Care Home: Homelea Residential Care Home

What the care home does well Homelea offers residents a homely place to live, the environment is clean and residents are able to personalise their rooms with their own possessions if they wish. Communication between residents, relatives and staff was relaxed and friendly, and residents appeared comfortable during the inspection. The visitor was positive about the support offered, people are always made welcome when they visit and the staff are very good. What has improved since the last inspection? There were no requirements from the last inspection. What the care home could do better: No requirements have been made following this inspection, however some issues have been identified and have been included in the body of this report. The process of offering support to residents is to be reviewed to ensure that they are able to make choices about all aspects of their lives. This will involve the development of person centred care and will require appropriate training for staff. Improvements to the environment, in terms of assessing the use of gates and restrictions on residents movements are to be made, and the home is to inform the commission in writing about the changes they have made. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Homelea Residential Care Home 15-17 Lewes Road Eastbourne East Sussex BN21 2BY     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: Kathy Flynn     Date: 0 6 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 25 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 25 Information about the care home Name of care home: Address: Homelea Residential Care Home 15-17 Lewes Road Eastbourne East Sussex BN21 2BY 01323722046 01323734047 enquiries@nifinaraltd.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Nifinara Limited care home 27 Number of places (if applicable): Under 65 Over 65 0 dementia Additional conditions: 27 The maximum number of service users to be accommodated is 27. The registered person may provide the following category/ service only: Care home only - (PC) to service users of gender: Either Whose primary care needs on admission are within the following categories: Dementia (DE). Date of last inspection Brief description of the care home Homelea is registered to provide care and accommodation for up to twenty seven people with a dementia type illness. The home is close to Eastbourne town centre and a short car journey from the seafront. It is comprised of three buildings combined into a large detached house with a small front garden and a large rear garden and car park. There is level access to all parts of the garden and seating is provided for residents. Two medical doctors own the home, one of which is also the registered manager. They are experienced and committed to providing a high level of care to their residents. The home aims to provide a safe homely environment in which residents are able to lead satisfying lives, retain dignity, privacy and exercise choice. Regular social activities within the home and outings are arranged. Information about the service, including the Statement of Purpose is made available to prospective service users or their representatives, on request, as part of the admission process. Intermediate care is not Care Homes for Older People Page 4 of 25 Brief description of the care home provided. The range of weekly fees is currently from 366 to 550 pounds; the fees do not include hairdressing, chiropody, aromatherapy, toiletries and newspapers. Care Homes for Older People Page 5 of 25 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 unannounced inspection was carried out on the 6th April and included a tour of the home, a review of pre admission assessments, care plans, staff records and training, medication records, activities, and menus. There were 24 residents at the home during the inspection. Residents were spoken with and a visitor to the home was happy to discuss the support provided. The manager, deputy manager, and the staff on duty discussed the care and support they provide at the home. Care Homes for Older People Page 6 of 25 The Annual Quality Assurance Assessment AQAA was completed by the manager, within the required timescale, and identified areas where improvements are planned for the benefit of residents. The reader should aware that the Care Standards Act 2000 and the Care Homes Regulations 2001 use the term service user to describe those living in care home settings. However for the purposes of this report those living at Homlea will be referred to as residents. 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 25 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 25 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. Pre-admission assessments are completed on all prospective residents, prior to the offer of a place, to ensure the home can meet their individual needs. Evidence: The pre-admission assessments have been reviewed and updated to include information about the social, spiritual and psychological needs of prospective residents. The manager confirmed that the assessments are carried out with the full involvement of prospective resident, their family, the providers and a senior member of the care team, This was supported by a visitor during the inspection. The manager informs the prospective resident, and their family, in writing if the home can meet their needs and is able to offer a place at Homelea. The letters are quite detailed and include clear information regarding the needs and preferences of residents following admission to the home. Care Homes for Older People Page 10 of 25 Evidence: People are invited to visit the home, to have lunch and talk to residents and staff, and the rooms are offered on a trial basis of four weeks. Prospective residents are encouraged to use the trail period to decide if they wish to accept a room on a permanent basis. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning system contains satisfactory information and enables staff to offer residents the personal care they need. Training with regard to medication is provided for staff to protect residents. Evidence: Six care plans were viewed and found to contain information about the needs of residents, including risk assessments for moving and handling, nutrition, pressure relief and falls. Daily records are kept for each resident and staff use tick boxes to reflect the personal support provided. Staff were noted to provide support for residents with regard to their personal care, assistance with meals, and support when transferring to and from lounge to dining room or bathroom. However there was very little evidence that staff involve residents in any decisions about the care they receive, and although there are details concerning the residents likes and dislikes or hobbies, these were not arranged for them during the inspection. The manager confirmed that she is reviewing the care planning system and aims to Care Homes for Older People Page 12 of 25 Evidence: introduce holistic care for the residents. The expectation is that training will be provided for staff to ensure that all residents receive person centred care, with their individual needs and preferences the basis of the care plans. Feedback from staff about the change in care provision was positive, those spoken with are looking forward to providing person centred care, which will be considerably different from the work has to be done and the task orientated process currently in use. The manager advised that the pharmacy provider has recently been changed, which has improved the service they receive, and training is provided for all staff at the home with regard to medication. The deputy manager is responsible for the ordering, storage and administration of medicines, and three staff are responsible for administering medicine as prescribed. Monthly audits are carried out by the manager to ensure that Medication Administration Record (MAR) charts are completed appropriately, and all but one of those viewed were completed correctly. Homely medicines are provided and there are policies and procedures in place for staff to follow. The relationship between residents, visitors and staff was relaxed and friendly and staff respected residents privacy and dignity when offering personal support. One resident prefers staff not to assist with personal care and became quite distressed, the manager has applied to the local authority for advice, in terms of supporting the resident whilst also respecting her choices and protecting her. Staff have attended training so that they are aware of supporting residents if their health needs change, the manager confirmed that this will enable them to offer appropriate care and support for residents, and their families. Residents are enabled to remain at the home unless there are medical reasons for transferring them to another facility. Care Homes for Older People Page 13 of 25 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. Some activities are available for residents, however these may not be based on their individual preferences and choices. The meals at the home are good, choices are offered and pureed diets are provided with assistance from staff if required. Evidence: The manager advised that there are a range of activities for residents to participate in if they wish, and there is a list for staff to follow. However it was not clear how residents could participate in these if staff are busy completing the work they are required to do in terms of washing and dressing residents, laundry, drinks, meals and ongoing personal support as needed. There were clearly many residents with a wide range of needs relating to different stages of dementia and further appropriate stimulation and socialisation, over and above the general day to day care duties is required to promote a person centred approach. The manager said that she has employed an activity organiser who will be responsible for developing a programme of individual activities for the residents, based on their interests and choices. Such a change would require the involvement of all the staff in the home and the expectation is that it will be developed as part of person centred Care Homes for Older People Page 14 of 25 Evidence: care programme they are introducing. Visitors are welcome at any time, there are links with the local community including church visits, and the home plans to have a summer party when the weather permits. However staff advised that they rarely have the opportunity to take residents out for a walk, although some may ask to do this, because they are busy providing personal care and support. Although they also said that trips for mobile residents are arranged monthly and involve visiting local areas and having tea. The manager and staff clearly aim to provide residents with the support and care they need, and the relationship between them was friendly and relaxed. Unfortunately there was very little evidence that residents are encouraged to make choices about their day to day lives. Residents are unable to walk freely around the home, because they may be at risk, this means they are restricted to the lounge area and the nearby corridors, and staff are not providing them with appropriate opportunities to make choices about what they do. The food provided at the home is good and choices are offered for each meal. Residents are assisted if necessary and pureed meals are available as required. It was noted that as a resident was assisted with their lunch in the lounge others were sitting waiting for their meal, or were being taken into the dining room. Meals were given out for some residents before others at the same table in the dining room, and salt, pepper and sauces were not offered until this was raised with the manager. The manager confirmed that drinks are provided regularly throughout the day and include tea, coffee and fruit juice, with biscuits or fruit offered. The afternoon tea session consisted of biscuits being taken into the lounge on a tray and then handed out to residents, cups of tea were brought in to the lounge some minutes later, and residents were asked if they wanted one but were not offered an alternative. There is considerable opportunity to make meals a pleasant and positive time for people with dementia, and with appropriate planning, staff training and sufficient staff numbers they can be a valuable social experience for them. Care Homes for Older People Page 15 of 25 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. Systems are in place to address any complaints and concerns, training is provided for staff to ensure they protect vulnerable adults. Evidence: Policies and procedures regarding complaints are in place, the Commission has received no complaints about the home, and the manager advised that there have been no complaints since the last inspection. Training in protecting vulnerable adults is provided for staff, and those spoken with have attended and were able to discuss what action they would take if they have any concerns. The manager is in the process of discussing the support provided for some residents, with the local authority in terms of their safety and protection, to ensure that their rights and choices are protected. Care Homes for Older People Page 16 of 25 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 home offers residents a comfortable and well maintained environment. Training in the control of infection is provided for staff to protect residents. Evidence: The homes environment is comfortable and homely, with a large lounge, a separate small seating area, and a dining room on the ground floor. There is a large garden to the rear, that the staff advise residents use when the weather permits, and there are plans to develop and extend into the car park to provide a larger lounge and activity area. Residents are encouraged to personalise their rooms and many have done this with pictures, ornaments and some furniture. Any furniture noted to be past its best was replaced immediately by the provider. A number of gates have been installed in the home, across the stairs and in the doorway of two rooms. The manager advised that these were installed following advice for the health and safety of the residents. However these may restrict the residents and the manager is seeking further information, to ensure that decisions about restrictions in the home do not prevent residents from making choices about where and how they spend their time. Care Homes for Older People Page 17 of 25 Evidence: Moving and handling aids, pressure relieving mattresses and cushions, pressure mats to reduce the risk of falls, a bath hoist and some hospital beds have been purchased to protect residents. A number use walking aids are used by residents, and staff were noted to be supporting them appropriately. Training to prevent cross infection is provided for staff and those spoken with have attended this and were using gloves and aprons correctly. Care Homes for Older People Page 18 of 25 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. Robust recruitment procedures are used to protect residents, and training relevant to their work is provided for staff. Evidence: Four staff files were viewed and found to contain all the required information, including completed application forms, Protection or Vulnerable Adults (POVA) and Criminal Records Bureau (CRB) checks and two references. The providers confirmed that all checks are completed before staff are allowed to work in the home. Induction training is provided for all new staff and those spoken with said they had completed this when they first worked at the home. Additional training including National Vocational (NVQ) courses are available. All care staff spoken with have completed NVQ level 2 or 3 and the home exceeds the required 50 percent of care staff with NVQ qualifications. The manager and staff felt there are sufficient numbers of staff in the home to meet the needs of the residents, and this may be appropriate if the emphasis is on providing personal support and care. As the person centred, holistic approach to care is developed and introduced staff numbers and their skills will need to be reviewed and updated as required. Care Homes for Older People Page 19 of 25 Care Homes for Older People Page 20 of 25 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 management approach encourages the involvement of residents, staff and relatives in the decisions about services provided at the home. Evidence: The manager and her husband are both doctors and owners of the home. They are actively involved in the day to day management of the service and advised they are available to residents, relatives and staff at any time. Feedback from staff was positive, they said they feel supported and are able to discuss any issues or suggestions they have with them. Visitors to the home were equally positive, saying the owners are approachable and they and the staff look after the residents well. Residents are supported by their families or representatives with regard to financial Care Homes for Older People Page 21 of 25 Evidence: decisions, and the manager advised that any moneys kept in the home for residents use is recorded with relevant receipts kept. Reference to comprehensive health and safety and infection control audits introduced during the past twelve months is made in the AQAA, and the manager confirmed that all systems in the home are checked and maintained as required. Relevant training is provided for staff and those spoken with have attended this, including fire training, food hygiene, infection control, medication, and moving and handling. Care Homes for Older People Page 22 of 25 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 23 of 25 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 24 of 25 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. 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