Care Home: Dovecott Care Home

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What the care home does well Staff are always friendly and open about the care they give to people in the home and how they view their working life. The Owners ensure that suitable checks are made to ensure they are safe to work with people in the home and are then trained and supervised to do their jobs. Staff ensure that people are adequately assessed and the home can meet their needs prior to admission. They then keep accurate records on events which have occurred which concern them in the home, what their daily lives consist of and who has been involved in their care. This ensures they are safe and free from harm. Audit checks are made to ensure the building is a safe place in which to live in work. What has improved since the last inspection? The staff now ensure that CQC is notified about all significant incidents and events which occur in the home so we can make a judgment as to whether the correct action has been taken. The Owners have now produced an annual development plan which shows us how they are looking after their business and what plans they have for the future. More accurate records are now kept on peoples personal allowance money and show accurate recordings of when money is used and what items purchased. What the care home could do better: There have been no requirements made at this inspection. Key inspection report Care homes for older people Name: Address: Dovecott Care Home 83 Weelsby Road Grimsby North East Lincs DN32 0PY     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: Theresa Bryson     Date: 0 5 0 3 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: Dovecott Care Home 83 Weelsby Road Grimsby North East Lincs DN32 0PY 01472878133 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: r.farenly@ntlworld.com Mrs Rita Ethel Farmery,Mr Stuart Peter Farmery care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Care plans and risk assessments must reflect the specific needs of the service users accommodated under the category of registration DE(E) and be maintained up to date. Date of last inspection Brief description of the care home Dovecott provides care for 20 people in the category of old age and dementia. The accommodation is set over two floors. The home has completed a first floor extension providing a further 7 single ensuite rooms and reconfiguration of an existing double bedroom into a single ensuite bedroom. The home is set close to the centre of Grimsby and local parks and other amenities. There is parking to the rear of the building and in side streets next to the home. The owners are developing the garden area and courtyard for service user use. The home has 3 communal areas including a dining room and service users can smoke in a designated area. There are ample toilet and bathroom facilities. Domestic and kitchen staff and a handyman support the care staff. Extras to fees include hairdressing, chiropody and toiletries charges, which are based Care Homes for Older People Page 4 of 25 Over 65 20 20 0 0 Brief description of the care home per item. The home will accept local authority funded persons and privately paying individuals. Fees are reviewed annually. Information on the home is provided by a service users guide and statement of purpose, which is available on request and is given by hand or sent to prospective service users andor their relatives. 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: This inspection took place over one day in March 2010. Prior to this we sent out a number of survey forms to people living in the home, relatives, staff and health and social care professionals. We also spoke to some health and social care professionals prior to the visit and immediately the site visit was concluded. The service sent us their Annual Quality Assurance Assessment prior to our visit which told us what improvements they had been making and what they hoped to do for the future. It also gave us a lot of statistical information. On the site visit day we spoke to some people who live in the home, this was limited as the majority of people could not make informed decision to speak to us. We also spoke to some staff on duty and visitors in the home. The Registered Manager was present through out the inspection and was joined at one point by the second owner. 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. 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 7 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 8 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. People are assessed prior to admission to ensure the home can meet their needs and people have information about the home which details the services the home can provide. Evidence: Since the last inspection the management team in the home has reviewed its Statement of Purpose and a copy was seen at the site visit. This now gives up to date information about the home, its staff, what is included in the fees charged and the services the home provides. This gives people the opportunity to make informed choices about whether the home can meet their personal needs. We looked at the care plan of the latest admission to the home and the preassessment tool was very comprehensive and gave an holistic view of the persons immediate needs. This is then used as a basis for a more detailed plan of care to be formed by staff to address current needs. People told us they had found it comforting that staff knew so much about them on their admission. Care Homes for Older People Page 9 of 25 Evidence: Senior staff have now been trained to undertake pre-admission assessments, as well as the manager so people can be admitted at any time and not have to wait for the managers approval. The home does not provide intermediate care and therefore Standard 6 is not applicable. 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. Peoples care plans are evaluated regularly to ensure they reflect their current needs and they are helped to remain free of risk and harm and to maintain as much independence as their conditions allowed. Evidence: Prior to the site visit for this inspection we sent out a number of survey forms to people living in the home, relatives and staff and we had over three-quarters returned. All of them made very positive comments about the care that was being delivered, the kindness of the staff and the times that the management team had helped them with decisions. We also spoke to several health and social care professionals prior to our visit by telephone who also spoke highly of the knowledge base of staff and their kind attitude toward people Dovecott staff look after. Staff should be commended on their hard work, with the management team, in putting together a more comprehensive set of care documentation to reflect peoples current needs who live in the home. When speaking to staff at the site visit, they all had a clearer understanding of how to document and plan peoples care and appeared to have truly embraced this part of their work. Senior staff now have responsibility for Care Homes for Older People Page 11 of 25 Evidence: checking each care plan on a regular basis and the audit sheets seen had been clearly written, and where necessary clear action plans written. We tracked three care plans of people with complex needs. The evidence had been clearly written and there was recorded evidence of when each care plan had been evaluated. There were also notes in the files about specific problems people were presenting with; for example reference to sleep apnoea and radiotherapy treatment. This is used, staff told us, as guidance when looking after those people. There was much better follow through for specific needs of people. For example for someone with memory loss, an initial core care plan had been developed after admission. Then specific risk assessments identified such as physical aggression, which detailed how staff can cope with these outbursts and details of what appeared to work best for that person to allow them to remain calm and not put themselves or others at risk of harm. In another example, a person who had a tube fitted to aid their digestive processes had a care plan explaining the reasons why it was there, when it could be used and how staff were to continue allowing the person to receive a diet by mouth at the moment. Other records in the care plan file detailed assessments by other health care professionals, visits by health care professionals as well as out patient and in patient appointments at the hospital. The core care plan also detailed how the persons weight, skin integrity and other health care needs were to be monitored by staff. We spoke to staff about this persons plan of care and they were able to verbally give us an accurate account of how the care was currently being managed, which was reflected in the care plan. In another care plan, a person with dietary problems not only had a core care plan, which was being evaluated regularly but also a specific assessment about their nutritional intake, the reasons why they were being weighed at the GP surgery but also a specific care plan about their skin integrity and mobility. Which in this case appeared to be important to their overall well being and allowed staff to limit the risk to this person of them becoming ill. In the surveys returned to us and on speaking to visitors and people living in the home during our site visit they all were able to detail how often they see their individual care plans and if they had agreed to what is written. During the day we were able to observe staff assisting people with a number of personal tasks such as personal hygiene tasks, using the toilet and preparing for a meal time. Each time, every staff member was calm in their approach, allowed the person to express their wishes and listened to those wishes and generally gave encouragement to maintain an independent lifestyle. We looked at the drug administration records, which had markedly improved. There was now an audit sheet, completed by senior staff, which was more regularly used. This gave clear instructions to staff where necessary changes and improvements Care Homes for Older People Page 12 of 25 Evidence: needed to be made. We observed some medication being given and safe practices appeared to be used and storage facilities were safe and secure. Care Homes for Older People Page 13 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. Peoples social, religious and cultural needs are being made through a variety of events both inside and outside the home. Evidence: During a tour of the home we inspected a selection of peoples individual bedrooms and there was ample evidence that they had been allowed to personlise them to their taste and needs. For example one person liked to have lots of pictures of their family, whilst another liked soft toys displayed as mementos of events. One person told us how this had helped them settle into the home. When we looked at the activities book this was more detailed and reflected not only group social activities taking place but also one to one sessions. For example when someone went shopping. Group events included topics such as favorite films, music and motivation, board games and craft sessions. Staff were also in the process of completing photo histories of some peoples time whilst in the home. This is often given to relatives after a person is passed away. The management team and staff have developed a memorabilia room which was full of artifacts. A recent day event to launch this idea, staff and people resident in the home told us, had been a success. A great deal of effort had been put in to seeking outside interests for people living in Care Homes for Older People Page 14 of 25 Evidence: Dovecott and staff appeared to have a better understanding of have to access community links. A reminiscence group happens on a regular basis and the person giving motivation therapy gives the home a progress report, which we saw. For Easter the home was in the process of purchasing an incubator to hatch some chicks, which people told us they were looking forward to and is helping them focus on the correct time of year. Three staff are commencing a new distance learning course called Active in Age which they feel will enhance their role. When both a morning and afternoon activity were observed staff approached people in a calm manner and encouraged them to take part. The whole atmosphere in the home during our visit was light and friendly and people appeared happy. In the surveys returned to us and when speaking to people each person commended the meals. Making such comments as really good home cooking and always a choice of meals. Some people said how well food was presented and every one told us they were never hungry. We made a brief tour of the kitchen and saw that food was being prepared in a clean and safe environment. The last environmental health officer had awarded the home 3stars, which is a good rating, for standards of hygiene in the home. We observed the lunch time meal, which was presented in a calm manner and staff were seen to give encouragement to those who required assistance. Care Homes for Older People Page 15 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. A robust system is in place to ensure people are protected from abuse. Evidence: Since the last inspection no concerns about the home had been made to CQC and the homes own log book which we saw also recorded no concerns made. The home also has a niggles book for what is considered more minor concerns such as curtains being cleaned but this was also empty. The policy manual has been reviewed and staff were able to tell us how to refer concerns of both a minor and more serious nature. People living in the home who we spoke to told us they had every confidence in the management team in dealing with concerns, should they need to raise any. The last time staff attended any training on how to protect people from abuse was in January 2010. This ensures staff are aware of what constitutes an abusive situation and how to respond and refer matters, should the need arise. We discussed with the senior management team the position of one staff member who had previously been the subject of an investigation, but this matter had been resolved and the person longer worked at the home. The management team and senior staff have become more professional in their approach in sending Regulation 37 notices. Details were given by the inspector of how this could be enhanced further. We tracked one persons details of an event which had occurred and found all the information to be correct. Care Homes for Older People Page 16 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 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 safe and secure environment suited to their needs. Evidence: During our site visit we were able to tour the home and grounds. A lot of work has been completed to the entrance to the home and the main garden area. This has included more colourful flower beds and raised flower beds so people living in the home can assist staff in maintaining the garden area. All parts of the garden area are accessible to wheel chair users and during our visit were free from hazards. When the Company had returned their Annual Quality Assurance Assessment (AQAA) they had detailed items of equipment which had been purchased. This included beds, bedding, crockery, carpets, curtains and towels. When touring the home these were all in place. We could also see that some bedrooms had been completely redecorated and also a sitting room area. Generally the home looked less cluttered and had a very homely feel. People living there told us we like living here, its home from home and also made comments to us such as its not run like a business, its a truly family atmosphere and we only choose this home because of how comfortable it looked. We looked at all the safety equipment certificates such as hoists, stair lift and fire fighting equipment. These were all valid. The management team also completes a Care Homes for Older People Page 17 of 25 Evidence: monthly audit and we saw these sheets. They also detailed when water temperatures are checked and make general comments about the environment. This ensures that any hazards and problems can be quickly identified and actioned. Care Homes for Older People Page 18 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. A robust recruitment process is in place to ensure staff are safe to look after people living in the home and are then trained to do their jobs. Evidence: When surveys were returned to us and when we spoke to people living in the home every one made positive comments about how staff look after them. Saying very caring and staff maintain high standards all the time. Relatives and health and social care professionals who visit the home told us how knowledgeable staff are about the people living there and that they keep all parties well informed about events which happen. No one indicated that their needs were not being met. We saw all the staff rotas and at the time of our visit there were no staff vacancies. Staff completing surveys and who we spoke to made positive comments about working in the home. They told us they felt there were sufficient staff on duty for them to meet peoples needs and felt moral was good and we help each other out and that they enjoy coming to work. Staff were very open and frank with us during our visit and the whole atmosphere in the home was friendly and welcoming. We tracked three staff personal files in depth and found them to to have sufficient written evidence to show that adequate checks had been completed prior to their commencement of employment to ensure they were safe to work with people in the home. Staff also made comments to us about the extensive amount of training the Company Care Homes for Older People Page 19 of 25 Evidence: has put in place to ensure they understand their job roles and have the knowledge base to look after people. We saw written evidence that new staff had completed the homes own induction package and continued the Skills for Care sessions. There was also written evidence to support that staff had attended courses in topics such as infection control, dignity in care, end of life care processes and the Mental Capacity Act. This ensures they have the skills to deal with problems of people currently living in the home. Some of the management team and senior staff have also been assisting with local projects such as infection control projects and attending meetings such as for the winter flu crisis. Other health and social care professionals told us senior management team members attend local meetings to enhance their knowledge base and also to contribute to the general picture about health care needs of older people in the community. Staff told us they had enjoyed attending these events which has helped them liaise with other community groups. Care Homes for Older People Page 20 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. People are consulted about the environment they live in, about their care needs and are looked after by suitably qualified staff who audit all processes to ensure people are safe and free from harm. Evidence: Since our last inspection the recording of events in the home, the quality assurance records and generally all paper records have been more professionally presented, recorded and persevered. The senior management team have kept us informed of events in the home and have liaised with us over important steps they have wanted to take to enhance the lives of people they look after. The Owners, Senior management team and all staff should be commended for their hard work. There was documented evidence of how staff are consulting with people who use the service and people living there told us that they are frequently asked their opinions about life in the home. They and relatives told us how they are consulted about their care plans and there was written evidence to support this consultation process. We also saw the Company business and continuity plan and their annual development Care Homes for Older People Page 21 of 25 Evidence: plan which details how they had audited the home through out the year and their plans for the future. The last surveys, we saw, had been sent out in December 2009. This ensures the home is aware of peoples needs and can respond quickly to ensure the home is being run for their benefit. We tracked three peoples personal allowance records and found them to be accurate. The Company may benefit from an audit check being made regularly to ensure records are accurate as only limited numbers of people control this aspect of the homes record keeping. We also tracked some staff supervision records and found a great improvement in the content of these records and frequency of sessions occurring. There was now a balance between discussion with staff and observational supervision. This ensures senior management are aware of how well staff are completing their job roles and where necessary can put action into place to ensure they are supported. We also saw written auditing documentation to show the Company is ensuring the home is a safe and comfortable place to live. This included fire checks, infection control policies in place and guidance for staff on how to perform practical tasks for people living there. Care Homes for Older People Page 22 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 23 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 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 35 As the personal allowance fund is managed only by a small group of people it would benefit from being audited by an independent person occasionally to ensure there all entries are correct. 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. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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