Care Home: Chater Lodge

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What the care home does well The home is a purpose built care home providing accommodation over two floors. The accommodation is decorated and furnished to a high standard and provides an attractive and comfortable environment which meet the needs of people living at Chater Lodge. The first floor accommodation is specifically designed to support people who have dementia and promotes engagement and activity for people living there. There is a wide range of social activities provided and this includes trips out of the home. People living at Chater Lodge are encouraged to make choices about routines of daily living. A great deal of care and attention is given to meal times and to ensuring meal times are a pleasurable experience. Staff also have their meals with the residents in the dining room. The home is well managed and staff are provided with clear direction on how to meet the needs of people living at Chater Lodge and protect them from harm. What has improved since the last inspection? Since the last inspection a staff training programme called yesterday, today and tomorrow has been introduced, this provides staff with the training they require to meet the specialist needs of people who have dementia. The providers told us that all staff would have received this training by the end of June 2009 and this included non care staff such as domestic and catering staff. The providers have responded appropriately to a medication error that occurred since the last inspection and have taken appropriate action to minimize the risk of any further errors occurring. What the care home could do better: The providers could continue to develop staff knowledge and experience in providing dementia care, this could be enhanced by staff receiving training in dementia care mapping, this training enables staff to look at the wellbeing or otherwise of individual residents and to develop a plan of care that enhances quality of life further. Using a recognized tool for assessing peoples cognitive abilities and providing appropriate activities which are meaningful to the individual would also enhance quality of life for people living at Chater Lodge. The registered manager told us that two staff would be attending the local authorities alerters training for safeguarding adults. Attending this training and cascading it to all staff would promote safety and protect people form harm. Key inspection report Care homes for older people Name: Address: Chater Lodge High Street Ketton Rutland PE9 3TJ     The quality rating for this care home is:   three star excellent 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: Debbie Williams     Date: 1 6 0 6 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 25 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 25 Information about the care home Name of care home: Address: Chater Lodge High Street Ketton Rutland PE9 3TJ 01780720376 01780720346 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.barchester.com Barchester Healthcare Homes Ltd care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Chater Lodge is registered to provide care to male and female service users in the following categories: Dementia (DE) 20, DE(E), 20, Older Persons (OP) 45, PD(E) 10 No more than 10 persons can be accommodated at Chater Lodge under the PD(E) category No more than 20 persons under the category or combined categories DE/DE(E) can be accommodated at Chater Lodge No person under the age of 55 can be accommodated at Chater Lodge under the DE category. The maximum number of persons accommodated at Chater Lodge must not exceed 45. Date of last inspection 20 0 0 Over 65 20 45 10 Care Homes for Older People Page 4 of 25 Brief description of the care home Chater Lodge is a purpose built residential care home within the attractive village of Ketton. The home was built some three years ago and is set within well-maintained grounds and is bright, clean and modern in design. All areas of the home and gardens are accessible to people who use wheelchairs. All rooms have en-suite facilities and can be personalised with the residents own furniture, if so desired. There are attractive communal sitting rooms and dining areas on both the ground and first floor. There are additional assisted bathing and showering facilities for less able residents. There is an in house laundry service and all food is freshly prepared and cooked on site. The Statement of Purpose and Service Users Guide (both give information about the home) are provided for all new residents, and a copy is available in the foyer, with the homes most recent inspection report. Care Homes for Older People Page 5 of 25 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: three star excellent 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 main method of inspection used was case tracking this meant selecting three residents and tracking the quality of their care through checking records, discussion with them and observation of care practice. We also looked at the providers Annual Quality Assurance assessment which they sent us, this provides information about what has happened at the service since the last key inspection. During this inspection we spoke with five people who live at the home and two relatives. We also spoke with care staff, catering staff and the registered manager. Care Homes for Older People Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 7 of 25 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 8 of 25 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 9 of 25 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 moving in to Chater Lodge have their needs assessed before moving in and are provided with the information they require to make an informed decision about moving in to the home. Staff have the skills and experience to meet the specialist needs of people living at Chater Lodge. Evidence: We looked at information the provider gave us in their annual quality assurance assessment. The providers told us that prospective residents are provided with a brochure, a service users guide and a welcome pack. These documents provide information about the service provided and enable people to make an informed decision before moving in to the home. People have their needs assessed before moving into the home to ensure the service is able to meet their needs. Care Homes for Older People Page 10 of 25 Evidence: A four week trial period is offered to people when they move in. The homes administrator spends time with each resident and or their relatives to explain the terms and conditions of residency. The service is registered to accommodate people with dementia and a staff training programme was in progress at the time of this inspection delivering in house dementia care training to all staff. The providers told us that all staff including non care staff would have received this training by the end of June 2009. This training will assist staff to meet the specialist needs of people living at Chater house. Care Homes for Older People Page 11 of 25 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 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 Chater Lodge have their health and personal care needs met. The care planning process is well managed by staff and ensures that people have their individual needs met and their changing needs attended to. Evidence: We looked at care records for the people we case tracked. People had an individualized care plan generated from their needs assessment. Care plans included peoples individual needs and preferences. Care plans included a life story and recorded life events significant to each individual, this helps staff to meet the individual needs of people who may not always be able to communicate them clearly. A record of peoples cultural, religious and social needs was also maintained. Evidence was seen that people living at Chater Lodge or their representatives were involved in the care planning process. Risks to each individual were also assessed and actions staff should take to minimize risk was recorded within care plans. Care records reflected the changing needs of people living at Chater Lodge and were reviewed at least once a month. Care records Care Homes for Older People Page 12 of 25 Evidence: provided evidence of people living at Chater Lodge having good access to health care services, people spoken with said they could see their GP when required. A GP also visits the home once a week. We looked at medication administration records, policies and procedures. Records inspected appeared accurate and up to date. Following a medication error in 2008 changes had been made to policy and procedure. The most senior person on each shift who is responsible for medication is now identified on the staff roster. A link person has been identified who is responsible for liaising with the pharmacist and medication ordering. More training regarding the safe management of medication has been provided to all staff and staff have been assessed in this area by the company clinical development nurse. People spoken with said that staff managed their medication effectively. Interactions observed between staff and residents were extremely positive. Staff responded to residents in a friendly and respectful way. It appeared that people living at Chater Lodge were relaxed around staff and felt able to go into the office to speak with the registered manager whenever they needed to. One person spoken with said the staff are super and are very kind, especially the manager. Care Homes for Older People Page 13 of 25 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 Chater Lodge are given opportunities to exercises choice and control over their lives and experience a lifestyle that matches their expectations and preferences. Evidence: We spoke with people living at Chater Lodge and they told us that routines of daily living were made flexible to meet their needs. Relatives and staff spoken with also confirmed this. A full time activities organizer is employed and a range of activities provided on a daily basis. Group activities such as games are provided as well as one to one activities which are tailored to meet individual needs. During this inspection some of the people living at Chater house went out in the minibus. One person spoken with said they attended a day center once a week. The providers told us that at least four activities a day are provided and that three staff members had attended training with age concern about fitness in care. One relative we spoke with told us they visited every day and were always made extremely welcome. Care Homes for Older People Page 14 of 25 Evidence: Accommodation is on two floors and there is also outside garden areas which are safe and secure and accessible for people with disabilities. People living at Chater Lodge were observed moving freely around the homes communal areas and enjoying the gardens during this inspection. Communal areas on the first floor were specifically designed to support people with dementia and provided sensory and reminiscence therapy through objects they could engage with. There was also a room designed to provide sensory stimulation with lights and music but this was not in use at the time of this inspection due to some refurbishment work being undertaken. People spoken with told us they enjoyed the meals provided and were always given a choice at each meal time. Menus of the days meal choices were on each table in the dining rooms and alternative meals were also available. We looked at menu records and saw that a nutritional and varied diet was on offer. A visual choice of two plated up meals is offered to residents who may have communication difficulties, this ensures that all residents are given a choice. The lunch time meal was served over two sittings, one of the sittings was specifically for people who needed assistance with their meals. Staff sit down and eat with residents at every meal time. The providers told us that the chef regularly visits people living at Chater Lodge to assess satisfaction and makes changes accordingly. A dining and nutrition audit is carried out twice a year. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Chater Lodge are protected by the providers complaints and safeguarding polices and procedures. Evidence: We spoke with people living at Chater Lodge and their relatives, people spoken with told us the management and staff team were approachable and would listen to any concerns raised and take appropriate action. The providers ensure a copy of their complaints procedure is given to all residents and a copy is also available at the front entrance of the home. Staff spoken with were able to demonstrate a good awareness of safeguarding adults, whistle blowing and complaints procedures and were able to describe the actions they would take if they had any concerns. Since the last key inspection, the providers have demonstrated their compliance with national safeguarding policies and procedures and have made appropriate referrals where necessary and taken robust and appropriate action to concerns raised. The registered manager told us that she would be attending the Local Authorities safeguarding adults training. Care Homes for Older People Page 16 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is, safe, comfortable and well maintained and meets the needs of people living at Chater Lodge. Evidence: Accommodation is on two floors and there is also outside garden areas which are safe and secure and accessible for people with disabilities. People living at Chater Lodge were observed moving freely around the homes communal areas and enjoying the gardens during this inspection. Communal areas on the first floor were specifically designed to support people with dementia and provided sensory and reminiscence therapy through objects they could engage with. There was also a room designed to provide sensory stimulation with lights and music but this was not in use at the time of this inspection due to some refurbishment work being undertaken. All areas of the home seen were clean and fresh. The home was furnished and decorated to a high standard and provided a comfortable and attractive environment suitable to meet the needs of people living there. Peoples private rooms were personalised and contained all necassary furnishings and euipment to meet peoples individaul needs. Staff had received training in infection control and this minimied the risk of cross Care Homes for Older People Page 17 of 25 Evidence: infection for people living at Chater Lodge. Care Homes for Older People Page 18 of 25 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. Staffing numbers and skill mix meet the needs of people living at Chater Lodge and recruitment policies and procedures minimize risk. Evidence: We spoke with people living at Chater Lodge and their relatives, people told us that staffing levels were sufficient to meet their needs and that staff were competent. Staff spoken with told us they did receive the training they needed to do their jobs and this included induction training when they first commenced working at the home. A staff training programme for supporting people with dementia was in progress, the providers told they expected that all staff, including non care staff would have completed this training by the end of June 2009. At the time of this inspection a staff training room was being developed. The providers told us that all mandatory training was up to date and that one member of staff had been allocated the responsibility of providing induction training to all new staff. Eight care staff had completed National Vocational Qualifications in care. The providers staff recruitment procedures ensure that people employed at the home are fit to do so. Staff are only employed following the receipt of two satisfactory Care Homes for Older People Page 19 of 25 Evidence: references and a Criminal Records Bureau check. Care Homes for Older People Page 20 of 25 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is well run and in the best interests of people living at Chater Lodge. Evidence: The registered manager has the skills and experience necessary to manage the service. People living at Chater Lodge, relatives and staff spoken with said the registered manager was approachable and would listen to them and take appropriate action if necessary. The registered manager was knowledgeable about peoples needs and was motivated to continually strive for improvement in order improve quality of life for people living at Chater Lodge. The providers have a comprehensive and ongoing quality assurance and audit programme which includes seeking the views of people living at Charter lodge and their visitors. Care Homes for Older People Page 21 of 25 Evidence: Records are maintained of all transactions regarding peoples personal money, this reduces the risk of financial abuse for people living at Chater Lodge. The providers told us within their annual quality assurance assessment that all health and safety training necessary to keep people safe had been provided to staff. Health and safety maintenance and safety checks had also been carried out. Records are maintained of all accidents that occur at the home and this information is used as part of the quality assurance and audit programme. All staff are provided with induction training which meets national training standard requirements. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 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 Care Homes for Older People Page 24 of 25 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. 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