Care Home: Courtfield Lodge Nursing & Residential Home

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What the care home does well The needs of people wishing to move in to Courtfield Lodge were assessed before admission and information had been gathered about each individual from a variety of sources, so that the staff team were confident that they could deliver the care and support needed. The plans of care contained a lot of good information about people`s assessed needs in accordance with information obtained before people moved in to the home, so that staff were aware of each person`s requirements. The privacy and dignity of people living at Courtfield Lodge was well promoted through the policies and procedures and the general every day practices adopted by the home. A variety of external professionals had been involved in the care of people living at Courtfield Lodge to ensure that their health care needs were being appropriately met. The management of medications was, in general, good so that people living at the home were protected from possible medication errors and drug misuse. The routines of the home were flexible and a range of activities were arranged for those who wished to participate. People living at Courtfield Lodge were treated equally so that everyone was given the same opportunities despite their disabilities. Relatives spoken to were happy about how visitors were received into the home and they told us that the staff were all very friendly, kind and caring. Sufficient information was provided to people about the use of the local advocacy services to act on their behalf, should they so require and people living at the home were able to have some control over their lives by managing their own finances, should they wish to do so. Personal allowances were managed well to ensure that people`s finances were safeguarded. People living at the home were provided with nutritious, well balanced meals so that their dietary intake was sufficient and those requiring support with eating their meals were assisted in a gentle manner, whilst others were encouraged to eat independently. The complaints procedure was freely available within the home and it was also included within the service users` guide so that people were given enough information about how they could make a complaint should they wish to do so. The policies and procedures in relation to safeguarding vulnerable adults were easily accessible and staff spoken to knew the procedure to take should an allegation of abuse be received by the home. The home was decorated and furnished to a very good standard and effective infection control measures were in place to ensure that the health and safety of people was well protected. Staffing levels had been calculated in accordance with the assessed needs of people living at the home and staff had been inducted and trained to provide the care and support which people needed, with 83% of care staff having achieved a recognised qualification in care, which was commendable. The health, safety and welfare of residents was protected by the robust recruitment practices and the policies and procedures adopted by the home to ensure that any hazards, which could pose a potential risk, were minimised or eliminated. A new manager had recently been appointed to Courtfield Lodge. However, the home continued to be well managed and it was clear that the provider gave continuous support to the daily operations of the service. People living at Courtfield Lodge looked happy and were evidently comfortable interacting with the staff. A range of systems were in place so that the quality of service provided could be closely monitored in order that any positive outcomes for people living at the home could be noted and any areas for improvement could be quickly rectified. When asked what the service does well one relative wrote on the comment card on behalf of a person living at the home, `I am very satisfied with the care provided to my wife. I visit every day and sit with my wife at lunch time to see what she is eating and I have a meal with her too. The staff welcome me to the home and keep me well informed of anything significant` and another commented,`the staff are very caring, who treat mum gently and with respect. She is always nicely dressed and the other residents look nice and cared for. The staff are very nice with visitors too`. What has improved since the last inspection? There were two requirements issued at the time of our last key inspection, one of which has been met. Seven of the nine recommendations made at that time have now been addressed. The provision of activities has improved since the last key inspection and people living at the home were satisfied with the amount and type of entertainment provided, although this could have been more widely publicised. The plans of care were bring reviewed each month and any changes in circumstances were reflected well so that staff were always aware about the care and support required by each individual. The percentage of staff achieving a recognised qualification in care had increased significantly, showing that a great number of staff were qualified to look after the people in their care. The home`s self-assessment shows that the service continues to improve through regular self audits so that any areas for improvement can be addressed quickly. What the care home could do better: The statement of purpose and service users` guide could have provided people with up to date information about the service, including the recent changes in registration details and the current management structure of the home. People living at the home or their relatives could have been given the opportunity to be involved in the planning of their own care so that they could decide how they would like to be supported. The care plans could have sometimes been more person centered by less use of vague statements and more detail about exactly how each individual`s needs were to be met. The programme of activities could have been more accessible for the people living at Courtfield Lodge so that they could plan their time and leisure interests accordingly. The menu could have been presented in a more suitable format for the people living at Courtfield Lodge so that they could view what meals were on offer when they chose to do so. Some areas of the home, particularly the en-suite bathrooms were being used as storage areas making the bathing facilities inaccessible for the people living at the home. Although the premises were in general well maintained some minor repair work was needed in certain areas as described within the section `environment` of this report. The policies and procedures of the home could have been reviewed and up dated on a more regular basis, so that staff members were provided with current guidance to allow them to have up to date knowledge and information. Stakeholders in the community, such as General Practitioners, District Nurses and Physiotherapists could now be invited to give their views on how the goals for people living at Courtfield Lodge were being met, so that these could be taken in to consideration. When asked what the service could do better one relative wrote on a comment card, `sometimes mum`s clothes do go missing, but I imagine this is understandable when dealing with a lot of people`. Key inspection report Care homes for older people Name: Address: Courtfield Lodge Nursing & Residential Home 81a Marians Drive Ormskirk Lancashire L39 1LG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Vivienne Morris     Date: 0 9 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Courtfield Lodge Nursing & Residential Home 81a Marians Drive Ormskirk Lancashire L39 1LG 01695570581 01695570885 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.flightcare.co.uk Flightcare Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 70 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC. To service users of the following gender: Either. Whose Primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. Dementia - Code DE. The maximum number of people who can be accommodated is: 70 Date of last inspection Brief description of the care home Courtfield Lodge is a purpose built home situated in a quiet residential area close to the town centre of Ormskirk. The home provides personal care for up to 70 older people. The accommodation is on two floors, the upper floor being reached by both stairs and a passenger lift. There is a lounge and dining room on each floor. The rooms are predominantly single but facilities are available if people choose to share Care Homes for Older People Page 4 of 32 Over 65 0 70 70 0 Brief description of the care home accommodation. The bedrooms all benefit from the provision of en-suites. Those living at the home are encouraged to personalise their bedrooms with their own belongings. The scale of charges as at 9th September 2009 ranged from £435 to £465 per week. Additional charges were being incurred for hairdressing, newspapers/magazines and private chiropody. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of this service took place on 20th September 2007. The quality rating for this service is two star. This means that people who use this service experience good quality outcomes. The site visit to Courtfield Lodge formed part of the inspection process and was conducted over one day in September 2009. It was unannounced, which means that the managers, staff and people living at the home did not know it was going to take place. During the course of the site visit, discussions took place with those living at the home, as well as relatives, staff and managers. Relevant records and documents were examined and a tour of the premises took place, when a random selection of private accommodation and all communal areas were seen. Care Homes for Older People Page 6 of 32 Comment cards were received from two people who were living at the home and four staff members and their feedback is reflected throughout this report. Every year the provider completes a self-assessment, known as an AQAA, which gives information to the Commission about how the service is meeting outcomes for the people living at the home and how the quality of service provided is monitored. It also gives us some numerical information about the service. Some of this information from the AQAA is incorporated in this report. We observed the activity within the home and tracked the care of three people during the site visit, not to the exclusion of other people living at Courtfield Lodge. The total key inspection process focused on the outcomes for people living at the home and involved gathering information about the service over a period of time. The Care Quality Commission had received one complaint and three safeguarding issues during the last twelve months. Some of the information received was referred to social services under safeguarding procedures and some was referred back to the provider to investigate using the homes complaints procedure. In all cases the home responded well to the information received and acted in the best interest of the people living at Courtfield Lodge. Care Homes for Older People Page 7 of 32 What the care home does well: The needs of people wishing to move in to Courtfield Lodge were assessed before admission and information had been gathered about each individual from a variety of sources, so that the staff team were confident that they could deliver the care and support needed. The plans of care contained a lot of good information about peoples assessed needs in accordance with information obtained before people moved in to the home, so that staff were aware of each persons requirements. The privacy and dignity of people living at Courtfield Lodge was well promoted through the policies and procedures and the general every day practices adopted by the home. A variety of external professionals had been involved in the care of people living at Courtfield Lodge to ensure that their health care needs were being appropriately met. The management of medications was, in general, good so that people living at the home were protected from possible medication errors and drug misuse. The routines of the home were flexible and a range of activities were arranged for those who wished to participate. People living at Courtfield Lodge were treated equally so that everyone was given the same opportunities despite their disabilities. Relatives spoken to were happy about how visitors were received into the home and they told us that the staff were all very friendly, kind and caring. Sufficient information was provided to people about the use of the local advocacy services to act on their behalf, should they so require and people living at the home were able to have some control over their lives by managing their own finances, should they wish to do so. Personal allowances were managed well to ensure that peoples finances were safeguarded. People living at the home were provided with nutritious, well balanced meals so that their dietary intake was sufficient and those requiring support with eating their meals were assisted in a gentle manner, whilst others were encouraged to eat independently. The complaints procedure was freely available within the home and it was also included within the service users guide so that people were given enough information about how they could make a complaint should they wish to do so. The policies and procedures in relation to safeguarding vulnerable adults were easily accessible and staff spoken to knew the procedure to take should an allegation of abuse be received by the home. The home was decorated and furnished to a very good standard and effective infection control measures were in place to ensure that the health and safety of people was well protected. Staffing levels had been calculated in accordance with the assessed needs of people living at the home and staff had been inducted and trained to provide the care and support which people needed, with 83 of care staff having achieved a recognised qualification in care, which was commendable. Care Homes for Older People Page 8 of 32 The health, safety and welfare of residents was protected by the robust recruitment practices and the policies and procedures adopted by the home to ensure that any hazards, which could pose a potential risk, were minimised or eliminated. A new manager had recently been appointed to Courtfield Lodge. However, the home continued to be well managed and it was clear that the provider gave continuous support to the daily operations of the service. People living at Courtfield Lodge looked happy and were evidently comfortable interacting with the staff. A range of systems were in place so that the quality of service provided could be closely monitored in order that any positive outcomes for people living at the home could be noted and any areas for improvement could be quickly rectified. When asked what the service does well one relative wrote on the comment card on behalf of a person living at the home, I am very satisfied with the care provided to my wife. I visit every day and sit with my wife at lunch time to see what she is eating and I have a meal with her too. The staff welcome me to the home and keep me well informed of anything significant and another commented,the staff are very caring, who treat mum gently and with respect. She is always nicely dressed and the other residents look nice and cared for. The staff are very nice with visitors too. What has improved since the last inspection? What they could do better: The statement of purpose and service users guide could have provided people with up to date information about the service, including the recent changes in registration details and the current management structure of the home. People living at the home or their relatives could have been given the opportunity to be involved in the planning of their own care so that they could decide how they would like to be supported. The care plans could have sometimes been more person centered by less use of vague statements and more detail about exactly how each individuals Care Homes for Older People Page 9 of 32 needs were to be met. The programme of activities could have been more accessible for the people living at Courtfield Lodge so that they could plan their time and leisure interests accordingly. The menu could have been presented in a more suitable format for the people living at Courtfield Lodge so that they could view what meals were on offer when they chose to do so. Some areas of the home, particularly the en-suite bathrooms were being used as storage areas making the bathing facilities inaccessible for the people living at the home. Although the premises were in general well maintained some minor repair work was needed in certain areas as described within the section environment of this report. The policies and procedures of the home could have been reviewed and up dated on a more regular basis, so that staff members were provided with current guidance to allow them to have up to date knowledge and information. Stakeholders in the community, such as General Practitioners, District Nurses and Physiotherapists could now be invited to give their views on how the goals for people living at Courtfield Lodge were being met, so that these could be taken in to consideration. When asked what the service could do better one relative wrote on a comment card, sometimes mums clothes do go missing, but I imagine this is understandable when dealing with a lot of people. 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 32 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 32 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. The needs of people wishing to move in to Courtfield Lodge had been thoroughly assessed so that the staff team were confident that they could provide the care and support required by everyone living at the home. Evidence: The manager of the home sent us the Annual Quality Assurance Assessment, which was very detailed and told us what the service does well and any areas for development. She wrote, prior to the service user moving into the home a comprehensive pre- admission assessment is undertaken to ascertain the Service Users needs, assistance required, equipment required, biography of health status and personal circumstances, risk assessments, service users self concepts and responses to life changes, their views and wishes, also their relationships and family dynamics. A draft care plan is also agreed. Also incorporated in this is information received from family and friends, social worker assessments and multidisciplinary assessments. All prospective service users have the information they need to make an informed choice Care Homes for Older People Page 12 of 32 Evidence: about Courtfield Lodge being their home. At the time of this key inspection we tracked the care of three people living at the home. The information gathered about peoples assessed needs before they moved in to Courtfield Lodge was thorough and provided staff with detailed guidance about the care and support required by each individual. Information was obtained from a variety of sources so that a clear picture of peoples needs was developed. This then formed the basis of the care planning process so that staff were aware of how peoples assessed needs were to be met. Courtfield Lodge has recently changed registration details and a new manager is in post. The statement of purpose and service users guide need updating in order to reflect the homes new registration and current management arrangements. Care Homes for Older People Page 13 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal and health care needs of people living at the home were consistently being met and their privacy and dignity was always maintained. Evidence: The three plans of care seen were of a very good standard. They provided staff with a clear picture of peoples assessed needs, in accordance with information obtained before they were admitted to the home. Detailed guidance was, in general, also recorded about how these assessed needs were to be met. However, although the care plans were in the main person centered, occasionally vague statements were used, which did not provide specific information about exactly how individual needs were to be met. There was not always evidence that people living at the home or their relative had been given the opportunity to be involved in the planning of their care so they could decide how they wanted their care and support to be delivered. Any changes in needs were reflected well in the plans of care and people were Care Homes for Older People Page 14 of 32 Evidence: supported by a wide range of external professionals to ensure that health care needs were being appropriately met. A variety of assessments had been conducted to ensure that any potential risks to the heath, safety and welfare of those living at the home were identified and strategies implemented to ensure that people were well protected. Staff were seen speaking to people with respect and talking to them in a comforting manner. We spoke to eleven people living at the home who all felt that their privacy and dignity was well maintained. One of these people said, staff go out of their way to make sure my needs are attended to in a dignified manner. The plans of care seen included the importance of protecting peoples privacy and dignity, particularly in relation to the provision of personal care. The statement of purpose told its readers about how those working at the home promoted a dignified care package for the people living at Courtfield Lodge. The management of medications was, in general, satisfactory. However, any hand written entries on the Medication Administration Records should be signed, witnessed and counter signed in order to avoid any transcription errors and any eye preparations should be dated on opening to ensure that they are discarded before their shelf life expires. One relative told us, Mum has been very happy here from day one. Everyone is so friendly and the staff all look after her needs well and another said, I am very satisfied with the care provided at Courtfield. Mum has difficulty eating so she is given her own menu. She can have whatever she wants. I have nothing but praise for this home. We have no complaints sat all. Both people who sent us comment cards and who lived at the home told us that they always received the care and support they needed, including medical support. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The daily routines of the home were flexible and activities were provided which people could join in, if they wished to. The management of meals was good and visitors were made welcome to the home. Evidence: Records reflected that people living at Courtfield Lodge had been asked about their preferred leisure interests and what they enjoyed doing. However, the plans of care did not show how people could be supported to maintain these activities whilst living at the home. An activities co-ordinator was employed at Courtfield Lodge, who was responsible for organising and implementing social activities for the people living at the home. We were told that an activity programme was held on the computer and so this was not easily accessible for everyone to see. The programme could have been more widely published so that the people living at the home could decide in advance which activities they wished to participate in. People spoken to told us that a variety of activities were provided, but that they could choose if they wished to join in or not. However, it was pleasing to see a large group Care Homes for Older People Page 16 of 32 Evidence: of residents and staff really enjoying a sing song on the patio under a gazebo on a sunny day. We could see that those living at the home obviously had a good rapport with staff as they laughed and joked with each other. Everyone looked very happy and the atmosphere was warm and friendly. We were told that ministers visited the home at regular intervals to enable people to follow their religious beliefs, if they wished to do so whilst living at Courtfield Lodge and some records seen supported this information. One person spoken to said that they received communion periodically. Those living at Courtfield Lodge told us that the routines of the home were relatively flexible, such as, times of getting up and times of going to bed. It was evident that people were allowed freedom of movement, being able to access their own bedrooms when they wished to do so and to choose where they wished to spend their time. Visitors spoken to said that they were made to feel very welcome to Courtfield Lodge and that they felt very comfortable visiting the home. This information was supported by the policies and procedures of the home and the interaction seen between visitors and those working at Courtfield Lodge. One visitor told us, it is like one big happy family and another commented, I feel very comfortable visiting Courtfield Lodge and everyone is very friendly. It was established that two people living at the home used the local advocacy services, so that they had an independent person acting on their behalf in order to support them to make decisions about their life. There were several documents available at the home telling people how they could access the local advocacy service should they wish to do so. Policies and procedures were in place at the home showing that everyone living at Courtfield Lodge were provided with the same opportunities irrespective of culture, disability, religion or diverse needs. We saw lunch being served, which looked appetising and alternatives to the menu were offered and provided, as requested. However, the alternative meal displayed on the lunch time menu was shown as meat, which was vague and none descriptive. The Records reflected that people living at Courtfield Lodge had been asked about their preferred leisure interests and what they enjoyed doing. However, the plans of care did not show how people could be supported to maintain these activities whilst living at the home. The manager told us how the service plans to improve in this area in the next twelve months, which included holding a garden fete with Morris Dancers, live music, Care Homes for Older People Page 17 of 32 Evidence: organised games for service users, staff, family and friends to attend. She wrote, We will continue building on developing an active activities programme, also further incorporate household activities. We have applied for funding to obtain equipment and a building to provide a workshop for the service users who have dementia who will be supported to partake in familiar activities e.g. woodwork, baking etc. under risk management. To also further develop both garden areas to provide leisure facility for service users to garden and enjoy spending time with family and friends there. One person who lived at the home and who sent us a comment card wrote, the staff are all very kind. They really are marvelous. The food is very good. Everything is smashing. I am very comfortable living here and I am happy with my bedroom and another commented, the food is extremely good and there are activities provided, but I choose not to join in. At least I am not forced to do something I dont want. The staff are lovely. Nothing is too much trouble. Care Homes for Older People Page 18 of 32 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. Complaints were managed well and people living at Courtfield Lodge were appropriately safeguarded by the robust policies and procedures adopted by the home. Evidence: The home had a well published written complaints procedure in place, which advised people of how to go about making a complaint and provided the assurance that any concerns raised would be fully investigated in a timely fashion. However, information within this procedure needed to be updated to show the Commissions correct details and Social Services as the complaint investigating authority. Records were held within the home of all complaints made, their investigation and subsequent outcome. In viewing these records we were able to confirm that any complaints were dealt promptly. However, it is recommended that a numbered page record book be used for recording complaints rather that loose sheets in order to avoid pages being mislaid or removed. People spoken to said that they would know how to make a complaint should they need to do so. There was comprehensive guidance in place for staff in relation to the protection of vulnerable adults. There were also policies in place telling staff how they should blow the whistle on poor practice. This guidance is given to staff at the start of their employment and ongoing training is provided in relation to abuse awareness and Care Homes for Older People Page 19 of 32 Evidence: prevention. Staff spoken to said that they would know what to do if they felt that someone living at the home was a victim of abuse. There have been recent changes in the law that relate to caring for people who may need decisions making on their behalf. The manager of the home showed a good understanding of the development and confirmed that she had been provided with training in this area. This training should now be rolled out to all carers to ensure that they have a good understanding of the new legislation and are working in accordance with it. Both people who sent us comment cards and who lived at the home told us that the staff usually listened to them and acted up on what they said and that there was someone to talk to informally if they were not happy about something. One of these people said that they would know how to make a complaint and the other said that they would not. Care Homes for Older People Page 20 of 32 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. The home provided a comfortable and, in general, safe environment for the people living at Courtfield Lodge. Evidence: The environment at Courtfield Lodge was found to be clean, pleasant smelling and, in general, well maintained. The bedrooms were individualised and homely. The communal rooms were pleasantly decorated and furnishings were of a good standard. One person told us, I am delighted with my bedroom. It is very comfortable. However, there were some areas needing improvement. Some of the en suite baths were inaccessible for the people using these bedrooms as they were being used for storage. One bedroom was vacant and yet the door was propped open with a table, which was a fire hazard. The bedside drawers in one bedroom were broken, creating a health and safety risk as they were unstable. One bedroom door slammed shut creating a potential risk of injury for people accessing this room. Several of the bedroom doors were scuffed and in need of repainting in order to enhance the environment for people living at Courtfield Lodge. There were good policies and procedures in place in relation to the control of infection and clinical waste was being disposed of in a correct manner to ensure that the possibility of cross infection was minimised. The training matrix showed that some staff members had completed infection control training and information was provided Care Homes for Older People Page 21 of 32 Evidence: for staff telling them what they should do in case of chemical contact. Both people who sent us comment cards and who lived at Courtfield Lodge told us that the home was usually fresh and clean. Care Homes for Older People Page 22 of 32 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. The number and skill mix of staff on duty met peoples needs and the recruitment practices protected those living at Courtfield Lodge. Evidence: The duty rota was clear showing which staff were on duty at any time of the day or night and demonstrating that the skill mix of the people working at the home was appropriate to the needs of the people living there. Records showed that staffing levels were calculated in accordance with the assessed needs of people living at Courtfield Lodge to ensure that they received the care and support required. Records showed that the home had a commitment to supporting staff in achieving relevant qualifications and training, including the Mental Capacity Act and Deprivation of Liberty Safeguards, which was pleasing to see. It was also commendable that that 83 of care staff had obtained a recognised qualification in care with four more enrolling to commence later this month. Three staff files were examined, which showed that all relevant checks been completed before people started working at the home so that those living at Courtfield Lodge were protected by the robust recruitment practices adopted by the home. Both people who sent us comment cards and who lived at the home told us that there Care Homes for Older People Page 23 of 32 Evidence: were always staff available when they were needed. All four staff who sent us comment cards told us that their employed carried out checks before they started working at the home. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was managed well so that the health, welfare and safety of the people living and working there was protected. Evidence: We noted that a wide range of policies and procedures were in place at the home giving people information about all aspects of daily life at Courtfield Lodge. However some of these had not been reviewed for quite some time to ensure that interested parties received current and up to date information. A variety of methods had been introduced at the home so that the quality of service provided could be closely monitored and any shortfalls rectified. A wide range of audits had been conducted and a variety of people had been requested to complete a survey about the standard of service provided so that their views could be taken in to consideration. The results of surveys returned to the home had been correlated and produced in a graph format, which was displayed in the reception area of the home so that people could see how the service was doing. Any negative comments had also Care Homes for Older People Page 25 of 32 Evidence: been included with the managers response as to how these had been handled, which was considered to be good practice. It is now suggested that stakeholders in the community be invited to complete a more relevant survey so that they can give their views about how goals are being met for the people living at Courtfield Lodge. Records showed that the Responsible Individual visited the home on a regular basis and completed a monthly report so that areas of good practice could be identified and any shortfalls addressed. The home had received accreditation by an external awarding body showing that the service is periodically monitored and audited by an outside professional company. A variety of meetings had been held at the home with minutes being retained so that all interested parties could read about the discussions which had taken place and any relevant information which had been passed on. It was pleasing to see that people had been kept well informed about the recent changes in registration of the home showing that the management team had been open and transparent. We spoke to one relative who had found an alternative placement for his mother because of the changes in registration status. He was happy with how things had been handled by the home and stressed that he would not be moving his mother to another care setting had the registration of Courtfield Lodge not changed. The personal allowance records of people living at the home were examined. They were clear and showed a detailed account of credit and expenditure so that the finances of those living at Courtfield Lodge were appropriately safeguarded. A wide range of health and safety policies and procedures were in place and staff were provided with a variety of relevant training sessions so that the staff and people living at the home were well protected. On touring the premises it was evident that people living at Courtfield Lodge were, in general, kept safe. However, one of the bedroom doors needed adjusting and a set of bed side drawers needed repairing as described within the environmental section of this key inspection report. The accident records were examined, which were found to be clear although these were not retained in line with data protection to ensure that information about people was kept secure. Certificates showed that external contractors serviced equipment and systems on a regular basis to ensure they were safe for use and risk assessments were in place so that any hazards were identified. A wide range of internal checks were also carried out on a regular basis so that the home was confident that the environment was safe for Care Homes for Older People Page 26 of 32 Evidence: the people living at Courtfield Lodge. All four staff members who sent us comment cards felt that they did not get enough support from the management of the home and that they never met with their manager to discuss how they were working. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 15(1) The registered person must 30/11/2009 give all residents or their representatives the opportunity to be involved in the planning of their care to ensure that the care provided is in accordance with their wishes. This is so that people receiving care and support can make some decisions about how it is delivered. Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 The homes statement of purpose must be updated to reflect the current registration details and management arrangements within the home. So that prospective service users, their relatives and any other interested parties are given information about the home, which is up to date. 15/10/2009 2 1 5 The homes service users guide must be updated to reflect the current registration details and management arrangements within the home. So that prospective service users, their relatives and any other interested parties are given information about the home, which is up to date. 15/10/2009 Care Homes for Older People Page 29 of 32 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 3 7 15 People living at the home or 01/12/2009 their relative must be given the opportunity to be involved in the care planning process. This is so that people living at the home can decide how they want their care and support to be delivered. 4 19 23 The premises must be kept 30/10/2009 in a good state of repair and suitable storage facilities must be provided for the people living at the home. So that the safety of people is consistently promoted and so that the premises are of a good standard for the people living there. 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 2 7 9 Care plans should always provide clear guidance for staff about how individual assessed needs are to be met. Any hand written entries on the Medication Administration Records should be signed, witnessed and counter signed in order to avoid any transcription errors. Eye preparations should always be dated on opening so that they can be discarded before their shelf life expires. 3 12 The activity programme should be more easily accessible for people living at the home so that they can plan their day in accordance with events taking place. Page 30 of 32 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 The plans of care should provide staff with clear guidance as to how people can be supported to maintain their leisure interests whilst living at Courtfield Lodge. 4 15 The alternative meal displayed on the menu should be descriptive so that people living at the home are aware of what meal choices are on offer. It is recommended that the menu be presented in a more suitable format for those living at the home. 5 16 The complaints procedure should be updated to show the Commissions correct details and Social Services as the complaints investigating authority. It is recommended that a numbered page record book be used for recording complaints to avoid loose pages being mislaid or removed. 6 33 It is recommended that stakeholders in the community be invited to complete a more relevant survey so that they can give their views about how goals are being met for the people living at Courtfield Lodge. The written policies and procedures of the home should be periodically reviewed and updated so that people are provided with current information. The accident records should be retained in line with data protection guidelines so that infornation about people is kept secure. 7 33 8 38 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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