Care Home: Cookridge Court and Grange

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What the care home does well Systems are in place to make sure people`s needs are assessed before they move into the home. We saw a lot of good practice and some lovely interaction where staff treated people with warmth and kindness. We also received some positive feedback about staff. Breakfast and lunch was observed in some of the units for people. These were well organised. Staff sat with people at lunch, chatting to them and providing support when appropriate. People can choose when to get up and when to go to bed. When we arrived at 7.00am some people were still in bed other people were up. One person said, "I decide when to go to bed and what I want to do. I wouldn`t be here if I couldn`t." People live in a very comfortable, clean and well organised environment. People who live at the home and staff said the environment is very good. The home is divided into six units, which are comfortable areas that make it easy to feel at home and much easier for staff to supervise and interact with people. What has improved since the last inspection? People who live at the home said they thought since our last visit the service has improved. One person said, "I`ll give them their due, it`s better but it`s still got some way to go." Staff also told us the home has improved. One staff said, "People are well cared for and we`ve worked hard to make sure of that." Another staff said, "Things are more settled. People get more continuity of care." At the last inspection we suggested that more robust systems should be introduced to make sure people are treated with dignity and respect at all times. In the AQAA the project manager said, "Management now spend more time observing the staff`s performance in line with having a positive and pro-active approach to individual care needs." We observed staff practices and people were treated with dignity and respect at all times. People receive better quality and choice of meals. At the last inspection we made a judgement that people were not offered good quality and nutritionally balanced meals and did not always have enough to eat. People who live at the home and staff told us the menus, quality of food, access to provisions has improved. Everyone also said there is enough to eat. People are offered more activities on a day to day basis although this should continue to be developed. The home has an activity planner that is displayed in each unit. People who live at the home said they can join in activities if they choose. Staff said there is more for people to do and more `outside entertainment` although some staff said the activity programme is not always followed because sometimes people don`t want to participate. Staffing levels are better. At the last inspection we found that sometimes there were insufficient staff on duty and said the staffing arrangements must be reviewed. The home sent us an improvement plan which told us staffing was increased soon after our inspection. Staff said generally there are enough staff to meet people`s needs although we looked at staff rotas which told us the home sometimes does not have the full compliment of staff during the night. Staff are properly recruited. We spoke to three staff that have started working at the home since the last inspection. They all said their employer carried out checks such as a criminal records check before they started work. We looked at the recruitment process for three people who have recently started working at the home and found that all necessary pre employment checks had been completed. We looked at the training matrix that has been developed since our last inspection. This told us that staff have done a lot of recent training and the majority of staff training is up to date. The matrix identifies which staff need to complete training. At the last inspection we made a judgement that the management team had taken some steps to improve the quality of the service but there were still serious shortfalls that put people at risk. We said the home must be managed with care, competency and skill. Although there is still work to do the management team continues to work hard to improve the quality of the service and has introduced some good systems to improve the quality of care for people living at the home. What the care home could do better: The care planning and risk assessment process could continue to be developed to make sure people`s care needs are properly identified. This will make sure people`s needs are recognised and met. The range of activities offered to people could continue to be developed. This will make sure people have stimulation and the opportunity to be occupied. Two people who live at the home acknowledged the home has improved recently but suggested they could be more involved in decisions about the home. One person said, "They don`t always ask us what we want. They have made the small room all nostalgic but nobody uses it. They didn`t ask us what we wanted when they did it." There could be better monitoring of people who have been identified of needing enriched diet because of low weight or weight loss. Contact details for other relevant agencies could be more accessible to people who live at the home and staff. This will make sure people can contact other agencies if they are not satisfied with the way the home are managing concerns and complaints. A system could be introduced to monitor the number of safeguarding incidents that occur at the home. This will help make sure incidents are properly monitored and people are safeguarded. The environment could continue to be developed to meet the needs of people with dementia. The staffing arrangements could be kept under formal review to make sure there are enough staff to meet the needs of the people living at the home taking into account the size and layout and purpose of the home. This will make sure people`s needs are met. Staff we spoke to said they would benefit from more in depth training on managing behaviour so they have a better understanding of how to deal with conflict between people who are living at the home. The staff training programme could continue to be further developed to make sure staff receive training that equips them with the knowledge and skills to meet people`s needs. Better management systems could be in place to make sure the home operates smoothly when managers are absent from the home. At the last inspection they said they have increased the number of deputies that work at the home and provided additional support to help them take on a more managerial role. However, management tasks are still predominantly carried out by the managers and deputies have little management input. The acting manager said she has noted that more incidents are taking place on a weekend and would be looking at making sure staff who are responsible for the running the home in the absence of the managers are equipped with the right knowledge and skills so the home continues to operate smoothly. Key inspection report Care homes for older people Name: Address: Cookridge Court and Grange Iveson Rise West Park Leeds LS16 6NB     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Carol Haj-Najafi     Date: 1 7 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 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 34 Information about the care home Name of care home: Address: Cookridge Court and Grange Iveson Rise West Park Leeds LS16 6NB 08452710793 01132672644 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.orchardcarehomes.com Orchard Care Homes.Com Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 96 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 96 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: Dementia - Code DE, Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Orchard Care Homes.Com Ltd owns and operates Cookridge Court and Grange. The home is situated in the Cookridge area of Leeds close to bus routes and local shops. There are good car parking facilities for visitors and safe garden areas for people to enjoy. The home began to operate in March 2008 and is registered to provide care to ninety-six people of which half may need dementia care. The accommodation is to a Care Homes for Older People Page 4 of 34 Over 65 0 48 48 0 Brief description of the care home high specification and is on three floors that are serviced by passenger lift. All bedrooms are single with en-suite facilities and some have patio doors with direct access to the gardens. There are six separate living areas each with a lounge/dining room and a quiet lounge. This set up makes the smaller living areas more homely and comfortable. Details about the care and services provided can be found in the homes statement of purpose and service user guide and these are available at the home. At the time of the inspection visit in February 2010 the range of fees was £424 to £625. The fees do not include dry cleaning, personal toiletries, hairdressing, private chiropody or fees for a personal phone installation and call charges. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The Care Quality Commission (CQC) inspects care homes to make sure they are operating for the benefit and well being of the people who use their service. More information about the inspection process can be found on our website www.cqc.org.uk. 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 last key inspection was carried out in February 2010. Before this visit we reviewed the information we had about the home to help us decide what we should do during our inspection. Care Homes for Older People Page 6 of 34 An annual quality assurance assessment (AQAA) was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We have included information from the AQAA in our report. Two inspectors were at the home for one day from 7:00am to 4:40pm. We spoke to people who live at the home, a healthcare professional, day and night staff, the acting manager a support manager and the area manager. Some people have limited communication and cannot tell us if they are happy with the care they receive or if their needs are being met so we also observed interaction between staff and people who live at the home. We looked around the home and looked at care plans, risk assessments, daily records and staff records. Feedback was given to the acting manager, support manager and area manager at the end of our visit. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? People who live at the home said they thought since our last visit the service has improved. One person said, Ill give them their due, its better but its still got some way to go. Staff also told us the home has improved. One staff said, People are well cared for and weve worked hard to make sure of that. Another staff said, Things are more settled. People get more continuity of care. At the last inspection we suggested that more robust systems should be introduced to make sure people are treated with dignity and respect at all times. In the AQAA the project manager said, Management now spend more time observing the staffs performance in line with having a positive and pro-active approach to individual care needs. We observed staff practices and people were treated with dignity and respect at all times. People receive better quality and choice of meals. At the last inspection we made a judgement that people were not offered good quality and nutritionally balanced meals and did not always have enough to eat. People who live at the home and staff told us the menus, quality of food, access to provisions has improved. Everyone also said there is enough to eat. People are offered more activities on a day to day basis although this should continue to be developed. The home has an activity planner that is displayed in each unit. People who live at the home said they can join in activities if they choose. Staff said there is more for people to do and more outside entertainment although some staff said the activity programme is not always followed because sometimes people dont want to participate. Staffing levels are better. At the last inspection we found that sometimes there were Care Homes for Older People Page 8 of 34 insufficient staff on duty and said the staffing arrangements must be reviewed. The home sent us an improvement plan which told us staffing was increased soon after our inspection. Staff said generally there are enough staff to meet peoples needs although we looked at staff rotas which told us the home sometimes does not have the full compliment of staff during the night. Staff are properly recruited. We spoke to three staff that have started working at the home since the last inspection. They all said their employer carried out checks such as a criminal records check before they started work. We looked at the recruitment process for three people who have recently started working at the home and found that all necessary pre employment checks had been completed. We looked at the training matrix that has been developed since our last inspection. This told us that staff have done a lot of recent training and the majority of staff training is up to date. The matrix identifies which staff need to complete training. At the last inspection we made a judgement that the management team had taken some steps to improve the quality of the service but there were still serious shortfalls that put people at risk. We said the home must be managed with care, competency and skill. Although there is still work to do the management team continues to work hard to improve the quality of the service and has introduced some good systems to improve the quality of care for people living at the home. What they could do better: The care planning and risk assessment process could continue to be developed to make sure peoples care needs are properly identified. This will make sure peoples needs are recognised and met. The range of activities offered to people could continue to be developed. This will make sure people have stimulation and the opportunity to be occupied. Two people who live at the home acknowledged the home has improved recently but suggested they could be more involved in decisions about the home. One person said, They dont always ask us what we want. They have made the small room all nostalgic but nobody uses it. They didnt ask us what we wanted when they did it. There could be better monitoring of people who have been identified of needing enriched diet because of low weight or weight loss. Contact details for other relevant agencies could be more accessible to people who live at the home and staff. This will make sure people can contact other agencies if they are not satisfied with the way the home are managing concerns and complaints. A system could be introduced to monitor the number of safeguarding incidents that occur at the home. This will help make sure incidents are properly monitored and people are safeguarded. The environment could continue to be developed to meet the needs of people with dementia. Care Homes for Older People Page 9 of 34 The staffing arrangements could be kept under formal review to make sure there are enough staff to meet the needs of the people living at the home taking into account the size and layout and purpose of the home. This will make sure peoples needs are met. Staff we spoke to said they would benefit from more in depth training on managing behaviour so they have a better understanding of how to deal with conflict between people who are living at the home. The staff training programme could continue to be further developed to make sure staff receive training that equips them with the knowledge and skills to meet peoples needs. Better management systems could be in place to make sure the home operates smoothly when managers are absent from the home. At the last inspection they said they have increased the number of deputies that work at the home and provided additional support to help them take on a more managerial role. However, management tasks are still predominantly carried out by the managers and deputies have little management input. The acting manager said she has noted that more incidents are taking place on a weekend and would be looking at making sure staff who are responsible for the running the home in the absence of the managers are equipped with the right knowledge and skills so the home continues to operate smoothly. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 34 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 11 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs will be assessed before they move into the home, which makes sure their needs are known. Evidence: At the inspection in August 2008 we found that people experience good outcomes in this area and peoples needs are properly assessed before they move into the home. Since October 2009 no one has moved into the home. Admissions to the home were suspended by the local authority because the home was not providing a safe service to the people who were living there. Orchard Care Homes also decided that they would not admit anyone to the home so they could put things right. When we visited the home 67 people were living at the home although the service is registered to provide a service to 96 people. Care Homes for Older People Page 12 of 34 Evidence: The acting manager contacted us three days before our inspection and said the home has made satisfactory improvements and they are in a position to start admitting people to the service again. Although, at this stage, they would only look at admitting one person a week. At the inspection we found that the home has made satisfactory progress and although they still need to build on these and continue to make further improvements. In the AQAA the project manager said, We have a detailed statement of purpose and service users guide, which is specific to our Homes elderly residents. It clearly set out with an introduction that describes Orchard Care Homes philosophy and passion for care, and gives full information on the accommodation, the qualifications and experience of staff, the support and specialist services we can provide etc. All residents are given a copy of the guide. The guide is discussed on admission enabling new residents and their representatives to question the content. We respond differently to each individual enquiry depending on the level of information the Prospective service user requires. We have an open door policy and welcome enquiries at any time of day. We assess our new residents using a comprehensive preassessment process. This is conducted either at a location that is convenient to the client. The pre-assessment usually is conducted by the Manager or a senior member of staff. The individual and the family are encouraged to participate and to be actively involved in the pre-assessment process. It is an opportunity for a two way conversation and through this we often get a good idea of how the client may cope in a care home environment. If an assessment has already been done through the Local Authority/Hospital, our pre-assessment process requires us to obtain a copy of the assessment and care plan before the client can be admitted. We still conduct our own pre-assessment as the needs of the individual may have changed. Following preassessment we inform all prospective residents in writing whether we are able to meet their needs and are offering a placement. The outcome of the assessment is scrutinised and the admission of that prospective resident is made based on our assessment of whether we can provide the service that they require. This decision is taken with due regard for the current resident population and their needs and requirements. Prospective residents are given the opportunity to spend some time in the home as this will enable them to enjoy our meals and activities and see how they feel about the environment. Care Homes for Older People Page 13 of 34 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. Systems are in place to identify peoples needs. The foundations are in place to make sure people receive the right care to meets their needs and wishes. The management team are working hard to make sure these are embedded in everyday practices. Evidence: In the AQAA the project manager said, The home strongly promotes independencewe support self medication if residents are assessed as being able to self medicate. There are several residents who currently self medicate. Residents are encouraged to maintain independence at all times and the plan of care reflects this. When meeting individual health and personal care needs, the home strives to identify and manage all areas pertaining to the principles of care such as privacy and dignity. When visiting professionals attend the home, they and the resident are escorted to the residents room to ensure privacy and confidentiality. Our personal support is flexible, consistent, and is able to meet the changing needs of the residents. Staff respect peoples preferences and have knowledge about individual personal needs when providing support, including intimate care. Residents care plans indicate whether they need support or assistance when having a bath or shower, and whether they like to be Care Homes for Older People Page 14 of 34 Evidence: left alone to undertake their personal care.The home fully respects the rights of people in the area of health care and medication. They recognise and work with the decisions made by the individual regarding any refusal to take medication, or any specific requests about how their healthcare is managed. If a resident refuses to take their medication, it is recorded in the carers notes on the back of MAR sheets with a reason. We are sensitive to the preferences of the elderly with regard to whom should deliver their care and ensure that a staff member of their preferred sex (male/female) is available and also of the appropriate age- where a preference has been expressed. Staff respond appropriately and sensitively in all situations involving personal care, ensuring that it is conducted in private and at a time and pace directed by the person receiving the care. GP appointment and other appointments- We make arrangements for health professionals to visit the residents at the home where necessary. We operate a diary system to make sure appointments are not missed. We talked to people who live at the home. We received some positive feedback about the home and people acknowledged that the service was improving. People thought the home should make further improvements. One person said, Its a good place. Im well looked after. Another person said, Im quite content and cant complain. Another person said. Im satisfied with the care but its the little things. I have family photos in my room. As far as I can recall they have never asked me about these. Either they are not interested or they dont care and I dont know which it is. People who live at the home said they thought since our last visit the service has improved. One person said, Ill give them their due, its better but its still got some way to go. Another person said, They get a lot right but not as much as they should. Staff also told us the home has improved. Staff are allocated to units so people are receiving care from the same group of staff so receive better continuity. One staff said, People are well cared for and weve worked hard to make sure of that. Another staff said, Things are more settled. People get more continuity of care. Part of the day was spent observing the care being given to people. This included how staff interact with people who live at the home. Staff treated people with dignity and respect. We saw a lot of very good practice and some lovely interaction where staff treated people with warmth and kindness. Lunch was observed in two of the units for people with dementia. These were well organised. Staff sat with people during the meal, chatting to them and providing support when appropriate. The general appearance of people who live at the home was good. They were dressed Care Homes for Older People Page 15 of 34 Evidence: appropriately and attention had been given to their personal care. Hairdressers visit on a regular basis. People said they can have a bath or shower when they want. At the last inspection we suggested the care planning and risk assessment process should be developed to make sure peoples care needs are properly identified and staff should receive more guidance and support to help them understand how peoples specialist needs should be met. We looked at three peoples care plans. One care plan had been written by the acting manager. This information was of a very good standard and provided detailed information about potential risks and how individual needs should be met. The care that staff described reflected what was written in the care plan. The two other care plans contained some good information about how peoples needs should be met but some of the information was unclear. For example, one persons care plan stated that they needed assistance with all personal cares ie. washing, dressing and grooming by one staff member. There was no information about what this person could do and should be encouraged to do. The evaluation of the care plan noted that this person needed to be encouraged to bath x2 weekly and shower in between but it was not possible to establish what was actually happening. The manager said they are working through the care plans and acknowledged that they need to continue developing the care planning process. In the AQAA the project manager said, The care plans are now more in depth. The care plans are now being cross referenced and followed up correctly. Care plans are now being reviewed at least once per month. Staff have a better understanding of the care plan paperwork. This is ongoing with different groups of staff. At the last inspection we also suggested that more robust systems should be introduced to make sure people are treated with dignity and respect at all times. In the AQAA the project manager said, Management now spend more time observing the staffs performance in line with having a positive and pro-active approach to individual care needs. Supervisions are completed for every staff member on an 8 week rota -focusing on key areas which promote individual residents values and beliefs. People told us the home always make sure they get the medical care they need. We saw records that told us peoples health is being monitored. Weight is regularly checked. Care Homes for Older People Page 16 of 34 Evidence: Daily records provide detailed information about the care that people receive. We read details of health appointments, food and fluid intake, personal care and changes in peoples well being. We looked at the medication systems including administration of medication. We found that there is good medication storage in place and staff who administer medication have completed medication training. Records were completed correctly. The manager has introduced a new weekly medication audit to check the medication systems. Care Homes for Older People Page 17 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given opportunities to take part in a variety of activities although this should should be developed further to make sure people have a fulfilling lifestlye. Meals are well balanced and people get good support at mealtimes. Evidence: In the AQAA the project manager said, We understand how important it is to respect the human rights of people in our home and treat them with fairness, equality, dignity, respect and autonomy. When completing the care profile for a resident we discuss all areas of daily activity. We ask the resident about their life history and include any family or representative to help complete this. The care profile contains a section dedicated to this area and when completed shows a full picture of the preferences of an individual. Religious beliefs are identified in the care profile. Residents are actively encouraged to participate in their religious belief and appropriate resources are being sourced to deliver this. Staff said routines are generally flexible although meal times are generally fixed. People can choose when to get up and when to go to bed. When we arrived at 7.00am some people were still in bed other people were up. One person said, I decide when to go to bed and what I want to do. I wouldnt be here if I couldnt. Care Homes for Older People Page 18 of 34 Evidence: Two people who live at the home acknowledged the home has improved recently but suggested they could be more involved in decisions about the home. One person said, They dont always ask us what we want. They have made the small room all nostalgic but nobody uses it. They didnt ask us what we wanted when they did it. One person who lives at the home was spending time in different units to where they were sleeping because there had been some conflict with another person who lives at the home. The problems were well documented and the persons family had been consulted. However, there had been no consultation with other people at the home. One person who lives at the home had apparently raised concerns that the person was spending time in their unit during the day. Staff said the new arrangements were not really discussed and they were asked to look after the person. The acting manager explained that they had taken advice from other professionals and in the mean time agreed to review this arrangement. People who live at the home said they can have visitors at any time and they are always made to feel welcome. At the last inspection we made a judgement that people were not offered good quality and nutritionally balanced meals and did not always have enough to eat. We said people must be offered varied and nutritious food in sufficient quantities and at suitable times. This will make peoples nutritional needs are met. We received an improvement plan from the home and they told us, A new menu has been sourced and it comprises of five meal options and has been developed by a professional nutritionist. Management and chefs are monitoring stock levels daily. Meal times have been adjusted to 9am, 12:30pm and 5pm. Meetings are held with the chefs on a fortnightly basis to assess our progress. The menus state that home baking is provided most days. People who live at the home and staff said snacks mainly comprise of biscuits and home baking is generally not provided. The acting manager said they had recognised snacks are not varied and have not included home baking, and they are addressing this. In the AQAA the project manager said, We ensure that mealtimes are not rushed and that residents have a choice of where they would like to sit. We have a group of ladies who like to sit together in the dining room. We encourage families to join relatives for meals. Care Homes for Older People Page 19 of 34 Evidence: People who live at the home and staff told us the menus, quality of food, access to provisions has improved. Everyone also said there is enough to eat. We observed breakfast and lunch in two of the units. Both meal times were very well organised and people who live at the home received good support. People enjoyed the food and it was well presented. On the day of our visit the homes chef was not on duty. The chef who had only worked at the home on two previous ocassions told us he had prepared some high calorie smoothies for people who are at risk because of low weight or weight loss. The kitchen did not have any information about people who require enriched diets so the chef had to rely on receiving the information from care staff. At the last inspection we suggested that the range and level of activities offered to people should be developed. In the AQAA the project manager told us they have improved activities and said, A comprehensive activities programme has been developed on the residential unit where activities take place on a designated floor each day to encourage residents to join in. Activities especially on the dementia unit take place daily and are recorded by staff on the relevant documentation. The acting manager said this is an area they are continuing to develop but have introduced more activities on a day to day basis. The home has an activity planner that is displayed in each unit. People who live at the home said they can join in activities if they choose. Staff said there is more for people to do and more outside entertainment although some staff said the activity programme is not always followed because people dont want to participate. We saw good practice on the dementia unit with staff working with people to provide occupation and stimulation for people. On one unit a member of staff had organised a sing song with many people joining in. The staff member told us that she had managed to teach people a number of songs and people clearly enjoyed singing along. Care Homes for Older People Page 20 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints and safeguarding are dealt with appropriately. Staff training and the availability of some information could put people at risk. Evidence: People who live at the home told us they talk to their relatives, staff or management if they are unhappy. In the AQAA the project manager said, We welcome feedback, complaints and suggestions. The information from our complaints help us to change our operations and procedures. In the AQQA they said the complaints procedure is displayed in the foyer. When we visited the home the procedure was not displayed although after we pointed this out to the acting manager she arranged to have it put up in the entrance to the home. The acting manager also agreed to have it displayed in each of the units. At a strategy meeting in May 2010 it was acknowledged that safeguarding referrals are being made in a more timely way and reports are improved in quality. Concerns were raised that there is still a reasonably high volume of safeguarding referrals being made and some repetition of apparently avoidable incidents and some behaviours appear not to be well understood with some staff knowing little about the people they are looking after. Staff we spoke to said they would benefit from more in depth training on managing behaviour so they have a better understanding of how to deal with conflict between Care Homes for Older People Page 21 of 34 Evidence: people who are living at the home. The acting manager acknowledged that they have had a number of safeguarding incidents between the same people who live at the home but also discussed actions that they have taken to minimise risks to people and referrals they have made to other agencies for support and advice. Staff we spoke to said they have received appropriate safeguarding training, and said they would report any concerns to the management team if they suspected abuse or had an allegation of abuse made to them. They were confident that the management team would deal with everything appropriately. We asked the acting manager how many safeguarding referrals there had been since our last inspection in February 2010. Although each safeguarding incident is documented, the acting manager did not have this information to hand because there is no system in place. The acting manager said she would introduce a better auditing system. The home has a safeguarding policy and procedure and a whistleblowing procedure. The whistle blowing procedure outlines the procedure for staff to raise concerns internally but there was no information about staff being able to raise concerns with other agencies. During our visit a senior manager printed off a contact sheet with telephone numbers of senior management of Orchard Care staff and other relevant agencies. The management team agreed to discuss the complaints procedure and whistle blowing procedure with people who live at the home and staff. Care Homes for Older People Page 22 of 34 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. People live in a very comfortable, clean and well organised environment. Evidence: People who live at the home and staff said the environment is very good. They said the home is always clean and tidy. There are good parking facilities for visitors and safe gardens for people to enjoy in the good weather. The interior is safe to move around with wide corridors for easy movement with wheelchairs and zimmer frames. There is ample equipment and space for people to be assisted with washing and bathing safely. Bedrooms are all single occupancy, en-suite and well equipped and people are encouraged to bring personal belongings to make their rooms more homely. People can have their own telephone installed if they wish. The home is divided into six units, each with their own communal lounge/dining room and a small lounge. These are comfortable areas that make it easy to feel at home and much easier for staff to supervise and interact with people. Themes have been introduced in some of the small lounges. For example one lounge has traditional furniture and equipment such as a hand sewing machine. Care Homes for Older People Page 23 of 34 Evidence: Three units provide a service to people with dementia. At the last inspection the management team said they are developing these environments to meet good practice standards. There is still work to do in this area. Appropriate signage is important for helping people with dementia find their way around the home. The units do not have much signage and many bedroom doors do not have anything to help people identify which is their room. Clinical waste is properly managed and staff wear protective clothing when attending to peoples personal care needs. Hand cleaning facilities are situated throughout the home. On the day of the visit the homes stock of some cleaning products was very low and some staff raised concerns. They had run out of paper hand towels, one type of disinfectant, some types of cleaning cloths and air freshener. During the day a large delivery of all cleaning products were received. The manager explained that they had changed the ordering system to make sure they did not run out of stock in future. Care Homes for Older People Page 24 of 34 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 are supported by a staff team that are trained and recruited properly although some more in depth training would better equip staff with the knowledge and skills to meet peoples specialist needs. Evidence: In the main, people who live at the home were generally complimentary about the staff that work at the home. People said they get good support from staff and generally thought there were enough staff. One person said, Staff are my friends and they give me what I need. Another person said, Staff are very good at helping me. One person thought the quality of staff varied and said, Some staff are good, some are not too bad and some have not got the right attitude and think they are paying us to stay here. In February, staffing was reorganised to help provide more consistency and they were allocated to work in specific units. Staff said this has made a big difference and has improved care. Staff thought team work and staff morale has continued to improve. At the last inspection we found that sometimes there were insufficient staff on duty and said the staffing arrangements must be reviewed to make sure there are enough staff throughout the 24hour period to meet the needs of the people living at the home taking into account the size and layout and purpose of the home. The home sent us an Care Homes for Older People Page 25 of 34 Evidence: improvement plan which told us staffing was increased soon after our inspection. Staff levels are generally satisfactory during the day. Night staffing levels were increased to ten staff after the inspection. Night staff said when they have the new agreed staffing levels there are enough staff to meet peoples needs although on occasions the home only has nine night staff. We looked at the homes rotas. These told us that the home has operated with nine night staff on a regular basis. The acting manager identified that the rotas did not reflect a true picture because agency staff had not been included on the rota although acknowledged that on occasion the home has operated with nine night staff. The acting manager said at times, when everything is running smoothly they could operate safely with nine night staff but agreed that they would maintain ten night staff. She said if they reduce night staff they would review this formally and consult safeguarding before making any changes. At the last inspection we also found that staff were not always recruited through a robust recruitment process and when they start working at the home they did not always receive important training or an induction to help them understand the needs of the people they are supporting. The homes improvement plan told us staff are being actively recruited and all new staff have completed a documented induction and a full training schedule commenced on 22 February. We spoke to three staff that have started working at the home since the last inspection. They all said their employer carried out checks such as a criminal records check before they started work. We looked at the recruitment process for three people who have recently started working at the home and found that all necessary pre employment checks had been completed. The three new employees also said they completed an induction when they started work and the induction covered everything they need to know to do their job well. They said they have completed mandatory training such as fire safety and first aid. Other staff said they have done a lot of training since our inspection. When asked what the home could do better some suggested doing more in depth training such as dementia and dealing with challenging behaviour as the current training is only basic. The acting manager said this is a good idea because some people who live at the home have complex needs and staff would benefit from more in depth training. We looked at the training matrix that has been developed since our last inspection. This told us that staff have done a lot of recent training and the majority of staff Care Homes for Older People Page 26 of 34 Evidence: training is up to date. The matrix identifies which staff need to complete training. Care Homes for Older People Page 27 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management team continues to work hard to improve the quality of the service although the management systems should continue to be developed to make sure people who live and work at the home receive consistency. Evidence: At the last inspection we made a judgement that the management team had taken some steps to improve the quality of the service but there were still serious shortfalls that put people at risk. We said the home must be managed with care, competency and skill. Since the last inspection we have received regular updates from the service telling us how they have improved. They told us a new manager was recruited and started working at the home in April 2010. The acting manager and new manager are being supported by a project manager, senior management and a community liaison administrator. Huddles are being held between staff and management, which is improving morale, allowing more efficient transfer of information and more effective Care Homes for Older People Page 28 of 34 Evidence: communication. In April 2010 a meeting was held with the registered individual and a senior manager of the company about the service. They discussed the work that had had been undertaken since the inspection in February 2010 and gave assurance that the home had made real improvement. A meeting was also held in May 2010 with senior managers from Orchard Care, the new manager and professionals who had visited the home. It was agreed at the meeting that the home seemed to be working in the right direction. We spent time with the acting manager during our visit. The manager discussed areas where the home has improved but also has a clear focus of where the home should develop to make sure people receive consistent high quality care. The acting manager was able to demonstrate that she has knowledge of best practice. The acting manager said she has completed her registered managers application but is waiting for some documentation before she can submit it. The acting manager has a support manager who works alongside her full time and said she receives good support from the organisation. People who live at the home and staff said the management of the home has further improved and, in the main, they thought the home was well managed. Some people suggested that communication from management could improve. The manager said they would look at improving communication systems. The acting manager and support manager work at the home Monday to Friday. Deputy managers work at the home and are responsible for running the home when the managers are absent. At the last inspection they said they have increased the number of deputies that work at the home and provided additional support to help them take on a more managerial role. Management tasks are still predominantly carried out by the managers and deputies have little management input. The acting manager said she has noted that more incidents are taking place on a weekend and would be looking at making sure staff who are responsible for the running the home in the absence of the managers are equipped with the right knowledge and skills so the home continues to operate smoothly. The home tells us about significant events that affect the health and welfare of people who live at that home. They provide detailed reports that tell us what action they have taken to make sure the person is getting the right support and any action that will Care Homes for Older People Page 29 of 34 Evidence: help prevent further incidents from re-occurring. The service sent us their annual quality assurance assessment (AQAA) when we asked for it. It was clear and gave us all the information we asked for. They provided good examples to show what they do well, how they have improved and improvements they need to make to the service over the next twelve months. The administrator discussed the system in place for looking after personal monies for people who live at the home. We looked at two peoples records. The amount of money held for each person corresponded with their financial record. Receipts were available for all transactions. We looked at several health and safety records, including fire safety records. These were all up to date and told us that equipment has been serviced and is tested on a regular basis. In November 2008 a food hygiene visit was carried out by the local authority and made three recommendations. Two recommendations have been met; one recommendation is not met. The acting manager started to address the recommendation on the day of our visit. Care Homes for Older People Page 30 of 34 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 31 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 The care planning and risk assessment process should continue to be developed to make sure peoples care needs are properly identified. This will make sure peoples needs are recognised and met. The range of activities offered to people should continue to be developed. This will make sure people are stimulated. Consultation processes should be further developed to make sure people who live at the home are involved when decisions are made that directly affect them. Systems should be developed to make sure people who are at risk because of low weight or weight loss receive enriched diets. A system should be introduced to monitor the number of safeguarding incidents that occur at the home. This will help make sure incidents are properly monitored and people are safeguarded. Contact details for other relevant agencies should be more accessible to people who live at the home and staff. This will make sure people can contact other agencies if they are not satisfied with the way the home are managing Page 32 of 34 2 3 12 14 4 15 5 18 6 18 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations concerns and complaints. 7 8 19 27 The environment should continue to be developed to meet the needs of people with dementia. The staffing arrangements should be kept under formal review to make sure there are enough staff to meet the needs of the people living at the home taking into account the size and layout and purpose of the home. This will make sure peoples needs are met. The staff training programme should continue to be developed to make sure staff receive training that equips them with the knowledge and skills to meet peoples needs. Management systems should be in place to make sure the home operates smoothly when managers are absent from the home. 9 30 10 32 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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