Care Home: Careford Lodge

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What the care home does well Careford Lodge provides a comfortable homely environment for the people who live there. All areas are well furnished and maintained. On the day of the inspection standards of cleanliness were excellent throughout the building. People living at the home stated that they continued to make decisions about their day to day lives. There are no set times to get up or go to bed and people choose how they spend their day. People said "you can do what you please." There is a weekly activity timetable, which is displayed in the main hall to allow people to plan their week. People have access to activities at the home and in the local community. Everyone said that visitors are welcome at anytime. Staff observed, and spoken with, demonstrated a good knowledge of the people who lived at the home. All appeared well motivated and competent in their roles. People living at the home said that staff were "very kind," "wonderful" and "all kind and helpful." Throughout the day it was observed that there was good interaction between people living and working at the home, this creates a warm and friendly atmosphere. One person said it was a "cosy and friendly place to live." What has improved since the last inspection? x. This is the first inspection since the home was registered to The New Careford Lodge Ltd in June 2009. What the care home could do better: People living at the home were asked if there was anything that they felt the home could do better. Two people said "Brighter lighting in the lounge would be nice" and another person said that they would like to see a greater choice of food as they found the meals "repetitive." As a result of this inspection two requirements have been made. It was noted that two members of staff had begun work before all checks and references had been obtained. To ensure that the risks to people living in the home are minimised the home must obtain all required documentation before any new staff begin work. The hot water temperatures in some en suite baths and showers exceed the recommended maximum temperatures. The manager was aware of this and assurances were given that an outside professional had been contacted. To reduce the risk of scalding action should be taken to address this without delay. Three recommendations for good practice have also been made and these are detailed in the report. Key inspection report Care homes for older people Name: Address: Careford Lodge Church Street Merriott Somerset TA16 5PR     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: Jane Poole     Date: 1 5 0 1 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 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Careford Lodge Church Street Merriott Somerset TA16 5PR Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) The New Careford Lodge Ltd Type of registration: Number of places registered: care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 18. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Careford Lodge is registered with the Care Quality Commission (CQC) to provide personal care to up to 18 older people. There are sixteen single rooms and one double, all have en suite facilities. The home is located in the Somerset village of Merriott, within walking distance of local facilities including a shop, two public houses and churches. Care Homes for Older People Page 4 of 28 Over 65 18 0 Brief description of the care home The building is one storey meaning that all areas are accessible to people with all levels of mobility. The home is owned by The New Careford Lodge Ltd and the registered manager is Lorraine Chant. Care Homes for Older People Page 5 of 28 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 quality rating for this service is 2 star. This means the people who use this service experience Good quality outcomes. The focus of this inspection visit was to inspect relevant key standards under the Commissions Inspecting for Better Lives 2 framework. This focuses on outcomes for people and measures the quality of the service under four general headings. These are:- excellent, good, adequate and poor. This inspection was carried out by one inspector over a one day period. During this time we, The Commission, were able to speak with people living and working at the home, tour the building, observe care practices and sample records. The home was welcoming and co-operative throughout the day. We were given unrestricted access to all areas and records requested were made available. Care Homes for Older People Page 6 of 28 Current (15/01/10) fees at the home range from £540.00 to £600.00 per week. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: People living at the home were asked if there was anything that they felt the home could do better. Two people said Brighter lighting in the lounge would be nice and another person said that they would like to see a greater choice of food as they found the meals repetitive. As a result of this inspection two requirements have been made. It was noted that two members of staff had begun work before all checks and references had been obtained. To ensure that the risks to people living in the home are minimised the home must obtain all required documentation before any new staff begin work. The hot water temperatures in some en suite baths and showers exceed the recommended maximum temperatures. The manager was aware of this and assurances were given that an outside professional had been contacted. To reduce the risk of scalding action should be taken to address this without delay. Three recommendations for good practice have also been made and these are detailed in the report. Care Homes for Older People Page 8 of 28 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 9 of 28 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 28 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 wishing to move in have their needs assessed and are able to sample life at the home before deciding to make it their home. Intermediate care is not provided. Evidence: The home has a statement of purpose and service user guide which gives details about the services and facilities offered by the home. A senior member of staff assesses anyone wishing to move to the home to ensure that they are able to meet their needs. Copies of pre admission assessments were seen at the inspection. The majority of people spoken with said that they had been familiar with the home before deciding to move in, others said that they, or a family member, had been able Care Homes for Older People Page 11 of 28 Evidence: to visit. In addition to full residential care the home also offers day care to a small group of people which enables them to become familiar with the home and staff group. The manager stated that the home holds a waiting list for people wishing to move in and these people are invited to social occasions and events held at the home. This again enables people thinking of moving in to sample life at Careford Lodge. Care Homes for Older People Page 12 of 28 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 living at the home have access to health care professionals according to their individual needs. People are treated with dignity and their privacy is respected. Evidence: Everyone living at the home has a care plan that is personal to them. 3 care plans were viewed as part of this inspection. Care plans contained details of peoples health care needs and some information about peoples lifestyle choices and preferences. People living at the home are registered with local doctors and other health care professionals according to their individual needs. Currently appointments with professionals are recorded within the daily records making it difficult to track appointments and treatments. Personal weights are recorded in a separate book and do not form part of the care plan. Where there is a concern about a persons weight or food intake monitoring charts are put in place. Intake charts seen had not been filled in consistently. For example it appeared that one person had not eaten or drunk for 2 Care Homes for Older People Page 13 of 28 Evidence: days but assurances were given that this was not the case. Where food charts are in place they should be correctly completed to ensure that the persons diet can be monitored and the effectiveness of the care plan can be evaluated. To minimise the risk of skin damage pressure relieving cushions and mattresses are in place for those at high risk. Staff spoken with displayed a good knowledge of peoples needs and preferred routines. It was observed that call bells were answered promptly meaning that people did not wait an excessive amount of time for assistance when required. People living at the home said that the staff were attentive if they were unwell and arranged for medical professionals to see them. One visiting health and social care professional said that there was good communication between the home and other professionals. Throughout the day it was observed that staff interacted with people in a friendly respectful manner. People are able to spend time in communal areas or in the privacy of their bedrooms. Staff were seen knocking on doors before entering. People living at the home said that staff respected their privacy. The home uses a Monitored Dosage System for medication and all staff receive training in safe medication administration. Medication Administration Records were found to be well maintained. All medication is signed for when it enters the home and when administered, refused or handed to the person to self administer. This gives a clear audit trail. A controlled drugs register is maintained and stocks sampled correlated with records held. The home carries out regular audits for medication to ensure that procedures are being followed and practice is safe. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People make choices about their day to day lives and are able to continue with their preferred personal routines. People are able to attend activities and functions at the home and in the local community. There are choices of food at every meal. Evidence: People living at the home are able to make choices about their day to day lives. There are no set times to get up or go to bed and people are able to choose how they spend their day. Some people said that they liked to get up early and others said that they liked to have a lay in. We observed that some people were having a lay in on the day of the inspection and staff were respectful of this. The majority of people said that they liked to have breakfast in their rooms but were able to come to the dining room if they chose to. One person said that the beauty of it is you can do just what you want. There are some organised activities in the home and some people attend events in the Care Homes for Older People Page 15 of 28 Evidence: local community. There is a weekly programme of events displayed in the main hall to enable people to plan their week and choose which activities they would like to attend. During the inspection a sherry morning was held, which was well attended, whilst a member of staff offered hand massages to people in their rooms. People said that they also enjoyed quizzes and exercise classes. Some people said that they preferred their own company and were happy to occupy themselves. People were seen knitting, reading the paper and doing puzzles. Library books are available in the home and these are regularly changed, Communion is held monthly and there is a trolley shop were people can buy basic requirements such as toiletries and sweets. Everyone said that they were able to have visitors at anytime. There is a six week menu in the home which offers a meat or vegetarian option at each meal. People said that they choose their meal the day before and if they did not wish to have what was on the menu they were offered another alternative. It was noticed that one person who did not eat their main meal was offered several alternatives. People asked were generally happy with the food in the home, some people said that there was a greater variety since the new cook had begun work at the home. Everyone said that portion sizes were ample. There is a lounge diner which is able to accommodate everyone but some people choose to eat in their rooms. Many people said that they liked to eat their main meal in the dining room but had tea bought to them on a tray in their rooms. Care Homes for Older People Page 16 of 28 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 are confident that any concerns raised would be listened to and action taken to address. Evidence: The home has policies and procedures about making a complaint, recognising and reporting abuse and whistle blowing. No complaints have been received by the home, or the Commission, since the current providers took over the running of the home. Staff spoken with were aware of the whistle blowing policy and all felt that they would be fully supported by the homes management if they had any concerns. All were aware of the ability to take serious concerns outside the home. People living at the home said that they knew about the homes complaints procedure but all asked said that they would be comfortable to raise any concerns with a member of staff on an informal basis. All felt that their concerns would be listened to and action would be taken. One person said They are so lovely and friendly you dont need to complain, you just have to tell someone rather than complain. The registered manager is fully aware of the Deprivation of Liberty safeguards (DOLs) and had made appropriate referrals to professionals in the area to ensure that peoples Care Homes for Older People Page 17 of 28 Evidence: rights are protected by this law. During the inspection it was observed that people had unlimited access to their personal rooms and all communal areas. Care Homes for Older People Page 18 of 28 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. Careford Lodge provides a homely environment for the people who live there. Standards of cleanliness throughout the home are excellent. Evidence: The home is located in the village of Merriott and is within walking distance of local facilities which include a shop, two public houses and Churches. All areas are fitted with a fire detection and call bell system. The building is one storey making all areas accessible to people with all levels of mobility. Communal areas consist of a large lounge/diner, a small lounge and a conservatory. There are also seating areas in the large corridors and hallways. There are garden areas all around the home and an enclosed courtyard for people to use and enjoy. There are 16 single bedrooms and one double, all with en suite facilities. At the time of this inspection all rooms were being used for single occupancy. People are able to bring personal possessions, including small items of furniture, with them when they move in. This gives rooms a very individual and personal feel. Care Homes for Older People Page 19 of 28 Evidence: All areas seen were well furnished and decorated in domestic style creating a very homely environment. There is a small laundry which is appropriate to the current needs of the home. The laundry and kitchen would benefit from refurbishment and staff stated that this is planned for the coming year. The standards of cleanliness throughout the home were very high. Care Homes for Older People Page 20 of 28 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 at the home are supported by a competent and well motivated staff team. Staff have good opportunities for training. Recruitment files show that some staff have begun work before all checks have been carried out. Evidence: The home employs 16 care staff and 8 ancillary staff. All care staff have either completed or are working towards a National Vocational Qualification (NVQ) in care. There are usually 3 care staff on duty each morning, 2 in the afternoon and 3 from tea time into the evening. Overnight there are two waking night staff. All ancillary and management hours are in addition to this. Rotas seen show that these staffing levels are consistent throughout the week and at weekends. Everyone asked said that there was adequate staff on duty at all times. It was observed that all requests for assistance were responded to promptly and staff were able to spend time with people living at the home. We were able to view the recruitment files of the three most recently employed Care Homes for Older People Page 21 of 28 Evidence: members of staff. The home checks people with the Independent Safeguarding Authority (ISA) and carries out Criminal Records checks for new staff. One recruitment file showed that the ISA check had not been carried out before the person began work. In two instances only one reference had been received before the persons start date and there was no evidence that a telephone reference had been obtained. The application form being used asks for personal details including date of birth and the home should review the form to ensure that it meets current legal requirements. New staff said that they had received a good induction into the home and that existing staff had been welcoming and helpful. Records of an induction programme were contained in recruitment files. All staff said that they were happy with the training opportunities at the home and felt well supported by the homes management. Staff observed during the day appeared competent in their roles and happy in their work. There was good interaction between people living and working at the home. Staff asked said that they had the skills and experience to meet the needs of people at the home. People living at the home were very complimentary about the staff who supported them. One person said Staff are very kind another said that staff will do anything for you. People attending the sherry morning said that staff were wonderful and friendly. Care Homes for Older People Page 22 of 28 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. There is a strong management team giving clear lines of accountability and responsibility. There are systems in place to seek the views of people who live at the home. Evidence: The registered manager of the home is Lorraine Chant. She has many years experience of working with older people and has qualifications in care and management. The registered manager is supported by a manager and care supervisor. In addition to this there are senior carers, making a strong management team. There is always a member of the management team on call and this is clearly marked on the duty rota. There are various quality assurance systems in place to monitor the quality of the service offered and seek peoples views. There are regular meetings for people living and working at the home. Everyone asked said that these were an opportunity to Care Homes for Older People Page 23 of 28 Evidence: make suggestions and voice opinions as well as sharing information. The home also send out surveys to people living at the home and their families. The results of last years surveys had been analysed and showed that generally people were very happy with the care at the home. A monthly newsletter is also produced to keep people up to date with events and news. The provider visits the home on a regular basis and audits the service on a monthly basis. Short reports are written on the findings of the monthly visits in line with regulation 26. Copies of these reports were made available. All records requested were made available, all were well maintained and up to date. As previously stated the application form should be reviewed to ensure that it meets current legislation. The home does not act as a power of attorney or financial appointee for anyone living at the home. People are able to deposit small amounts of money for safe keeping. There are records held for all individual monies and receipts are obtained. A sample of these monies was seen and records kept correlated with monies held. A full health and safety audit was carried out in July 2009 and regular testing is undertaken to ensure that all areas and equipment is well maintained. A full fire risk assessment has been completed. Fire alarms are tested on a weekly basis. Equipment in the home is regularly serviced and an annual check had been carried out on all portable electrical appliances. Monthly checks are carried out on hot water outlets in communal areas and in personal en suites. Records seen showed that the temperature of water in some en suites regularly exceeded the recommended temperature of 44 degrees for baths and 41 degrees for showers. The manager stated that the home were aware of this and were awaiting a plumber to attend to it. Assurances were given that all staff receive training in health and safety issues although the training matrix was not available at the time of the inspection. Staff spoken with said that they received training in moving and handling, fire safety and infection control. An up to date certificate of insurance is in place. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 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 29 19 All checks and references 18/02/2010 must be received by the home before new staff begin work. To minimise the risks of abuse to people who live at the home. 2 38 13 (4) The home must ensure 26/02/2010 that bath and shower hot water temperature do not exceed the recommended 44 & 41 degrees. To minimise the risks of scalding. 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 8 Appointments with health care professionals should be recorded separately to running records to make it easier to see when people have been seen by health care professionals. Care Homes for Older People Page 26 of 28 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 2 8 Personal weight records should be included in individual care plans. Food and fluid intake charts should be correctly filled in to ensure that diet can be monitored and the effectiveness of care plans can be evaluated. The home should review the application form to ensure that it is in line with current legislation. 3 37 Care Homes for Older People Page 27 of 28 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). 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