Care Home: Danesmoor Residential Care Home

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What the care home does well Service users needs are regularly reviewed to ensure staff are aware of each individual`s current needs. There are effective ways of ensuring staff have up to date knowledge of each individual. People are treated with respect and their dignity is maintained. Service users have access to the full range of medical support available in the community, which helps to maintain their health and well being. Visitors are made to feel welcomed by the staff team and communication between relatives and the staff is good. The provision of food is good. People believed that complaints would be sorted out satisfactorily. Service users felt safe, in so far as they were protected from abuse or exploitation by the staff team at Danesmoor. The service provides a pleasant, homely environment which is well maintained, clean and hygienic. An extensive refurbishment program was underway at the time of our visit. All service users and relatives who we spoke to during our visit, and comments received in the returned surveys were generally positive about their experience of the home. Comments included: "lots of changes for the good"; "[staff are] very very attentive and seem to be genuinely caring"; "[x is] now in good hands, absolutely lovely girls [staff]", "they [staff] don`t say no to anything"; "very nice, everybody is friendly". Staff who we spoke to were also positive about the service they offered, the way they worked as a team, and the way in which they supported each other. What has improved since the last inspection? This was the first inspection following the new registration. However several people told us that they thought the service had improved. What the care home could do better: No requirements were made as a consequence of this inspection. Recommendations which we made relate to administrative issues which, while not having an immediate detrimental effect on any service user, makes it harder for the service always to demonstrate fully the good care provided. It was recommended that the documents used to assist the assessment and review of service users` needs are used (or not used) more thoughtfully, to reflect the individual person being assessed. While complaints seemed to be dealt with well, there was not always a record to demonstrate that. Keeping a central log of all complaints - including those dealt with informally and immediately, provides both an audit and a quality assurance tool and enables the home to demonstrate that it deals with concerns and complaints in an open and responsive manner. Key inspection report Care homes for older people Name: Address: Danesmoor Residential Care Home 45 Helmshore Road Haslingden Rossendale Lancs BB4 4BW     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: Steve Chick     Date: 0 3 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 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Danesmoor Residential Care Home 45 Helmshore Road Haslingden Rossendale Lancs BB4 4BW 01706216862 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Botany House Limited Name of registered manager (if applicable) Miss Margaret McCarthy Type of registration: Number of places registered: care home 24 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 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. The maximum number of service users who can be accommodated is: 24 Date of last inspection Brief description of the care home Danesmoor is an established care home which was taken over by new owners towards the end of 2009. It provides accommodation for up to 24 people over the age of 65. There are 16 single rooms and four double rooms each with a wash hand basin. Accommodation is provided in a large converted house with an appropriate range of equipment and a variety of communal areas. The building is in its own grounds. Care Homes for Older People Page 4 of 27 Over 65 24 0 Brief description of the care home The home is situated just outside the centre of Haslingden Village with easy access to local facilities. The fees are between £356.50 to £460 per week. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. We (the Care Quality Commission) undertook a key inspection, which included an unannounced visit to the home. This meant that no one at Danesmoor Residential Care Home knew that the visit was going to take place. For the purpose of this inspection three service users were interviewed in private, as were four visitors to the home and two staff members. Additionally discussions took place with the Manager. We also looked at information we have about how the service has managed any complaints, what the service has told us about things that have happened in the service, these are called notifications and any relevant information from other Care Homes for Older People Page 6 of 27 organisations. We had asked the management of the home to fill in a questionnaire, called an Annual Quality Assurance Assessment (AQAA). This is a legal requirement. The AQAA should have told us what they thought they did well, what they need to do better and what they have improved upon. The information in the AQAA was not as helpful as it could have been. We had asked for surveys to be distributed to some staff and service users. At the time of writing this report we had received one completed survey from a staff member and three from service users. We undertook a tour of the building and looked at a selection of service user records as well as other documentation, including staff rotas, medication records and the complaints log. We have not received any complaints about the service since our last Key Inspection, nor have we been made aware of any safeguarding concerns. This key inspection was the first to be undertaken since the service was first registered under new ownership. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: No requirements were made as a consequence of this inspection. Recommendations which we made relate to administrative issues which, while not having an immediate detrimental effect on any service user, makes it harder for the service always to demonstrate fully the good care provided. It was recommended that the documents used to assist the assessment and review of service users needs are used (or not used) more thoughtfully, to reflect the individual person being assessed. While complaints seemed to be dealt with well, there was not always a record to Care Homes for Older People Page 8 of 27 demonstrate that. Keeping a central log of all complaints - including those dealt with informally and immediately, provides both an audit and a quality assurance tool and enables the home to demonstrate that it deals with concerns and complaints in an open and responsive manner. 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 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users needs are assessed before moving to the home to ensure that their needs can be appropriately met. Evidence: This was the first inspection since Danesmoor was taken over by the current proprietors. We were told by the registered manager that only one service user had been admitted to the home since the takeover. The manager told us that prospective service users would be assessed to ensure that the staff team was able to meet the identified needs of that person. We looked at the file relating to the person who had been admitted to the home since the ownership changed. There was documentary evidence that the manager had Care Homes for Older People Page 11 of 27 Evidence: visited to assess that persons needs and had recorded the outcome of that assessment, before the service user moved to the home. Discussion with one relative confirmed that they had been able to visit the home before a decision was reached about its suitability. Danesmoor does not offer intermediate care. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users health, personal and social care needs are met by the consistent implementation of policies and procedures. Staff practices also serve to promote the dignity of the service users. Evidence: We looked at a selection of service users files. Each had a record of the care plan and evidence that the plan was periodically reviewed. The files looked at also contained evidence, by way of a signature, that either the service user themselves or a relative had been involved in discussion and agreement with the plan. The written care plan is important to help ensure that staff are kept up to date about changing needs of service users and to ensure that identified care needs are consistently met. The manager used a fairly structured series of tools as an aid to identifying the level of need for each person across a range of areas such as moving and handling, pressure care and nutritional screening. These individual assessments were then collated into one overall assessment of dependency. There was some evidence to suggest that these tools were in danger of being completed as a routine administrative Care Homes for Older People Page 13 of 27 Evidence: exercise rather than an aid to the professional assessment. For example a risk assessment for bed rails, including a consent form, had been completed even though the service user did not require the use of bed rails. Similarly some assessments appeared to indicate a level of risk which may require some intervention, but without a corresponding plan to minimise that risk. Discussion with the manager and staff provided strong evidence that this was an administrative failing and not a failure to provide appropriate care. All visitors and service users who we spoke to were positive about the care provided. One visitor who we asked cited the care and attention received by their relative as amongst the best things about the home and another described the staff as very caring and very responsive to [xs] needs. Comments from talking to service users included: they dont rush you, they are very kind and helpful to everybody who needs help and the girls are lovely, do the very best for you. All service users who returned a survey to us said they received the care and support they needed either always or (2) or usually (1). Staff who we asked told us that they thought that communication within the home was good, the key worker system was working well and that the overall system for care planning ensured that they were kept up to date about the changing needs of individual service users. There was good documentary evidence that service users have access to the full range of medical services available in the community. All service users who returned a survey to us said they always received the medical support they needed. This was also confirmed by visitors and service users who we spoke to. Medication presented as being stored safely and securely, including a dedicated fridge for medication which needed to be kept cool. We looked at a sample of medication administration records which presented as being well maintained. This is important to demonstrate that the correct medication had been given to the correct service user at the correct time and in the correct dose. Observation and discussion with service users, visitors and staff indicated that people were treated with respect and had their dignity and privacy maintained. One visitor, when asked what the best thing about the home was, said the kind staff and the way [Xs] dignity was maintained. How people are treated as individuals. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An appropriate range of activities was available for service users, and visitors are welcome in the home, which enhances service users fulfilment and social stimulation. The provision of food to maintain service users health and well-being is good. Evidence: All visitors and, service users and staff who we asked confirmed that there were no unreasonable restrictions on visiting. Visitors told us they were welcomed by staff. Service user files contained information in connection with preferences for the routines of daily living, which would help to ensure that social fulfilment is provided according to the preferences of the individual. Service users, who we spoke to, presented as being happy with the activities on offer. Some visiting relatives told us that they believed there were more social activities since the change of ownership, including birthday parties, Christmas and Easter celebrations. Activities were advertised, on the noticeboard, including holy communion being provided at the home on the second Wednesday of each month. We looked at some minutes of residents meetings which included discussions about the menus and whether or not people would prefer individual teapots on the tables. Care Homes for Older People Page 15 of 27 Evidence: This level of detailed discussion is important as a way of service users exercising control over their lives. Staff who we asked, told us that service users were free to get up and go to bed when they choose and could access any communal facilities or their own rooms according to their preferences. This was confirmed by service users who we asked. The dining room had tables which had been attractively laid out for lunch including cut flowers and cruet sets. We sampled one meal during this unannounced inspection which was well prepared and tasty. All the service users who returned a survey to us said that they liked the meals either always (2) or usually (1). Service users who we asked said that they liked the food and confirmed that there was a choice at mealtimes. Service users also told us that they could have drinks whenever they wished, including during the night. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are protected from abuse or exploitation by the homes policies and practices and are confident that any complaints they may have would be dealt with appropriately. Evidence: The manager informed us that no formal complaints had been received since the change of ownership. Consequently we did not look at the complaints log. We discussed how best practice would suggest that a central record of all complaints, even informal ones which are quickly resolved, provide a useful overview for management to identify if any minor patterns of dissatisfaction are developing. Some visitors told us that they had been able to complain and had received a satisfactory outcome. All visitors and service users who we asked, expressed confidence that any complaint would be listened to and responded to positively. Staff who we asked were confident that they, their colleagues and the manager would all respond positively to any complaint raised. Staff training records indicated that a high proportion of the care staff had received training around safeguarding vulnerable adults. Staff who we asked presented as understanding the need to be vigilant about the possibility of abuse or exploitation. They also told us that they believed all service users were safe at the home, however, Care Homes for Older People Page 17 of 27 Evidence: if necessary they would be prepared to whistle blow if they became aware of any poor practice which was not being challenged. All service users and visitors who we asked told us they believed that people living at Danesmoor were safe. One relative, when asked what the best thing about the home was replied I know [x] is safe. One service user, in response to the same question, said ... [the staff] are very nice and they dont lose their patience, and another said feeling content, nothing to worry about. We have not been made aware of any complaints or allegations about his home. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is appropriately maintained, decorated and cleaned to enable service users to live in a pleasant, safe and hygienic environment. Evidence: During this unannounced inspection we undertook a tour of the building which included the communal areas and some service users bedrooms. The manager had told us in the AQAA that a significant amount of improvement and upgrading to the fabric and fixtures of the building was being undertaken by the new owners. This was confirmed both by observation and discussion with service users and visitors. Although some areas of the building were still looking tired, the extensive refurbishment programme was clearly being continued. Service users who we asked said that they liked their rooms. Bedrooms which we looked at showed clear variation in how they had been personalised by the service user whose room it was. Communal areas were well maintained, including the well kept gardens. At the time of this visit the weather was very pleasant and several service users were sitting outside in the gardens. The building presented as clean and tidy with no unpleasant odours. All service users, visitors and staff who we asked, confirmed that this was the normal state of the Care Homes for Older People Page 19 of 27 Evidence: building. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers and skills mix of staff on duty promotes the independence and wellbeing of service users. Evidence: We were told by the manager that staffing levels are usually provided on the basis of three care staff being available between 08:00 -- 21:00 and two carers between 21:00 -- 08:00. The manager told us that in her judgement this was sufficient staffing to meet the needs of the service users who were currently resident. She also told us that she would be able to increase staffing levels should that become necessary to meet any increased dependency of the service users. We were given a copy of the staff rota for the week beginning the 24th of May 2010 as evidence that these staffing levels were maintained. Staff who we asked said that staffing levels were adequate to meet the needs of the residents. Service users who we asked also said there were usually enough staff and comments included, if I ask for help I get it and [staff are] very kind and helpful to everyone who needs help. Service users also told us that staff during the night responded well if called. We looked at a training matrix which provided information in connection with what training had been undertaken by individual staff members. This indicated that 14, out Care Homes for Older People Page 21 of 27 Evidence: of 21, carers had obtained NVQ II (National Vocational Qualification) and that 4 more were booked to undertake this qualification. Two staff members held NVQ III with a further five intending to take it. In addition to basic mandatory training, including for example moving and handling, a significant proportion of the carers had also received training in connection with dementia care and The Mental Capacity Act, and safeguarding vulnerable adults. Staff who we asked, told us they believed they had good access to training courses and were encouraged by the management to attend. They also told us that they had good access to support within the home and were encouraged to seek it if necessary. A visiting professional told us that they believed that staff were well supported, had good access to training opportunities and worked well together. We were told by the manager that only one carer had been recruited since the new owners took over. We looked at some staff files, including the new recruit, to make sure that vetting had been undertaken thoroughly and within the legally required standards. The records which we saw demonstrated that appropriate checks were undertaken before staff commenced work. Service users and visitors spoke positively about the attitude and competency of the staff team. One visitor when asked what the best thing about the home was, said the care and attention. Staff are very very attentive and seemed to be genuinely caring, not put on things. Another visitor said that staff were smashing and very caring and very responsive to [Xs] needs. Comments from service users included a real nice set of girls and very nice, everybodys friendly. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is competent to run the home, and implement the health and safety procedures for the benefit of service users and staff. Evidence: The manager moved to Danesmoor following its acquisition by the new owners. Before coming to this home she had been registered by us as a manager elsewhere and consequently has significant experience of managing care homes. Visitors who we spoke to were confident that the home was being well run. Some, who were in a position to make a comparison, told us they thought the service generally had improved under the new management. We looked at a sample of records of money held on behalf the service users by the home, including a sample of receipts for items purchased on behalf of service users. The records presented as being maintained in a way which protects the interests of the service users. Care Homes for Older People Page 23 of 27 Evidence: The manager told us in the AQAA that equipment in use in the home was appropriately checked and serviced. We looked at a small sample of maintenance records, including the fire detection and alarm systems and the passenger lift. These presented as being in order. Staff who we asked confirmed that they were always provided with, and used, personal protective equipment such as disposable gloves and aprons to minimise the likelihood of cross infection. They also told us they were encouraged to identify and report any issues which may affect the health and safety of either themselves, visitors or people living in the home. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 The registered person should ensure that if any assessment tool is used, the resulting care plan addresses that assessment. The registered person should maintain a central record of all complaints, including informal ones. This would allow for the early identification of any developing patterns of dissatisfaction with any aspect of the service and would also provide evidence of the managers willingness to receive and resolve complaints. 2 16 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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