Care Home: Hope House Care Home

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What the care home does well People who use the service were treated with respect and personal care was carried out in private. One person said, "The staff are very polite and friendly." Another person said, "Nothing`s too much trouble for them." One of the visitors said, "They go over the care plan every so often to make sure things are ok." One person who completed the survey in answer to the question what does the home do well wrote, `Make sure residents are well looked after`. A range of leisure activities were organised at the home. One person said, "We play balloon games and draughts." One person wrote on the survey, `They organise events for residents to take part in both during the day and at night`. Trips out to local amenities such as Oswaldtwistle Mills and the local pub were also arranged. All the people asked said the meals were good. One person said, " The meals are very nice." Another person explained how they were offered a choice at mealtimes. What has improved since the last inspection? Then following action has been taken in order to comply with with the requirements made at the last key inspection of 9 July 2007. New employees are not allowed to start working at the home until two written references, an initial protection of vulnerable adults check or enhanced Criminal Records Bureau check had been obtained. This ensures people using the service are protected from the employment of unsuitable staff. A detailed risk assessment for the use of bed rails and other equipment such as crash mats and wedges were in place for people who were at risk of falling out of bed. This ensures that the correct equipment is used safely in order to prevent people from falling out of bed. What the care home could do better: When a person using the service has been diagnosed with an acute healthcare problem a care plan to address this must be put in place. This will ensure members of staff know exactly what they need to do in order to care for that person and promote their recovery. To ensure medication is managed correctly and enable accurate checks to be made all containers of medication should be dated when they are opened. Clear written instructions should be in place for staff to follow to ensure medication prescribed when required is given correctly. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hope House Care Home Rishton Road Clayton-le-moors Accrington Lancashire BB5 5PN     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: Susan Hargreaves     Date: 0 6 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Hope House Care Home Rishton Road Clayton-le-moors Accrington Lancashire BB5 5PN 01254397220 01254381521 hopehouse@schealthcare.co.uk 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) : Ashbourne (Eton) Limited care home 42 Number of places (if applicable): Under 65 Over 65 42 0 0 old age, not falling within any other category physical disability terminally ill Additional conditions: 0 20 4 Staffing for service users requiring nursing care will be in accordance with Notice issued 17th May 2000. The registered provider should employ a care manager who is a registered first level nurse. The registered provider, should employ a suitably qualified and experienced person who is registered with the Commission for Social Care Inspection as manager of Hope House Care Home. Within the overall total of 42 a maximum of 4 service users requiring terminal care. Within the overall total of 42 a maximum of 20 service users requiring nursing care who fall into the category of either OP or PD Within the overall total of 42 a maximum of 28 service users requiring personal care who fall into the category of OP. Date of last inspection Care Homes for Older People Page 4 of 28 Brief description of the care home Hope House is a purpose built house set in its own grounds. It is situated in ClaytonLe-Moors opposite a park and close to local amenities. The home offers 24-hour personal and nursing care for up to 42 residents. Accommodation is provided in single rooms, all except one room have en-suite facilities. There is a spacious communal lounge with dining area on the ground floor. There is also a conservatory on the ground floor. Another lounge is situated on the first floor. A passenger lift facilitates access to all areas of the home. An enclosed garden with seating is easily accessible to all residents. A parking area is available for use by visitors and staff. Hope House is part of a larger company providing care throughout the UK. The current fees charged at Hope House are £320 to £555 per week. Additional charges are payable for hairdressing, newspapers and toiletries. A statement of purpose and service user guide was available to prospective residents and their relatives on request. 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: A key or main unannounced inspection, which included a visit to the home, was conducted at Hope House on 6 July 2009. As part of the inspection process we looked at all the information we have received about Hope House since the last key inspection which took place on 9 July 2007. This included an Annual Service Review on 9 July 2008. The purpose of this was to assess if the quality of care provided to people living at the home had changed and to make sure the home was being properly managed. Information about the last key inspection and the Annual Service Review can be obtained from Hope House or www.cqc.org.uk The manager completed an annual quality assurance assessment several weeks before this visit to the home. This document is a self-assessment that focuses on how well Care Homes for Older People Page 6 of 28 outcomes are being met for people who use the service. It also gives us some numerical information about the service. Four completed surveys were returned from people using the service and ten from members of staff. At the time of this visit thirty six people were living at the home. A tour of the premises took place and we looked at staff files and care records. We also spoke to members of staff on duty and people who use the service. Discussions also took place with the manager regarding issues raised during the inspection. 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. Care Homes for Older People Page 8 of 28 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 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. A thorough admission procedure ensured the health and personal care needs of people using the service were identified and met. Evidence: A copy of the statement of purpose and service user guide is available to people who are considering using the service and their relatives on request. These supply information about the care and facilities provided at the home. The manager or a senior member of staff visited people who were considering using the service in hospital or their own home before admission. The purpose of this visit is to assess the persons health and personal care needs to ensure they can be met at the home. Where possible the persons relative was involved in the assessment process. One of the pre-admission assessments we looked at had been signed by a relative to indicate their agreement with the assessment and the care offered. Care Homes for Older People Page 11 of 28 Evidence: We looked at the care records of three people using the service. Pre-admission assessments were seen in all three files. This information was used to develop and have in place a basic care plan before the person was admitted to the home. This ensured that members of staff knew what they needed to do to care for a person new to the home and help them to settle in. 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 who use the service were cared for in a manner which promoted their privacy and dignity. Medication was managed safely. Evidence: We looked at the care plans of three people who use the service. Two of these plans identified the health and social care needs of each person and provided clear directions for staff to follow to ensure their individual needs were met. The other care plan we looked at stated the person had recently been seen by the doctor for an acute healthcare problem. However, a care plan explaining exactly what members of staff needed to do to manage this problem and aid recovery was not in place. Two members of staff were asked how they looked after this person and despite the shortfall in care planning both of them were aware of the acute healthcare problem. One section of each care plan provided detailed information about the individual likes Care Homes for Older People Page 13 of 28 Evidence: and dislikes of each person using the service. One of these advised members of staff that the person liked to have a shower because it enabled them to be more independent. Another one told staff that the person did not like being told what to do or woken up. This information helped members of staff to care for people in the way they preferred. Appropriate risk assessments including ones for falls, nutrition and the development of pressure sores were in place. Guidance for staff to follow about how to manage identified risks was also included in the care plans. A written report about the care given to each person using the service was written during each shift. This ensured that all staff had up to date information about the condition of each person in order to ensure continuity of their care. Care plans and risk assessments were reviewed monthly and updated when the needs of the person changed. Where possible the person using the service or their relatives were involved in care planning and had signed the care plan to indicate their agreement with the care provided. The relative of one person said, They go over the care plan every so often to make sure things are ok. There were records of the involvement of GPs and other healthcare professionals including the chiropodist and district nurse in the care of people who use the service. The manager explained that to improve the quality of the end of life care for people using the service they were committed to implementing a recent initiative called the Gold Standard Framework. This involved further training for members of staff in order to increase their knowledge and understanding of the physical and emotional needs of people approaching the end of their life. Medication was stored correctly and administered by qualified nurses. We looked at the records for the management of medication. These included a record of medication received into the home and a record of unused medication collected for disposal by a licensed waste carrier. We checked a sample of medication records and stock but found it difficult to account for some medication. This was because medication was not always dated on opening. Writing the date on medication when they are opened helps to prevent mishandling. A number of people were prescribed pain killers to be taken when required. However, Care Homes for Older People Page 14 of 28 Evidence: there were no written instructions for staff to follow stating if the person was able to tell them when they needed pain killers or what signs and symptoms they displayed if they could not. Having clear written instructions for the administration of when required medication ensures people using the service are given their medication when they need it. We checked how controlled drugs were handled, these are medicines that can be misused. A special register was used for record keeping and was seen to have been completed correctly. Personal care was carried out in the privacy of the persons own room or the bathroom. Members of staff were observed attending to people in a polite and friendly manner. One person said, The staff are good, they cant do enough for you. Another person said, Ive always been well looked after. Care Homes for Older People Page 15 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Leisure activities and meals are well managed and enabled people using the service to have an interesting and fulfilling lifestyle. Evidence: A full time member of staff was employed to organise leisure activities and social events at the home. Although this person was not on duty during this visit members of staff spent time in the afternoon playing a large size noughts and crosses game with people sitting in the lounge. Discussion with people using the service and members of staff confirmed that they played draughts, dominoes, bingo, cards, balloon games, skittles and Wii games such as bowling. Other activities included arts and crafts, pottery, planting seeds and baking. When the weather was nice people could sit outside or go to the local park with members of staff. One person said, They take me out in the park and they take me to the hairdressers up the road. One member of staff said that entertainers regularly visited the home and when a group came recently people using the service had enjoyed playing percussion instruments. The manager stated in the Annual Quality Assurance Assessment that the activities organiser spent one time individually with people if they were unable to join in group Care Homes for Older People Page 16 of 28 Evidence: activities. Surveys from people living at the home show that they are satisfied with the arrangements for leisure activities and the choices available. People using the service could choose to have their done by the visiting hairdresser if they wanted. A room on the ground floor of the home had been refurbished as a hairdressing salon. To ensure this was a pleasant social experience people having their hair done were offered refreshments and could chat to each other as they would if they had gone out to the hairdressers. A local Vicar regularly visited the home and offered communion to people who wished to practice their faith in that way. People from the British Legion also visited the home and reminisced with people using the service about their wartime experiences. People using the service and members of staff said that visitors were welcomed into the home at anytime and offered refreshments. The daily routine was flexible in order to meet the needs and preferences of people using the service. All the people asked said they could choose when to get up and go to bed. The meal served at lunchtime looked wholesome and appetising and a choice was offered for both main course and dessert. Members of staff were observed sitting and chatting with people using the service at lunchtime and assisting them with feeding when necessary. Lunch was unhurried allowing people time to socialise and enjoy their meal. A diet notification form was completed for each person using the person using the service. This provided members of staff with information about each persons likes and dislikes and any special dietary requirements. One these forms told staff that the person liked most types of food and will try anything. Fresh fruit was readily available and staff were observed offering this to people with their mid-morning drink. All the people asked said the meals were good. One person said, The meals are very nice, we had prawns the other day. Another person said, Im enjoying the food, we have a choice at mealtimes. Care Homes for Older People Page 17 of 28 Care Homes for Older People Page 18 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. Complaints were taken seriously and investigated. Members of staff had the training necessary to ensure people who use the service were protected from abuse. Evidence: A copy of the complaints procedure was included in the statement of purpose and service user guide and displayed in the home. The ten members of staff who completed the survey indicated that they knew what to do if a person using the service or their relatives expressed any concerns to them. The relative of a person using the service said that would feel confident to make a complaint should it become necessary. The manager said she had investigated two complaints in the last year. A record of these complaints, the investigation and the action taken were available for inspection. No complaints have been made directly to the Commission. We looked at the policies and procedures for safeguarding vulnerable adults. The procedure stated the action that members of staff must take if allegations of abuse are made. Discussion with three members of staff confirmed that they had received training in safeguarding vulnerable adults. They all said they would report any concerns immediately and knew the procedure they must follow. Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The premises are well maintained and provide a comfortable and homely environment for people who use the service. Evidence: A tour of the premises confirmed that the home was clean, tidy and well maintained. This provided a homely and comfortable environment for people using the service. During the visit one of the bedrooms was being redecorated. A care worker explained that when a bedroom became vacant it was always redecorated to make it nice and fresh for the next person. One person using the service said, The rooms are nice and clean. The surveys completed by people using the service told us that they are happy with the standard of cleanliness at the home. People using the service were encouraged to bring personal items for their bedrooms to make them more homely. These included, ornaments, photographs and pictures for the walls. The grounds and gardens were well kept and accessible to people using the service. On the day of this visit the weather nice and Several people were sitting outside Care Homes for Older People Page 20 of 28 Evidence: enjoying the sunshine. All the laundry was done at the home. A suitably equipped laundry room ensures clothes are washed promptly and returned to people using the service. Gloves and plastic aprons were available throughout the home for members of staff to use in order to protect themselves and people using the service from infection. The care manager was also the designated link nurse for infection control. She attended regular meetings arranged by the Primary Care Trust in order to keep up to date with current practice in infection control and in particular the action to take if there was an outbreak of flu at the home. Care Homes for Older People Page 21 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. Members of staff are encouraged to acquire the skills and knowledge necessary in order to meet the needs of people using the service. Recruitment procedures are thorough Evidence: The duty rota provided details about the grades and number of staff on duty for each shift. Ten members of staff completed the survey and in answer to the question are there enough staff on duty to meet the individual needs of all the people who use the service five stated always and five usually. One person using the service said, Theres staff around when I need help. The manager explained that additional staff were on duty when people using the service went on trips out and to accompany people to hospital appointments. We looked at the files of two members of staff appointed since the last inspection. These files indicated that all the required information had been obtained before both members of staff had started working at the home. These included two written references and a Criminal Records Bureau check. However, only the initial protection of vulnerable adults check was available for inspection. The record of the full enhanced Criminal Records Bureau check was kept at head office. Although the manager explained that any issues with these checks were always discussed with her she was Care Homes for Older People Page 22 of 28 Evidence: advised to ask the company to provide her with some evidence that the full enhanced check had been received. Pre-employment checks ensure that people who use the service are protected from the employment of unsuitable staff. Discussion with the manager and members of staff confirmed that training for all members of staff was actively encouraged. This included induction training for new employees, moving and handling, safe use of bed rails, basic food hygiene, first aid, safeguarding vulnerable adults, infection control and fire awareness. In addition to this half of the care workers have National Vocational Qualifications at level 2 or 3 in health and social care. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a competent manager and the views of people using the service are considered when decisions about the care and facilities provided at the home are made. Evidence: The manager is an experienced nurse and keeps up to date with current practice by attending relevant training, reading care journals and using the internet. Two members of staff interviewed during this visit said the manager was approachable and supportive. Discussion with the manager confirmed that she was committed to running the home in the best interests of the people living there and had achieved the nationally accredited Investors in People Award. The people using the service and their relatives were asked to give their views about the home by completing anonymous satisfaction questionnaires every year. This had been done recently and we were shown several Care Homes for Older People Page 24 of 28 Evidence: completed ones. The responses were generally positive. Meetings with people using the service were held every two months to enable them to discuss any aspect of their life at the home. At the last two meetings leisure activities and menus were discussed. Meetings with the relatives of people using the service were also held every two months. At the last meeting in April they had discussed leisure activities and recent legislation about the deprivation of liberty safeguards. The manager said that she had an open door policy and would see people using the service and their relatives at anytime when she was on duty. She also said that she frequently walked round the home and chatted to people informally. The Annual Quality Assurance Assessment stated that as a result of listening to the views of people using the service they have arranged shopping trips to Oswaldtwistle Mills, visits to local pubs and incorporated more choices in the menus. Several people using the service had a small amount of money kept at the home to pay for hairdressing, chiropody and other personal needs. To ensure this was managed safely records of all transactions were kept. We checked one of these during the visit and found the records to be up to date and accurate. Policies and procedures for safe working practices were in place. These help to make sure the home is a safe place to live and work. Fire alarms were tested weekly and emergency lighting monthly. An up to date fire risk assessment was in place and fire drills took place every month. We looked at the records of the routine servicing of equipment. These included up to date electrical installation and gas safety certificates and evidence that the testing of small electrical appliances was carried out annually. Care Homes for Older People Page 25 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 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must identify and 28/08/2009 address any acute healthcare needs for each person using the service. This will ensure that all the nurses and care workers will know what they need to do to look after the person and promote their recovery. 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 9 All containers of medication should be dated when they are opened. This will ensure medication is managed correctly and enable accurate checks to be made. Clear written instructions should be in place for staff to follow to ensure medication prescribed when required is given correctly. 2 9 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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