Care Home: Fenland Lodge

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What the care home does well Fenland lodge always completes detailed health and safety risk assessments and audits. This helps to ensure the resident`s live in a safe environment. One letter from a resident`s relative about the resident`s recent birthday celebration stated `Nothing was too much trouble, from the beautiful cake, and the lovely tea you provided...every effort was made to give her a good time, and to make my family feel that it is still all worth while`. What has improved since the last inspection? At the previous inspection six requirements were made (two of which had been carried forward from a previous inspection). All six requirements had been met. The resident`s care plans showed that they are now being offered regular baths and assistance with personal care. The staff have received the training they require to meet the needs of the resident`s. The records showed that there has been an improvement in the administration of medication so that the resident`s are now receiving the correct medication at the specified times and that this is accurately recorded. Daily actives have improved so that resident`s personal likes, interests and abilities are taken into consideration. Staff are now aware that they can take the time to sit down with a resident and chat about things that are important to the resident rather than their work being all task orientated. The personnel files contained all of the necessary recruitment documentation. This helps to ensure the right people are employed to work with the resident`s. The senior management team have worked hard with daily, weekly and monthly audits to ensure that improvements to the home are sustained. The staff we spoke to during the inspection stated that they felt a sense of ownership to the home and that they had been instrumental in the improvements for the resident`s. What the care home could do better: It is recommended that all staff receive training in catheter care and diabetes. This will help to ensure that there is always someone available with this specialist training. The kitchen needs to be updated to improve infection control. Key inspection report Care homes for older people Name: Address: Fenland Lodge Soham Road Stuntney, Ely Cambridgeshire CB7 5TR     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: Joanne Pawson     Date: 1 9 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 24 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 24 Information about the care home Name of care home: Address: Fenland Lodge Soham Road Stuntney, Ely Cambridgeshire CB7 5TR 01353668971 01353772734 fleuropeancare@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): European Care (Central) Limited Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: care home 49 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Fenland Lodge is owned by European Care and is situated between Ely and Stuntney. The home is registered to provide care and support for up to 49 places for older people, some of whom may have dementia. There are 45 single occupancy bedrooms and two shared rooms. All have en-suite facilities. Additional costs include those for hairdressing, private chiropody and toiletries. 1 1 0 1 2 0 1 0 0 0 Over 65 49 49 Care Homes for Older People Page 4 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. During this inspection we looked around the premises and we also looked at some of the documentation. We case tracked three of the residents. Case tracking means speaking with some of the residents and visiting their rooms and speaking with some of the staff who are looking after them. We also carried out a short observation of the interaction between the residents and staff. We compared what we saw and heard with the peoples individual records. We also spoke to other people who were not part of our case tracking. The inspection was carried out over one day by two inspectors. We also spoke with the acting manager, their line manager and the chief operating Care Homes for Older People Page 5 of 24 officer representing European Care (Central)Limited the registered provider for Fenland Lodge. Care Homes for Older People Page 6 of 24 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 Care Homes for Older People Page 7 of 24 order line 0870 240 7535. Care Homes for Older People Page 8 of 24 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 24 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. Prospective residents will have their needs assessed to ensure that the home can meet their needs. Evidence: Fenland Lodge have chosen not to admit any residents since the home was judged as poor in August 2009 until the home has shown significant improvements and been assessed as providing adequate outcomes for the residents. As needs assessment is a key standard we looked at the pre admission procedures and forms. The manager told us that anyone interested in moving into the home would be assessed by herself to see if the home could meet their needs. If she thought they could they would be invited to visit the home and possibly stay for a meal or an overnight stay. If needed the persons main carer could also stay to offer support and guidance. Once a new resident moves into the home they are welcomed by the manager and assigned a member of staff to help to settle them in for the day. Care Homes for Older People Page 10 of 24 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 care plans have been improved to ensure that the staff have all the information they need to care for the residents. Evidence: As part of the inspection we carried out a short observation of four residents and also looked at their care plans to see if the care they were receiving matched what was stated in their care plan. For one resident the care plan stated does not like to engage in activities, staff are to try and talk to the resident and initiate communication staff were seen doing this. The care plans also stated that the resident enjoys having her nails manicured and this was seen being done. The care plan stated that the resident needed glasses which she was wearing during the observation. There was evidence that the care plan had been reviewed and the relatives were involved with the review. The appropriate risk assessments had been completed. The records showed that medical attention had been sought when needed. The care records showed that the resident was being offered regular baths. The second care plan we looked at contained very clear information about how staff Care Homes for Older People Page 11 of 24 Evidence: should work with the resident. For example the care plan stated to use visual prompts such as a flannel and soap when the resident needed assistance with personal care. The care plan had been written in a manner to encourage independence and stated what the resident could do and what they needed help with. There was a short term care plan which stated the issue, what action was to be taken and then was concluded when the care plan was no longer needed. The care plan stated that the resident was very sociable and liked to talk to the staff and this was witnessed during the observation. The care records showed that the resident was being offered a bath regularly. The third care plan we looked at contained risk assessments for falls and pressure care and also specific risk assessments about the protecting the residents dignity. The mobilising care plan noted that that the resident may not recognise obstacles in their way and during the observation the resident was seen being guided by staff when walking. The activities care plan stated that the resident especially enjoys art work and this was witnessed during the observation. The bathing records showed that the resident had a bath on the 8th, 11th, 13th, 15th and 17th May. The care notes showed that the resident had been reviewed by their G.P. and the medication changed appropriately. The manager told us that all care plans are reviewed by the management team once every three weeks to ensure that they are up to date. We looked at the medication administration records and found them to be satisfactory. There was no written guidance for one resident who receives a medication which must be administered in a specific manner. The manager stated that this would be included in the residents care plan and added to the medication administration sheets. The trolley for prescribed creams was stored in a corridor. The corridor was very warm. The temperature of the corridor was not being recorded to ensure that the creams were not being stored above 25C. The manager stated that trolley would be moved into the medication cupboard to ensure it was stored at the correct temperature. All of the senior staff who are responsible for the administration of medication have received the appropriate training. All of the staff apart from one had completed a competency assessment for the administration of medication. (A date had been set for the last person to complete the assessment). The management team are checking the medication on a daily basis to ensure that there has been no mistakes or omissions for signing of administration of medication. Where any issues have been identified this Care Homes for Older People Page 12 of 24 Evidence: has been dealt with through supervision. We observed one resident being transferred in a hoist. This was done by explaining each step to him and the resident looked relaxed and was not alarmed. The residents were seen to be treated in a manner that respected their privacy and dignity throughout the inspection. Care Homes for Older People Page 13 of 24 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. All staff are now responsible for the daily activities as part of their work. This was seen to be effective and the residents were seen taking part in activities that they enjoyed. Evidence: The home has worked hard with the carers to make them aware that daily activities is the responsibility of all the staff and not just the daily activities coordinator. We observed the residents taking part in various activities. There was a table permanently set up with craft materials on it so the residents could go over to it and spend as long as they wanted taking part. This was seen to be effective on the day of the inspection. We also observed one resident spending time siting in the courtyard talking to a member of staff. One resident who preferred to stay in his bedroom was playing skittles in his bedroom with a member of staff. There is also a weekly plan of activities to be carried out. This includes things like the residents making displays for special events such as the world cup and pat dogs visiting. Residents can have visitors at any reasonable time and they are offered a meal and drinks whilst visiting. This was confirmed by a relative visiting a resident at the time of the inspection who stated the staff were welcoming and she was always made a drink. Care Homes for Older People Page 14 of 24 Evidence: The residents are encouraged to bring their personal possessions with them so that they have familiar items in their bedrooms. Mealtimes are now served by dishing up each option so that the residents can look at them and choose which one they would like. The food has changed from the majority being frozen to the majority being fresh food and home cooked. When we spoke to one of the chefs he was very enthusiastic about the new way of cooking. However as the home gets more residents the kitchen equipment may not be suitable to carry on providing the home cooked food in larger quantities. The manager was aware of this and there are plans to refurbish the kitchen. Care Homes for Older People Page 15 of 24 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. The residents are cared for by staff who know what to do if they suspect a resident has been abused. Evidence: We spoke to several members of staff during the inspection. They were all able to tell us what the correct procedure was if they suspected a resident had suffered any kind of abuse. All staff have received training in safeguarding. The manager has reported one incident to the appropriate authorities and has been working with the care manager on the case. One relative of a resident we spoke to on the day of the inspection stated that she was not aware of the formal complaints procedure but that another member of her family maybe. She stated that she had no complaints. We looked at the complaint log, only one complaint had been received since our last inspection. The complaint had been investigated and the appropriate action taken. The manager informed us that the care plan reviews are now completed with the resident so that they can discuss any complaints or concerns they may have. Care Homes for Older People Page 16 of 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents have a clean and pleasant environment in which to live. Evidence: All areas of the home were seen to be clean and free from offensive odours. The manager and the maintenance man discussed plans for refurbishing areas of the home and providing access to a garden area rather than just a courtyard area. Regular maintenance audits are carried out to ensure the home is well maintained. The manager confirmed that the problem with the heating and hot water over the christmas period had been resolved. The kitchen area is looking worn and in need of refurbishment. There are broken cupboard doors, worn through worktops and broken tiles. This could lead to an infection control risk. One of the fridges has to be defrosted every five to six weeks in order to maintain its performance. Some of the patio slabs in the courtyard area are uneven and could pose a risk to the residents when accessing the courtyard. Care Homes for Older People Page 17 of 24 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. The residents are cared for by staff who have the necessary training and skills to meet their needs. Evidence: We looked at the recruitment and training files for three member of staff. The records showed that the correct recruitment procedures had been followed. The manager confirmed that where gaps in the recruitment process had been identified at the last inspection steps have been taken to ensure that all of the necessary information is now available. The training matrix showed that the majority of staff had attended refresher training in the mandatory subjects. Where there were any gaps they had already been identified by the manager and the appropriate training courses booked. Six staff have attended diabetic awareness and 7 staff have attended catheter care training. It would be advisable if all care staff could attend training in these two subjects. The programme manager had also highlighted this as an area of need at his recent management audit. All staff had recently received further training in caring for people with dementia. The manager had completed the local authority training in safeguarding and stated Care Homes for Older People Page 18 of 24 Evidence: that all of the staff would also attend the local authority training in safeguarding which would be extra to their in-house safeguarding training they had already completed. When we looked at the personnel file for one member of staff it was not clear what the outcome of one disciplinary hearing had been. The observation of the interaction between the residents and the staff showed that the majority of the staff showed compassion and warmth to the residents. Only one member of staff could have improved their manner and this was thought to be a cultural difference rather than a disregard for the resident. The manager was aware of this issue and was already dealing appropriately with it. Care Homes for Older People Page 19 of 24 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. The quality assurance system is being used to ensure the residents get a consistent service. Evidence: The manager has been working in the home on a permanent basis since December 2009. She is in the process of applying to the commission to become the registered manager. All of the staff we spoke to during the inspection were complimentary about the manager and felt that they could approach her if they had any concerns. One member of staff stated we should have had her years ago. The registered manager and other senior managers for European Care have completed daily, weekly and monthly audits to ensure there has been an improvement to the care received by the residents living at Fenland Lodge. The staff team working at Fenland Lodge also told us that they feel a key part of the improvements and our proud to be offering a better service to the residents. Care Homes for Older People Page 20 of 24 Evidence: All of the requirements from the last inspection have been met. The home must ensure that this improvement is sustained. The programme manager has stated that European Care are committed to sustaining the improvement and will continue to monitor the home closely in order to achieve this. European Care stated that if there star rating has improved as a result of this inspection then they will start to admit new residents. This must be done in a structured manner so that it does not affect the standards of care currently being delivered in the home. Staff meetings are carried out monthly. There has not been a recent residents/relatives meeting. The manager stated that she had tried to hold one but only two relatives attended so communication had been done on a more informal basis with all the relatives. The manager stated that she will be holding a residents/relatives meeting to discuss the findings of the inspection and the refurbishment of the home. There are monthly audits carried out of the incident/accident reports to check if there are any patterns developing and to ensure that where necessary the relevant professionals are contacted. This was seen for one resident who had sustained several falls so the local falls team and assisted living team had been involved. The maintenance man carries out thorough health and safety risk assessments and safety audits of all the equipment in the home. The fire alarm system is checked weekly. The emergency lighting is tested weekly. The financial records and money held were checked for three residents and found to be accurate. Care Homes for Older People Page 21 of 24 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 24 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 1 19 23 The kitchen must be kept in a good state of repair. This will reduce the risk of poor hygiene standards in the kitchen. 01/12/2010 2 19 19 The patio slabs must be safe 10/07/2010 for the residents to walk on and not pose a trip hazard. This will help to reduce the risk of residents falling. 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 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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