Care Home: Digby Court

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What the care home does well Digby Court provides a pleasant, homely and clean environment for people to live in. There are good assessments and care plans in place to make sure that people`s needs and wishes are identified, and met in the way they want them to be. Staff treat people with respect, they are well trained and those spoken to had a good understanding of people`s needs and they were observed helping people to be as independent as they could be. There are good systems in place to make sure that people are protected, including robust recruitment procedures, staff training and up to date policies. Visitors are made to feel welcome and gave us positive comments about the care provided. People are able to take part in various recreational activities and are able to choose the level of their involvement. Leadership in the home is good and quality monitoring systems are in place to ensure the home is run in the best interest of the people living there. What has improved since the last inspection? The service has commenced an intermediate care service for up to two people. The service has listened to people`s comments about a lack of communal space and have opened up the lounge area and re-sited the day centre to an alcove off the dining room. Both areas have been refurbished with input from people regarding colour schemes and furniture. Improvements have also been made to the garden area and self closures have been fitted to bedroom doors. A new manager has been appointed and is currently applying to be registered with us and the organisation is supporting new managers by offering a `buddy` system with existing managers. What the care home could do better: The Statement of Purpose and Resident Guide should be updated to make sure people have the correct information about who is managing the home and that they know how to access our reports. Pre-admission assessments and care plans could be improved further by showing who provided the information and the level of involvement. Evaluations and reviews should also show that people are involved and in agreement with any changes to their care. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Digby Court St Christopher`s Lane Bourne Lincs PE10 9AZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Elisabeth Pinder     Date: 2 9 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Digby Court St Christopher`s Lane Bourne Lincs PE10 9AZ 01778422035 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : manager.digby@osjctlincs.co.uk The Orders Of St John Care Trust care home 36 Number of places (if applicable): Under 65 Over 65 36 0 old age, not falling within any other category physical disability Additional conditions: 0 1 The home is registered to provide personal care for service users of both sexes whose primary needs fall within the following category:- Old age, not falling within any other category (OP) - 36 The maximum number of service users to be accommodated is 36 To provide accommodation for one service user under the category Physical Disability (PD), as named in the variation application V38976 dated 16 February 2007 Date of last inspection Brief description of the care home Digby Court is a purpose-built home for up to 36 older people, which was formerly owned by the local Authority and is now owned by the Orders of St. John Care Trust. The home is a two-storey building set in its own grounds close to the town centre of Bourne, which has a good range of shops and facilities. Accommodation is on the ground and first floors which is accessed by a passenger lift. There are gardens to the rear and a car park to the front of the building. The home has a day care centre for up to 10 people daily, which is part Local Authority funded; it did not form part of the Care Homes for Older People Page 4 of 27 Brief description of the care home inspection. The current fees range from £360.00 - £571.00. Additional charges are made for chiropody, hairdressing, newspapers and personal toiletries. A copy of our last inspection report is available in the home. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means that the people who use the service receive good outcomes. This was an unannounced visit and it formed part of a key inspection, focusing on key standards which have the potential to affect the health, safety and welfare of people who use the service. Throughout this report the terms we and us refer to the Care Quality Commission (CQC). The visit lasted six hours and took into account previous information held by us including the previous inspection report, their service history and records of any incidents that we have been notified of since our last visit. The Commission are trying to improve the way that we engage with people who use Care Homes for Older People Page 6 of 27 services so that we gain a real understanding of their views and experiences of social care services. During this visit we used a method of working where an Expert by Experience visited the home as part of the inspection. An Expert by Experience is a person who, because of their shared experience of using services, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The expert met and talked to people living in the home, visitors and staff. Before we made our visit the manager had returned the Annual Quality Assurance Assessment (AQAA). This gave us information about their own assessment of how well they are meeting standards and their plans to improve aspects of the service. We sent out surveys to people living at the home and to staff before we visited and these are mentioned throughout the report. The main method used to carry out the inspection is called case tracking, this includes following the care of a sample of people through their care records and assessing their care. We spoke to people who use the service and saw rooms of those who said we could and to members of staff and visitors. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 Care Homes for Older People Page 8 of 27 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. Generally people know about this service and are assured that their needs can be met due to a clear introduction and assessment process. Evidence: Information sent to us prior to the inspection told us that people have access to a range of information about the service and are able to visit the home and spend time there before making a decision about moving in. Information is available in a Statement of Purpose and Service User Guide. The Statement of Purpose was updated in September 2008, it does not give people information about the intermediate care service available or tell people about the changes to management. The Service User Guide was looked at and we saw that this included information about the new manager but it did not tell people how to access our reports. Both documents give information about how differing needs, such as religion and culture will be met and tell people about the new laws regarding how people make decisions. People living in the home Care Homes for Older People Page 11 of 27 Evidence: also receive a copy of the Trust magazine. The records of two people who had recently been admitted were looked at and showed that a needs assessment had been carried out prior to their admission. However, these did not tell us who had provided the information. Assessments for people admitted for intermediate care are carried out by an external dedicated intermediate care team. The care staff of Digby are responsible for writing daily records. Five surveys from people living at the home were returned to us before the visit, four identified enough information about the service had been received before their admission and two told us they had been given a contracts/terms and conditions of residency, two did not know and one indicated they had not. Terms and conditions of residency/contracts and copies of letters confirming that after the assessment the service could/could not meet needs were on the files looked at. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are happy with the support they receive for personal and health care needs. Evidence: Care plans of the four people whose care was being followed were looked at and these had been written as if the person had written them and contained information about how they want their care provided including the level of help needed, making choices, encouraging independence and the level of support needed to receive their medicines safely. However, they did not tell us if the person had been involved or was in agreement with their care plans and did not give much information about how the persons privacy and dignity was to be met. Evaluations/reviews of care plans also did not show that the person had been consulted and when we discussed this with the manager we were told that the Trust is addressing this and changes to the care planning system are being trialled at four other homes and if successful will be rolled out in all the homes. Care records were clear and easy to follow and included, medical histories, appointments with other healthcare professionals, peoples preferences Care Homes for Older People Page 13 of 27 Evidence: regarding male or female carer and life histories including hobbies and present interests. Detailed risk assessments had been written and these showed the action staff should take to minimise the identified risk. Various other assessments had been completed on subjects such as, manual handling, pressure risk and nutrition. Daily notes were written and these showed the care people were receiving each day. Three of the five surveys received from people living at the home told us they always receive the care and support needed, including the medical support, one sometimes and during our visit people told us that they were generally happy with the level of support given. Staff spoken to had a good understanding of peoples needs and they were observed helping people to be as independent as they could be. One relative spoken to told us she was very satisfied with the care, she is always informed of important issues affecting her relative and feels confident to raise any concerns. The report written by the Expert by Experience read I was able to speak with 10 residents, on a one to one, pairs and small group basis, all indicated that the home was welcoming and friendly. The staff response time was good and for those residents who needed personal care, this was done in the main by women and none of the residents minded this. No-one is administering their own medication at the moment and records showed that this is discussed prior to and during admission. We saw that staff followed medication procedures in a satisfactory way and staff told us they had received relevant training. Administration records contained a photograph of the person and there were clear instructions for medication that is only needed when necessary. One person told the Expert by Experience that the carers had run-out two days previously of a spray but had been informed that more had been ordered and was not unduly distressed by this and we have since been informed that this has been addressed. Staff who are designated to give people their medicines have their competency levels assessed to make sure they are up to date and competent to continue with this role. The homes pharmacist visited the home on 30th June 2009, no issues were raised. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to take part in various recreational activities and maintain contact with family and friends as they wish. Meals provided are well balanced and take into account personal preferences and special dietary requirements. Evidence: Information taken from the AQAA tells us an activity co-ordinator is employed for 20 hours each week and is responsible for seeking out peoples views and choice of activity. An activity board is displayed in the reception area of the home telling people whats happening that day and of all forthcoming events. During our visit we saw that people are encouraged to make their own decisions and choices about how they live their daily lives, for example, what activities they take part in and who they spend their time with. A monthly community coffee morning was taking place and we saw some people taking part in bingo organised by the activity co-ordinator but led by a volunteer. People told us of other activities they enjoy which included, PAT (pets as therapy) dogs who come into the home each week, trips out in the homes mini bus, movement to music, reading sessions with the book club and knitting for a charity supplying the special care baby unit in a local hospital. Monthly meetings are held and minutes showed that the main topics centred around food and activities. Some people Care Homes for Older People Page 15 of 27 Evidence: told the Expert by Experience that they felt they were being talked to rather than consulted at these meetings and this was fed back to the manager who agreed to look into this. Four relative surveys received prior to our visit indicated that the service always or usually supports people to live the life they choose. People told us they are able to keep in touch with family and friends and have visitors whenever they choose and visitors spoken to all said they were always made to feel very welcome. Surveys received prior to our visit gave a mixed response about the food, three identified they always liked the meals, 1 usually and 1 sometimes. A comment written by a relative read food is variable quality, when I have eaten there it has always been fine, but my mother has complained of inedible meals. However, during our visit people told us they were happy with the food provided, the Expert by Experiences report read all residents said the food was good and there was a choice whereby they can indicate what they like from the menu the day before. The food was praised and the portions were adequate. The provision of fresh, rather than frozen vegetables appeals to two of the residents I spoke with. Breakfast consisted mainly of cereal and toast but residents said they were able to have a cooked breakfast if they so wished. There was no complaint about the food. A relative told us the kitchen staff know the residents well and know their likes and dislikes. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by the procedures in place for handling complaints and allegations of abuse. Evidence: Information taken from the AQAA tells us there is an open door for communication. Clear policies and procedures are in place regarding complaints and safeguarding adults. Information on how to make a complaint is given to every person and included in the Statement of Purpose, Service User Guide and is on display in the reception area of the home together with information about advocacy. This was confirmed during our visit and the manager told us she would make sure these documents were updated to show our new contact details. The whistle blowing procedure is discussed during staff interviews and staff are aware of the need to report any concerns. People told us they feel able to raise issues with their relatives, key worker, care leader or manager and felt these would be taken seriously. Four of the five surveys received from people living at the home prior to our visit told us they know how to make a complaint and who to speak to if they are unhappy. All surveys returned from relatives/representatives indicated they know the procedures and felt the service has responded appropriately to any concerns raised. Within the last twelve months the service has received three complaints, one of which the manager is currently investigating. Care Homes for Older People Page 17 of 27 Evidence: One referral had been made to Lincolnshires Safeguarding Adults team and this had also been dealt with in a correct way to protect people living in the home. Staff told us they had received training in these subjects and their records verified this, they had a good understanding of the types of abuse and the correct procedures to take to report any incidents. 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. People live in a well-maintained, clean, comfortable and homely environment. Evidence: People we spoke with were satisfied with the cleanliness and the accommodation in the home. The home was odour free, clean and nicely decorated. A partial tour of the building was carried out and we looked at some bedrooms of people whose care was being followed with their permission. These were clean, individualised with pictures, mementos and ornaments. Four of the five surveys returned to us from people living at the home told us they feel the home is always fresh and clean, 1 usually. Specialist equipment is provided such as raised toilet seats, specialist baths, hoists and pressure relieving mattresses and the use of these was detailed in peoples care plans. Staff told us they felt they worked in a safe environment and were observed using protective clothing when needed. Information taken from the AQAA told us that within the last twelve months improvements have included; redecoration to the lounges, dining room and hall. A path has been provided around the rear garden with a handrail for people to use. The service received some negative feedback in previous quality assurance questionnaires regarding a lack of communal space and the lounge has been opened up and the day Care Homes for Older People Page 19 of 27 Evidence: centre moved to an alcove off the dining room. Some people also said they did not like the winged armchairs as it made it difficult to talk to the person sitting next to them and a number of these have now been replaced. The manager told us that their Environmental Health Officer had recently visited and awarded a five star rating. 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. People are protected by recruitment procedures and a well trained staff team. Evidence: We looked at staff records and these showed that application forms, criminal record bureau checks, identification and written references had all been completed before the person started work. Staff told us they had been given a good induction to the home and their training records showed that they had been trained in fire safety, protecting people, dementia care, health and safety, moving and handling and end of life care. The majority of staff hold a nationally recognised care qualification at various levels and there is also a training plan in place which includes the new laws to help people with decision making. All care leaders are appointed people for first aid and a care leader is working on every shift. Staff told us they feel that there are usually enough staff on duty and they are able to complete their tasks without rushing. On the day of the visit 33 people were living in the home and duty rotas looked at for the past two weeks showed that there were generally four care staff from 07:00 - 12:00, three carers from 12:00 - 14:30, two carers from 14:30 - 16:00 and three carers until 21:30hrs. In addition to this there is a care leader on every shift and throughout the weekdays there is a manager and an administrator. Throughout the night there are two care staff and one care leader. Care Homes for Older People Page 21 of 27 Evidence: Three surveys received prior to our visit from people living at the home told us staff were always available when needed, 1 usually and 1 did not know. During our visit people told us they generally felt well cared for. They told the Expert by Experience that staff were very pleasant, skilled, patient and competent. The Expert by Experience report read at my visit there seemed to be sufficient staff to care for residents needs. Four surveys returned to us by relatives/representatives identified that care workers always or usually have the right skills and experience to look after people properly and respond to their differing needs. One comment read most staff are friendly and helpful and the place has a good atmosphere. 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. This home is well managed and people have a say in how the home is run. Evidence: The manager has been in post since April of this year and is currently applying to become the registered manager for this service. She has moved from another Trust home where she had been the homes administrator for the past five years. She has completed a four day residential course in leadership and is due to commence the Registered Managers Award. The organisation is supporting new managers by offering a buddy system with existing managers. Surveys received prior to the visit raised no concerns regarding the current management arrangements and people told us they feel the manager is very approachable, ready to listen and very efficient. Staff told us that there is good team work within the home and they feel supported in their work. They told us they receive supervision from senior staff and their records confirmed this, however, not all had been completed in the recommended six times a Care Homes for Older People Page 23 of 27 Evidence: year. The manager told us that an internal audit had highlighted this issue and action was being taken to address it. Discussion and records showed that there are various systems in place to monitor the quality of the service being provided. This includes seeking the views of people through meetings and questionnaires, the results of surveys are collated and an action plan is written detailing the timescale for any issues to be addressed. A representative of the organisation was visiting during the inspection carrying out a monthly evaluation to see how the home is running. Reports for previous visits were looked at and showed that regular monitoring of the service takes place. The homes administrator keeps records of peoples financial transactions and two of the people whose care was being followed were looked at and these were up to date and accurate. Information provided in the AQAA told us that there are a range of policies and procedures in place and the majority of these had been reviewed and updated in 2008. We were also told of equipment maintenance and service dates. Building risk assessments are in place and regular health and safety audits are completed. The Department of Health Essential steps is used to assess infection control and records showed staff receive health and safety training. 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 2 7 7 Care plans should include information about how peoples privacy and dignity is to be met. Care plan reviews/evaluations should show whether the person has been involved and has agreed with any changes to their care. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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