Care Home: Goodwood Orchard

What the care home does well The staff give good care with dignity, privacy and they relate well to the residents. ` Best home I have been in the staff are very caring` ` Very happy with the home, `it is a home`` The residents live in a clean, pleasant and well - maintained home with bedrooms that are personalised and suit their needs. The home gives the residents a good and nutritious diet and they have choices in what they have to eat. ` I enjoy the food and we get a choice`. What has improved since the last inspection? The staff records are complete and contain all the required information. What the care home could do better: The care plans should all be regularly updated and reflect the residents current needs and consideration given to using nutritional and pressure area assessments. The manager should obtain information about all of the drugs coming into the home and record and store appropriately any controlled drugs. The manager could undertake supervised medicine rounds done by the staff and audit the medicines and the records. The complaints form could be updated to include an audit trail of dates and signatures. Staff should be given the opportunity of having regular supervision with their line manager to discuss work and training issues. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Goodwood Orchard 304 Uppingham Road Leicester Leicestershire LE5 2BE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Anthea Richards     Date: 1 7 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 28 Information about the care home Name of care home: Address: Goodwood Orchard 304 Uppingham Road Leicester Leicestershire LE5 2BE 01162766239 01162766239 taylcar@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr David Boulton,Mrs Carole Boulton care home 18 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: Service User Categories DE(E) & MD(E) No person who falls within categories/combined categories MD(E) or DE(E) may be admitted to the Home when 8 persons of combined categories MD(E) DE(E) are already accommodated in the Home Date of last inspection Brief description of the care home Goodwood Orchard Residential Home is a care home providing personal care and accommodation for 18 older people with a physical frailty and/or mental confusion. Carole and David Boulton own the home, with Carole working as the manager. Care Homes for Older People Page 4 of 28 Over 65 8 8 18 0 0 0 0 8 0 1 2 0 0 9 Brief description of the care home The home is situated on the outskirts of Leicester in a residential area and is easily reached by private and public transport. There is parking available in the grounds of the home. The accommodation is a converted three storey detached house with a flat where the owners live on the second floor. There are two lounges and a dining room on the ground floor. There is a mixture of single and shared bedrooms on both floors and some of them have en-suite facilities. The first floor can be accessed by stairs or by a passenger lift. Outside there is a large well maintained garden with an aviary. A patio area with seating for the residents overlooks the garden and both are accessible for the residents. The home can be contacted by telephone, fax or email. The fees range from £ 408.45 for a shared room and £ 433.86 for a single room. There are extra charges for hairdressing, chiropody, newspapers and personal items. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection of a care home for older people, which ended with an unannounced visit to the service. Before the visit we (throughout the report the use of we indicates the Care Quality Commission), spent five hours reviewing information received by the Care Quality Commission (CQC) since the last inspection on the 10th April 2008 and a Random inspection undertaken on 30th December 2008. The visit took place on the 17th April 2009 and lasted seven hours. During the visit we checked all the key standards as identified in the National Minimum Standards. This was achieved through a method called case tracking. Case tracking means that we looked at the care provided to three of the residents. Care Homes for Older People Page 6 of 28 To achieve this we spoke with the staff supporting their care and looked at the records relating to their health and welfare. We spoke with the residents and their families. With their permission the residents bedrooms were looked at. We also checked how the home was run and organised. This included looking at staff records, training and how the staff are organised. We looked at health and safety records, menus, minutes of meetings and the quality audit. The policy for handling complaints and how the home dealt with them was looked at. We looked at how prospective residents and their families are given information about the services the home can offer and whether they are suitable for them. We checked the Annual Quality Assurance Audit (AQQA) that the home had sent to us. This describes the services provided at the home for the residents, how the home is hoping to improve services and statistics about the residents and the staff. We looked at the comment cards that we had returned to us from the residents, relatives and the staff. During the visit we spoke with the homes manager, the staff, the residents and visitors to the home. 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 set out 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 28 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 28 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 residents needs are always assessed before moving into the home and they have good information to help them make the right choice about the home. Evidence: The residents or their families who were case tracked told us that they had seen the Statement of Purpose and had been given the terms and conditions. The Statement of Purpose contained thorough information that described the services that the home provided. These documents are available in other formats including large print and other languages to give as many people as possible the opportunity to read them. The manager or a senior member of staff always visits prospective residents to complete a pre assessment of the residents needs. This makes sure that the home has a full picture of the resident before they are admitted, they also have the opportunity to visit the home. These assessments were seen in the residents care plans and the residents and the families spoken with told us that they had a visit Care Homes for Older People Page 10 of 28 Evidence: before they came in. The staff spoken with told us that they always knew about the resident before they were admitted. The current registration certificate from the Commission for Social Care Inspection (CSCI) was displayed in the entrance of the home with the latest report from the CSCI and an up to date public liability insurance certificate. Care Homes for Older People Page 11 of 28 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 staff mainly meet the care needs of the residents, with privacy, dignity and respect. Evidence: The records for the residents who were case tracked were found to contain good individual evidence of the care being given to the residents and mainly reflected the care that the residents needed. One care plan had not been updated to reflect the current needs of the resident. The home does not complete a nutritional assessment or an assessment to check the risk of developing a pressure sore. There are records of the residents weight that do indicate that the resident is eating sufficiently. This should be considered as the residents become more frail. There was evidence that the residents and/or their relatives have been involved in planning the care. The residents and the families spoken with told us about the care that they needed and that they were happy that they received it. A District Nurse who we spoke with told us that she was very happy with the care that the home was giving to the residents and that they always referred people to her as they should. Care Homes for Older People Page 12 of 28 Evidence: Comments received on the day and in the surveys received by us included: Very happy in the home, it is a home The staff are very good There are records of the involvement of G.P.s, district nurses, chiropodist and optician, where needed in the care plans, showing that thorough health care is being provided for the residents. The residents and their families spoken with said that they could see the doctor and other health professionals when they needed to. There was evidence that the care plans are regularly reviewed and the residents and the families spoken with confirmed that they could be involved and were aware of the care to be given and that they were happy with it. The daily record of care was up to date and contained details about the residents day and night. This makes sure that the staff know what has happened to the resident during the day or night. We saw residents being treated with dignity and respect when staff spoke with them and undertook their care, particularly when moving them. They were seen to be knocking on the residents bedroom doors before they went into them. There were risk assessments in place to cover all the identified risks for the residents and how the staff should manage those risks. This makes sure that the residents and the staff are protected from any risks that have been identified, without restricting their activities. Medication records for the case tracked residents were in order. Medicines are given by senior care staff who have regular updating in medicines. We saw that the medicines were administered individually and the residents were seen to be taking them. Medicines are supplied in a monitored dosage system where each tablet is in a separate pop out card, which is a safe method of administration, helping to make sure that the resident is always given the right medicines. The staff spoken with were knowledgeable about the medicines and where to obtain information. They were also aware of the requirements for the receipt, storage and disposal of medicines. The manager does not carry out a monthly written audit of the medicines and the medicine sheets to make sure that they are correct. The manager does not do supervised drug rounds to make sure that the nurses are safe when giving medicines. The home told us that they did not have any controlled drugs in the home, however Care Homes for Older People Page 13 of 28 Evidence: we were shown one that was in the drug trolley. The manager was unaware that this was a controlled drug and immediately placed it in the controlled drug cupboard and entered the details into the controlled drug book. This drug had not been opened or used and it was planned that the District Nurse was to administer it. There was a self-medicating policy in place but there were no residents looking after their own medicines at that time. Care Homes for Older People Page 14 of 28 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. The residents enjoy the activities that they want to and have their spiritual and nutritional needs met. Evidence: The staff were seen to be spending individual time with the residents reading the newspaper, talking with them and discussing the programme on the T.V., which the residents told us that they were enjoying. Two of the residents were playing scrabble. Activities that were enjoyed by the residents included: board games, hand massage and manicures, singing, talks, music, memory games, music and chair aerobics. The residents, families and the staff told us about the activities and how they enjoyed them. The clergy can visit whenever the residents would like. A hairdresser visits weekly, which the residents enjoy. The staff, the residents and the families spoken with told us that they were happy with the amount of activities. Care Homes for Older People Page 15 of 28 Evidence: All the families spoken with said that they were made very welcome in the home, which we saw whilst we were there. The residents spoken with said that the food was good and that they had a choice of what they had. The menus were varied and were discussed with the residents at residents meetings. Comments made by the residents included: The food is good and I can choose what I want . We spoke with the residents during their lunch, which was served attractively and they told us that they were enjoying. Care Homes for Older People Page 16 of 28 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 are systems in place to support and protect residents and staff are aware of the processes. Evidence: There is a complaints policy in place which gives the details of how to complain and who to complain to in the home if they needed to. This could be made available in a large print and other languages if it was needed, which would make sure that as many people as possible could read it. The complaints form did not have dates and places for signatures, this means that the home have no method of tracking a complaint. The home has received no complaints since the last inspection on 10th April 2008. The Care Quality Commission (CQC)and the Social Services have received one complaint in this time. There was an investigation into this and a random inspection by the CQC, which did not uphold the complaint. The residents and the families spoken with were aware of the policy, of how to complain and who to complain to. They were happy that their concerns would be listened to and acted on. The staff spoken with were aware of how to handle any complaints. The staff spoken with were able to describe how they would deal with an allegation of abuse, knew the areas where abuse could happen and could describe the process that Care Homes for Older People Page 17 of 28 Evidence: they would go through if they suspected any abuse. They confirmed that they had had training in safeguarding adults and whistle blowing and the manager and the records seen supported this. All of the staff have either got an National Vocational Award at least at level 2 or have started the award, during which they receive training in safeguarding as well as the training given in the home. They were confident that the management would handle any issues correctly. We looked at the accident book, which had been completed correctly. These practices make sure that the residents are safe from any abuse and that any concerns are handled correctly. Care Homes for Older People Page 18 of 28 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 residents are protected by the policies and procedures in the home to provide a safe and pleasant environment. Evidence: Goodwood Orchard is large house that has been converted into a care home. It is situated on a main road on the outskirts of Leicester. The home was warm, clean, homely and welcoming on our arrival. There are lounges and a dining room on the ground floor, with bedrooms on both floors. The first floor can be reached by the stairs or by the passenger lift in the home. The lounges and dining room were clean, bright, well decorated and well furnished with suitable seating for the residents. All of the bedrooms seen had been personalised and were found to be clean and well decorated. The residents spoken with were happy with their rooms and said that they were able to bring their own belongings in with them. There was evidence of equipment in the home to help the residents, such as wheelchairs and special mattresses. There was a good provision of bathrooms in the home and these were found to be clean and clear of any items that could cause a hazard for the residents. Care Homes for Older People Page 19 of 28 Evidence: There was a patio area and grounds that were easily reached by the residents and made a pleasant place to sit and walk for them. The residents and the families spoken with were happy with the cleanliness of the home, and told us that the staff worked hard to keep it clean. There are staff employed to complete the cleaning in the home and they have had training in health and safety. The cleaning products are stored in a locked cupboard, which we saw. The records for hot water testing were being completed regularly and all the temperatures were within the recommended levels. The fire records for testing alarms and fire drills and training were looked at and found to be up to date. The staff spoken with told us that they had regular training and fire drills. There was an up to date registration certificate and public liability insurance certificate displayed in the entrance. Care Homes for Older People Page 20 of 28 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 recruitment policy and the staff training meet the residents needs and protect their safety. Evidence: We looked at three staff files and the required information was complete in all of them. This included evidence of identification, adequately completed application forms, two written references, a Criminal Records Bureau (CRB) check and a Protection of Vulnerable Adults check. The manager makes sure that all the required documentation is in place before an employee starts work. This was confirmed by the staff spoken with, who told us that they could not start until they had all the paperwork in place. The staff spoken with confirmed that they had received recent training in moving and handling, dementia awareness, the mental capacity act and safeguarding of vulnerable adults. The manager has a matrix with all the training courses that are arranged and when the staff need to attend them. Care Homes for Older People Page 21 of 28 Evidence: The residents and the families spoken with felt that the staff were well trained to do their job and that there were enough staff to look after them. We saw the induction programme that all the staff complete and it contained all the required mandatory training needs. Most of the care staff either hold a National Vocational Qualification (NVQ) at least at level 2 or are in the process of completing it. The National Vocational Qualification is a qualification for care staff to make sure that they receive training in the needs of the resident group whom they are caring for. Care Homes for Older People Page 22 of 28 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 residents safety is protected by the practices in a home that is run in their best interests. Evidence: The manager who owns home has managed the home for several years and is registered with the Care Quality Commission. There are regular meetings held for the residents and for their families, to discuss activities and menus in addition as to how the home is meeting their needs. The manager is available to talk with the residents and the visitors every day that she is in the home. The residents and the families spoken with told us that they saw her regularly. There were quality questionnaires sent to the residents and their families every year and the questionnaires that we saw on the visit confirmed this. The families and the residents told us that they had completed the questionnaires. Care Homes for Older People Page 23 of 28 Evidence: We received positive comments from the residents and the families at the visit and from the surveys that we sent them, amongst which were that the staff were very supportive of them and their relative. The home does not hold any accounts for the residents. There was evidence from the staff spoken and from the records seen with that they are having supervision of practical tasks but not the opportunity of formal supervision with their line manager. Formal supervision of the staff gives them and their line manager the opportunity to discuss work and training issues and needs. There are regular staff meetings held, confirmed by records held and by the staff spoken with. All the areas of health and safety such as hot water temperatures and fire drills and alarm testing were found to be in order. Care Homes for Older People Page 24 of 28 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 25 of 28 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 7 14 (2) That the care plans are 15/05/2009 regularly reviewed to reflect the residents current needs. To make sure that the resident receives the care that is required. 2 9 13 (2)That the manager and the staff obtain information about drugs that come into the home, making sure that controlled drugs are stored and administered correctly. To make sure that the residents and the staff are protected against inappropriate use of those medicines. 15/05/2009 3 29 19 (b)(i) To provide sufficient 30/06/2009 space on the employment application form to include a full employment history. To allow any gaps in employment to be explored by the interviewee. Care Homes for Older People Page 26 of 28 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 4 36 18 (2) That the Registered Manager holds formal supervision with the staff at the required intervals. To give the staff the opportunity to have time with their manager to discuss work and training issues. 31/07/2009 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 2 7 9 That consideration is given to using nutritional and waterlow assessments. That the manager undertakes regular supervision of the staff doing the medicine rounds and regularly audits and documents the medicines and medicine records. That the home produce a complaints form that will give an audit trail as to the progress of the complaint. 3 16 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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