Care Home: Dove Court

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What the care home does well One relative told us:` Dove Court always puts the care and well being of the service user first. The staff keep me informed immediately of any change of health in my mother, due to the fact she cannot move unaided they always see she gets put in the lounge so she is not alone`. Another reported: ` my dad appears to be very settled and happy in Dove Court and that`s my main concern` and: `mum is always clean and content and the staff seem to know her well as an individual`. A lot of work and thought has gone into designing a stimulating and interactive environment for residents with dementia. The recently introduced chickens have proved popular amongst residents, as has the introduction of doll therapy. Staff training is good ensuring they have the skills and knowledge to look after residents appropriately. Staff recruitment is also robust, ensuring that only the right people are employed to look after vulnerable adults. What has improved since the last inspection? There have been good improvements since we last visited The use of agency staff has reduced substantially in the last year ensuring that residents receive consistent care from staff who know them well. Lunch on the day we visited was much better co-ordinated making it a calm and sociable event ,with no resident left without assistance to eat. Staff do not start working at the home until a full CRB disclosure has been received ensuring that residents are protected from unsuitable people. Signage around the home has improved making it easier for residents to find their specific bedrooms. What the care home could do better: Staff must avoid the use of patronising and generic terms for residents and call them by their preferred names. All hand written additions to the printed MAR sheets should be signed, dated and checked by a second person to ensure their accuracy. In addition, only the person actually administering creams to residents must sign to say they have given it. Vegetables and gravy should be served separately to residents at mealtimes so they can decide how much and what they want to eat. Key inspection report Care homes for older people Name: Address: Dove Court Kirkgate Street Wisbech Cambridgeshire PE13 3QU     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: Janie Buchanan     Date: 2 0 0 5 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 25 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 25 Information about the care home Name of care home: Address: Dove Court Kirkgate Street Wisbech Cambridgeshire PE13 3QU 01945474746 01945474846 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 76 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 76 The registered person may provide the following category of service only: Care Home with Nursing - Code N to service users of the following categories: Old Age, not falling within any other category - Code OP, Dementia - Code DE. Date of last inspection Brief description of the care home Dove Court is a purpose built residential care home, situated in a residential area on the outskirts of Wisbech. It is owned by Ashbourne Homes Ltd and provides care and support for up to 46 residents over the age of 65 with dementia. The home has 46 single rooms, all with en suite facilities. In addition to the en suite facilities there are 5 bathrooms and one shower, all with toilet facilities. Resident accommodation is on two floors, the upper floor being accessible by stairs or lift. There is a variety of communal Care Homes for Older People Page 4 of 25 Over 65 0 76 76 0 Brief description of the care home areas available to service users. An enclosed garden is at the rear of the home and provides a safe environment for service users to enjoy the garden features. Fees for the home range between £342 -£650 per week. CQC inspection reports are available in the office for people to read if they wish or can be downloaded from www.cqc.org.uk Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: For this inspection we, (The Care Quality Commission), looked at all the information that we had received since the last inspection. This included the annual quality assurance assessment (AQAA) that was sent to us by the home. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the home. We received 10 completed questionnaires from residents and their advocates giving us their views of the home. We visited the home and talked with residents, staff and the manager. We checked medication storage and a sample of administration records, toured the premises to check on health and safety matters, and viewed a range of documents and policies Care Homes for Older People Page 6 of 25 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 7 of 25 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 8 of 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is good information about the home to help prospective residents decide if it is where they want to live, and the homes admission procedures ensure their needs can be met there. Evidence: There is a statement of purpose and service users guide which give good information about the services and facilities the home offers. People who completed our survey told us they received enough information about the home to help them decide if it was right for them. Residents also receive a contract that sets out the terms and conditions of their stay there, and the fees payable. We checked the files for two recently admitted residents which showed us their needs had been fully assessed before they were admitted to the home in addition to assessments completed by the local primary care trust Care Homes for Older People Page 10 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health care needs are met at the home. Evidence: We checked the care plans for three residents which were generally well written, with detailed information for staff in what must be done to meet residents individual needs. We checked the care plans for one resident with type 2 diabetes and found that there was good guidance for staff in what they must do to manage it. In particular, we noted good risk assessments in place for one resident with Parkinsons disease. Residents health was monitored, and we noted that their dependency levels, nutrition and weights were reviewed monthly. We checked care records (including food and fluid intake charts, and elimination records) in two residents bedrooms. These had been completed regularly to ensure residents health was monitored. However records we viewed showed that one resident was not receiving quite enough fluid to keep him properly hydrated. We spoke to one visiting nurse who told us she received appropriate referrals from staff, and that staff were good at identifying skin blemishes early. Care Homes for Older People Page 11 of 25 Evidence: We saw that one resident had a nasty bruise on her face. We checked her records which showed that it had been properly recorded and dealt with. The home has appointed a specific dignity champion to ensure residents are treated with respect. However, we noted one resident with unsightly chin whiskers that needed removing and another whose hospital tag had not been removed from her wrist. We heard one member of staff repeatedly calling residents: pet, darling, honey bunch and sweetheart, rather than using their correct names. We checked medication storage and a sample of residents medication administration records on Magnolia Unit. These were satisfactory with staff signing clearly and accurately when residents received their medication. There have been improvements since we last visited: the date on which liquid medication bottles are opened is now recorded, and the amount of medication recorded on the MAR sheets tallied with the number of tablets actually in stock. We saw that the temperature of the storage area was regularly recorded and each resident had their photograph to help identify them. However, we noted that a number of handwritten additions to the printed MAR sheets had not been signed, dated or checked by a second person to ensure their accuracy. There was also some confusion about which staff should sign for creams that were applied to residents, causing them to be signed for twice on some occasions. Care Homes for Older People Page 12 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have access to a range of activities to keep them stimulated. Mealtimes at the home are pleasant and sociable. Evidence: The home employs 2 staff with specific responsibilities for providing activities for residents, and forthcoming events are advertised round the home. In the last month there have been a range of activities for residents to participate in such as baking, church services, a VE Day celebration, visiting musicians, soft ball games, flower arranging and doll therapy. The home has trained some staff to undertake specialist Montessori activities with residents to improve their remaining abilities. Despite these events however, a visiting nurse felt there should be even more for residents to do. Staff support residents to keep in touch with their relatives and two relatives we spoke to told us that staff were good at letting them know what was happening with their loved ones. One told us: staff are on the ball and if dad falls they ring straight away. We took lunch with the residents so we could observe how staff interacted with them and also check on the quality and choice of food. Lunch was a pleasant and calm affair: residents did not wait too long for their food and were given plenty time to eat Care Homes for Older People Page 13 of 25 Evidence: it. Those that required assistance were given it sensitively. Lunch on the day we visited consisted of steak and kidney pudding or Cornish pasty with carrots potatoes and Brussel sprouts and was tasty and nutritious. However it was served fully plated up(including gravy) thereby denying residents choice in what and how much they ate. This practice is a little institutionalised. We noted that additional snacks such as chocolate and crisps were offered to all residents with their morning tea ensuring they received lots of calories Care Homes for Older People Page 14 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents complaints are responded to appropriately and their well being is safeguarded. Evidence: The complaints procedure is available in the homes statement of purpose and service users guide and is also well advertised around the home. People who completed our questionnaire stated they knew how to make a complaint and felt that the home usually responded appropriately when they raised concerns. We looked at the details of one complaint received concerning a number of alleged shortfalls. These had been investigated thoroughly by the manager and the complainant responded to in writing. We have attended two adult protection meetings in the last year concerning the quality of care for some residents. Although not all the allegations were upheld, some have been highlighting shortfalls in the homes practices. The manager has always responded promptly and effectively to these shortfalls, quickly implementing measures to rectify and improve care practices. There have been a number of incidents of aggression between residents and one social worker told us that staff always reported these and dealt with them appropriately Care Homes for Older People Page 15 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a comfortable, interesting and stimulating environment. Evidence: There are many excellent aspects to the design of the homes dementia units. There are a number of themed areas such as a bus stop, a garden and a beach offering residents stimulation. Long and uninteresting corridors are decorated with fiddle boards and interesting displays to engage residents. A nurses station has been transformed into a pleasant seating are for residents to use. There is a doll therapy area in the downstairs lounge thoughtfully furnished with a cot high chair changing mate etc. We viewed one resident putting her baby to bed in the cot. The garden too has been well though out to meet the needs of people with dementia. It contained memorabilia items, attractive seating for people to rest, and a circular walking path so that residents could wander safely without getting lost. The garden area was easily accessible to residents via patio doors on the ground floor and easily visible from the main lounge so that staff could watch residents unobtrusively. There is also an allotment area where residents can grow vegetables. The home has recently purchased chickens which residents help look after. Two people who completed our survey told us that the cleanliness of the home was sometimes lacking. However we found it to be generally clean and hygienic on the day Care Homes for Older People Page 16 of 25 Evidence: we visited, with no strong smells. We talked to one member of the domestic staff who showed a good knowledge of the extra precautions needed to assist someone with MRSA. The entranceway to the home contains helpful information sheets for relatives and visitors about the many different types of dementia Care Homes for Older People Page 17 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive their care from competent staff who have been recruited safely. Evidence: One relative told us: staff are friendly and very caring towards service users and also the family. One district nurse reported that:the senior care staff are very good. There are a minimum of eight care staff (and often more) on duty to meet the needs of 44 residents currently. They are supported by domestic staff, activities cocoordinators and a manger. Staff we talked described staffing levels as OK and that they had time for individual work with residents. However one relative told us that sometimes staff seemed very rushed. The use of agency staff has reduced significantly which staff we spoke to clearly appreciated, one reporting: everyone knows their job now. We checked the training files for three members if staff which showed they had undertaken relevant training for their role. Staff told us they received regular training which they found useful. We checked the personnel files for two recently appointed members of staff. Each file contained an appropriate application form, interview notes, and evidence that satisfactory references and CRB checks had been completed before they started Care Homes for Older People Page 18 of 25 Evidence: working at the home. Staff we spoke to reported that their recruitment had been fair and thorough, and that they had received an induction to their new job Care Homes for Older People Page 19 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a well managed home. Evidence: The manager has successfully registered with us since our last visit. She has wide experience of running homes for older people and holds NVQ 2,3 and the level 4 registered manager s award. She has recently undertaken a course in dementia care mapping. One local social worker who knows the home well told us: I cant fault the management, they have worked really hard to change things. One staff member commented about the manager:if something needs done, shell do it another stated :she is approachable and her door is always open for a knock and moan session. Staff told us they received regular supervision with their line manager and files we checked also evidenced this. We checked the minutes for recent staff meetings, and also residents and relatives meetings which provided good opportunities for people to raise concerns. There is also a regular newsletter to inform residents and their visitors what is going on in the Care Homes for Older People Page 20 of 25 Evidence: home. Details of forthcoming relatives meetings are advertised on the main notice board in the entrance to the home, as is a poster detailing the managers surgery times. The home is regularly audited by external staff from Southern Cross to monitor its standards and we viewed two recent and thorough audits of the homes medication and care practices. There are also surveys available for relatives and health care professionals who visit the home to seek their views on the standards of care provided. We viewed a number of these which showed overall satisfaction with the service. The home holds money for some residents. We checked a sample of records which showed that proper accounting procedures and receipts were kept for money that was spent on their behalf. We checked a number of records in relation to health and safety (including water temperatures lift and hoist servicing) which showed us the home regularly checks and maintains its equipment to ensure its safety. The homes kitchen has been awarded four stars ensuring that residents food is prepared in a safe and hygienic environment Care Homes for Older People Page 21 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Hand written additions to 01/07/2010 the printed MAR sheets must be signed, dated and checked by a second person. You must do this to ensure their accuracy and so that residents receive their medication as prescribed. 2 9 13 Only the person who 01/07/2010 administers topical applications to residents should sign to say they have done so. You must do this to ensure there is an accurate record of who has administered what to residents 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 10 Residents should be called by their preferred name of Page 23 of 25 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 choice. Care Homes for Older People Page 24 of 25 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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