Care Home: Cary Brook

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What the care home does well Cary Brook provides a very comfortable and welcoming home for the people who live there. The home specialises in the care of people who have a dementia. The staff receive ongoing training in dementia and person centred care and demonstrate a high level of understanding of the needs of people living at the home. Staff are well motivated and enthusiastic about their jobs. People living at the home were very complimentary about the staff who supported them. People said " staff are always ready to help and give time to listen" and "Staff are always approachable and friendly." There is a comprehensive activity programme in the home and continual social stimulation for people. Throughout the inspection day there was constant interaction between people living at the home and the staff who supported them. This creates a very relaxed and friendly atmosphere. Everyone asked was happy with the food in the home and it was noted that people were able to choose where they ate their meal. No one was rushed with their food and assistance was provided in a discreet manner for those who required it. One person wrote on their questionnaire "I get completely looked after." Another person, spoken with during the inspection, said that they were very comfortable and felt very much at home. What has improved since the last inspection? Since the last inspection the home has added a 30 bedded extension and are in the process of redeveloping the older part of the home. The home has been built and refurbished using the latest research for environments for people with a dementia. This has created a very enabling environment for people. Ongoing training has continued to ensure that staff have the skills and knowledge to care for the people at the home. What the care home could do better: No requirements have been made as a result of this inspection. The home has recently implemented a computerised care planning system. Care plans seen would benefit from further development to ensure that they give clear guidance for staff and reflect the person centred care being provided in the home. Key inspection report Care homes for older people Name: Address: Cary Brook Millbrook Gardens Castle Cary Somerset BA7 7EE     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 0 0 8 2 0 0 9 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 24 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 24 Information about the care home Name of care home: Address: Cary Brook Millbrook Gardens Castle Cary Somerset BA7 7EE 01963359700 01963351364 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Somerset Care Limited care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Registered for 45 people in categories OP and DE Date of last inspection Brief description of the care home Cary Brook is situated close to the town of Castle Cary, at the top of a small hill overlooking a residential housing estate. The home was purpose built in the 1960s and has recently had a 30 bedded extension added. The older part of the home is currently being up dated and completely refurbished. When complete the home will be able to accommodate up to 45 people in single bedrooms. The home offers a generally relaxed, homely atmosphere with planned and informal activities. The home is owned by Somerset Care Ltd and the registered manager is Judith Pullen. Current (10/08/09) fees at the home range from 425 to 575 pounds per week. 45 0 Over 65 45 0 Care Homes for Older People Page 4 of 24 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 over a one day period by one inspector. During the day we, The Commission, were able to speak with people living and working at the home, observe care practises, view records and tour the building. Before the inspection we sent out questionnaires to people living at the home and staff. We received 4 completed surveys from staff and 8 from people living at the home. Care Homes for Older People Page 5 of 24 People were assisted to complete questionnaires by an independent advocate. Some of the comments have been incorporated into this report. The relief manager completed an Annual Quality Assurance Assessment prior to the inspection which gave details about the home, their achievements in the past year and plans for the future. Care Homes for Older People Page 6 of 24 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 24 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 24 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 into Cary Brook have their needs assessed by senior staff at the home and by outside professionals. The first four weeks of any stay is considered a trial period to ensure the home meets the needs and expectations of the new person. Intermediate care is not provided. Evidence: The home has an up to date statement of purpose and service user guide. These documents give clear details about the home and the facilities and services offered. The service user guide sets out what is included in the basic fee and what items and services will incur additional costs. Care Homes for Older People Page 9 of 24 Evidence: Anyone wishing to move to the home has their needs assessed by a senior member of staff. Copies of pre admission assessments seen during the inspection gave basic details about the person and their needs. Staff said that they also obtained copies of assessments carried out by professionals outside the home before offering a place to any new person. The home specialises in the care of older people who have a dementia. The environment has been adapted in line with up to date research to enable people to maintain independence where possible. All staff receive ongoing training in the care of people who have a dementia and they were able to demonstrate their skills and knowledge during the inspection. The first four weeks of any stay is considered a trial period. This to ensure that the home is suitable and meets the expectations of the new person. Care Homes for Older People Page 10 of 24 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 are treated with dignity and their privacy is respected. Care plans are not always reflective of the high standard of care observed during this inspection. Evidence: The home uses a computerised care planning system which has been in operation for about 4 months. Staff said that they had received training on how to use the new care plans but felt that they were still learning. Three care plans were viewed in detail. They gave limited information about each person and there appeared to be a lack of information about how peoples dementia affected their day to day lives or the support that staff could give to assist people. However staff spoken with and observed during the day demonstrated a good knowledge of people and their needs. Assessments had been completed in respect of nutrition, skin care and mobility. One care plan showed that the person had lost a considerable amount of weight. Although the nutritional assessment has been up dated there was no written evidence that any further action had been taken. Senior staff were able to outline the action that had been taken by Care Homes for Older People Page 11 of 24 Evidence: the home. People living at the home said that staff assisted them to make appointments with local healthcare professionals if they were unwell. Appointments are recorded in the care plan. Care plans gave details of the level of support people require with personal care. One person said that staff who assisted them with personal care were very sensitive and that they were able to choose to have a male or female member of staff to assist with intimate tasks. Everyone asked felt that their privacy was respected. It was observed that people were able to spend time in communal areas or in their personal rooms. Staff were observed to knock on bedroom doors before entering and all assistance was given in a way that promoted peoples dignity. The home uses a monitored dosage system for medication. There are adequate storage facilities for medication including controlled drugs and medicines that require refrigeration. All medicines are signed for when they enter the home and when administered or refused. This gives a clear audit trail. Controlled drugs were checked and stocks held correlated with records kept. The lunchtime medication round was observed. Medication was administered in a discreet manner that did not disturb peoples meals. Medication is only administered by senior staff who have received specific training. Staff receive refresher training every three years. In order to ensure that staff continue to be competent in this area it is recommended that the home carries out periodic supervisions of medication practises with individual staff. The home carries out internal monthly audits of medication and any errors found are addressed. Care Homes for Older People Page 12 of 24 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 living at the home are able to make choices about their day to day lives. People are able to take part in activities according to their interests and abilities. Visitors are always made welcome. Evidence: People living at the home said that they were able to choose when they got up, when they went to bed and how they spent their day. One person said You can do what you like, its a nice place to live. 7 out of the 8 people who completed a questionnaire answered ALWAYS to the question Does the home arrange activities that you can take part in? People spoken with during the inspection said that there was lots going on. The weeks organised activities are displayed around the home and the days activities are written on boards in the main communal areas. Activity workers are employed at the home but all staff assist people with activities and occupation. Throughout the inspection day there were organised activities and Care Homes for Older People Page 13 of 24 Evidence: constant interaction between staff and people living at the home. In the morning there was a bingo session and a quiz in the afternoon. One person helped a member of staff clean out the pet rabbit cage, one person was doing a jigsaw puzzle and another said that they had been for a short walk with a member of staff. The hairdresser visits regularly and was at the home on the day of the inspection. There are TVs and radios in communal areas and in personal rooms. Some people have a daily newspaper delivered and there were magazines and books available for people to browse through. People said that there are trips out, including short trips into the local town, and visiting entertainers. Representatives from local churches visit the home to enable people to continue to practise their faith if they wish to. Some people living at the home said that they very much enjoyed the company of other people. There are comfortable homely lounges and various places around the home where people can sit and socialise. It was observed that staff spent time sitting with people chatting. Everyone said that they were able to have visitors at anytime and that their visitors were always made welcome. The home also holds social functions when people living at the home are able to invite friends and family. The most recent social event was an evening cheese and wine party. One person said Its very comfortable here, it feels like home. There is a seven week menu in place that has been drawn up in conjunction with a nutritionist and gives a good variety of nutritionally balanced meals. People said that the food was good and that they always had a choice. The lunchtime meal was observed, people were able to choose where they ate their meal and no one was hurried with their food. Assistance was provided in a very discreet manner to those who required it. The aqaa states that the home is able to cater for a wide range of diets depending on peoples physical, cultural or religious requirements or their personal preferences. It was observed that people who did not want anything from the menu were offered a wide variety of alternatives. Hot and cold drinks were available throughout the day and there are baskets of fresh fruit and small sweets around the home that people can help themselves to. Care Homes for Older People Page 14 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has taken reasonable steps to minimise the risks of abuse to people living at the home. Evidence: The home has policies and procedures on recognising and reporting abuse, making a complaint and whistle blowing. Everyone who completed a questionnaire prior to the inspection answered YES to the question Is there someone you can speak to informally if you are not happy? People spoken with during the inspection said that they would be comfortable to share any worries with a member of staff. All felt that they would be listened to. 3 of the 4 staff who completed a questionnaire said that they knew what to do if someone living at the home, or their advocate, had concerns about the home. No formal complaints have been received by the home or the Care Quality Commission in the past year. All staff have undertaken training in the protection of Vulnerable adults and all spoken with were aware of the whistle blowing policy and the ability to take serious concerns outside the home. Care Homes for Older People Page 15 of 24 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. Cary Brook provides a comfortable, enabling environment for the people who live there. Environmental aids and adaptations, to assist people who have a dementia to maintain their independence, have been incorporated throughout the building. Standards of cleanliness are good. Evidence: The home is located in a residential area in the small town of Castle Cary. Since the last key inspection the home has had a 30 bedded extension added and the original part of the building is being completely refurbished. This work is nearing completion and should be re opened at the end of this month (August 2009.) This will enable the home to accommodate up to 45 people in single rooms. At the time of this inspection the there were 24 people living at the home and only the new extension was in use. The home has been designed using up to date research on environments for people with a dementia but retains a homely atmosphere. All areas seen have been built and furnished to a high standard. There are comfortable seating areas around the home and many objects and ornaments to occupy people. Outside Care Homes for Older People Page 16 of 24 Evidence: there are secure garden areas that are in the process of being developed. During the inspection it was noted that people had unrestricted access to outside space and some people were seen independently accessing a patio area outside the downstairs lounge. Bedrooms are for single occupancy and all rooms in the new extension have en suite facilities. A further 10 en suite bedrooms have been created in the older part of the home and the remaining 5 rooms have toilet and bathroom facilities close by. Outside each room there are memory boxes to assist people to identify their own rooms and therefore maintain independent movement around the home. People are able to bring personal possessions and small items of furniture with them to the home. This gives rooms an individual homely feel. Aids and adaptations have been put in place to meet the needs of the people living at the home. En-suites have level access showers with shower seats, there are assisted bathing facilities and hand-rails throughout the home. The new call bell system is linked to phones carried by staff meaning that they sound quietly to staff and do not disturb people living at the home. Staff stated that at night the phones are turned to vibrate mode to ensure that they do not disturb people who are sleeping. All beds are fitted with pressure sensors that are connected to the call bell system and alert staff when people get out of bed. This means that staff are quickly able to attend to people who require assistance during the night. A new laundry has been created in the older part of the home. All areas seen were clean and fresh. Care Homes for Older People Page 17 of 24 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 excellent 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 an excellent team of staff who receive ongoing training to ensure they have up to date skills and knowledge. Staff work in a very person centred way which ensures that everyone receives care that is personal to them. Evidence: The aqaa states that the home employs 26 permanent care staff, 11 (42 ) have a National Vocational Qualification (NVQ) in care at level 2 or above. All 4 staff who completed questionnaires said that they received ongoing training that was relevant to their jobs. Records seen during the inspection confirmed that there is an excellent ongoing training programme for staff at the home. There is a comprehensive induction programme which staff felt was appropriate to the home. New staff said that, as well as undertaking the induction programme, they were able to shadow more experienced staff and were not asked to undertake any task until they felt confident to do so. As well as statutory training staff receive training that is specific to the people living at the home. This includes ongoing training in dementia and person centred care. Staff spoken with felt that the training opportunities were good and gave them the skills Care Homes for Older People Page 18 of 24 Evidence: they needed to work at the home. Staff observed during the inspection were confident and enthusiastic in their jobs. Throughout the day there was constant interaction between staff of all levels and the people living at the home. This creates a very friendly and person centred atmosphere. All staff asked said that they enjoyed their jobs. People who completed questionnaires and those spoken with during the inspection were very complimentary about the staff who assisted them. People said staff are kind and polite, and staff are always quick to help. Comments on questionnaires included Staff are always approachable and friendly, staff are always willing to help and Staff are always available. Three recruitment records were viewed. These gave evidence of a robust recruitment procedure which included obtaining written references and appropriate checks before the person begins work in the home. One recruitment record demonstrated that as part of the interview the candidate had been asked to spend time with someone living at the home and relay back to the interview panel what they had found out about the person. This demonstrates the homes commitment to ensuring that they employ people who have the right skills to work in a person centred way. Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is effectively managed with clear lines of accountability at all times. Appropriate systems are in place to ensure the health and safety of people living and working at the home. Evidence: The registered manager of the home is Judith Pullen. She has achieved the Registered Managers Award (NVQ level 4.) At the time of this inspection the manager had been away from the home for a number of months. To ensure the smooth running of the home it is currently being managed by an experienced relief manager and a competent deputy. There are always senior staff on duty who offer support and guidance to less experienced members of the team. This ensures that there are clear lines of accountability and responsibility. Care Homes for Older People Page 20 of 24 Evidence: To monitor the quality of the services and care offered there are regular in house audits and visits from senior managers within the company. There are regular meetings for people living and working at the home. Minutes of meetings showed that these are an opportunity to share ideas and opinions as well as information. Staff said that they felt able to express their views at meetings and felt listened to by the management team. The home does not act as a power of attorney or financial appointee for anyone living at the home. They do offer a facility that enables people to deposit small amounts of money for safekeeping. These monies are securely stored and clear records are kept of all transactions. People living at the home are able to access this money at anytime. The home is well maintained and there are systems in place to ensure the health and safety of people living and working at the home. All areas are fitted with a fire detection system which is regularly tested in house and serviced by outside contractors. All equipment in the home is regularly serviced. Up to date certificates of registration and insurance are displayed. Care Homes for Older People Page 21 of 24 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 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Care plans would benefit from further development to ensure they are fully reflective of peoples wishes and the care being given. To ensure that all staff who administer medication remain competent the home should carry out periodic supervisions in this area. 2 9 Care Homes for Older People Page 23 of 24 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. 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. 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