Care Home: Chevy Chase

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What the care home does well The home is small and provides a friendly and homely environment. Everyone spoken to enjoys living there. Residents enjoy each others company and also the company of the staff team. They all know each other very well. Residents are encouraged and enabled to use the village facilities. Residents` health is well monitored. Meals are well presented and tasty. What has improved since the last inspection? Some staff training has been done to ensure people living in the home are protected from potential abuse. The manager now meets regularly with each person in the home to ensure their views are considered. These meetings are recorded. What the care home could do better: A system of induction should be in place to ensure that staff employed are assessed as competent before working unsupervised in the home. This will ensure that people living in the home are supported in accordance with their needs and preferences. A record of the names and signatures of staff dispensing medicines should be available so that any errors made in the recordings can be easily identified and appropriate action taken. Also hand written information in the medication administration records should be signed and checked for accuracy. Staff must receive regular instruction in fire procedures to ensure they are confident should any fire actions be necessary to protect people who live in the home. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Chevy Chase Percy Arms Hotel Otterburn Northumberland NE19 1NR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Allan Helmrich     Date: 1 6 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 26 Information about the care home Name of care home: Address: Chevy Chase Percy Arms Hotel Otterburn Northumberland NE19 1NR 01830520057 01830520567 percyarmshotel@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs A Emerson,Mr C Emerson care home 17 Number of places (if applicable): Under 65 Over 65 17 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is: 17 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 admisison to the home are within the following category: Old age, not falling within any other category - Code OP, maximum number of places: 17 Date of last inspection Brief description of the care home Chevy Chase is a care home attached to the Percy Arms Hotel in the centre of Otterburn, a rural village in Northumberland. Community facilities are limited. There is a post office and general store, a coffee shop, community centre and social club. The home has 15 single bedrooms, four of which share two small, private sitting rooms. Two of the bedrooms have en suite toilet and washing facilities. One bedroom is registered for double occupancy. There is a passenger lift to the first floor. Care Homes for Older People Page 4 of 26 Brief description of the care home Nursing care is not provided. The weekly charges are £433. Additional charges are made for toiletries, personal newspapers and professional hairdressing. Information kept in the reception area includes the homes service user guide and a copy of the last inspection report. The file is kept on a shelf under the signing in book. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience Good quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The inspection was unannounced and was completed in the day. Care Homes for Older People Page 6 of 26 Before the visit we looked at: Information we have received since the last visit on 17th April 2008. How the service dealt with any complaints and concerns since the last visit. Any changes to how the home is run. The providers view of how well they care for people. The views of residents, their relatives and other professionals who visit the service. During the visit we: Talked with people who use the service. Talked with the registered manager and staff on duty. Looked at information about the people who use the service and how well their needs are met. Looked at other records which must be kept, including medication. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. Looked around the building to assess if it was clean, safe and comfortable. Checked what improvements had been made since the last visit. All six residents returned a questionnaire as well as one health care professional. Information from these is used in the report. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Comprehensive pre admission assessments and clear pre admission information for residents are in place. This is so they can make an informed choice and know their care needs will be met before moving into the home. Evidence: Everyone is given the opportunity to spend time in the home prior to admission. There is a statement of purpose, service user guides and a copy of the most recent inspection report in the entrance lobby of the home available to all. These are also available to anyone on request and copies of peoples service user guides were seen in their bedrooms. Each of the survey returns from people living in the home confirmed they had sufficient information provided prior the moving in and one person commented they were happy with the information given to them. The home receives an assessment from the persons care manager prior to admission. Care Homes for Older People Page 10 of 26 Evidence: This information is looked at by the manager and a pre admission visit is then made by the manager or other designated staff when other information is collected to ensure the home can meet the persons needs. Each of the case records reviewed contained an assessment of the persons needs and other appropriate supporting information. Within a short time of admission each resident has a plan of care constructed by senior staff in the home. These plans identify any special needs the individual may have such as religious or cultural requirements as well as personal care needs and preferences. The manager stated the home does not provide a rehabilitation service but short-term respite beds are available. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff team support people to maintain their health needs and to consult other medical professionals when necessary. The manager is proactive in promoting good health care for the people in the home. Evidence: Shortly after admission a range of assessments to determine the physical and mental needs of the resident are carried out and any identified needs are included in the persons plan of care. The care plans demonstrated by signature that residents were involved in their development. They are reviewed by key staff each month. This ensures that staff are considering the individuals needs and wishes on a regular basis. Five of the surveys returned from residents stated they Always receive the care and support they need. Additional comments made were very good carers and every time so far. One return stated they Usually receive the support they need. A health visitor commented that staff know the residents well and appear fond of them. They also stated the home Usually seeks advice to manage and improve individuals health care needs. Care Homes for Older People Page 12 of 26 Evidence: Records demonstrated that residents regularly see health care professionals to promote their good health with details of health checks, visits to their GP and hospital appointments being recorded in the individual files. The files are also regularly reviewed by the manager who when an issue is identified will ensure appropriate support is provided. This was demonstrated for one person who was identified from a nutritional assessment as being at high risk. The persons GP was contacted for advice in managing this issue and a written response was in the persons health care notes. This person was seen being encouraged to eat during the day. A set of sit-on scales is available in the home to accurately record the weights of residents. Three residents spoken to all stated the home provides a good standard of support and staff were observed throughout the inspection talking to residents and involving them in ad-hoc activities. All senior staff that dispense medicines have had training in the safe handling of medication. The following areas of practice were identified to ensure residents health and well-being is maintained. Not all hand written entries in the medication records were signed by the transcriber and checked for accuracy. A record of staff administering medicines with their signatures of identification should be available in the records. The storage of medicines was appropriate and there were no gaps in the recordings in the medication administration record MAR sheets. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported in their choice of activities. Visiting times have recently been amended to ensure the wellbeing of people in the home can be maintained. A good standard of healthy food is provided. Evidence: The records reviewed showed that activities are provided in the home and a record is maintained of those people who choose to be involved. In conversation with the manager and some residents, the preference is for individual or small group activities. Of the six survey returns, three people stated there are Always activities to take part in and three stated Usually. One person commented that they are not sociable and do not join in. During the day one person was seen leaving the home with a member of the care staff for a short trip into the village. Two people from a local church were making a regular visit to the home to give bible readings and some hymns were sung accompanied by a small electric organ. Five people spoken to enjoyed this event. The records described recent activities people were involved with. These included; reading newspapers, baking cakes, reminiscence, Velcro darts and dominoes. One person without good sight said that she really enjoys playing dominoes as the set used Care Homes for Older People Page 14 of 26 Evidence: is specifically marked for use by people who cannot see. The records also showed that people use the local village hall when events are organised and one person goes into the village unsupported when they choose. During a tour of the building Easter cards and baskets made by residents were seen. People spoken to said they could have visitors at any time. However the manager has recently written to visitors requesting they consider visiting outside lunchtime. This mirrors practice in hospitals where they have protected mealtimes to ensure that staff can focus on ensuring that people get the proper support they need to eat their meals, free from other distractions. Meals are provided by the kitchen of the attached hotel. These meals promote a healthy diet. On the day of the inspection residents were provided with two choices; liver and onions or chicken casserole with broccoli and carrots. Sweets included rice pudding, ice cream or yogurt. The menu for the day is displayed. Sufficient staff were available at all times to ensure each person was supported appropriately. Everyone spoken to said they had enjoyed there meal. One person said they dont enjoy eating but that staff do their best to encourage and will provide small snacks if requested. All six people who returned a survey stated they Always or Usually like the meals provided. One person commented they wouldnt change the menu. The minutes of a recent meeting included a favorite food list. The manager said that this will be used at the next menu review. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The views of people who live in the home are listened to and addressed. People feel safe and supported but further training is needed to ensure this continues. Evidence: The home has a complaints procedure that is provided to new residents and their families. Copies of these were seen in peoples bedrooms. The manager meets regularly with residents individually or in small groups to ensure they are comfortable in the home. All six survey responses stated people know how to complain and who to complain to. Residents spoken to all stated they would be happy to talk to the manager or staff if they had a concern. The home maintains a log to record any concerns but nothing was recorded since the last inspection. Staff demonstrated they know where policies and procedures related to the protection of vulnerable people are and in discussion demonstrated an awareness of the issues. Staff training has been provided and this is ongoing with two staff still to attend a training event. The manager provides some training in the home using question and answer sessions. Care Homes for Older People Page 16 of 26 Evidence: Residents spoken to during the inspection stated they feel safe and supported in the home. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally safe and clean but there are areas that should be modernised for the benefit of people who live there. Evidence: The home was clean with no offensive odours noted. All six returned surveys stated the home is Always fresh and clean. Maintenance work to maintain a safe home is being done but other maintenance work and general improvement works are not currently being addressed. The home is currently operating at less than half capacity and this has impacted on the monies available to improve the home. The bathroom, out of order at the inspection last year is still out of action although the proprietor has attempted to address the issue of lack of water to the wash basin. A residents bedroom door is without a lock as recently the door had to be forced open as an emergency. This limits the privacy to this bedroom. The laundry is appropriate to the size of home. Equipment can meet disinfection standards and instruction regarding washing is posted for staff. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A caring staff team is employed in numbers sufficient to meet the health and personal care needs of people who live in the home. Recruitment processes do not include a full induction process to ensure appropriate care is always provided. Evidence: There are currently seven care staff employed at the home of which six have a National Vocational Qualification (NVQ) in care that demonstrates their ability to provide good care. Currently six people live in the home and sufficient staff are on duty each day to ensure their needs can be met. The staff records for two staff were reviewed and each file contained appropriate information such as references and criminal record bureau checks to ensure appropriate people are employed. The files did not demonstrate that an appropriate induction was done to ensure these staff have the necessary skills to provide care before working unsupervised. The manager has however recently completed an appraisal of these staff which identifies there abilities. Care Homes for Older People Page 19 of 26 Evidence: Five staff returned questionnaires and each was positive about the support received and the training provided. One member of staff referred to the manager as Matron. This should be discouraged as the home is not registered to provide nursing care. This term was also used throughout the inspection by some residents. One member of staff spoken to during the inspection stated they have achieved NVQs at levels 2 and 3 and that they have recently done safeguarding training and a distance learning course in Infection Control. This promotes good practices in the home to benefit people who live there. The staff team have reveiwed the Department of Health booklet concerning Mental Capacity but have not received formal training in this area of care practice. They have however had training related to the Deprivation of Liberty to ensure people in the home are appropriately supported. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is reasonably safe and managed for the benefit of people who live there. Evidence: The manager has managed a care home for several years and has obtained the Registered Managers Award. Also recently she has updated her knowledge of care practices with training in; food and nutrition, infection control at level 2 and deprivation of liberty. She demonstrated throughout the inspection her awareness of the personal and health care needs of the people in the home. The manager has full control of the care provided on a daily basis. Staff spoke highly of her managerial skills. She has regular staff meetings, these have an agenda and minutes are produced. The last recorded meeting was four weeks before the inspection. She also meets with each resident regularly either individually or in small groups to ensure they are involved in the running of the home. A record of these discussions is maintained and issues identified are addressed. From the last meeting, Care Homes for Older People Page 21 of 26 Evidence: held two months ago, a favorite food list was produced. A quality assurance system is being used to monitor the standards provided in the home. The proprietors regularly conduct regulatory visits to the home and a record of their findings is given to the manager. The home also uses questionnaires to ensure residents, their visitors and professional visitors have the opportunity to comment on the standards of care provided. The home holds some monies at the request of residents. A file of expenditure is maintained and two signatures confirm each transaction. Accident and fire records are well recorded but the fire instruction training for staff should be more regular. Maintenance certificates are in place for gas, electrical wiring and electrical items in the home. Water temperatures were checked and found to operate within the safe, comfortable range with the exception of the bathroom not used on the first floor. Cleaning materials used in the home are safely stored and information related to safe working is posted for staff in the laundry area. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 23 Repair the lock to the bedroom door. Ensure that personal privacy can be maintained by providing a suitable lock to the bedroom door currently without one. 29/05/2009 2 31 1 The manager must ensure that an appropriate induction system is in place and that all new recruits are provided with this induction. An induction to the home ensures that the competence of new staff is assessed and recorded before they work unsupervised in the home. This promotes the homes good practices and ensures the wellbeing of people who live there. 29/05/2009 3 38 23 The manager must ensure that staff are regularly instructed in fire protection issues. Day staff must 29/05/2009 Care Homes for Older People Page 24 of 26 receive appropriate instruction twice each year and night staff four times annually. A staff team well trained in the procedures to be followed in the event of a fire can better protect people who live in the home. 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 9 A list of staff who dispense medicines together with their signature should be retained. This enables anyone looking at the medical administration records to identify the dispenser. Hand written elements of the medical administration records should be signed by the transcriber and countersigned by the checker to promote accuracy of recording. Continue to look at interesting activities to stimulate people and encourage physical activity. Continue with staff training related to the protection of vulnerable people. Provide a realistic improvement plan/list for the building showing dates for completion. Ensure by training that staff are aware of The Mental Capacity Act. 2 3 4 5 12 18 19 31 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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