Care Home: Close House

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What the care home does well All residents spoken to made positive comments about the standard of physical care and attention given in the home. Some described the care as excellent and they said staff were attentive to personal needs. We noticed that residents did look clean and well cared for. Residents told us they had good choices in relation to personal hygiene and that they were always offered a bath or a shower on a regular basis. We thought the individual care of people was very good. In questionnaires residents and their relatives expressed a high degree of satisfaction with the care. Medication storage, administration, ordering and disposal was well managed. Small adjustments needed to the system were carried out immediately. Care plans are stored electronically using a recently purchased care systems tool. The information can be printed for residents and relatives to view at any time. The care plans were up to date and did reflect residents needs, wants and abilities. The system tracks assessments and gives indication of when reviews are required. There was good evidence that residents had access to various health professionals who visited regularly. The food was very good. Residents told us that they liked the food on offer. We ate the lunch provided. The food was hot enough, tasty and well cooked. The dining tables were nicely set as were trays for people eating in their rooms. Residents told us they could eat alone if they wished and had options if they did not want what was on the menu. There have not been a large number of complaints in the home. Residents said they knew how to complaint but did not have any complaints to make. The home was clean, tidy and odour free. Residents bedrooms were individual, well personalised and comfortable. Residents said they could bring items from home and many had done this. The laundry and ancillary areas were clean and hygienic. The home was adequately staffed. New staff had received good induction training. All new staff had been thoroughly screened before they were employed at the home. This included checking of employment history and criminal records. Residents told us that staff were pleasant and caring. They said staff responded quickly to call bells and, although sometimes busy, they were always caring. The manager consults with staff and residents on a regular basis. She holds meetings with staff to discuss the home`s policies, procedures and any issues. Staff reported that they find the manager helpful and they appeared to have a good working relationship with her. Formal staff supervisions were up to date. Residents meetings have stopped through lack of attendance. The manager stated that as the home is small she is able to see everyone on an individual basis. She believes this gives people a better opportunity to raise any small concerns, requests and questions. Satisfaction surveys are sent out regularly. We looked at the results of the latest one and found all comments to be very positive. The information we received inour own questionnaires indicated that people were very happy with the service. Health and safety checks and tests were up to date. All hazardous substances were secured. Fire exits were clear and there were no obvious trip hazards. What has improved since the last inspection? The Provider has spent a lot of money and put a lot of thought into upgrading the premises. Some overhead lifting equipment has been installed and a new shower room provided. This means more dependent residents are offered better choice of bathing facilities. New carpets have been provided to corridors and communal rooms. Windows have been replaced and the heating system upgraded. What the care home could do better: Staff training had lapsed and some staff had fallen behind in their training plans. Staff have now been booked on training courses and a new system of monitoring training is in place. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Close House Close House Hexham Northumberland NE46 1ST     The quality rating for this care home is:   three star excellent 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: Janet Thompson     Date: 3 0 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 25 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 25 Information about the care home Name of care home: Address: Close House Close House Hexham Northumberland NE46 1ST 01434-602866 01434603552 nursing@hexhamshire.com 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) : Mr D W Robson,Mr J R Robson care home 22 Number of places (if applicable): Under 65 Over 65 1 21 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 0 Close House is an adapted, extended building located in a rural setting on the outskirts of Hexham. It is a family owned and managed business. There are 18 single rooms and two doubles, one of which is used as a single room. Six bedrooms have en-suite facilities. All parts of the building are accessible by way of a passenger lift. There are extensive gardens surrounding the property, which have been attractively landscaped. Parking spaces are available at the main entrance. Close House can accommodate up to 22 older people, most of who require nursing care. The current fee for a place at the home is charged at the standard rate set by Northumberland County Council and the local Health Care Trust. Details of the fees to be paid are set out in the homes individual contract with each resident. The most recent inspection report was available in the main entrance area. The service user guide and statement of purpose were also available. Care Homes for Older People Page 4 of 25 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: This is an overview of what the inspector found during the inspection. The quality rating for this service is three stars. This means the people who use this service experience excellent 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. This will only happen when it is considered that people who use the service 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. Care Homes for Older People Page 6 of 25 This was an unannounced inspection. It took place over two days. The provider was present on the first day, the manager and provider were present on the second day. Before the visit we looked at information we have received since the last inspection visit, including how the service dealt with any complaints or concerns. We also looked at any changes to how the home is run and asked for the managers views of how well they care for people. We always seek the views of people who use the service, their relatives, staff and other users of the service. This is usually given to us in the form of questionnaires. We received 18 completed questionnaires. The information has been used to form the judgments in the report. During the unannounced visit we talked with people who use the service and some of the staff. We looked at the information about people who use the service and how well their needs are met. We looked at other records the home is required to keep and checked that staff had the knowledge, skills and training to meet the needs of the people they care for. We looked around the building to make sure it was clean, comfortable and safe. and we checked what improvements had been made since the last inspection visit. Feedback was given to the manager and provider at the end of the visit. What the care home does well: All residents spoken to made positive comments about the standard of physical care and attention given in the home. Some described the care as excellent and they said staff were attentive to personal needs. We noticed that residents did look clean and well cared for. Residents told us they had good choices in relation to personal hygiene and that they were always offered a bath or a shower on a regular basis. We thought the individual care of people was very good. In questionnaires residents and their relatives expressed a high degree of satisfaction with the care. Medication storage, administration, ordering and disposal was well managed. Small adjustments needed to the system were carried out immediately. Care plans are stored electronically using a recently purchased care systems tool. The information can be printed for residents and relatives to view at any time. The care plans were up to date and did reflect residents needs, wants and abilities. The system tracks assessments and gives indication of when reviews are required. There was good evidence that residents had access to various health professionals who visited regularly. The food was very good. Residents told us that they liked the food on offer. We ate the lunch provided. The food was hot enough, tasty and well cooked. The dining tables were nicely set as were trays for people eating in their rooms. Residents told us they could eat alone if they wished and had options if they did not want what was on the menu. There have not been a large number of complaints in the home. Residents said they knew how to complaint but did not have any complaints to make. The home was clean, tidy and odour free. Residents bedrooms were individual, well personalised and comfortable. Residents said they could bring items from home and many had done this. The laundry and ancillary areas were clean and hygienic. The home was adequately staffed. New staff had received good induction training. All new staff had been thoroughly screened before they were employed at the home. This included checking of employment history and criminal records. Residents told us that staff were pleasant and caring. They said staff responded quickly to call bells and, although sometimes busy, they were always caring. The manager consults with staff and residents on a regular basis. She holds meetings with staff to discuss the homes policies, procedures and any issues. Staff reported that they find the manager helpful and they appeared to have a good working relationship with her. Formal staff supervisions were up to date. Residents meetings have stopped through lack of attendance. The manager stated that as the home is small she is able to see everyone on an individual basis. She believes this gives people a better opportunity to raise any small concerns, requests and questions. Satisfaction surveys are sent out regularly. We looked at the results of the latest one and found all comments to be very positive. The information we received in Care Homes for Older People Page 8 of 25 our own questionnaires indicated that people were very happy with the service. Health and safety checks and tests were up to date. All hazardous substances were secured. Fire exits were clear and there were no obvious trip hazards. 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 9 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 10 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 are properly assessed, taking account of their needs and wishes, so that they can be assured this is a suitable home and receive an individual care service. Evidence: Three pre-admission assessments were seen. They contained enough information to enable staff to assess if they could meet the individual needs of people before admission. Information from other health professionals and carers was included in the assessment. 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 receive personal care that is well planned and takes account of their diverse needs. Evidence: Three care plans were examined and two were case tracked. This means that we spoke to the individual residents or observed their care then matched our observations to what was written in the care plan. Both case tracked care plans did reflect the actual care needed by the residents. Care plans took account of peoples diverse and differing needs. People were supported to achieve independence and meet individual goals. Other health professionals contributed to the planning of care. These contributions were clearly recorded. The home has recently introduced electronic care planning. We identified some minor things that could be improved in the system and these were done immediately. Residents or their relatives had signed their consent to care plans. A summary of the care plan can be printed off for relatives or residents to see at any time. Care Homes for Older People Page 12 of 25 Evidence: The actual care people received appeared to be very good. We spoke to residents who told us that they were well cared for. They said staff responded quickly if they rang the call bell and were attentive to their needs. We noted that everyone was well dressed and looked clean and cared for. We observed staff supporting residents to wash their hands, clean spectacles and hearing aids. Staff were knowledgeable about individual needs. One resident had a specific skin care routine that staff assisted with. One resident told us that she had improved in her physical health since coming to the home due to the attention of staff. Medication ordering, administration, storage and disposal were examined. All medicines were accounted for and all those administered were signed for. Four amounts of controlled drug were checked and were correct. We noted that the medication records needed to be reviewed by the GP and Pharmacist as medicines that were no longer required where repeated on the administration records. This was attended to immediately. Staff were seen to treat residents politely and respectfully. Minutes of staff meetings showed that they are reminded about issues to do with residents privacy and dignity. Residents told us that staff do try to protect their privacy when carrying out personal care tasks. The home sent satisfaction surveys to residents and relatives in November 2008. We looked at the results of these which showed a high level of satisfaction with the care given. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to lead a healthy and fulfilling personal lifestyle. This takes account of their wishes and diverse abilities. Evidence: There is a staff member in charge of activities. She supports residents to use a range of services within the local community. Residents are encouraged to be in control of their own lives as far as possible. There is a broad plan of activities which showed that residents are offered things such as bingo, skittles, music,crafts and card games. We thought the activities were a little repetitive and the activities co-ordinator agreed that she would like some training in this area. Local religious leaders do visit the home. A monthly service held by the local vicar is well attended and the manager is trying to get this more frequently. Social history and life stories were in place for residents in care plans. The activities co-ordinator said that she tries to take some residents out of the home very week. Some people go out regularly with their families. One questionnaire indicated that one of the good things about the home was that people could be taken out without any problem about return time and no restrictions about fitting in with any Care Homes for Older People Page 14 of 25 Evidence: routine. Residents told us they could choose exactly how to spend their day. One resident said she had chosen the home for its peaceful location and she liked to sit in the lounge watching the countryside without pressure to join activities. Residents also said they liked the food. We ate the food at the home. It was well presented. The food was hot enough and very tasty. The standard of the cooking was very good. The menus have recently been changed to reflect residents request for more variety at supper time. Dining tables were attractively set as were trays for people eating in their own rooms. 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 who use the service are protected from harm through thorough policies, procedures and staff training. Evidence: Staff follow the homes policies and procedures relating to the management of complaints and allegations of abuse. Some staff require refresher training on the protection of vulnerable adults. This has been booked for the earliest date available. Residents are told how to complain through the complaints procedure. This was clearly visible within the home. Residents spoken to said they would complain if they needed to but none of them had any current complaints. We spoke to three residents who assured us that all small issues were dealt with immediately. They said they could not find anything to complain about because of this. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a safe comfortable home that is generally pleasant and clean. Evidence: Although most of the home is not purpose built, and poses some difficulties for using equipment due to the size of rooms and corridors, every effort has been made to utilize the space well. The home was generally clean and free from odours. The furniture and general decor provides residents with a comfortable homely environment. A great deal of upgrading has taken place. In the past year the provider has replaced some windows, rewired the home, provided a wet room with overhead tracking for a hoist, provided tracking hoists in some bedrooms, replaced carpets in corridors, lounges, the dining room and some bedrooms, purchased a large screen TV, installed new boilers and some solar panels. The external grounds are currently being redesigned to provide an area easily accessed by wheelchair users. Residents told us that the home was warm and comfortable. We noted that bedrooms were very individual and well personalised. One resident said she was pleased that her room had been made slightly larger and fitted with wardrobes. The laundry was clean and well organised. The floor and sills have been repainted to enable thorough and easy cleaning. The laundry is fitted with machines that cope with Care Homes for Older People Page 17 of 25 Evidence: soiled and infected linen to control the risk of infection. 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. People using the service are supported and protected through staff numbers, skill and ability. Evidence: The home was adequately staffed on the day of inspection and enough staff were scheduled to be on duty in the near future. The manager confirmed that over 50 of staff had achieved NVQ level 2. Most staff were up to date with essential training, where they were not up to date they were booked onto a training course in the near future. The areas where training had lapsed were adult protection and infection control. There had not been a training overview chart, which would have helped to ensure that staff do not fall behind in statutory training. This is now in place on the recently purchased electronic system. The provider explained that the system sends a warning when training is due therefore no future lapses should occur. There was not a lot of evidence to show that vocational training has taken place in the past year. The manager stated that this was because staff had been busy training for NVQ which had taken some time. Care Homes for Older People Page 19 of 25 Evidence: Four staff recruitment files were examined. These were for one new carer, one nurse and two long term employed staff. All contained good information. Thorough background checks had been carried out before employment. Residents were protected through checking of criminal records information for all employees. 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. People using this service are protected through reflective management taking account of the diverse needs of the service. Evidence: The home has an experienced registered manager. She has been assessed as having the competency and skills to run the home. Residents told us that the home seems to run well. Staff appeared to be able to communicate with the manager and ask her advice. The relationship between the provider, manager, staff, residents and relatives appears to be good. In questionnaires many relatives and residents said the home felt like a large family of which they were part. Staff receive formal supervision on a regular basis. This gives them an opportunity to contribute to the running of the home and identify any training needs they might have. The home does operate a quality assurance system. Residents, their relatives and Care Homes for Older People Page 21 of 25 Evidence: professionals are consulted about the service provided. The latest consultation was late in 2008 and the results were very positive. The manager stated that residents and relatives meetings had stopped as they were not well attended. She feels that the home is small enough that she is able to see people on an individual basis regularly. Servicing and maintenance agreements are in place for facilities and equipment. Risks in the environment and tasks, including safe working practices are assessed and reviewed. All fire safety checks, tests and instructions to staff are conducted at the required frequency and recorded. There were no obvious trip hazards in the home. Fire exits were clear of obstruction and all hazardous fluids locked away. The staff do not handle personal money for residents. This is the policy of the provider who ensures that relatives, or an advocate, deal with money if a resident is unable. 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 1 12 Continue to develop the range of activities on offer. Provide training for the activities co-ordinator. Care Homes for Older People Page 24 of 25 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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