Care Home: High Wray Residential Home

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What the care home does well We received a number of responses to our written survey and also had the opportunity to consult staff and residents during our visit. People gave us very positive feedback about the home and expressed satisfaction with all aspects of the service. Comments we received included; ``I have never worked anywhere where the management are so good.`` `I am extremely happy living at High wray - especially since Janet Shaw took over.` `The manager and owner have the residents` interests first and foremost and because they gave a caring attitude it filters down.` `The residents` needs, interests, problems are listened to and action is always taken from relatively minor issues to bigger issues.` `It is a happy environment and a lovely place to work.` Throughout our visit we observed staff going about their duties in a pleasant and professional manner. Residents appeared relaxed and comfortable in their surroundings and appeared to get along very well with the staff. People told us that there were enough staff on duty at all times and one resident said ``Anything I need is dealt with straight away.`` Discussions held and records viewed confirmed that people are provided with the opportunity to take part in a variety of activities both inside and outside the home. The home have employed an activities coordinator to oversee the area and ensure that everyone has equal opportunity to take part. Staff told us that they were happy with the training at the home and records showed that almost all the carers hold National Vocational Qualifications in care at level two or above. The one remaining carer is currently working towards the qualification. The home benefits from the input of an experienced manager and provider. Throughout the inspection it was apparent that they had developed the service a great deal since taking over in September 2008. In addition, they shared a number of plans to further enhance the service provided. It was also clear that changes had been made as a result of listening to people who live at the home. Plans are in place to hold regular meetings for residents to ensure that they have regular opportunities to express their views and opinions. What has improved since the last inspection? This was the home`s first inspection since its registration in September 2008. What the care home could do better: We found that here were generally safe systems in place for the management of people`s medication. However, we did identify some areas that could be improved andas such made a requirement and some recommendations. We made a requirement that regular and detailed checks of medication stock and records must be carried out so that the manager can ensure people are receiving their medication as prescribed and that staff are working safely with people`s medicines. We recommended that any hand written entries on residents` medication administration records be witnessed and double signed to reduce the risk of errors being made. We also made a recommendation that people who deal with residents` medication are regularly assessed by the manager as being competent to do so and that these assessments are recorded. Inspecting for better lives Key inspection report Care homes for older people Name: Address: High Wray Residential Home 15 Formby Lane Aughton Ormskirk Lancashire L39 7HG     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: Marie Cordingley     Date: 2 0 0 1 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: High Wray Residential Home 15 Formby Lane Aughton Ormskirk Lancashire L39 7HG 01695421420 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Shawcare Limited Name of registered manager (if applicable) Miss Joan Woods Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC To people of the following gender Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Physical disability - Code PD The maximum number of people who can be accommodated is: 24 Date of last inspection Brief description of the care home High Wray residential home is situated in the picturesque village of Aughton, Ormskirk. The house once a private dwelling, has been altered over the years to provide accommodation for up to 24 older people. The home provides single and shared accommodation and the majority of bedrooms Care Homes for Older People Page 4 of 28 care home 24 Over 65 22 0 0 2 Brief description of the care home include en-suite facilities. There are a variety of communal areas including several lounges and dining areas. Care is provided on a 24 hour basis including waking watch care throughout the night. At the time of our visit (20th January 2009) we were advised that fees for care and accommodation ranged from £411 to £450 per week. All the above information and more can be found in the Service User Guide which is available on request from the home. 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: The inspection of the home included an unannounced sit visit which was carried out over one day. As the inspection was unannounced the residents, staff and managers did not know it would be taking place until we arrived. During the visit we held discussions with residents, staff, the registered manager and provider of the home. We also viewed a variety of documents including staff personnel files and residents care plans. A tour of the building was carried out and we viewed a selection of residents private accommodation as well as all the homes communal areas. Care Homes for Older People Page 6 of 28 We carried out a case tracking exercise during our visit. This involved us looking closely at the care of a small number of residents from the point that they were admitted to the home. Prior to our visit we asked the manager to complete a very comprehensive self assessment questionnaire. The questionnaire looked at all aspects of the service and also included some numerical information such as number of staff and their qualifications. We wrote to a selection of residents and staff and asked them to take part in a written survey about standards at the home. We received a good response with 11 completed surveys returned to us. What the care home does well: What has improved since the last inspection? What they could do better: We found that here were generally safe systems in place for the management of peoples medication. However, we did identify some areas that could be improved and Care Homes for Older People Page 8 of 28 as such made a requirement and some recommendations. We made a requirement that regular and detailed checks of medication stock and records must be carried out so that the manager can ensure people are receiving their medication as prescribed and that staff are working safely with peoples medicines. We recommended that any hand written entries on residents medication administration records be witnessed and double signed to reduce the risk of errors being made. We also made a recommendation that people who deal with residents medication are regularly assessed by the manager as being competent to do so and that these assessments are recorded. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 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 10 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. People are provided with a good standard of information to help them make a decision about moving to the home. Evidence: The home has a Service User Guide which is available on request for anyone making enquiries. The Service User Guide is a helpful document that provides information about all aspects of daily life such as mealtimes and activities. The guide also outlines the services available and associated fees. We viewed the Service User Guide and confirmed that it contained up to date, accurate information and included details of recent changes in management. In discussion, were were advised that the Service User Guide is only available in a standard written format. We made a recommendation that the guide be produced in a Care Homes for Older People Page 11 of 28 Evidence: variety of formats such as large print and audio so that everyone has equal access to the information. The registered provider took over the home in September 2008. As there were plans in place to carry out extensive improvements to peoples accommodation a decision was made not to admit any new residents until some of the building work had been completed. As such, we were unable to assess the quality of the homes admission process but were able to confirm that a comprehensive pre-admission pack had been put in place, ready to use when the home begin to admit new residents. In discussion, the registered provider and manager showed a good understanding of the need to ensure that pre-admission assessments are carried out in a sensitive and person centred manner. Care Homes for Older People Page 12 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. People are provided with a good standard of care that is in line with their individual needs and wishes. Evidence: There was a written plan of care in place for every resident detailing their individual needs and the care they required in each area. We viewed a selection of care plans and found that they contained a fairly good level of information about the individual resident. Areas covered included personal and health care, mobility and peoples individual preferences and needs in relation to social aspects of their lives such as activities and relationships. We found some good examples where peoples own views and preferences had been included in their care plan and where their care had been tailored to meet their individual preferences. Care Homes for Older People Page 13 of 28 Evidence: In discussion, the manager told us that plans were in place to continue to develop person centred working and ensure that all residents care plans were as individual as the residents themselves. During our case tracking exercise we found that people had good support from health care professionals such as district nurses and GPs. We also noted that carers monitored peoples health carefully and responded quickly to any issues identified. There were detailed risk assessments in place in areas such as pressure sores and falling for each resident, and where risk was identified, there was guidance for staff in how to minimise risks and help keep people safe. We looked at the storage of residents medication as well as peoples medication administration records. We found that medication administration records were generally well maintained and contained a good amount of information, for instance in relation to peoples as and when required medicines. We also noted that the home had introduced a comprehensive homely remedies policy and procedures. This is beneficial for residents because it means that they can be supported to use non prescription medicines quickly. Although we found that processes for managing peoples medicines were generally safe we did identify some issues that needed to be addressed. We found a small number of errors when looking at residents medication administration records. These were usually where staff had not signed when they had given a medicine. In addition, one box of tablets did not add up with records of receipts and administration indicating that it had been given and not signed for. We discussed these issues with the registered manager who agree to address them and also advised us that she would continue to monitor the area closely by carrying out regular audits. Medicines were found to be safely stored and well organised but we noted that the home did not have a dedicated fridge for storing medicines. We raised this with the manager and have made a requirement in relation to the matter. 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. People are provided with regular opportunities to take part in activities they enjoy. Evidence: People who responded to our written survey and those consulted during our visit told us that they felt the provision of activities had improved a great deal in recent months. One resident said There seems to be more going on now and more trips out as well. A staff member told us We have more time to spend with the residents because there are more staff on duty throughout the day. We noted during our visit that there was a pleasant and relaxed atmosphere in the home and staff were observed spending time with residents throughout the day. A visiting musician entertained the residents which they seemed to enjoy. All the residents care plans we viewed contained information about how they liked to spend their time and records showed that people were able to choose from a variety of activities on a daily basis. We also noted that people were provided with regular opportunities to take part in trips outside of the home for instance, to local garden centres. It was pleasing to see that the manager ensured that all residents were Care Homes for Older People Page 15 of 28 Evidence: offered these opportunities on an equal basis. Menus showed that a varied and nutritious diet is provided and that people are able to choose from a variety of options at each meal time. People told us that they were happy with the quality and variety of meals provided. One resident said I think the food is very good, I always enjoy whatever we have. 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. People are enabled to raise concerns, and any concerns raised will be dealt with quickly and effectively. Evidence: The home has a complaints procedure in place which provides guidance on how to go about making a complaint and explains what will happen in this event. The procedure is written in a clear and easy to understand manner but at the time of our visit, was only available in a standard written format. We made a recommendation that the procedure be made available in a variety of formats so that everyone has equal access to the information. There is a record designed for recording complaints, action taken and subsequent outcome which is kept within the home. On viewing this record we were able to confirm that there have been no complaints made at the home since its registration, in addition there have been no complaints received by the Commission about the home. People who responded to our written survey and those we spoke with during our visit were aware of how to go about raising concerns and also told us that they felt confident any concern they did raise would be dealt with properly. One person wrote I doubt I would have any cause for complaint but if I did I am sure it would be dealt with immediately. Care Homes for Older People Page 17 of 28 Evidence: All homes are required to have written procedures in place to be followed if it is suspected that a resident has been the victim of abuse. These are generally referred to as Safeguarding procedures. We were able to confirm that the home had these procedures in place and people we spoke to had a good understanding of them. Records confirmed that all staff are provided with some training in Safeguarding as part of their induction. However, we made a recommendation that more in depth training in this area be provided, particularly for staff in senior carer positions. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The ongoing programme of improvement will result in people enjoying a good standard of accommodation. Evidence: High Wray is a very large detached building set in its own grounds. It is a spacious home and offers beautiful views from residents bedrooms. However, during the last inspection under previous owners, we found that the home was extremely run down and in need of much improvement and we made a judgement that people living there were provided with a poor standard of accommodation. The current registered provider took over the home in September 2008 and it was apparent during this visit that she had worked very hard to improve peoples accommodation. We found that much improvement work had been undertaken and work was ongoing at the time of our visit to continue the improvements. The registered provider explained how she ensured that the improvement work did not disrupt residents daily lives. One of the measures taken had been to stop all new admissions to the home for the foreseeable future. We were able to confirm that residents and where appropriate their relatives had been Care Homes for Older People Page 19 of 28 Evidence: consulted about the plans and were being kept updated about developments as they went along. We carried out a tour of the home and found that all residents private and communal areas were clean, warm and comfortable. One staff member said Finally, this home has been given some TLC, it will be beautiful when its finished. 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. People receive their care from carefully recruited, well managed staff. Evidence: We looked at some personnel files and found evidence that careful procedures are followed during the recruitment of new staff. All the files viewed confirmed that appropriate background checks are carried out for prospective employees before they are offered an appointment, such as Criminal Records Bureau checks and previous employment references. There were completed application forms on all the files we viewed which included full employment histories. We noted that there were some gaps in the employment history of one staff member. We discussed this with the manager who explained that she had investigated these gaps. We made a recommendation that records be kept of any such investigations in the future. During our visit we noted that there appeared to be plenty of staff on duty and carers were observed providing support in a relaxed and unhurried manner. People who responded to our written survey and those we consulted during our visit told us that staffing levels at the home were suitable. One staff member said The staffing levels Care Homes for Older People Page 21 of 28 Evidence: are so much better, staff are less stressed and residents are much happier, families have noticed the difference as well. A resident told us Anything I need is dealt with straight away. We found that the home have a good approach to the induction and ongoing training of new staff. A new induction programme has been developed and we were able to confirm that this was in line with Skills for Care standards. Records showed that ongoing training is provided in all the key health and safety areas such as moving and handling and fire safety. Additional training in areas such as working with people with dementia is soon to commence. We noted that out of 23 carers, 22 hold National Vocational Qualifications in care at level 2 or above. This is a very good level of qualified carers and exceeds the national standard which is 50 per cent. People consulted confirmed that there are regular staff meetings and that one to one meetings (supervisions) were held regularly. One staff member said You are encouraged to give your opinion about the home. Another said of the managers, They are so supportive, you could go to them about anything, you never feel like you are on your own here. 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. People who live and work at the home benefit from strong leadership and a committed management team. Evidence: There is a registered manager in post who has extensive experience in managing health care services. Throughout the inspection she demonstrated that she had the skills and knowledge to lead the service effectively. In addition, the registered provider is on site on a full time basis providing further management support. We received extremely positive feedback about the new management of the home from people we consulted during our visit and those who took part in our written survey. One staff member said I have never worked anywhere where the management is so good. Another wrote The home has benefited so much from the new management, staff and residents are so much happier, even residents families have noticed a big difference. Care Homes for Older People Page 23 of 28 Evidence: We received a completed self assessment from the manager within agreed timescales and this contained some very good information. It was apparent that the manager and provider monitor all aspects of the service closely. A number of improvements were detailed in the self assessment and there was supporting evidence that these improvements had been carried out. In discussion, the manager and provider demonstrated a genuine commitment to providing a good quality service and shared a number of ideas as to how the service will be developed further. There is a health and safety policy in place which is supported by a number of individual procedures in areas such as fire safety and infection control. At the time of our visit all staff were receiving update training in key health and safety areas such as moving and handling and fire safety. There is extensive improvement work ongoing at the home and the provider explained how she ensured people are safe during this work. The provider told us that risk assessments are updated daily in conjunction with the building manager to ensure that any new risks are identified and minimised. 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 9 13 Regular audits must be carried out of medication records and stock. This is to help ensure that people receive their medicines as prescribed. 31/03/2009 2 9 13 A fridge must be obtained which is soley for the use of medication. This is to help ensure that peoples medicines are stored safely. 20/05/2009 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 1 The homes Service User Guide should be made available in a variety of formats so that everyone has equal access to the information. The care planning system should be reviewed to ensure that care plans are user friendly. This is so that people can access information quickly and efficiently. 2 7 Care Homes for Older People Page 26 of 28 3 9 All hand written entries on residents medication administration records should be witnessed and double signed. The complaints procedure should be made available in a variety of formats so that everyone has equal access to the information. Safeguarding training should be provided for all staff members to help ensure the safety and wellbeing of residents. Any gaps in an applicants employment history should be fully investigated and a record made of the investigation. Regular meetings for residents and their relatives should be held so that people have the opportunity to contribute to the development of the service. 4 16 5 18 6 7 27 33 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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. 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