Care Home: High Pines

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What the care home does well Care guideline records reflect the needs of residents and their aspirations. These contain information about how residents are progressing, aims of care identified by staff and agreed with residents, their health requirements and risks associated with their daily living and activities. The owners and manager have considerable experience in the care of older people. The garden is suitable for use by residents, staff and visitors. Emphasis is placed on enabling staff to administer medicines safely. Staff are well supported and there are good recruitment procedures. What has improved since the last inspection? This was the first inspection of the service. In the first six months of operation, the owner and manager have made significant improvements. Prospective residents receive a full assessment of their needs. care plans are in place to meet their support needs. New medicine storage and recording arrangements benefit staff and residents. Residents are helped to remain physically and mentally active. They are protected through recruitment procedures and staff training and this training is set to improve. The owner and manager are making changes that emphasise the need for supporting residents well. For this purpose, staff routines to a high standard are required and performance indicators are being used by the owner and manager to ensure that the required procedures are followed day and night. Arrangements are in place to ensure that residents and/or their families/advocates are responsible for all their financial matters. The premises have been improved over this short period and further improvements are imminent. What the care home could do better: This report contains no recommendations or requirements. Recommendations to improve practices for the benefit of residents and staff are contained within the report. Key inspection report Care homes for older people Name: Address: High Pines 47 Pigeon Lane Herne Bay Kent CT6 7ES     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: Eamonn Kelly     Date: 2 3 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: High Pines 47 Pigeon Lane Herne Bay Kent CT6 7ES 01227368454 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): High Pines Residential Home Ltd Name of registered manager (if applicable) Mr Soomandeeren Paneandee Type of registration: Number of places registered: care home 21 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: 21 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Date of last inspection Brief description of the care home High Pines provides personal care, support and accommodation for up to 21 people. Bedrooms are on the ground and first floors. There is a stair lift between these floors but a shaft lift will be installed during 2010. Some bedrooms have an en-suite facility. Prospective residents and their advocates may receive a written outline of services and Care Homes for Older People Page 4 of 26 Over 65 21 0 Brief description of the care home facilities from the manager. Weekly fees are £320 to £360 for Local Authority funded residents and £450 for privately funded residents. Additional charges are made for chiropody, newspapers and hairdressing. 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: 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 that people who use the service experience good quality outcomes. The inspection took place on 23rd November 2009. It comprised discussions with the owner, Mr M Paneandee, support workers on duty and residents met during the inspection. A case tracking exercise relating to three residents was carried out to assess how they were being supported. Care practices were discussed and most parts of the premises were visited. Some records were seen during the visit principally those addressing the personal and healthcare support of residents. This was the first inspection since Mr Paneandee bought the home earlier in the year. The information provided by the owner when the service was registered provided Care Homes for Older People Page 6 of 26 information about how residents would be supported and how the service would be developed. Mr Paneandee also provided the Commission with an AQAA (annual quality assurance assessment). This is a self assessment of how the service is being taken forward. The evidence of this inspection visit indicated that rapid progress is being made in the interests of resident welfare and comfort and towards meeting the overall objectives of the service. This report contains no recommendations or requirements. Care Homes for Older People Page 7 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 8 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 9 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents and their supporters receive initial advice and guidance to help them assess the facilities and suitability of the service. They receive a full assessment of their needs. Evidence: Prospective residents and their representatives receive assistance and guidance to help them decide if the home is able to meet their support needs. New residents receive a personal contract that contains information on the rights and responsibilities of both parties. The manager carries out an assessment of prospective residents support needs with assistance where necessary from Social Services care managers. Some residents have support needs associated with the onset of dementia as well as substantial mobility problems and other disabilities. The manager has completed the VRQ Certificate in Dementia Care and it is the intention of the owner and manager to Care Homes for Older People Page 10 of 26 Evidence: extend this staff training to all members of staff. This is because of the identified need for all staff to be able to fully understand how best to support people with this major illness as it develops. The care plan record begun at this stage outlines the support needs of the prospective resident and how these needs would be met. A checklist and associated notes are taken at this stage that form part of subsequent care plan records. A review of two care plans that contained completed pre-admission assessments provided useful insights into how residents are supported at this stage. The manager begins to prepare an initial description of the residents background at this stage for inclusion in the care plan folder. This biographical outline is updated as soon as possible when more information is obtained. As procedures develop to the standards required by the owner and manager, this type of information is being obtained by staff and added to when additional relevant biographical information becomes available via activities for residents and other means. Discussion of three profiles of residents with the manager and observation of residents current circumstances showed that support needs are moderate in most cases and relatively high in some. Because of this, the owner and manager have good staffing levels in place (manager and three care staff during the time of the inspection) and it is the intention to maintain these levels. Members of staff have very specific roles to perform whilst caring for vulnerable people during the day and at night. Relatives may therefore be confident that residents are well supported and cared for at all times. Potential residents may not always (but generally do) visit the premises prior to taking up residence. They and their representatives are invited to do so. The home admits residents for respite care and this information is carried in the Statement of Purpose of the service. In the case of one such resident, a care plan had been prepared and was kept updated in case her support needs changed and needed further attention. Care Homes for Older People Page 11 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health, personal care and social care needs are identified and addressed. Evidence: Care plan folders seen for two residents contained information about residents support needs and how these were being met. A third care plan, for a person receiving respite support, also contained reasonable information about the resident. These included risk assessment information, pre-admission outline, weight records, healthcare checks and access to healthcare services, and care plans outlining assessed needs and how to address the needs. There was evidence that a Local Authority contracts officer had case tracked some records also and found that these were suitable for addressing the care needs of residents. There was some evidence that routine reviews by Local Authority care managers are decreasing. The manager was aware that this places a higher priority on maintaining essential records in an effective manner for the benefit of staff and residents. Care Homes for Older People Page 12 of 26 Evidence: In the examples seen, there was evidence that care plan records are person-centred and this effort to maintain each in such an individual way avoided the prospect of excessive similarity of entries. This person-centred approach again benefits staff and residents and it is a procedure that the manager intends to continue. In the care plan records checked, risk assessments covered moving and handling issues and the range of risks posed to the health of residents with high physical and mental health support needs. Members of staff complete daily records in respect of important aspects of residents health and changes in health or disposition. These issues were said to be discussed during staff changeover to enable in-coming staff to be aware of changes in residents temperament or health. During the inspection visit, members of staff treated residents with understanding and respect. Discussions about the profiles of residents and how they are supported also indicated a high level of understanding of and respect for clients. Where difficulties occur in the continuing support for some residents, there was evidence that care managers and family members are involved in reviews and any necessary changes in the levels of support. Care plan folders showed that GPs visit as necessary. The services of district nurses are routinely obtained and they have an increasingly important role as the support needs of residents increase. In the case of one resident, district nurses visit twice a day to give insulin injections. Residents met said they receive very good healthcare and other support. They also said that carers have a good understanding of the difficulties faced by residents and are skilful in providing the personal support needed. The owner and manager said they believed residents have good access to dentists, chiropodists and opticians. The manager explained how medications are administered. MAR sheets are completed at the time of administration. A photograph of each resident accompanies their MAR sheet. In the case of residents receiving respite care, a MAR sheet was said to be completed manually to control and supervise their medication. A new medicines room has been created. There is a new drugs trolley, medicines fridge, stock intake cupboard, controlled drug cupboard and cupboards for separation of liquids and creams. The manager stated she was satisfied that members of staff administering drugs are well supported and trained. This includes checking by two members of staff. Care Homes for Older People Page 13 of 26 Evidence: Members of staff help residents who have hearing aids to keep them in working order and they encourage them to continue using the aids. Records indicated that residents weights are recorded monthly or more often if necessary. Care Homes for Older People Page 14 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. Residents receive support on a day-to-day basis to remain mentally and physically active and alert. Evidence: The evidence seen during the inspection was that members of staff help residents to remain physically and mentally active. The good staffing levels contributed to this and procedures being introduced by the owner and manager promote its importance. Residents said that relatives and visitors provide good support and that they may visit at any time. Residents are encouraged to continue the patterns of their former lives as far as possible within their changing circumstances and to exercise control over longer and shorter-term decisions. The manager said she is working towards having relevant biographical details of each resident included in care plans. This is to enable members of staff to more fully appreciate and understand the nature of residents previous lives and occupations. During the inspection, the manager had a good knowledge of residents abilities and expectations and she said that members of staff are being encouraged to develop this detailed knowledge of residents also. Care Homes for Older People Page 15 of 26 Evidence: Weight charts and nutritional assessments were said by the manager to be maintained. Residents were seen to be able to have their meal over an extended period in the dining area and members of staff give them assistance as needed. There were a number of examples seen during the inspection that suggested they are helped in a number of ways to remain mentally and physically active. This included staff assisting residents on a one to one basis, helping them to walk about the premises including using the stairs and stair lift, provision of books and newspapers, talking to them, providing music and helping residents visit the garden. A bingo session was to take place in the later afternoon. During the inspection, there was a positive atmosphere and carers were working actively with residents when they were not engaged in household activities. The service now has the benefit of access to a minibus that is shared beyween the owners four residential homes in the area. Residents are assisted to continue practicing their religion. Discussion with the owner and manager showed that renewed emphasis is being placed on providing good food for residents and encouraging them to express a choice. Different meals were provided in some instances where the cook knew that residents preferred a particular food. Care Homes for Older People Page 16 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. Residents are protected from abuse and exploitation. Evidence: The service has a complaints procedure and residents are encouraged to express any views they have. The evidence was that residents and their relatives are encouraged to express their views, comments, complaints and suggestions in order to enhance the service. Examples discussed with the manager suggested that careful consideration is given to outcomes of direct contact with users of the service. Policies and procedures for safeguarding adults are available to all members of staff and these give specific guidance to those using them. The manager said she is confident that carers understand Local Authority procedures for Safeguarding Adults and their personal responsibilities for safeguarding vulnerable people. The Commission is notified of incidents (notifiable incidents) that occurred and reflection on these is reportedly used as part of quality assurance measures for the protection of residents. The recruitment procedure contains the checks (including CRB checks) necessary to help contribute to the protection of residents and all members of staff receive training for their responsibilities under current POVA arrangements. Care Homes for Older People Page 17 of 26 Evidence: The evidence was that members of staff are aware of the rights of residents and of how their interests must be identified and promoted. The manager has taken steps to gain knowledge about how staff and residents could be affected by aspects of the Mental Capacity Act and how essential procedures might be affected as these measures come into being more fully. Care Homes for Older People Page 18 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 premises are suitable for use by frail older people. Evidence: The premises contain mostly single bedrooms for residents (with currently two rooms for people wishing to share), garden, kitchen, dining and communal areas. A room is being redecorated as a quiet room for residents and visitors. Residents bedrooms are situated on the ground and first floors with a stair lift in place. The second floor is used for staff accommodation. Most bedrooms have an en-suite facility. The garden is a major asset for staff, visitors and residents. The premises were maintained in a clean and tidy way at the time of the inspection visit. The new owner is committed to undertaking a number of improvements during 2010. The main planned refurbishments are replacement of all carpets, installation of a new kitchen, conversion of both shared bedrooms to single rooms, installation of a shaft lift and removal of the stair lift and general redecoration. Planning permission for a few more bedrooms is under consideration. Care Homes for Older People Page 19 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. Residents are protected by the use of a range of checks in the recruitment of staff and by the training and support being put in place for staff. Evidence: Discussion with the manager and owner showed that most members of care staff have achieved an NVQ 2 or 3 qualification and all are encouraged to do so. Members of staff undertake training in moving and handling, infection control, health and safety, and medication administration. The manager has completed the Certificate in Dementia Care and, because many residents have the onset of dementia, members of staff will, over the next two years, be given the opportunity to achieve this essential qualification. The owner and manager said they place a high priority on enabling members of staff to receive relevant training focussed on delivering improved outcomes for residents. This is included in the process of formal recorded supervision carried out at intervals with each member of staff. The certificates being given to staff on a variety of topics may be a little misleading for staff to whom they are given. This is because the certificates are based on short sessions provided by an individual. The manager said she would actively investigate Care Homes for Older People Page 20 of 26 Evidence: how best to provide more appropriate training in, for example, dementia care, medication administration, diet and nutrition and infection control. These training courses (NCFE and VRQ) generally take place over up to 12 weeks and have a high element of competency testing. This progression would be in the longer term interests of the service for staff, owner and residents. Three staff files seen indicated that job descriptions and specifications define the roles and responsibilities of staff. According to the staff files, new staff are subject to full checks before they start work. These include CRB checks, references and other recruitment checks. During the inspection, there were three carers on duty in the morning as well as the manager. Two cares are on duty at night. Other staff (administrator, cook, domestic staff and laundry assistant) were also at the service. Care Homes for Older People Page 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a residential service that acts in their best interests. Evidence: The manager, Mrs Lorraine Tyler, has the experience and skills to manager the service well. The owner, Mr Paneandee, stated that the Commission would receive an application to register the manager with the Commission when they had discussed registration procedures with the Commissions registration inspector. In the six months since he bought the home, the evidence is that Mr Paneandee has introduced many reforms and that residents are being supported effectively. Mrs Tyler is taking a central role in these developments and all aspects of the service either have been improved or improvements are planned/imminent. Arrangements are being put into place to ensure that members of staff carry out their work to the highest standards and performance indicators are being used to measure success. The service aims is to provide a good quality of life for residents. There is a focus on person centred thinking with residents centrally involved in shaping the support they require. Care Homes for Older People Page 22 of 26 Evidence: Quality assurance and monitoring procedures are being put into place for the efficient running of the home, to give value for money and deliver effective outcomes for the people who use the service. Residents receive advice on how to obtain impartial legal and financial advice if they need this. The service does not act as an appointee for any resident. A written record of all financial transactions is maintained where additional charges are made to residents. Prospective residents receive a full assessment of their needs. care plans are in place to meet their support needs. New medicine storage and recording arrangements benefit staff and residents. Residents are helped to remain physically and mentally active. They are protected through recruitment procedures and staff training and this training is set to improve. The owner and manager are making changes that emphasise the need for supporting residents well. For this purpose, staff routines to a high standard are required and performance indicators are being used by the owner and manager to ensure that the required procedures are followed day and night. Arrangements are in place to ensure that residents and/or their families/advocates are responsible for all their financial matters. The premises have been improved over this short period and further improvements are imminent. Care Homes for Older People Page 23 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 24 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 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 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). 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. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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