Care Home: Downham Grange

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What the care home does well Observations at this time did show that staff consider the dignity of people living in the home. The preferences of residents were asked and people chatted and laughed with the staff. One resident said that staff are kind and are always there when needed. While eating lunch another person said that they had more than enough to eat and that their appetite is good. The staff supported people in an appropriate manner and without rushing anyone. On the day of the inspection the meal looked and smelt appetising and residents were enjoying their meal. New staff are appropriately inducted into their role and have training that enables them to provide support to residents. Staff confirmed this and also said they are fully supported by the manager and have regular supervision and training. Two staff members said that the staff team work well together and support each other. What has improved since the last inspection? All previous requirements have been addressed and care plans have been developed to reflect the choices and wishes of residents. The adjustments to the environment have also been completed, including redecoration and refurbishment, presenting a comfortable and suitable home for those living at Downham Grange. What the care home could do better: The manager must ensure that medication records are checked regularly and staff competences assessed to ensure the safety of residents. An alternative area for staff to undertake telephone calls and confidential paperwork would ensure confidentiality is maintained at all times. Risk assessments are to be completed on care plans for all areas that may pose a risk to residents and any identified risk is to be minimised. Key inspection report Care homes for older people Name: Address: Downham Grange Clackclose Road Downham Market Norfolk PE38 9PA     The quality rating for this care home is:   one star adequate 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: Brenda Pears     Date: 2 7 1 1 2 0 0 9 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 26 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) 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Downham Grange Clackclose Road Downham Market Norfolk PE38 9PA 01366387054 01366385861 helenforsyth@kingsleycarehomes.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Kingsley Care Homes Ltd Name of registered manager (if applicable) Mrs Helen Forsyth Type of registration: Number of places registered: care home 28 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: 28 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Downham Grange, formerly known as Clackclose House, is a registered care home, providing personal care and accommodation for up to twenty-eight older people and is owned by Kingsley Care Homes Limited. The home is located in the market town of Downham Market and is close to shops, pubs, the post office and other local amenities. Downham Grange is a two-storey building and accommodation is provided on the Care Homes for Older People Page 4 of 26 Over 65 28 0 2 6 0 1 2 0 0 9 Brief description of the care home ground and first floors. The home has eight double and twelve single bedrooms, the majority of which have en-suite facilities. There are two passenger lifts. The home has extensive gardens that are well maintained and easily accessible. The fees vary according to the individual needs of the person and the staffing levels required. Additional charges are made for items such as hairdressing, private chiropody, newspapers and personal toiletries. Further information about the fees and a service user guide can be obtained by contacting the home direct. A copy of our inspection report is available on request from the home or via our website www.csci.org.uk Care Homes for Older People Page 5 of 26 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: one star adequate 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 was an unannounced inspection undertaken on the 27th November 2009 and started at 10.00am. The focus of this inspection was on the previous requirements, on the core national minimum standards and on the quality of life for people who receive support in the home. The methods used to complete this inspection consisted of looking at the care a resident receives and the records that support this. Information was provided to us by the home on an assessment form known as an Annual Quality Assurance Assessment (AQAA). During the visit to the home we spoke to the manager, with members of staff and also with five residents. These methods and previous findings all inform the outcomes of this report. Care Homes for Older People Page 6 of 26 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 26 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 26 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 do receive full information about the home and assessments are completed to ensure needs can be met before a permanent move is undertaken. Evidence: A full assessment is completed to ensure the needs of the resident can be met by the home. We were told by residents at this inspection, by those who were able to make a comment, that they felt they had enough information to make a decision about moving into the home. They also told us that appropriate discussions were undertaken before they came into the home. Care Homes for Older People Page 9 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans have been developed since the last inspection and contain information and details of the support needed. However, current routines regarding medication do not ensure the safety and well being of residents at all times. Evidence: Care plans were not in a lockable cupboard at the time of this inspection and the manager stated that this was being addressed and files will be locked away as soon as possible. A new format for care plans has been developed and we looked at five care plans. One was using the old format and all others were in the new format that contains sections and information that includes such areas as likes and dislikes, choices for going to bed and getting up and personal hygiene needs. Guidance for staff included comments for ensuring reading glasses are cleaned regularly, goals for the resident and things to aim for. Discussions were undertaken at this inspection regarding further information for staff supporting people who have a visual loss, as there are currently two people who have limited sight living in the home. Care Homes for Older People Page 10 of 26 Evidence: We looked at the incidents of falls in the home and these were fully documented and we were able to track this information in the hand over book and the daily records. Review dates for care plans were recorded and signed on all but one of the care plans we read. The pre admission assessment is clearly set out and a summary of needs is also on the care plan to allow ease of access for staff. The manager showed us the system used to monitor any records of a person having a fall in the home and how a pattern is identified. We saw completed assessments regarding the skin integrity and nutritional assessment for the resident on each care plan. The staff working area and telephone is in the main entrance lobby. When we entered the building there were papers regarding areas of care and details of medication left on the desk. Some discussions are also undertaken in this area that has the main door leading to the front of the building plus two other doors leading to the dining room and resident rooms. While the manager stated that doors are closed at all times, we were talking at this desk and visitors were being let into and out of the building. The doctor arrived and also had to walk through this area while we were discussing matters. If a member of staff was on the telephone and discussing any area of care, this would be overheard. At the time of this inspection a representative from the local primary care trust (PCT) was undertaking an audit of medication records in the home. The areas discussed following this autdit were that balances of medication had not been carried over onto a new sheet. The manager stated that the senior member of staff who usually does this had been off work and staff had not carried balances forward onto new records to provide an audit trail. Other observations were that staff had not always written if one or two tablets had been administered with such items as pain relief. When medication had been adjusted or stopped, this must be accompanied by two signatures at all times supported by confirmation from the pharmacy. This was discussed in depth with the manager at this time. Medical administration records (MAR) sheets were otherwise found to be clearly completed and records were accompanied by a picture of the resident. One prescribed medication had not been given by staff although this was on the medication administration record (MAR) sheet. It is noted that this was not vital medication and did not therefore have an adverse outcome on this occasion. Medication to be given is highlighted with a bright colour and this particular medication had not been highlighted. It is assumed that staff thought this was no Care Homes for Older People Page 11 of 26 Evidence: longer prescribed as records do contain details of medications that have been discontinued. We discussed and reviewed all this documentation with the PCT and the manager. Discussions will be undertaken with the local pharmacy regarding the continued practice of printing medication that has been discontinued. We looked at the storage area for the medication that has been moved to a cooler area. While this area is not ideal, the choices are limited in the home and medication is securely stored and temperatures monitored. Care Homes for Older People Page 12 of 26 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. Activities and a choice of meals are provided and family and friends are welcomed into the home. This ensures that residents have a choice regarding how they spend their time. Evidence: We spoke to residents at lunch time and in their rooms. Comments included that enough food was provided and one person said they could not eat any more than was given and they have a good appetite. There is no cooked breakfast offered at any time but a choice of cereals, toast, juices and hot drinks are available. Those people we asked said they enjoy breakfast and can have as much as they like. The lunch looked and smelt appetizing and portions were as large or small as the resident chose. This was a relaxed meal time and staff were considerate and did not rush anyone. Two people were observed when staff assisted with their meal and again staff acted with consideration and at the pace the person needed. A new cooker is currently on order and checks of temperatures for cooked food, fridge and freezer are recorded. All staff handling food have completed their food hygiene Care Homes for Older People Page 13 of 26 Evidence: training. The staff dealing with meals do a good job considering the small amount of space in the kitchen area. Residents told us that family and friends visit when they choose and are made welcome into the home. There are regular meetings for residents and these are minuted and points to be actioned are recorded. Discussions at this time confirmed that a resident can stay in bed if they choose, although staff do encourage people to mix a little and not become isolated. One resident explained this and said that they choose how they spend their time and that staff are always helpful. Activities provided include bingo, crafts, cards, pamper days and hand massage. Discussions are also undertaken in groups or with individuals. The manager explained that staff also try to include residents in small jobs in the home, such as sorting their clothes and deciding where these are stored. At Christmas the local school choir is coming into the home to sing carols, there will be a party for residents and their chosen family and friends will be invited. The cast of a local show are also attending to perform for the residents. All activities are recorded under the individual name of each resident to show who attends and enjoys certain activities. Care Homes for Older People Page 14 of 26 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. There is a complaints procedure on display and previous issues that have arisen have been dealt with appropriately. Evidence: There are details of how to complain on display in the main entrance hall. Residents and staff told us that they feel confident to discuss any matters with senior members of staff. A previous matter was appropriately directed to the local safeguarding team at social services and agreed actions undertaken. Staff receive training regarding the protection of adults and expressed a thorough knowledge of safeguarding, dignity and choice when discussing their work and routines with us. However, as set out in the staffing and management section of this report, the policies and procedures must be current to fully support the safety and welfare of residents and staff. Care Homes for Older People Page 15 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home continues to be improved with ongoing redecoration and refurbishment, providing a comfortable and suitable environment for people. Evidence: The previous requirements regarding the environment have been completed. The manager told us that all fire safety alterations have been completed and meet with guidance. The emergency lighting in the home has been replaced and major repairs have been completed to the roof. New carpet has been installed where needed and a few residents have chosen not to have their room re carpeted. This is mostly due to the fact that they would have to move their belongings and also leave their room while this is completed. The manager told us that these rooms will be addressed if a resident moves to another room. Lighting has been improved around the home with replacement and also changing the strength of some bulbs providing additional light in most areas. When we looked around the home we found the dining room was brightly presented with the menus displayed on each table and a choice of meals listed. Individual rooms are brightly decorated and comfortably furnished. Each room contained personal possessions and reflected the type of person using this area. Care Homes for Older People Page 16 of 26 Evidence: Discussions were undertaken at this time regarding the use of towels in the communal bathroom and toilet areas. To comply with infection control, guidance states that some form of disposable towel is to be used. The manager said she would order dispensers for this immediately. We have therefore not made this a requirement in this report. It is noted that there were pump soap dispensers in communal areas except for one, that had a bar of soap. The manager again said this would be moved immediately. A number of rooms contained prescribed medication creams and in some cases, the amount was quite large. Such medication must be stored appropriately and the dignity of the resident must be considered. Where toiletries and other personal items are on display, these must be risk assessed and clearly be documented on care plans. This is for the safety of all residents assessing the risk that may be posed if these products are used incorrectly or consumed accidentally. The temperature of the hot water is high in certain rooms but the manager told us that this is regulated in communal areas. Where water is hot in individual rooms, the person is able to deal with this themselves or have staff to assist. We discussed the need for a risk assessment to show this on all care plans for those people having to deal with high temperatures of water. Care Homes for Older People Page 17 of 26 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. Staff are appropriately trained and given skills to undertake their role, however, the safety and well being of residents must be maintained through fully completed recruitment checks. Evidence: On the day of this inspection, the manager was assisting with residents during the early morning as one member of staff had phoned in sick. The staff on duty consisted of the manager,one senior carer and one care assistant, one cook, a maintenance person who has been newly appointed and a cleaner due to start work at 11 am. It is noted that when we discussed a criminal record check (CRB) for the maintenance person, this had not been addressed. The manager stated that this person currently is dealing with external gardening work, however, as this person will have access to the home to undertake maintenance jobs a complete and appropriate CRB must be received prior to any internal work, or this person must be supervised at all times. Staff have an ongoing training programme and a copy was provided for us at this time. Training includes the protection of adults, moving and handling, infection control and NVQ levels two and three. The manager explained that a date for health and safety training was due to be confirmed and the only staff just commencing NVQ training have recently been recruited. Care Homes for Older People Page 18 of 26 Evidence: We looked at three staff files and two contained all appropriate recruitment documentation and one had an initial check completed known as a POVA first. We discussed this in depth with the manager who was unaware that a full CRB check is required before staff commence work in the home. A POVA first is only acceptable if there is a risk to residents when a member of staff does not start work . In such a situation the member of staff must be supervised at all times. The manager stated she would deal with this matter. Care Homes for Older People Page 19 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has an open and inclusive management style but certain areas require strengthening to ensure the complete safety and well being of residents. Evidence: The manager of the home has addressed all previous requirements but needs to be fully aware of current legislation regarding staff recruitment. We looked at the organisational policy and procedures for staff recruitment and other areas but these were all out of date and did not provide support for the manager. The manager explained that there have been updates on some documents but an updated and recent folder has not been issued to the home. Supervision is regularly undertaken as are staff meetings. This was confirmed in discussions with staff who felt supported by the manager and senior staff members. Monthly quality audits are carried out and a copy of this report is kept in the home. However, an audit of staff recruitment files and medication records would clearly Care Homes for Older People Page 20 of 26 Evidence: identify areas that require strengthening. There is also an annual quality assurance survey undertaken by the home and this is currently awaiting publication. Residents, family members and visitors have all been included in this recent survey. One identified problem area is the shaft lift that has been out of service when new parts have been needed. The lift is currently working but due to the age of this lift, problems do arise. The manager gave us details of a planned new building that is in the planning stages and the old lift will be used until the new building is complete. All maintenance and service checks were up to date and current including the equipment used in the home and regular fire checks are also completed. Care Homes for Older People Page 21 of 26 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 26 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 12 The registered person shall 31/12/2009 ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of residents. All staff administering medication must be fully competent to do so. Spot checks are to be undertaken to ensure staff are dispensing and recording medication appropriately. 2 19 13 All parts of the home to which residents have access are so far as reasonably practicable, free from hazards to their safety. The environment must be safe and free from potential hazards so that people are safeguarded from harm. In this instance with particular regard to hot water and 29/01/2010 Care Homes for Older People Page 23 of 26 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 medications in individual rooms. 3 29 19 The registered person shall 29/01/2010 not employ a person to work at the care home unless the person is fit to work at the care home subject to the schedule set out in this standard. The the manager is aware of all required documents in regard to the recruitment of staff and all staff files meet this requirement. 4 36 12 The registered person ensures that the employment policies and procedures adopted by the home and its induction, training and supervision arrangements are put into practice. That current policies and procedures are issued to the home to ensure the management of the home meets current legislation and requirements in all areas. 22/01/2010 Care Homes for Older People Page 24 of 26 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 That a more suitable area is found for dealing with confidential matters relating to residents to ensure privacy and dignity is maintained. Care Homes for Older People Page 25 of 26 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). 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