Care Home: Catterall House

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What the care home does well It was pleasing to see that the new manager of the home had introduced a wide range of better policies, procedures and practices, which had significantly improved the standard of service for the people living at Catterall House. It is important that the manager is now allowed and supported to sustain that level of improvement in order to create a stable and consistent environment and management structure for everyone involved with Catterall House. The needs of people had been thoroughly assessed before they were admitted to the home, so that the staff team were confident that they could provide the care and support required by each individual moving into Catterall House. The plans of care for two of the three people whose care we `tracked` were detailed, person centered documents, provided staff with clear guidance about the needs of those living at the home and how their assessed needs were to be best met. The care plans had been reviewed regularly and any changes in people`s needs had been reflected well, so that staff were provided with upto date information about the people in their care. A wide range of external professionals were involved in the care of those living at Catterall House to ensure that their health care needs were being consistently met, including pressure and nutritional care. Visitors to the home were made to feel welcome and people were supported to access local advocacy services should they wish to have an independent person to help them to make decisions about their life. People living at the home were offered a variety of choices and were supported to make informed decisions about what they wanted to do, taking into consideration their preferences and ensuring that their privacy and dignity was consistently respected. Catterall House was hygienic and well maintained providing a pleasant place for people to live with personalised bedrooms and comfortable communal areas, offering a variety of rooms for people to spend their time. People living at Catterall House were well protected by the recruitment practices adopted by the home and their needs were being met by the numbers of staff on duty at any one time. The health and safety of those living at the home was well protected and systems were in place so that the quality of service provided could be closely monitored. One person living at the home told us, "I`m very happy with how they look after me. The food is good. I`m very happy with the staff and the home. I`m able to come and go as I please, as long as I tell them where I`m going". When asked what the home does well comments written on the surveys by people living at the home include: `It takes care of us residents`; `Everything` and`It looks after us, cares for us and feeds us`. What has improved since the last inspection? It was pleasing to establish that the home had appropriately addressed all twenty requirements made at the last key inspection, which was commendable. A lot of improvements had been made by the manager of the home since our previous inspection and plans were in place to fully introduce the new systems so that the improvements could be sustained. The Statement of Purpose and Service Users` Guide had been updated, so that current information was provided to any interested parties. The care files seen were organised and well structured, allowing staff to easily access any relevant information about people in their care. Two out of the three plans of care examined were very detailed, providing staff with clear guidance about the needs of people in their care and how these needs were to be best met. The management of medications had improved so that people living at the home were better protected against the possibility of any medication errors or drug misuse. The management of meals had significantly improved since our last key inspection. A menu had been introduced offering people a choice of meals, which was available in a laminated format on each dining table. The system for ordering food items was better, allowing the chef to obtain items needed in accordance with the planned menu. The dining room provided a comfortable and homely environment and tables were pleasantly arranged to enhance the overall dining experience for the people living at the home. The complaints policies and procedures had been reviewed and they were now appropriate to the needs of the people at the home so that they were confident that their concerns would be dealt with effectively. The policies and procedures in relation to protecting people living at the home had been reviewed and updated to incorporate the correct procedures in reporting any actual or possible allegations of abuse to ensure that those residing at Catterall House would be better safeguarded. A programme had been implemented to incorporate mandatory and health related training for staff, in accordance with the individual needs of those living at the home, so that the staff team could provide the care and support required by every one living at Catterall House. The management of Catterall House was better by the appointment of a person to be in day to day control, who had implemented systems to ensure that all confidential records in relation to those living at Catterall House were kept securely, so that they could only be accessed by the relevant people in order to maintain confidentiality in accordance with data protection legislation. A wide range of systems had been introduced to allow thorough monitoring of the quality of service provided, so that any strengths could be recognised and developed further and any areas for improvement could be addressed in a timely fashion. The issues highlighted at the last key inspection, which put people living at the home at a degree of risk had been appropriately addressed to ensure that the health, welfare and safety of those residing at Catterall House was now well protected. It was pleasing to see that 19 of the 22 recommendations made at the last key inspection had been addressed, so that those living at Catterall House received a better overall service. One person living at the home commented, "It is a lot better here now. It is tidy and absolutely spotless. The staff are marvelous and the food is very good". What the care home could do better: People living at the home could have been given the opportunity to be involved in the care planning process and any reviews of care needs, so that they could make some decisions about how their care and support was to be delivered. One of the care plans examined could have provided staff with clearer guidance about how the individual`s assessed needs were to be best met and vague, none specific terminology could have been avoided to ensure that this resident received person centered care and support. This could be achieved by abolishing the interim care plans intended for people staying at the home for respite care and using the same format as is used for people living permanently at the home. Hand written entries on the Medication Administration Records could have been consistently signed, witnessed and countersigned in order to reduce the possibility of any transcription errors. The management of activities provided could have been better. It is suggested that this area be reviewed, so that leisure activities are organised in accordance with people`s individual interests through a regular structured, person centered and more interesting programme. The manager of the home could have been more familiar with systems in place involving the personal allowances of one of the people living at Catterall House. This would have allowed her to have better insight into the management of people`s financial matters who wished the home to take on this responsibility. The risk management framework could have been better followed in day to day practice, so that any potential risks were always minimized in order to protect the people living at the home. One person living at Catterall House said, "I didn`t know I could see my file. I don`t like any of those activities. I don`t want to do any of them". When asked what the service could do better one person wrote on the comment card, `I don`t think it could do any better` and another simply commented, `nothing`. Key inspection report Care homes for older people Name: Address: Catterall House Garstang Bypass Road (A6) Catterall Preston Lancashire PR3 0QA     The quality rating for this care home is:   one star adequate 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: Vivienne Morris     Date: 0 8 0 6 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 33 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 33 Information about the care home Name of care home: Address: Catterall House Garstang Bypass Road (A6) Catterall Preston Lancashire PR3 0QA 01995602220 01772816967 rameshvarshagulati@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dr Varsha Gulati Name of registered manager (if applicable) Manager post vacant Type of registration: Number of places registered: care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care Home only - Code PC To Service Users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of Service Users who can be accommodated is: 24 Date of last inspection Brief description of the care home Catterall House is a two-storey building with single accommodation on ground and first floor levels; there is one double bedroom for those wishing to share facilities. Bedrooms are furnished to a satisfactory standard. The home is situated on a main road position in the rural area of Catterall on the outskirts of Preston and a short drive from Garstang. The home has adequate car parking space to the side of the house and is on a bus route and within walking distance of local shops. Catterall House caters for Care Homes for Older People Page 4 of 33 Over 65 24 0 0 4 0 2 2 0 1 0 Brief description of the care home up to twenty-four elderly people, who require assistance with personal care and the home has been adapted to suit the needs of this category of resident. A passenger lift is installed and ramps are fitted to entrances of the building to allow easy access for those in wheelchairs and the less mobile. At the time of this visit to the service the fees for care ranged from £365 to £410 per week, with additional costs for hairdressing, chiropody and excursions. Care Homes for Older People Page 5 of 33 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: one star adequate 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 last key inspection of Catterall House took place on 4th February 2010. The quality rating for this service is one star. This means that people who use this service experience adequate quality outcomes. The site visit to Catterall House formed part of the inspection process and was conducted over one day in June 2010. It was unannounced, which means that the managers, staff and people living at the home did not know it was going to take place. During the course of the site visit, discussions took place with those living at the home, staff and managers. Relevant records and documents were examined and a tour of the premises took place, when a random selection of private accommodation and all communal areas were seen. We received comment cards back from eight people who lived at the home, but none were returned from staff members. Some comments made by the people involved in our survey are incorporated into this report. Every year the provider completes a self assessment, known as an AQAA, which gives Care Homes for Older People Page 6 of 33 information to the Commission about how the service is meeting outcomes for the people living at the home and how the quality of service provided is monitored. It also gives us some numerical information about the service. Some of the information from the AQAA is incorporated in this report. We observed the activity within the home and tracked the care of three people during the site visit, not to the exclusion of other people living at Catterall House. The total key inspection process focused on the outcomes for people living at the home and involved gathering information about the service over a period of time from a variety of sources. The Care Quality Commission had not received any complaints about this service since the last key inspection. Care Homes for Older People Page 7 of 33 What the care home does well: It was pleasing to see that the new manager of the home had introduced a wide range of better policies, procedures and practices, which had significantly improved the standard of service for the people living at Catterall House. It is important that the manager is now allowed and supported to sustain that level of improvement in order to create a stable and consistent environment and management structure for everyone involved with Catterall House. The needs of people had been thoroughly assessed before they were admitted to the home, so that the staff team were confident that they could provide the care and support required by each individual moving into Catterall House. The plans of care for two of the three people whose care we tracked were detailed, person centered documents, provided staff with clear guidance about the needs of those living at the home and how their assessed needs were to be best met. The care plans had been reviewed regularly and any changes in peoples needs had been reflected well, so that staff were provided with upto date information about the people in their care. A wide range of external professionals were involved in the care of those living at Catterall House to ensure that their health care needs were being consistently met, including pressure and nutritional care. Visitors to the home were made to feel welcome and people were supported to access local advocacy services should they wish to have an independent person to help them to make decisions about their life. People living at the home were offered a variety of choices and were supported to make informed decisions about what they wanted to do, taking into consideration their preferences and ensuring that their privacy and dignity was consistently respected. Catterall House was hygienic and well maintained providing a pleasant place for people to live with personalised bedrooms and comfortable communal areas, offering a variety of rooms for people to spend their time. People living at Catterall House were well protected by the recruitment practices adopted by the home and their needs were being met by the numbers of staff on duty at any one time. The health and safety of those living at the home was well protected and systems were in place so that the quality of service provided could be closely monitored. One person living at the home told us, Im very happy with how they look after me. The food is good. Im very happy with the staff and the home. Im able to come and go as I please, as long as I tell them where Im going. When asked what the home does well comments written on the surveys by people living at the home include: It takes care of us residents; Everything and Care Homes for Older People Page 8 of 33 It looks after us, cares for us and feeds us. What has improved since the last inspection? It was pleasing to establish that the home had appropriately addressed all twenty requirements made at the last key inspection, which was commendable. A lot of improvements had been made by the manager of the home since our previous inspection and plans were in place to fully introduce the new systems so that the improvements could be sustained. The Statement of Purpose and Service Users Guide had been updated, so that current information was provided to any interested parties. The care files seen were organised and well structured, allowing staff to easily access any relevant information about people in their care. Two out of the three plans of care examined were very detailed, providing staff with clear guidance about the needs of people in their care and how these needs were to be best met. The management of medications had improved so that people living at the home were better protected against the possibility of any medication errors or drug misuse. The management of meals had significantly improved since our last key inspection. A menu had been introduced offering people a choice of meals, which was available in a laminated format on each dining table. The system for ordering food items was better, allowing the chef to obtain items needed in accordance with the planned menu. The dining room provided a comfortable and homely environment and tables were pleasantly arranged to enhance the overall dining experience for the people living at the home. The complaints policies and procedures had been reviewed and they were now appropriate to the needs of the people at the home so that they were confident that their concerns would be dealt with effectively. The policies and procedures in relation to protecting people living at the home had been reviewed and updated to incorporate the correct procedures in reporting any actual or possible allegations of abuse to ensure that those residing at Catterall House would be better safeguarded. A programme had been implemented to incorporate mandatory and health related training for staff, in accordance with the individual needs of those living at the home, so that the staff team could provide the care and support required by every one living at Catterall House. The management of Catterall House was better by the appointment of a person to be in day to day control, who had implemented systems to ensure that all confidential records in relation to those living at Catterall House were kept securely, so that they could only be accessed by the relevant people in order to maintain confidentiality in accordance with data protection legislation. A wide range of systems had been introduced to allow thorough monitoring of the quality of service provided, so that any strengths could be recognised and developed further and any areas for improvement could be addressed in a timely fashion. The issues highlighted at the last key inspection, which put people living at the home at a degree of risk had been appropriately addressed to ensure that the health, welfare Care Homes for Older People Page 9 of 33 and safety of those residing at Catterall House was now well protected. It was pleasing to see that 19 of the 22 recommendations made at the last key inspection had been addressed, so that those living at Catterall House received a better overall service. One person living at the home commented, It is a lot better here now. It is tidy and absolutely spotless. The staff are marvelous and the food is very good. 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 Care Homes for Older People Page 10 of 33 order line 0870 240 7535. Care Homes for Older People Page 11 of 33 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 12 of 33 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. Peoples needs are thoroughly assessed before they are offered a place at the home, so that the staff team are confident they can provide the care and support required by each individual. Evidence: At the time of our visit to Catterall House there were nine people living at the home. One of these people had been admitted since our last key inspection. We tracked the care of this individual, plus another two people who had lived at the home longer. The needs of this newest admission had been assessed before she was offered a place at the home, so that the staff team were confident they were able to provide the care and support she required. Records showed that this person had been involved in the pre-admission process, so that she could make some decisions about the way she wished her care to be planned. This lady told us that the manager of Catterall House had visited her with another member of staff before she was admitted, to see what Care Homes for Older People Page 13 of 33 Evidence: she needed and to decide if the home could meet her needs. As the other two people whose care we tracked had been admitted to the home prior to our last key inspection we did not assess the pre-admission process for them on this occasion. When asked what the service does well, the manager of the home wrote on the homes self-assessment, Catterall House provides a detailed brochure and information to prospective residents and relatives. We also encourage the prospective resident to come and visit Catterall House to have a look around the home and also offer the oppurtunity of a trial period. Pre-admission asssesments are completed and care plans are in place prior to admission. Care Homes for Older People Page 14 of 33 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. The health and personal care needs of people living at Catterall House are, in general, being met by the policies, procedures and practices adopted by the home and the management of medications is good. Evidence: We tracked the care of three people living at the home during our visit to this service. The new manager of the home had introduced an improved format for assessing peoples needs and for planning the care of those living at Catterall House. It was pleasing to see that two out of the three people whose care we tracked had an assessment in place for each area of need and then a linked plan of care to cover the needs identified, which provided a clear picture of care and support required. The care files seen were well organised and very structured, making information easy to find, allowing staff to quickly access relevant details about each person living at the home. The plans of care had been reviewed and any changes in need were reflected Care Homes for Older People Page 15 of 33 Evidence: well, so that up to date information about the care and support required by each person was available to staff. The care plan evaluations included any tasks completed, such as the review of risk assessments and weight records, which was considered to be good practice. Two of the three plans of care were, in general, detailed and included peoples assessed needs and how these needs were to be best met, in relation to health and personal care. However, some areas of need could have been more informative and person centered, such as for one person who experienced intermittent pain. The care plan did not identify the area or level of pain or the intervention that was needed for pain control in order to make this person more comfortable. The pressure and nutritional needs of people were being fully met by the care planning process adopted by the home and this was confirmed by the people living at Catterall House and our observations throughout the course of the day. The management of medications was satisfactory. However, hand written entries on the Medication Administration Records had not always been signed, witnessed and countersigned in order to avoid any transcription errors. The daily notes held good information, including input from a wide range of external professionals, giving a clear picture of the needs of people living at the home. We spoke to a number of residents who all said that their needs were being fully met. One person told us, When I was poorly they (the staff) called a Doctor straight away and he came five times when I was ill and another commented, The girls are smashing and Brian, the chef is wonderful. He is really caring too. A wide range of risk assessments and checks had been conducted on a regular basis to make sure that peoples health and personal care needs were being appropriately met, although instructions within the risk management framework had not always been followed through in day to day practice to ensure that strategies were consistently implemented in order to minimise or eliminate the element of risk. Relevant signatures had not always been obtained when agreements were required, such as on contracts, care plans, risk assessments and consent forms, to show that people had been given the opportunity to participate in the decision making process. The preferences of people were well recorded in relation to personal care and the importance of maintaining peoples privacy, dignity and independence was evidently an important aspect of the care planning process. One care plan stated, Prefers to have a bath on his own, with one staff member outside the bathroom door. We noted Care Homes for Older People Page 16 of 33 Evidence: staff being tactful and polite throughout the day, by knocking on bedroom doors and responding to requests in a pleasant and helpful manner. The care records for the third person whose care we tracked were less detailed and person centered. The individual had been admitted on a short term basis only. The manager told us that an interim care plan was developed for those admitted for respite care, which we felt was not totally sufficient. Although assessed needs had been recorded there was little guidance for staff about how this person could be supported to meet her needs. Some of the statements were vague and non-specific, which did not always promote person centered care. Care plans for people admitted for respite care could have been as detailed as the ones for those on a permanent contract to ensure consistency of the service provided. When asked what the home could do better the manager wrote on the selfassessment, Manager to audit care plans on a monthly basis to point out any room for improvement. We received comment cards from eight people living at the home who all told us that they always received the support they needed, including medical care. Care Homes for Older People Page 17 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities provided for people living at Catterall House are limited. However, meals are well managed and residents are encouraged to keep in regular contact with family and friends. Evidence: On arrival at Catterall House we noted that four people who lived at the home were being transported to a local coffee morning, which was pleasing to see. A policy was in place in relation to activities provided by the home and this information was included in the Service Users Guide, so that people were aware of activities provided by the home. Records showed that information had been gathered about peoples life history and what they liked to do, including their preferences, interests and things that were important to them, so that staff had a clear picture of each persons social care needs. An activity programme had been developed and it was displayed within the home, so that people could plan their day. The manager told us that she had designed the programme in accordance with the preferences of people living at the home. However, we felt that the range of activities provided was somewhat limited and could have Care Homes for Older People Page 18 of 33 Evidence: been more imaginative, so that people living at Catterall House had more choice about what they did at each time of the day. On the day of our visit for long periods people just sat in chairs around the television, with little stimulation. One person said she wasnt particularly watching the television, It is just background noise she added. We were told that outside entertainers visited the home on the odd occasion and that trips out were organized a few times a year. One person said, We go to see Blackpool illuminations in the winter and on a barge trip in the summer. Oh and there has just been a Gala weekend, but that is about all and another commented, We do gentle exercises, play dominoes and bingo, but I like reading and doing crosswords, so I can keep myself entertained. We go to a coffee morning each Tuesday. We were told that one person who is more able, went out for a walk when staff were available to take her and another person visited some relatives occasionally, who lived nearby. Some people living at the home wanted to remain as independent as possible by making their own drinks or drying the pots. One lady said, I like to do my bit to help. When asked what improvements are planned for the next twelve months the manager wrote on the self-assessment, A more robust and person centered daily activities calender to be implemented involving what the residents would like to do as their daily activities. Regular residents, relatives & staff meetings to be held on a 6 to 8 weekly basis and documented minutes to be kept. We received comment cards from eight people living at the home who told us that, in general, the home arranged activities they could take part in, if they wanted to do so and they also said that they liked the meals at the home. Visitors were welcome to the home at any time and those spoken to said that they always felt at ease visiting Catterall House and that they are always offered refreshments. There was a visitors policy in place telling people about the visiting arrangements. People living at the home told us that their relatives called to see them whenever they wished and they usually saw them in the lounges of the home, although they could go to their room if they preferred. There was sufficient information available telling people about the local advocacy services, should they wish to appoint an independent person to act on their behalf. One relative told us, I am always made welcome to the home and am offered a cup of tea and some cake. I feel comfortable when visiting Catterall House and all the staff are lovely. Comments received from the people living at the home included, Were very well Care Homes for Older People Page 19 of 33 Evidence: looked after. You only have to ask and you get. I wouldnt go anywhere else. We do some activities, such as exercises, dominoes and some other things and We are always looked after. The girls are very good. Weve got a good cook too. We observed lunch being served. The dining room was nice and bright with well laid tables, providing a pleasant dining experience for those living at the home. Laminated menus were positioned on each table and condiments were available, to encourage people to help themselves. The chef told us that the three weekly menu was still on trial and he hoped to eventually develop it into a four weekly cycle. The menu of the day was clearly displayed on the board in the dining room for all to see. The kitchen was very well organised and we saw that it was well stocked with fresh and frozen goods and a variety of home baked products were available and offered to residents. The ordering system for food seemed to have improved, with the chefs requirements being supplied to allow him to follow the menu, so that the meals served coincided with what people had selected from the menu. We observed a variety of alternative choices to the menu being offered to people at lunch time and during the meal the chef was constantly at the dining tables making sure that residents were managing and happy with the food he had served. Those we spoke to all said that they enjoyed the meals at the home and they all praised the chef with comments like, Weve got a good cook here, He (the chef) knows what we like and Brian, the chef is a wonderful cook you know, he looks after us well and he is very jolly with it. Just what we want in a care home. It is a bit of fun. Care Homes for Older People Page 20 of 33 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. Complaints are, in general, managed well and people living at Catterall House are protected by the policies and procedures in place at the home. Evidence: The complaints policy and procedure had been updated, so that people were given accurate guidance about how to make a formal complaint, should they wish to do so. Although this was prominently displayed within the entrance of the home, other copies available in a variety of different places did not reflect the same details, which could be confusing for people. All those spoken to at the time of our visit told us that they would know how to make a complaint if it was necessary and a system was in place, so that any complaints received could be recorded and monitored. However, it is recommended that a numbered page book be used to document complaints, so that it would be easy to recognise if any pages were removed. The written policies and procedures in relation to the protection of vulnerable adults were found to be much improved and were easily accessible by those working at the home. We must emphasise the importance of staff following these procedures in day to day practice, so that those living at the home are well protected. The training matrix showed that staff had received safeguarding training and the home had made this a mandatory annual requirement, which was pleasing to see. Care Homes for Older People Page 21 of 33 Evidence: Staff spoken to were aware of what they needed to do should they be concerned about the health, welfare or safety of anyone living at Catterall House. When asked how the home had improved in the last twelve months the manager wrote on the self-assessment, By learning from previous complaints & implementing these in policies & procedures. People who sent us comment cards and who lived at Catterall House told us that, in general, the staff listened to them and acted on what they said. They also told us that there was someone they could speak to informally if they were not happy. However, three of the residents said that they would not know how to make a formal complaint, if they wished to do so. Care Homes for Older People Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is comfortable and homely, providing a pleasant environment for people to live in and systems in place to control infection are good. Evidence: During our visit to this service we toured the premises, viewing all communal areas of the home and a random selection of private accommodation. It was pleasing to see that the maintenance issues identified at our last inspection had been appropriately addressed, therefore improving the environment for the people living at Catterall House. The home was found to be clean, tidy and pleasant smelling throughout and bedrooms contained peoples own possessions, including items of furniture, so that a homely environment was created. Those spoken to told us that they were happy with their bedrooms and one person said, I asked to be moved to a different room and they (the staff) let me. We noticed that the toilet, adjacent to the passenger lift on the first floor was being used to store some domestic appliances and clinical waste bags, which was not in the best interest of the people using this facility. Care Homes for Older People Page 23 of 33 Evidence: A new carpet had been fitted along a good part of the first floor corridor, making this area much more pleasant for the people using this part of the home. We found the laundry department to be well organised and fit for purpose with sufficient equipment for the needs of the home and the people living there. Care staff were responsible for completing laundry duties, which we felt at this time was acceptable due to the low occupancy. However, once the occupancy increases then consideration should be given to the employment of dedicated laundry staff. Infection control policies and procedures were in place and clinical waste was being managed appropriately, so that the risk of cross infection was minimised. Evidence was available to show that training for staff in the control of infection was booked for next month to ensure that they were fully aware of their responsibilities in protecting people in their care from possible infections. Care Homes for Older People Page 24 of 33 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 Catterall House are protected by the recruitment practices adopted by the home and they are supported by the number and skill mix of staff on duty. Those working at the home receive a varied training programme, so that they are able to provide the care required. Evidence: At the time of our visit to this service there were nine people living at the home and we found that the needs of these people were being met by the number and skill mix of staff on duty. We received comment cards from eight people living at the home who told us that there were staff available when they were needed. We examined the records of three people working at the home and found that good recruitment systems were in place and that staff files were well structured and organized, making information easy to find. The manager told us that staff would not be employed without a Criminal Records Bureau disclosure being received. However, the work permit for one person recruited from overseas had expired. We were told that a new one had been applied for, although this was not present in the staff members file. We discussed this with the manager of the home who confirmed that she would follow this up and inform us of the outcome. Care Homes for Older People Page 25 of 33 Evidence: We saw that there was an ongoing training programme and that most staff had attended the mandatory courses. The home had almost achieved the recommendation of 50 of staff having achieved a national vocational qualification. Staff spoken to were able to discuss the needs of people well. They were happy with the management support and felt that the new manager was approachable. They told us about the recent supervision they had had and about the various training courses they had attended, which showed that staff were kept upto date with current legislation, guidelines and new ways of working. When asked what improvements are planned for the next twelve months the manager wrote on the self-assessment, The new manager to implement a training matrix to highlight which staff require training. Also ongoing training to be continued. We intend to continue with our In-House Training Programme, which means that once a month one of our staff will give a presentation to the rest of the staff on relevant topics. Our next presentation is on Dignity-in-Care. Care Homes for Older People Page 26 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Catterall House is being managed in the best interests of the people living there. Evidence: The management of Catterall House had previously been poor because of constant changes of managers at the home over several years, therefore a stable management structure had rarely been provided. Managers tended to stay at the home for short periods of time only, a number leaving because they were not allowed to actually manage the home, make decisions or take on full responsibility of Catterall House. The new manager of Catterall House had recently been appointed, therefore she had not yet been registered with the Care Quality Commission. However, she had evidently worked hard to improve the standard of service provided for the people living at the home. One relative said, This new manager is getting things sorted out. Things are on the up and staff spoken to told us that they felt supported by the new manager as she was very approachable. We assessed progress toward the home meeting the requirements made at the last inspection and found that all twenty had Care Homes for Older People Page 27 of 33 Evidence: been appropriately addressed and that most of the recommendations had also been attended to, which was commendable and pleasing to see. The service has been without a registered manager for several years and whilst some improvements have been made there is still no manager registered with the Care Quality Commission. The management of the home now need to demonstrate that the improvements can be sustained over a period of time. The manager told us that she felt very supported by the provider of the home, although she was allowed autonomy to manage Catterall House and to make decisions on a day to day basis, which is a good management structure that will be beneficial for those living at the home and the general operation of the service. We recognise that the home has made some significant improvements, which was very pleasing to see and we are hoping that these improvements can now be sustained and built upon even further. The manager had set up an internal auditing process, which covered a wide range of areas and which will over time, if used correctly, be a good part of the quality monitoring system. We saw evidence that resident, relative and staff meetings were held regularly and that discussions taking place were recorded, so that relevant parties were kept informed of any important information and so that people could express their opinions and discuss any chosen topics. A range of frequent surveys had been conducted to obtain feedback from anyone with an interest in the care of the people living at Catterall House, so that any strengths could be identified and any areas for improvement recognised in order improve the quality of service provided. We suggested that perhaps it would be better to obtain feedback from residents and their relatives on a less frequent basis, so that surveys captured an extended time frame. The provider has started to produce a structured monthly report, following her unannounced inspections, which were kept on site and which formed a big part of the Quality Assurance system, so that service provision was being closely monitored. It is recommended that an annual development plan now be introduced, so that a predicted plan of action is used to reflect aims and outcomes for people living at the home, based on a systemic cycle of planning, action and review. Care Homes for Older People Page 28 of 33 Evidence: We looked at the personal allowance accounting system used by the home and found that peoples monies were held securely and that brief records were kept with the signature of the manager to approve any transactions taking place. However, it is recommended that the resident also signs the accounting sheets when a withdrawal or deposit is made in order to tighten up systems already in place. We discussed the personal allowances of one person living at the home, which were not clear and so advised the manager of the home to obtain a clearer picture of this individuals finances to ensure that accurate transactions were recorded. The accident book was appropriately maintained and records showed that staff had received relevant training, so that they were aware of how to promote the Health and Safety of people living at Catterall House. A wide range of upto date policy and procedures were in place, providing staff with clear guidance about Health and Safety matters and how to ensure that people were kept safe. A random selection of service certificates were examined, which showed that systems and equipment had been appropriately checked, in accordance with the manufacturers guidelines, to ensure it was safe for use. A wide range of assessments were also in place, so that any risks were identified and strategies implemented to ensure that the possibility of injury to people was minimised. When asked what the home does well the manager wrote on the self-assessment, Catterall House has recently appointed a new Manager who has NVQ level 4 and 15 years experience as a care assistant/senior carer and has two years experience as a Deputy Manager. Although this is her first job as a home manager we are hoping for long term management and continuity of care. The new manager has taken on the responsibility of staff induction, training, supervision and appraisals. She has been given a job description, which includes health & safety and welfare of residents & staff. The residents do control their own finances where possible with the exception of those residents who can not. We do keep documentation relating to any transactions made. Care Homes for Older People Page 29 of 33 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 30 of 33 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 The plans of care for people admitted for periods of respite should contain the same level of detail as those for people on permanent contracts so that everyone is provided with person centered care. Relevant signatures should always be obtained when agreements are required, such as on contracts, risk assessments, care plans and consent forms, to show that people have been given the opportunity to participate in the decision making process. Some areas of assessed needs should have been more informative and person centered, so that clear guidance was given to staff about how to manage certain aspects of peoples care. Any instructions within the risk management framework should be followed through in day to day practice, so that recommended strategies are put in place to reduce the possibility of people being placed at risk. Hand written entries on the Medication Administration Records should always be signed, witnessed and countersigned in order to avoid any transcription errors. Page 31 of 33 2 7 3 7 4 8 5 9 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 6 12 It is recommended that the provision of activities be reviewed, so that this area can be further developed by the introduction of a more interesting programme, in order to offer a more stimulating environment for people living at the home. It is recommended that any complaints received be recorded in a numbered page book, so that it can be easily recognised if any pages are removed. All copies of the complaints procedure should provide the same details, so that people are given up to date information about how to make a complaint, should they wish to do so. Communal areas of the home should not be used as storage areas for appliances or equipment as this is unsightly and could create a potential risk for those living at Catterall House. It is recommended that the home continues to progress towards achieving 50 of care staff with a National Vocational Qualification, so that the collective work force is appropriately qualified. The manager of the home should follow up the work permit of one employee from overseas to ensure that it has been renewed. It is recommended that an annual development plan be introduced, so that a predicted plan of action is used to reflect aims and outcomes for people living at the home, based on a systemic cycle of planning, action and review. We suggest that perhaps it would be better to obtain feedback from residents and their relatives on a less frequent basis, so that surveys capture an extended time frame. The manager of the home should familiarise herself with each individuals personal allowances, so that she knows what benefits are being paid and how these are calculated for payment of fees and personal allowances. It is recommended that the resident signs the financial accounting sheets when a withdrawal or deposit is made in order to tighten up systems already in place. 7 16 8 16 9 19 10 28 11 29 12 33 13 33 14 35 15 35 Care Homes for Older People Page 32 of 33 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. © 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. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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