Care Home: Cleeve House

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What the care home does well Cleeve House provides written information to help people decide if they wish to move in. People also have the opportunity to visit the home prior to making a decision. The home makes sure that people`s individual needs are fully assessed before they move in, so that staff know the care that needs to be provided. People can be confident that their health and personal care needs will be met at the home. The home provides person-centred care, which places each person at the heart of the care planning process. Medication is managed safely. Staff ensure that people`s privacy and dignity is promoted. The home provides activities and social opportunities which are tailored to each person`s individual needs. Food is of a high standard, and provides a nutritious and balanced diet. People can be confident that any concerns will be listened to and resolved. Staff recruitment protects the people who live at the home by making sure that only suitable staff are employed. Staff understand their responsibilities in protecting vulnerable people from neglect or abuse. Cleeve House provides a safe and comfortable home for people to live in. Infection control is well managed. Staff at the home are kind and caring. They are provided with the training they need to ensure that they have the skills and knowledge necessary to care for vulnerable people. Recruitment is carried out safely, and this means that only suitable staff are employed. The home is managed in the best interests of the people who live there. The manager and her team work hard to ensure that the needs and wishes of the people who live at the home are at the heart of everything they do. What has improved since the last inspection? At the previous inspection, most of the areas above had caused us concern, because people were at high risk of poor outcomes. The home has worked hard to make sustantial improvements in all areas. The challenge now will be to sustain those improvements. What the care home could do better: There is some interior redecorating work to be done to ensure that the environment remains safe and hygienic, but the manager has told us that there is a planned programme of redecoration ongoing. Key inspection report Care homes for older people Name: Address: Cleeve House 49 Hornyold Road Malvern Worcestershire WR14 1QH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sarah Blake     Date: 0 2 0 7 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 27 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 27 Information about the care home Name of care home: Address: Cleeve House 49 Hornyold Road Malvern Worcestershire WR14 1QH 01684564454 01684573637 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Cleeve House Care Ltd Name of registered manager (if applicable) Mrs Breda Anne Goulding Type of registration: Number of places registered: care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 16. 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 (OP) 16 Date of last inspection Brief description of the care home Cleeve House is registered to provide residential care for up to sixteen older people who are frail, with mild to moderate personal care needs. The large, detached, Victorian property is situated in a pleasant residential area of Malvern, approximately one mile from the town centre. There is an established and well-maintained garden which is accessible to people living at the home. The original house has been extended on the ground floor. The home is owned by Cleeve House Care Ltd. The responsible Care Homes for Older People Page 4 of 27 Over 65 16 0 3 0 0 3 2 0 1 0 Brief description of the care home person is Mr Darren Mills, and the registered manager, with responsibility for the day to day running of the home, is Ms Breda Goulding. Information about the fees is available on request from the home. A copy of this inspection report can be viewed at the home. Care Homes for Older People Page 5 of 27 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: This was an unannounced inspection. One inspector spent a day at the home, talking to the people who use the service and the staff, and looking at the records, which must be kept by the home to show that it is being run properly. These include records relating to the care of people who use the service. We looked in detail at the records for two people living at the home. The service had previously completed an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. We also received completed survey forms from people who use the service, their relatives and health professionals who work with the home. The information from these sources helps us understand how well the home is meeting the needs of the people Care Homes for Older People Page 6 of 27 using the service. Care Homes for Older People Page 7 of 27 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. Care Homes for Older People Page 8 of 27 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 9 of 27 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 10 of 27 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. Cleeve House provides written information to help people decide if they wish to move in. People also have the opportunity to visit the home prior to making a decision. The home makes sure that peoples individual needs are fully assessed before they move in, so that staff know the care that needs to be provided. Evidence: The home provides people with written information, in the form of a Service User Guide, to help them decide if they wish to move into Cleeve House. We saw that the Service User Guide had recently been updated and contained useful information about life at the home. Records showed that the manager visits people before they move in, so that a full assessment of their needs can be carried out. We looked at the care records for one person who had recently moved into the home. We saw that there was a brief, but informative, assessment which took into account the persons individual needs and Care Homes for Older People Page 11 of 27 Evidence: wishes. This information helps the home to ensure that it can meet peoples individual needs, and gives staff the information they need to provide care for people. In the AQAA and in our conversations with her, the manager showed that she has a good understanding of the fact that moving into a care home can be an unsettling experience for people, and that she and the staff do all that they can to make sure that people are supported as they settle in. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their health and personal care needs will be met at the home. The home provides person-centred care, which places each person at the heart of the care planning process. Medication is managed safely. Staff ensure that peoples privacy and dignity is promoted. Evidence: People living at the home and their relatives told us in our surveys that staff provide the care that they need, and that staff are available when needed. We looked in detail at the care provided for two people who live at the home. This included checking their care plans and medication records, and talking to staff about how their care is provided. We saw that care plans had been regularly reviewed and updated, and were written in a person-centred way, with an emphasis on protecting peoples privacy and dignity. The Alzheimers Society explains how person-centred care works: Instead of treating the person as a collection of symptoms and behaviours to be controlled, personCare Homes for Older People Page 13 of 27 Evidence: centred care considers the whole person, taking into account each individuals unique qualities, abilities, interests, preferences and needs. The care plans addressed peoples individual needs by giving staff clear information about their needs and how to meet them. We saw that some people need specialist equipment in order to be able to mobilise safely. There were clear assessments in place to show the risks which are associated with using this specialist equipment, and detailed instructions for staff in how to use it safely. Records showed that the home accesses medical support promptly. We saw that one person had been in pain, and the home had called the GP in immediately to prescribe some pain relief. The manager knows each person individually, and was able to tell us about the GPs visits and what had happened as a result of the visits. We checked the written records, and these had been fully completed to give an accurate record of how the persons pain had been managed. At the last inspection, we were concerned that staff were not adequately monitoring people who were at risk of developing pressure sores. The manager showed us the homes new system for ensuring that pressure area care is managed effectively. The system is clear, and staff were able to tell us when they should report any concerns and how to record them. We saw that peoples preferences, such as preferred time of going to bed, were noted in the care plans, and people told us that staff respect their choices. During the day of the inspection, we saw staff encouraging people to make choices about the day to day aspects of their lives, such as what they would like to do after lunch or what they would like for tea. The home has put into place robust procedures for the management of medication. We saw that medication was stored securely and safely, and that storage cupboards were clean and tidy. The manager audits the medication regularly, and we found that the auditing was accurate. We saw that all staff who administer medication have recently attended accredited training, so that people can be confident that medication is administered safely. At the last inspection, we had found that peoples privacy was not always protected. The areas of concern had been improved, and we saw that staff always took care to make sure that people were treated with dignity and respect. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides activities and social opportunities which are tailored to each persons individual needs. Food is of a high standard, and provides a nutritious and balanced diet. Evidence: The first page of each persons care plan gives a detailed account of their life history, and clearly describes their likes and dislikes, and any social or leisure interests. The manager and staff have clearly been working hard to improve the range of activities within the home. We saw that a lounge has been made into a sensory room, with sensory and activity equipment such as reminiscence packs, painting equipment, soft toys, scented modelling dough, and a bubble lamp. The records kept by the home showed that the variety and frequency of activities has continued to improve. The manager told us that some people enjoy helping with tasks within the home, such as hanging out washing, folding laundry and dusting. This helps people to feel that they are part of the life of the home. The manager and deputy manager told us about a beach party that they are Care Homes for Older People Page 15 of 27 Evidence: planning for the summer. This will take place in the garden, and they explained that people living at the home have been fully involved in planning the party, and will be making flower garlands and other items for use at the party. On the mantelshelf in the dining room, there is a carefully displayed selection of perfumes and cosmetics for people to try out and use as they wish. Staff told us that people enjoy this, and were able to explain how using the cosmetics and enjoying the scents can evoke memories of the past, and can lead to people remembering and being able to talk about their lives. Cleeve House has always provided a high standard of food. The menus are rotated on a four weekly basis and were seen to provide a nutritionally balanced diet. Lunch on the day of the inspection was fish pie, and we saw that people were enjoying the meal. Supper always includes a cooked option, such as a jacket potato or sausage rolls, as well as soup and sandwiches. Hot drinks are served during day, with biscuits and homemade cake. Care Homes for Older People Page 16 of 27 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 can be confident that any concerns will be listened to and resolved. Staff recruitment protects the people who live at the home by making sure that only suitable staff are employed. Staff understand their responsibilities in protecting vulnerable people from neglect or abuse. Evidence: The home keeps records of any complaints and concerns. We saw that the home had received one complaint since the last inspection. The manager had kept detailed records of the complaint and was able to explain how it had been resolved. We, the Commission, have not received any complaints about the service since the last inspection. We saw that the homes complaints procedure is clearly set out and tells people how the home will respond to any concerns or complaints. People told us in our surveys that they know how to complain, and know who to talk to if they have any concerns. We spoke to staff, who showed a good understanding of how to protect people from the risk of neglect or abuse. Training records showed that staff have not yet received training in this area, but the manager told us that she will be attending training soon, so that she can support and advise staff until they can all attend the training. One of the ways in which homes can help to ensure that people are not at risk is to Care Homes for Older People Page 17 of 27 Evidence: make sure that only suitable staff are employed at the home. We saw that the home has robust recruitment procedures, which include all the necessary checks. Care Homes for Older People Page 18 of 27 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. Cleeve House provides a safe and comfortable home for people to live in. Infection control is well managed. Evidence: Cleeve House is a large town house which has been adapted and extended to meet the needs of the people who live there. There is no car park, but it is possible to park in the road outside the home. The manager and staff have recently begun to use some sensory and reminiscence items to brighten up the corridors downstairs. The manager told us that these items, which include textiles and vintage advertisements, stimulate peoples memories of the past, and that people really enjoy this. The TV lounge is a pleasant room with armchairs and a leather sofa. The dining room is a spacious and airy room, with enough space for everyone to eat in comfort. There are armchairs and sofas in the dining room, and during the day we saw that people were enjoying sitting there, looking at the newspapers and chatting to staff. There is a stair lift for people with mobility problems, but there is no other lift access to the upper floor, so anyone who uses a wheelchair would have to be accommodated on the ground floor. Care Homes for Older People Page 19 of 27 Evidence: People are encouraged to personalize their bedrooms with their own ornaments, pictures and any furniture they wish to bring with them. We saw that the bedrooms were clean and people told us that the home is always clean and fresh. The garden has a well-kept patio area, and a covered gazebo with wooden garden furniture. There is a small lawn area and paved paths, so that people can walk safely. Throughout the home, the furniture was seen to be of good quality and in good condition. The paintwork throughout most of the communal areas of the home was chipped and shabby, and some carpets were very worn and stained, especially the stair and landing carpets. The provider will need to ensure that these are not a hazard for people, as worn carpets could be a cause of falls. We saw that people are encouraged to personalise their bedrooms with their own furniture and personal possessions. Bedroom doors have large print laminated labels on them, with the persons name and photograph on them. This helps people with dementia to know which is their bedroom, if they are no longer able to understand the written word. All bathrooms and toilets contained supplies of liquid hand wash and paper towels. People told us that the home is kept clean, and during the day we saw that staff were using gloves and aprons appropriately. These measures help to limit the risk of infection spreading through the home. Care Homes for Older People Page 20 of 27 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. Staff at the home are kind and caring. They are provided with the training they need to ensure that they have the skills and knowledge necessary to care for vulnerable people. Recruitment is carried out safely, and this means that only suitable staff are employed. Evidence: At the previous inspection, we had raised concerns about the numbers of staff available on some shifts. The provider assured us that he had increased the staffing levels. We looked at the staffing rotas, and these showed that the staffing levels appeared to be sufficient for the number and needs of the people living at the home. People told us that there were more staff available, and staff told us that they appreciated having the time to spend one to one with people living at the home. We spoke to staff, who showed a good understanding of the needs of the people who live at the home. Training has been provided to ensure that staff have the skills and knowledge they need to provide care for people who live at the home. Staff have the opportunity to work towards NVQ qualifications in care. This is good practice, as it helps to ensure that people receive a consistently high standard of care. Cleeve House does not have a high turnover of staff, and people told us that they Care Homes for Older People Page 21 of 27 Evidence: appreciate the consistency of staffing at the home. The home has robust recruitment procedures, and previous evidence shows that they always carry out the necessary checks before new members of staff start work at the home. Care Homes for Older People Page 22 of 27 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 managed in the best interests of the people who live there. The manager and her team work hard to ensure that the needs and wishes of the people who live at the home are at the heart of everything they do. Evidence: At the previous inspection, we had been very concerned that the manager was not receiving enough support from the provider. All the issues which we identified at that inspection have now been addressed. The home has a deputy manager, and there is time set aside for the management team to carry out their duties. We observed that the manager and deputy manager communicate well with each other. They were both enthusiastic about the future of the home, and about working together to improve peoples quality of life. Since the previous inspection, the provider has shown willingness to work with us, the Commission, and with the Local Authority, to make the necessary improvements. Care Homes for Older People Page 23 of 27 Evidence: The manager now attends regular meetings with managers from other local care services, arranged by the Local Authority. This gives her the opportunity to share good practice and to receive support from other colleagues. At the last inspection, we saw that peoples personal money was not being managed safely at the home. The home has since put procedures into place to make sure that money is managed safely. We found minor discrepancies in some recording of transactions, but generally the system is effective and people can be confident that any personal money is stored securely and is fully accounted for. The manager and provider have worked together to address issues about health and safety which we had identified as being a concern. They have met every requirement which was set at the previous inspection, and have shown that they are committed to providing a good service to people who live at Cleeve House. Care Homes for Older People Page 24 of 27 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 25 of 27 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 19 You should assess the risks of the damaged carpet on the stairs and landing to people living at the home, and ensure that control measures are put in place if a risk is identified. This is so that people are not at risk of injury. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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