Care Home: Dower House

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What the care home does well People moving into The Dower House can be confident that staff will be able to meet their needs. This is because they are involved in their assessment, before they are offered a place. The home has experienced staff who are trained in meeting the needs of older people. A resident told us that the home `Provides excellent caring services`. People can be confident that they will be involved in planning their care so staff know how they wish to be supported and they are offered choices. Residents, relatives and staff feel there is a homely environment for people to live in. People can be confident they will be offered a choice of meals that they will enjoy and meets their dietary needs. What has improved since the last inspection? The owner and staff make small improvements to the service that they offer to residents continually. These changes may not be huge but they feel that the small things make a big difference. What the care home could do better: The owner of this service has a good awareness and understanding of what they want to achieve and how to do this including involving people who use the service. The sequence of care plan recording could be better, so staff show that their train of thought regarding assessment, care delivered to meet needs and evaluation is more obvious to the reader. The provider should consider formalising a system for quality assurance within the home. Quality monitoring of the service requires further development in order to formally gain the views of the residents and their representatives and continue to improve the overall service. Key inspection report Care homes for older people Name: Address: Dower House Dower House Henley Ludlow Shropshire SY8 3HB     The quality rating for this care home is:   three star excellent 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: Pat Scott     Date: 1 7 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 20 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 20 Information about the care home Name of care home: Address: Dower House Dower House Henley Ludlow Shropshire SY8 3HB 01584873456 01584879529 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Elizabeth Mary Owen Name of registered manager (if applicable) Mrs Linda Ann Williams Type of registration: Number of places registered: care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 5 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category (OP) 5 Date of last inspection Brief description of the care home The Dower House is set in the village of Henley, within the grounds of Henley Hall. The home benefits from being situated amidst beautiful surroundings, close to the town of Ludlow, making it well placed for access to all local amenities. Originally built as the Dower House to the country estate the property has been sympathetically converted to provide accommodation on one level, comprising 5 single Care Homes for Older People Page 4 of 20 Over 65 5 0 Brief description of the care home bedrooms (3 with en-suite facilities), spacious communal living area of lounge / dining room, with access through french windows to an attractive and well-maintained garden. Care Homes for Older People Page 5 of 20 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: three star excellent 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 is a key inspection for The Dower House. This inspection site visit provided an opportunity to find out how peoples developing care needs are being met, together with the services plans for improvement. This report draws on information received from the home in their Annual Quality Assurance Assessment, which is a self-assessment process that requires care services to record how well care outcomes for the people living in their service are being met as well as providing a range of statistical information about the service. We also looked at information we have about how the service has managed any complaints and responded to safeguarding referrals. We reviewed what the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. Care Homes for Older People Page 6 of 20 We reviewed the previous key inspection outcomes and annual service reviews. We gathered relevant information from other organizations such as the Environmental Health Office (EHO), Health and Safety Executive (HSE) and the Fire Safety Officer (FSO). We spoke with people about their experience of care and reviewed their care plans. One Regulatory Inspector carried out this inspection over 2 hours. Care Homes for Older People Page 7 of 20 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 8 of 20 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 20 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessment process for this service is thorough so that people experience safe and appropriate care that meets their needs and protects their rights. Evidence: The two assessment records reviewed relating to new admissions centred on these people as individuals and considered all aspects of their immediate and longer term needs. Risks had been identified and statements written as to how these will be managed and reviewed. Care Homes for Older People Page 10 of 20 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The records for administering medicines do not show that people who use this service have their medicines at the time they need them. Peoples rights and choices are promoted as they state they are clearly involved in identifying their care treatment and support options. Evidence: Review of medication records showed that medicines are not always signed for when given, but a resident confirmed that they get medication at the right time. Medication is reviewed and changed as peoples needs or condition changes. Staff are trained to monitor the effect of medication. Discussion with the owner identified that there are clear procedures which she will ensure are followed in practice in that staff are regularly supervised. Basic plans are in place which are followed by staff and people tell us that they get the care and support that they need in a way they prefer. Staff identify where a person is at risk of poor nutrition or dehydration and are swift to take any action necessary. Discussion with staff identified that they know what a balanced diet is and those Care Homes for Older People Page 11 of 20 Evidence: involved in food preparation have had relevant training. Care Homes for Older People Page 12 of 20 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. The service promotes peoples well-being by taking account of all their needs including social and daytime activity The service provides choices of food and drink so that people have a nutritionally balanced meal which supports their health. Evidence: The resident we spoke with stated that the meals were very nice and they enjoy a variety of foods. Staff are aware of their likes and dislikes and plan meals accordingly. People told us they were able to spend their day in a way that they prefer. They said that staff respect their wishes about whether to engage in any pursuits. Care Homes for Older People Page 13 of 20 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. Staff are regularly trained in adult protection so that people are protected from the risk of abuse. The service has a good complaints system so that people can be sure that their comments and complaints are listened to and acted on effectively. Evidence: The service has not received any complaints or had to make any adult protection referrals over the last three years. Staff spoken to are fully aware of the systems in place to deal with comments and complaints. The service encourages and supports a culture of openness that ensures people are able to speak about their concerns if any should arise. Comments in our surveys showed that people would be happy to talk to staff if they had any concerns. Care Homes for Older People Page 14 of 20 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The owner ensures that the premises are well maintained so that people who use services and others who work in or visit the premises can be confident that they are safe. Evidence: This is a small home on one level. The owner ensures that relevant legislation is met regarding safety and fire. People living here tell us that the premises are spacious, warm, pleasantly decorated and very comfortable. Care Homes for Older People Page 15 of 20 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 supported by a long serving staff team that have been selected for their suitability to work with vulnerable people and receive the training and supervision they need to respond to peoples diverse and changing needs. Evidence: There are sufficient numbers of staff with the right competencies, knowledge, qualifications, skills and experience to meet the needs of people who use the service at all times. Discussion with staff showed that they know the needs of people and can respond to changing circumstances. The AQAA informed us that all mandatory training is in place. Staff are supervised and encouraged to acquire further skills and qualifications that are relevant to the work they undertake. Care Homes for Older People Page 16 of 20 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident in the services provided at The Dower House because the home is well managed and takes account of their views. Evidence: The owner provides effective leadership and management of the home based on providing good outcomes for the people who live there and involving their relatives. A person told us there is a genuine commitment from the owner to listen to what people say about the home, ideas are acted upon and people provided with feedback. The home has a good history of meeting the required standards and providing excellent outcomes for people. However, there is no formal quality assurance system in place and the owner relies upon day to day rapport with people. Care Homes for Older People Page 17 of 20 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 18 of 20 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 Care Homes for Older People Page 19 of 20 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. © 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. Care Homes for Older People Page 20 of 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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