Care Home: Cartref Residential Care Home Trading as Alverant Ltd

What the care home does well They ensure that people`s needs and wishes were fully assessed before they moved into Cartref. this helps ensure that the home has the facilities to met the individual`s needs. Care plans were in place to inform staff what support a person needed during their day to day life. Systems were in place to help ensure that people receive the medical assistance they require. People are supported by a staff team who knew them well and who receive training for their role. People were confident in the homes complaints procedure and felt that there was always someone for them to speak to. People told us they were happy with the care and support they receive at Cartref. Comments from people included "the home is run exceptionally well from all aspects" and "you need have no worries or fears as far as the wellbeing of all its residents." What has improved since the last inspection? This is the first key inspection of the service under its current ownership. What the care home could do better: They must improve the way in which medication is recorded so that an accurate record all people`s medication is maintained. This will help ensure that people`s medication is managed appropriately and safely. To help ensure that people live in well maintained environment a programme of refurbishment must be developed. The proprietors of the service must produce a report on a monthly basis regarding their visits in which they have assessed the standards of care and their opinion of the care provided at the home. A copy of the report must be given to the registered manager. Key inspection report Care homes for older people Name: Address: Cartref Residential Care Home Trading as Alverant Ltd 61 Derby Road Widnes Cheshire WA8 9LQ     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: Adele Berriman     Date: 1 6 0 2 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 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © 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 26 Information about the care home Name of care home: Address: Cartref Residential Care Home Trading as Alverant Ltd 61 Derby Road Widnes Cheshire WA8 9LQ 01514244775 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Alverant Limited Name of registered manager (if applicable) Miss Claire Marie Brophy Type of registration: Number of places registered: care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following categories of service only- code PC, to people of the following gender:- Either. Whose primary care needs are within the following categories:- Old age, not falling within any other categeory - Code OP (maximum number of places 24). Dementia - Code DE (maximum number of places 6). The maximum number of people who can be accomodated is 24. Date of last inspection Brief description of the care home Cartref Residential Care Home provides personal care only for up to 24 older people. The home is located close to local amenities in Widnes town centre. The home is close to public transport links and a car park is available at the front of the building. 6 0 Over 65 0 24 Care Homes for Older People Page 4 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 carried our an unannounced visit to the home on the 16th February 2010. The visit began at 10.25am and ended at 5.55pm. This visit formed part of the first key inspection of the service under the current ownership. During our visit we spent time talking to people living at Cartref, a visiting relative, staff members, the registered manager and the proprietors. We looked at all the communal living areas and a selection of bedrooms and bathrooms. we looked at a selection of records, policies and procedures during the visit, these included care plans, staff files, medication records and daily records. As part of the inspection process five people completed a survey form, two with the assistance of others to tell us their thoughts on the service provided at Cartref. Five staff also completed a staff survey form. Care Homes for Older People Page 5 of 26 Prior to our visit the manager of the service completed an Annual Quality Assurance Assessment (AQAA). This document gave them the opportunity to tell us what they thought they did well, what they thought they could do better and their planned improvements for the next 12 months. The AQAA was well written and gave us some of the information we asked for. Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their needs assessed before they move into Cartref to ensure that their needs can be met. Evidence: We saw that a pre admission assessment was carried out prior to a person moving into Cartref. The purpose of this assessment was to ensure that the staff were aware of peoples individual needs and to ensure that the home had the facilities to meet these needs. We saw that information gained during the pre admission assessment was recorded on a set format. The document gave the opportunity to record peoples care and health needs within their day to day life. We saw completed pre admission assessments on some of the care plan files that we looked at. They told us that prospective residents were invited to visit and spend time at the Care Homes for Older People Page 9 of 26 Evidence: home before they made their decision to move in. During our visit we spoke to a relative of a resident. They told us that they had been given enough information about the service before their relative moved into Cartref. The home does not provide intermediate care facilities. Care Homes for Older People Page 10 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples personal care needs were being met by staff who respected their privacy and dignity. Evidence: We saw that each person had their own file that contained their personal information, pre admission information and their care plan. We looked at the care plans of three people. We saw that the care plans contained information about peoples day to day needs and wishes. The majority of the information was detailed and gave guidance to staff on how and when a person wished to receive care and support. All staff who completed a survey form told us that they are given up to date information about the needs of the people they support and care for. We saw that the care plans did not contain information relating to peoples capacity to make decisions. Where necessary, care plans should contain information about individuals capacity to make decisions under the Mental Capacity Act 2005 framework. Care Homes for Older People Page 11 of 26 Evidence: We saw that risk assessments specific to individuals needs formed part of the peoples care plans. We saw risk assessments that considered falls, the environment, pressure sores and moving and handling. Daily records were maintained and updated throughout the day. We saw that the records contained information relating to peoples personal care and support. Records contained in the care plans demonstrated that people had regular access to their GP, dentist and other local health care professionals. All of the people who completed a survey form told us that the home always made sure that they got the medical care they needed. All of the people who we spoke to during our visit told us that staff respected their privacy and dignity. The majority of people who completed a survey form told us that staff always listen to them and act on what they say. We saw that they had a policy for the recording, receipt, administration and disposal of medication. Information contained in the policy and procedures was in need of reviewing and updating to ensure that it gave the correct information to the staff team. For example, the policy referred to medication being delivered on a monthly basis which was not the procedure within the home. We saw that medication administered was recorded on Medication Administration Records (MARs). We looked at several of these records and saw that not all of the information required on the record had been completed. For example, a record of the date and quantity of medication received was not always recorded; we also saw that two records had been signed on more occasions than it was administered. To help ensure people receive their medication when they should do, clear accurate records of all medication received and administered must be maintained. We saw that a lockable trolley and cupboard was available to store medication safely. However, no secure storage was available for medication requiring refrigeration. A lockable facility should be made available for all medication requiring refrigeration to ensure that it can be safely stored. Care Homes for Older People Page 12 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The way in which peoples needs are met means they can make choices that help maintain their Independence. Evidence: On our arrival at the home we saw several people were reading the daily newspapers and two people were playing a game of scrabble. They told us that staff encourage and support people each afternoon in carrying out activities. They told us in their AQAA that they place no restrictions on residents and always respect their choice and wishes. Staff offer activities daily and encourage residents to take part. People who completed a survey form told us that the home usually arranges activities for them to take part in. They told us that visits from local churches enable people to maintain their faith. These visits included monthly visits from a representative from the Church of England and weekly visits from a lay preacher who offered communion. Care Homes for Older People Page 13 of 26 Evidence: They told us that people were encouraged to vote in elections and were supported either with a postal vote or visiting the local polling station. People told us that they were able to get up and go to bed when they wished. We saw evidence of peoples preferences in individuals care plans. One person wrote in their survey form they look after me well. Staff are always happy. Staff make it feel like my home. I am able to make my own decisions. I can have time to myself or with my friends. Another person told us I love where I live and the people, I have made lots of new friends. People told us that they can receive visitors at any time. A relative that we spoke to during our visit told us that they were able to visit at all times. They told us that they were happy with their mums care and that the staff are very helpful. We saw that meals were served in one of two dining rooms within the home. One dining room had recently been decorated and tables were set with cutlery, sugar, condiments and flowers. We saw a sample of the food menu. It demonstrated that on the majority of occasions people were given a choice of two meals at lunchtime and teatime. The menu was in written form. The introduction of other means for people to choose their food should be considered to help orientate people at meals times, for example, a pictorial menu. People told us that they usually liked the meals served at the home. They told us the food is good, you have a choice and you can have as much and as little as possible. Care Homes for Older People Page 14 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service were aware of and protected by the complaints and safeguarding procedures available. Evidence: We saw that they had a complaints procedure that was readily available in the home. They told us that all residents are given a copy of the services complaints procedure when they move into the Cartref. They told us in their AQAA that no complaints had been received under the current ownership. All of the people who completed a survey form and who we spoke to during our visit told us that there was always someone to talk to if they were not happy and all said that they know how to make a complaint about the service. One person told us I have no complaints, I dont need anything and if I need anything I ask the staff who help me. We saw that policies and procedures were in place for the protection of vulnerable people. A copy of Halton Councils safeguarding procedures were also available. During the visit the manager demonstrated a good awareness of local safeguarding procedures. Care Homes for Older People Page 15 of 26 Evidence: No safeguarding referral had been made regarding the service within the last 12 months. Care Homes for Older People Page 16 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A programme of redecoration must be developed to ensure that people continue to live in a comfortable environment. Evidence: Cartref is situated close to public transport services and close to Widnes town centre and its amenities. A garden area is available to the rear of the home and a car park is situated at the front of the property. We looked around several areas of the property. We saw that peoples bedrooms were personalised with their own effects to help create a comfortable environment. We look at the dining room, lounges and several bathrooms that were for communal use. We saw that they were clean and tidy and contained furniture and equipment to meet peoples needs. We saw that some of the equipment in use was in need of attention and he carpets in the hallway downstairs and other areas were in need of cleaning or replacing. The proprietor told us that these issues would be addressed. They told us that within the last six months improvments to the home have included new windows, the decoration, flooring and new furnishing to the dining room. They told us that they planned a programme of redecoration of bedrooms and communal areas. A copy of this plan must be sent to the Commission. Care Homes for Older People Page 17 of 26 Evidence: Laundry facilities were available within the home. They told us in their AQAA that they have an action plan to deliver best practice in the prevention and control of infection. Most people who completed a survey form told us that the home was always fresh and clean. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive care and support from staff who have the skills to support them correctly. Evidence: When we visited saw that the registered manager, a senior carer and two carers were on duty along with a cook and a domestic to meet the needs of the fifteen people in residence. The majority of the staff who completed a survey form told us that there were always enough staff to meet the individual needs of people. People told us good things about the staff team, their comments included the girls are very good, the staff are great and staff make it feel like my home. We observed staff supporting people in a caring and supportive manner. The staff team demonstrated a good awareness of peoples needs. We saw that the service had a good recruitment procedure. We looked at the staff files of three people. We saw that the files contained written references, application forms, record of interviews and evidence that Criminal Record Bureau disclosures had been sought. Care Homes for Older People Page 19 of 26 Evidence: They gave us information about training that staff had undertaken in the past 12 months. The information demonstrated that the majority of staff had completed training in moving and handling, first aid, food hygiene, infection control, the mental capacity act, challenging behaviour, medication and fire training. In addition several staff had undertaken training in equality and diversity and the subject of diabetes. All staff told us in their surveys that they felt they had enough support, experience and knowledge to meet the different needs of the people living at Cartref. They told us that further training and refresher training was planned over the the next few months in the areas of moving and handling, the protection of vulnerable people, dementia care and medication. The majority of staff had completed a National Vocational Award (NVQ) level 2 or 3 and a further 6 staff were in the process of completing their award. They told us that all newly recruited staff undertake an induction of the national induction standards with Halton Council when they commence employment. We saw evidence on staff files that staff were receiving formal supervision for their role. Most staff told us in their survey forms that their manager gives them enough support and meets with them to discuss how they are working. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Cartref is managed so that it is run in the best interests of the people who live there. Evidence: The registered manager has several years experience in working in social care environment. During our visit the manager demonstrated a good awareness of peoples needs and and what actions were needed to further improve the service. Prior to our visit the manager had completed an Annual Quality Assurance Assessment (AQAA). The AQAA gives the service the opportunity to tell us what they think they do well, what improvements have been made and their plans for the future. The AQAA contained some of the information we asked for. They told us that the proprietors of the home visit on a regular basis. We saw reports that had completed by the proprietor following their visits. The last report available was dated December 2009. The proprietor should ensure that a report of their visits is completed on a monthly basis and a copy made available to the manager of the home. Care Homes for Older People Page 21 of 26 Evidence: To help monitor quality assurance they told us that they random send out survey forms asking for peoples views on one specific of several areas of the service. Once the information from the surveys has been collated a report is written and a copy is sent to the Commission. One person told us that the proprietors were always available to speak to and another person told us that they had introduced a comments box for people to post any comments or suggestions they may have. We saw that procedures were in place for the safe management of peoples money. We saw that accidents were being recorded and the records were stored appropriately to protect peoples information. We saw that policies and procedures were available to support and protect the health, safety and wellbeing of people. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 clear accurate records of all medication received and administered must be maintained. This is to help ensure that people receive their medication when they should do. 14/04/2010 2 9 13 Secure storage must be available for all medication that may require refrigeration. This is to help ensure that all medication is stored within the manufacturers guidelines. 14/04/2010 3 19 23 A programme of 15/04/2010 refurbishment for the building must be developed and a copy of the programme sent to the Care Quality Commission. Care Homes for Older People Page 24 of 26 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 This will help ensure that people continue to live in a clean and comfortable environment. 4 33 26 The proprietors of the service should produce a report on a monthly basis regarding their visits in which they have assessed the standards of care and their opinion of the care provided at the home. This will help ensure that regular monitoring of the standard of care at the home takes place. 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 14/04/2010 1 7 Care plans should include information that considers peoples capacity as outlined in the Mental Capacity Act 2005 framework. The service should consider using several means of displaying the menu available to help people make a choice of the food they wish to eat. To minimise the risk of of harm, regular checks should be made of all hot water facilities available to people to ensure that the temperature is within the current health and safety guidance. 2 15 3 19 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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