept of staff supervision. There are regular meetings for both residents and relatives where information about the home, staff changes, the forthcoming refurbishment and activities are shared. There is also a newsletter to help keep people informed of what is going. Satisfaction surveys are routinely sent out to residents, relatives and visiting professionals so that their views can be sought on the quality of the service. We checked a number of records in relation to health and safety (including portable appliance testing, gas, fire, water temperatures) which were well maintained and up to date, showing us that the home regularly maintains and services its equipment to ensure its safety. We checked the home,s incident book and noted that residents falls were clearly recorded and body map charts were completed so that any injuries could be monitored. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 8 12 The amount of fluids taken by residents at risk of dehydration must be added up daily. You must do this to ensure that they receive adequate fluids to maintain their health. 01/04/2010 2 9 13 Medication records must be signed at the time when residents receive it You must do this to ensure there is an accurate record of when residents receive their medication. 01/04/2010 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 2 12 19 Residents should have easy access to interesting and varied objects to help keep them stimulated. Better signage and oreination aids should be provided to Page 25 of 27 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations help people find their way about. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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