Care Home: King Edward Care For The Elderly

What the care home does well By looking at records, talking to people and making observations, we found the home provides care in a flexible way, so that people have the opportunity to live their daily lives as they choose to. Comments included, "we don`t really have any rules and people can move a round the home as they choose", " A few people have been here for a long time and we all know them well". The way we saw staff speak to people show they do it with sensitivity and consideration. They make sure peoples needs are being met, so that they are comfortable. We talked to the staff team on duty who confirmed they have a good knowledge of the individual care needs, social and cultural needs of people living at the home so that they are not disadvantaged in any way. Comments included, "Everybody is different, but they all have their own characters which makes it so interesting". Staff told us they feel very supported by the manager of the home, who encourages them to develop their skills in providing care to people. We saw evidence that the home has emrbaced new legislation to ensure that residents human rights are respected and their liberty is only deprived when it is in their best interests and there are no less restricive ways of keeping them safe and well and giving the care and/or teatment they need. What has improved since the last inspection? Staff files show the home has improved its recruitment to ensure people have completed fitness checks in place prior to commencing work at the home. There have been improvements to the environment so that consideration has been given to colour schemes and flooring types, which are best suited to people with dementia conditions. What the care home could do better: Staff records should all include dates of commencement so that it is clear when auditing the files that people have received their fitness checks prior to commencing work at the home. We found some staff have not received training in safeguarding people and should be provided with training in this area for the protection of users of the service. Key inspection report Care homes for older people Name: Address: King Edward Care For The Elderly 7/9 Warbreck Drive Blackpool Lancashire FY2 9JX     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jacqueline Riley     Date: 2 4 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: King Edward Care For The Elderly 7/9 Warbreck Drive Blackpool Lancashire FY2 9JX 01253354785 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: nadinejohnson@btconnect.com Mrs Sarah Lynne Pitman,Mr David John Wheeler care home 11 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The registered person may provide the following category of service only: Care Home only - Code PC To Service Users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia - Code DE The maximum number of Service Users who can be accommodated is: 11 Date of last inspection Brief description of the care home King Edward care home provides residential care for 11 people diagnosed with various levels of dementia. The care home is situated in a residential area close to amenities and public transport services. There are nine single rooms and one double, three of which are on-suite. People living at the home have a range of aids and adaptations in place to help them to remain as independent for as long as possible. The first floor can be reached by two sets of stairs and there is a passenger lift for people with poor mobility.There is an enclosed garden area to the rear, which is secure for the safety of people living there. Care Homes for Older People Page 4 of 27 Over 65 0 11 Brief description of the care home There is a statement of purpose/service user guide, which is given to all prospective residents. This written information explains the care service that is offered, who the owners and staff are and what the resident can expect if he or she decides to live at the home. At the time of the inspection visit the fees for living at the home were £375-£425 per week. Any additional costs are inlcuded in individual contracts. Care Homes for Older People Page 5 of 27 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: three star excellent 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 main inspection of King Edward Care Home was undertaken including a visit to the service over a five hour period on 24th September 2009. We spoke to the registered manager and three staff members. There were no visitors there during the inspection of the home. We spent time in and around the communal areas of the home making general observations to get a flavor of how the home operates on a daily basis. As part of the inspection process we talked to people using the service and asked staff about those peoples needs. We also looked at their rooms, care plans, records and daily notes this is called case tracking. We also invite others using the service to pass on their opinions if they wish, however due to the level of dementia some of the comments were limited. Care Homes for Older People Page 6 of 27 We had some responses from questionnaires sent to people who use the service for their views on how they experience the service. Comments were positive and some are included in this report. Every year the person in charge or manager is asked to provide us with written information about the quality of the service they provide, and to make an assessment of the quality of the service. We use this information, in part, to focus upon our inspection activity. We looked at recruitment and training records of three staff members. We walked around the building and watched people living and working in the home to see how everyone supported and talked to each other. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our Care Homes for Older People Page 8 of 27 order line 0870 240 7535. Care Homes for Older People Page 9 of 27 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 27 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. Residents, families and friends have information about what services they can expect to receive if they choose to live at the home. Admission and assessment procedures are in place so that the home knows they can meet the individual needs of people. Evidence: We looked at the records of three people living at the home. The records were for people living there on a permanent basis. We saw they had assessment details in place from social workers, and a range of other healthcare professionals including, hospital discharge teams and psychiatry departments. In addition the home has their own admission assessment which is used by the homes manager so they can gather information they feel they might need to provide care to the person. The information showed the home is informed through these assessments of the needs of the person. Staff spoken to said they use this assessment information to determine the level of care the person needs. Comments received said, when placements are being made we are generally well informed of the persons essential needs. Care Homes for Older People Page 11 of 27 Evidence: We saw the home has in place information about the home and what services it provides. This information is generally given to relatives and advocates, so that they know what the home can provide and make an informed decision based upon information they receive. Care Homes for Older People Page 12 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Promotion of health is taken seriously. Peoples welfare is monitored and their health needs are identified and met. Evidence: The three care planning records we looked at were accurate and up to date. There was excellent information about individual healthcare needs as well as how those needs are going to be met. Staff we spoke to said the information is very clear and they can follow the plans to maintain and support people who live in the home. Comments included, the care planning records are used by all staff so we know what is going on with each individual resident, we have worked hard to get these plans in place, and the staff team know how to use them to get the information they need. We found the home has been working closely with other organisations to introduce risk assessment for people relating to the Deprivation of Liberty Safeguards (DoLS). This resulted from the Mental Capacity Act 2005 to protect people who may be at risk of being deprived on any basic human right. The records we looked at showed each file includes reference to this and a confidential assessment to identify any one specific Care Homes for Older People Page 13 of 27 Evidence: area which may result in deprivation of a persons liberty. The manager and staff spoken to said the training they have received has made them aware of their responsibility and duty placed upon them by the Mental Capacity Act and Deprivation of Liberty Safeguards. The records we looked at show there are also general risk assessments in place for people, which highlight what the risk is, how it can be managed and what the outcome is for the person. There was evidence of risk assessments and care plans being reviewed on a monthly basis by the manager. In some instances we saw evidence of changes being made as the needs of the person changed, so that staff were able to meet the presenting need at the time. By looking closely at the records we found there are links between the home and other healthcare professionals including, doctors, district nurses, Psychiatric professionals, so that peoples healthcare and psychological needs are being met. Medication records and observation of practices in administration showed us it is safe. Only trained staff or the manager administers medication. We looked at three records and found them to be complete and up to date. We looked at how the home stores medication and found it to be in a locked purposeful facility. We saw peoples privacy and dignity is respected during the visit by looking at how staff talk to and respond to residents. We found staff to be respectful and sensitive to individual needs throughout the inspection. Staff spoken to said, we know there is a need to respect people and treat them with sensitivity, many of them dont know what they are doing and it can be very upsetting for their relatives to see, and as staff we understand that. Care Homes for Older People Page 14 of 27 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. Social activities and meals are arranged to meet peoples needs, activities are varied so that people have choice. Evidence: We spoke to some of the staff about routines in the home. They said they are flexible and people can get up and go to bed when they choose. However they said some people get up fairly early as this is their usual routine. Most people we saw stay in the communal area. We saw there is space in the communal areas for people to use, and a number of residents spent time walking around the communal lounges and corridors without any restrictions. Staff were seen to interact well with people living there, talking to them, spending time with them when they were having a drink or just chatting. The interaction between staff and residents was seen to be positive at all times during the inspection. Staff told us they like the way they can spend time with people, comments included, we know the residents well and how their moods can change very quickly, so we are ready for that, I like to spend time with the residents, they all have their own character. The home prepares its own meals which are based upon a balanced nutritional diet. The manager and staff told us of the flexibility in meals for people living at the home. Care Homes for Older People Page 15 of 27 Evidence: In some instances people will not sit at the table and so, other ways to support them have been used including finger foods and nutritional supplements following dietary advice from other professionals. Comments we received told us people like the food and say there is choice available. Staff told us they are informed of a persons nutritional needs when they are admitted to the home, and they cater for medical conditions such as diabetes or any other nutritional need. They told us they know the individual likes and dislikes of people living there so that they can meet their nutritional needs on a daily basis. The registered manager told us of recent development in providing a range of activities for people living there which is designed around the specific needs of people with dementia conditions. We saw individual records for people living there for activities they are involved with, including hand massage, aromatherapy, board games, musical movement and accompanying some people to hairdressing appointments and regular parties for birthdays and Christmas. In addition peoples cultural needs are taken into account for religious services. We were told of regular visits by clergy for individual residents who like to receive communion. There are no restrictions for visitors to the home, although none were present during the time spent there. We were told of some people going out with their relatives and friend and this is encouraged by the manager and included in the risk assessment so people are protected. Care Homes for Older People Page 16 of 27 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. The arrangements for recording and responding to complaints are good making sure people feel listened to. Staff are knowledgeable in safeguarding people although not all have attended training meaning the protection of users of the service may be limited. Evidence: We looked at the homes complaints procedure, which is made available to people using the service including their relatives or advocates during the admission process. We were told by staff they are aware of the complaints procedures and how to use them. Comments included, we are made aware of the complaints procedure and how to use it during our induction. Comments from surveys told us people have the information they need to raise an area of concern. There has been one safeguarding investigation since the previous inspection however it was unsubstantiated.. We spoke to the manager and staff about how residents are protected. We were told all staff have access to safeguarding adults guidance which is used by the manager during the induction programme in order to ensure people are protected. The files we looked at showed us that some staff have attended training in this area, and others will be attending training in the next local authority session. Staff we spoke to demonstrated they were knowledgeable in protecting people by using the procedures Care Homes for Older People Page 17 of 27 Evidence: in place. Care Homes for Older People Page 18 of 27 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 home is designed to be homely and comfortable for people living there. Evidence: We looked around the home and found there have been improvements since the previous inspection. The entrance hall and dining room have had solid flooring to replace carpets. The communal lounge will shortly have solid flooring. The manager told us she has researched good practice guidance for environments where people with dementia conditions live and found neutral colour schemes are known to be calming and beneficial to peoples behavior. The home is therefore taking this into account when decoration is taking place. Ground floor decoration is neutral with plenty of natural light. We saw all windows and doors have been replaced with UPvC, which provides more insulation. A new heating system has also been introduced and has improved the consistency of the heating throughout the home. We were told the decoration programme is continuing for people rooms. Some we looked at have been decorated and new furniture items in place whilst others require decoration and soft furnishings replaced so the rooms are well maintained and provide a comfortable environment. Care Homes for Older People Page 19 of 27 Evidence: We saw both bathrooms have been improved with a wet room on the ground floor and a walk in shower and toilet on the first floor. The ground floor wet room is specifically designed for people with limited mobility, thereby easing access. Comments from surveys told us people are satisfied with the environment. Care Homes for Older People Page 20 of 27 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. There are procedures in place for recruiting staff, ensuring the safety and protection of people living there. Training is delivered so that the staff team have the necessary skills to meet peoples needs. Evidence: We looked at how the staff team is utilised to meet the needs of people during the day and nighttime periods. We found the home is using a skills mix of staff so that there is always a senior member of staff on each shift. We saw there are sufficient numbers of staff to meet the needs of people living there. Staff we spoke to said they were happy with the way they are supported and how they work in the home. Comments included, We all work really well together as part of a team, Ive been on lots of courses and this helps me in the job I do. All members of the care staff have achieved a recognised national care qualification with others being enrolled to complete further training. Most records we looked at showed staff have attended Dementia training at various levels over time so that the specialist needs of people living at the home can be met. We looked at two staff files. They showed us staff are recruited safely using procedures which take into account information about their skills and competences for the role applied for. Information about them included application records, references Care Homes for Older People Page 21 of 27 Evidence: which have been checked, Criminal Record Bureau (CRB). Protection of Vulnerable Adults (POVA)checks to make sure they are safe to work with people who may be vulnerable. However one record did not clearly show the commencement date, making it difficult to confirm the applicant had commenced after fitness checks had been received by the home. It was noted staff who have worked at the home for over three years have recently renewed fitness checks to ensure people are protected. Staff we spoke to told us they feel well supported by the manager, who has introduced induction training for all staff using a Skills for Care format, which covers all aspects of the staffing roles. In addition supervision and appraisal is being used on a regular basis to ensure staff are supported in their roles and their personal development is being recognised by the manager. Care Homes for Older People Page 22 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed for the benefit of all users of the service with systems and policies in place for the saftey and protection of people living there. Evidence: We saw the manager is running the home on a day to day basis in the best interests of people living at the home and staff. Comments included, the manager is very supportive, You can talk about things with the manager at any time. We talked to the management team about how they involve the staff in the running of the home. They told us and showed us records of supervision, meetings and appraisals which are held regularly to share views about the running of the home. Staff spoken to said they feel part of the decision making processes and felt their own veiws are valued. We found that all records and systems in the home are up to date, so that the information is current. Staff were able to follow clear instructions in the records for the Care Homes for Older People Page 23 of 27 Evidence: health and welfare of people. We saw there is a clear line of management responsibility and that staff communicated well with the manager throughout the inspection process. We looked at how peoples money is handled and were told the home does not manage any money belonging to people living there. Relatives or advocates are advised about this at the time of admission. By looking at records we saw regular tests and servicing of essential equipment inlcuding, gas, electric and fire they were safe. Care Homes for Older People Page 24 of 27 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 27 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 1 2 3 18 19 29 Staff should continue to receive training in safeguarding people so they are protected. Decoration of peoples rooms should continue so that they are comfortable for people to live in. Staff files should have the date of commencement so that there is a clear audit trail to ensure they commenced employment after satisfactory fitness checks have been received. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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