Care Home: Hernes Nest House

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What the care home does well A lot of effort is going into promoting a person centred service that focuses on the emotional wellbeing. This includes involving people in daily life tasks and pastimes that they find therapeutic and meaningful. Medicines are being managed safely and these are administered by two care workers to help avoid errors. There is always a first aider on duty and people`s health needs are being met. The mealtime experience is a very positive one that helps people with dementia feel relaxed and eat well. The home is well maintained, safe, clean and attractive. Ongoing improvements are being made. Routine safety checking systems are in place. Complaints are taken seriously and staff are trained to identify and report any concerns or abuse. Staff feel supported and training is well planned and organised. There is a clear management structure and a senior leads each shift. The manager and provider have worked together for many years and are fully aware of their responsibilities. Feedback showed that people find the manager approachable and committed to making the service as personalised as possible. What the care home could do better: The way activities are arranged could be improved to provide a more equal service for all people living in the home. Team work could be further improved to help people receive a consistent service. This will help people with dementia feel reassured and comfortable within their home. High risk care needs and activities should be assessed more fully and guidance in the care plans expanded on these areas. Establish access to routine dental checkups as part of promoting overall health and wellbeing. Promote the completion of Living Wills. Staff should be recruited to vacant posts and trained in the new ways of working. The manager should make sure there is always enough staff on duty to meet people`s assessed needs and to provide activities. Record keeping arrangements can be improved and the use of quality assurance feedback surveys should be reintroduced. A central complaints log should be set up. Random inspection report Care homes for older people Name: Address: Hernes Nest House Hernes Nest Off Park Lane Bewdley Worcestershire DY12 2ET three star excellent service The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Jean Littler Date: 2 1 0 5 2 0 1 0 Information about the care home Name of care home: Address: Hernes Nest House Hernes Nest Off Park Lane Bewdley Worcestershire DY12 2ET 01299402136 01299403750 sgurney@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Heather Tong Type of registration: Number of places registered: Conditions of registration: Category(ies) : Community World Limited care home 21 Number of places (if applicable): Under 65 Over 65 0 21 0 dementia old age, not falling within any other category physical disability Conditions of registration: 21 0 21 The maximum number of service users who can be accommodated is: 21 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: Dementia (DE) 21 Physical disability (PD) 21 Old age, not falling within any other category (OP) 21 Date of last inspection Care Homes for Older People Page 2 of 10 Brief description of the care home Hernes Nest House is a large, detached Georgian building located in a quiet residential area a short distance from Bewdley town centre. The premises occupy an elevated position with a pleasant rear garden and sitting areas that provide attractive views over the surrounding countryside. The registered provider is Community World Ltd. The building has been adapted and extended for its present use and is registered as a residential care home for a maximum of 21 older people who are frail and unable to live independently. People may also have a physical disability and/or a dementia illness. Short-term placements can be provided in the form of respite care. The home and the rear gardens are accessible to people in wheelchairs. There are car-parking facilities at the front of the premises. People are accommodated on the ground and first floor of the premises in thirteen single and four double bedrooms. The home does not have a passenger lift. However, a stair lift has been installed to enable the service users accommodated on the first floor to have easier access to their bedrooms. The second floor of the premises is designated as an area solely for staff use. The purpose of the home is to provide a quality service by caring, competent and welltrained staff in a supportive environment where people are enabled and encouraged to live a full, interesting and independent lifestyle as far as they are able. The fees ranged from £440.37 per week to £483.21 per week. Care Homes for Older People Page 3 of 10 What we found: We (the Care Quality Commission) carried out this inspection unannounced, which means no one at the home knew we would be arriving. One of our inspectors spent a day at the home and looked at a cross section of things. While we were at the home we met some of the people who live there and spoke to two of the staff. We walked around the building and looked at some of the most important records, such as those about care needs, medication and staff training. We were able to see staff supporting people and we got a picture of day to day life in the Home. We found out how activities and food are organised and saw the meal served at lunch time. Some weeks earlier the manager sent us the annual quality assurance assessment (AQAA for short). This is a document which services are required to send to us to tell us what they do well, what they think they need to improve and what their plans are to achieve these changes. The AQAA was completed in detail. It showed that improvements have been made during the last year and that people using the service have been consulted, as far as possible, about what can be changed to enhance their quality of life further. Ongoing development plans are in place. We also received surveys from three staff and one person living in the home, who was assisted to give their views by a family member. The feedback was overall very positive. Staff told us there are good training opportunities and that people living in the home have their individual needs well catered for. One worker said, It is a pleasure to work in the home. Suggestions for improvements included, better team working, staffing levels increased on some shifts and activities being offered to people in a more equal way. Our findings showed that people living in the home are treated as individuals. They are having their health and care needs met in a personalised and flexible manner. The staff seemed very caring and were spending quality time with people, as well as meeting their practical needs. Several people were seen enjoying being outside in the sun, reading or playing catch with staff, and later eating lunch on the terrace. There was a calm atmosphere and people were moving freely around the home. Items have been placed in communal areas to enable people with dementia to find and interact with them. Some people are enabled to do normal life tasks, such as, pegging out the washing, making their bed or laying the table to help their self esteem and so they are part of running the home. The home was warm, clean and well maintained. The conservatory has been improved with the purchase of plants and bistro style tables and chairs. The sample of bedrooms seen had been personalised. A new carpet was on order for the one room where there was an odour problem. Infection control arrangements have been improved and following some building work the way laundry is managed is going to be changed. The manager has been working to introduce a modern approach where staff work by Care Homes for Older People Page 4 of 10 focusing on peoples feelings and reactions rather than a set routine of household and care tasks. Staff are now eating with people and the meals are more family like. Some food is served from the table and people are encouraged to get involved and even help each other. Small tea pots and toast racks are used at breakfast to promote independence. The staff are trying to adapt to these new ways of working. Some have embraced the changes more than others and there has been some difficulties within the staff team as a result. Training has been provided to help them better understand the needs of people with dementia. The care records for two people were sampled. These showed that the information has been kept up to date to guide staff about how to meet peoples needs. Care staff record details of the daily care they give as well as visits from family or health professionals. The manager was in the process of expanding the information now the company has provided formal assessment tools for pressure area care and nutritional needs. She agreed to expand information in areas where risks to the person are high such as moving and handling, responses to behaviour that challenges staff and bed rails safety assessments. The manager was aware of the new legislation about peoples mental capacity and had recently obtained an assessment form that will be completed for everyone in the home. It would be positive if the completion of Living Wills were promoted as part of care planning. If these are completed while people have mental capacity then their views about their future medical and general care are framed in a legal document. A lady was seen to have a bruised face, so the circumstances were explored. An accident report had been completed showing that the cause was unknown and the person was unable to explain what had happened. First aid had been given and staff were observing to see if medical treatment was needed. Another lady was feeling unwell. Staff were seen to be supporting her in her bedroom where she was resting. One lady had her lunch on a tray in the lounge, at her request, as she was not feeling well. Medication systems were found to be in good order and people are receiving the medicines prescribed for them. These are being kept under review by the doctor. Medicines are not seen as a first step in response to people being restless as part of their dementia. Specialist health professionals are being appropriately involved to give advice or treatment. Dentists are only accessed when a problem is identified. A more proactive approach could be beneficial to people, particularly those who still have their own teeth. The home has received two complaints in the last year. We received one complaint directly, which was passed to the provider to investigate. The records showed that all complaints had been taken seriously and formally investigated. There have not been any safeguarding issues in the last year. Two staff recruitment files were sampled. These showed that a robust procedure had been followed. One reference was missing on one workers file, but this was forwarded to us afterwards to show it had been in place before the person started work. The training matrix showed that staff are given essential safety and awareness training in core areas and routine updates are being provided. Staff have attended in depth dementia awareness training and more is planned. Over half of the staff team hold a National Vocational Qualification in Health and Social Care. Another six are working towards an award. Care Homes for Older People Page 5 of 10 There are some staff vacancies that have not been recruited to. The manager said it has been hard to find people with the right attitudes and values. The number of carers on duty in the daytime is still usually four or five. Occasionally there has been only three for short periods of time and staff told us this makes it difficult to provide activities. The manager said extra cover is often found or she will stay on, but this is not always recorded on the rota. She was advised to keep accurate rota records and complete a risk assessment to show why the situation is deemed safe if only three staff are on duty. Staff feedback indicated they have felt under pressure covering the gaps within the team as no bank or agency staff are used. The manager has worked in the home for seventeen years and has been manager for over two years. She has continued to attend relevant training to update her knowledge. The sole provider has owned the home for twelve years, so the management arrangements are very stable. There has been a vacant deputy position for over two years. The manager said this was because the right candidate could not be found. This has resulted in some record management and quality assurance systems not being fully implemented, such as the feedback surveys that are usually distributed. A new deputy is now in post and the back log of office work is being addressed. During this time some regular administrative support could have helped maintain standards. At the last Key Inspection in May 2007 we judged that people using the service were experiencing Excellent outcomes. We have considered all the information we have to help update our view and we found that overall people are still receiving Excellent outcomes. What the care home does well: A lot of effort is going into promoting a person centred service that focuses on the emotional wellbeing. This includes involving people in daily life tasks and pastimes that they find therapeutic and meaningful. Medicines are being managed safely and these are administered by two care workers to help avoid errors. There is always a first aider on duty and peoples health needs are being met. The mealtime experience is a very positive one that helps people with dementia feel relaxed and eat well. The home is well maintained, safe, clean and attractive. Ongoing improvements are being made. Routine safety checking systems are in place. Complaints are taken seriously and staff are trained to identify and report any concerns or abuse. Staff feel supported and training is well planned and organised. There is a clear management structure and a senior leads each shift. The manager and provider have worked together for many years and are fully aware of their responsibilities. Feedback showed that people find the manager approachable and committed to making the service as personalised as possible. Care Homes for Older People Page 6 of 10 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 2. Care Homes for Older People Page 7 of 10 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 10 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, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Expand the care plan records to show detailed assessments have been carried out and clear guidance is in place about high risk areas, such as, the use of bed rails, moving and handling manoeuvres and complex or challenging behaviours. This will help protect people by ensuring staff support them following current best practice. Ensure that there is good lighting in all areas accessed by people living in the home as part of falls prevention measures. Recruit to staff vacancies more quickly. Then provide the training and support needed during the probation period to assess if the new worker can embrace the modern approach the home is striving towards. Complete a risk assessment before staffing is allowed to fall below the normal levels provided to this vulnerable group of people. Levels should not be permitted to fall below a safe level where the staff on duty can realistically perform their duties and provide the level of supervision required. 2 19 3 27 4 27 Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 10 of 10 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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