Care Home: Lady Forester Residential & Day Care Centre

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What the care home does well People who are thinking about moving in are assessed to make sure that the home can meet their wishes and needs. People consulted as part of the inspection process told us they receive good care and support from a caring staff group who treat them with dignity and respect. There are systems in place for the administration of medication which aim to protect people who live at the home. The home has a robust recruitment procedure in place. Care staff are supervised, and receive training to help them do their job and to understand the needs and wishes of the people they care and support. People are protected from potential abuse and by the systems in place to protect their finances and health and safety. The home is managed in the best interest of the people living at the Lady Forester care home. It is run by an experienced manager who has the required qualifications and regularly updates her knowledge and skills. What has improved since the last inspection? Some areas of the home have been re decorated. The appointment of an additional housekeeper has ensured continuity of good cleaning standards are maintained throughout the home. What the care home could do better: Care plans could contain more detail so that staff have all the information they need to meet the health and social care needs of people living at the home. The home could show evidence that they are involving people or their representatives in the care planning process. Key inspection report Care homes for older people Name: Address: Lady Forester Residential & Day Care Centre Church Street Broseley Shropshire TF12 5BQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Karen Powell     Date: 2 1 1 2 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 25 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 25 Information about the care home Name of care home: Address: Lady Forester Residential & Day Care Centre Church Street Broseley Shropshire TF12 5BQ 01952884539 01952884552 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Lady Forester Residential & Day Care Centre care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 13. 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: Old age not falling within any other category (OP) 13 Date of last inspection Brief description of the care home Lady Forester Residential and Day Care Centre is registered with the Care Quality Commission to provide accommodation and personal care to a maximum of thirteen elderly people. Twelve rooms are provided for permanent service users and one bed is provided for respite purposes. The home is situated on the outskirts of Broseley, Shropshire and set in well maintained grounds. The building was formerly the Cottage Hospital. The centre is a charitable organisation and managed by a board of Trustees. The home is situated on the ground and first floor of the centre, which is accessible via a passenger lift. Two small quiet rooms are situated on the ground floor. All bedrooms Care Homes for Older People Page 4 of 25 Over 65 13 0 Brief description of the care home are single. Day Care is provided three days a week on the ground floor and people living at the home are able to participate in activities arranged by day care staff if they wish to do so. The home is managed by Trish Cornes who is suitably qualified and experienced in working in the care sector. People can obtain information about this service from the homes Statement of Purpose and Service User Guide. The reader is advised to contact the home to obtain up date information on the fees charged. Inspection reports produced by CQC can be obtained direct from the provider or are available on our website at www.cqc.org.uk 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: The inspection of the service was unannounced and took place on 21st December 2009 by one inspector over a period of approximately six hours. A range of evidence was used to make judgements about this service to include discussions with people using the service, the registered manager and staff. We also examined a number of records to include care records of people living at the home, staff training, staff recruitment and health and safety records. Two people who live in the home were case tracked this involves establishing individuals experience of living in the care home by meeting them, discussing their care with staff, looking at care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. An Annual Quality Assurance Assessment (AQAA) document was posted to Lady Care Homes for Older People Page 6 of 25 Forester care home for completion. The AQAA is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for them to share with us areas that they believe they are doing well. By law they must complete this and return it to us within a given timescale. The registered manager completed this, and some of the information is included in the report. The purpose of the inspection was to assess all 22 Key National Minimum Standards for Care Homes for older people and any further standards necessary. Information to produce this report was gathered from the findings on the day and also by review of information received by CQC prior to the inspection date. A quality rating is provided throughout the report based on each outcome area for the people who use the service. These ratings are described as excellent/good/adequate or poor based on findings of the inspection. The weekly fee range is £418.00 to £460.00 per week. Readers wishing to know more about this information should contact the service directly. Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 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. People are provided with information and encouraged to make informed decisions about the home before moving in. Pre placement assessments ensure that individual needs are met. Evidence: The completed AQAA told us assessments are carried out by the manager before they are admitted to the home to ensure their care needs can be met and also answer any concerns they may have. We spoke to the manager about the pre-admission assessment for someone who had recently moved into the home. The manager explained to us that this was done in quite a short space of time and the home had knowledge of the person before they came into the home as they had accessed the domiciliary care agency managed from the home. Other information had been gained from a relative who arranged the placement with the manager. In some cases this may be information gained from a social worker or medical professional. We Care Homes for Older People Page 10 of 25 Evidence: spoke to this person who confirmed that they had been admitted quite quickly due to a change in their circumstances and that their representative had arranged the placement on a temporary arrangement. The manager told us people wanting to move into Lady Forester can visit and spend some time there to meet other people living at the home and staff. This is sometimes done by a relative or advocate on their behalf. People are provided with a statement of purpose and service user guide which gives them information about the home. The home also has a web site. The home does not provide intermediate care. 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. Although care plans have improved they could be further developed to ensure that staff have all the information they need to meet individuals health and social care needs fully. Evidence: The completed AQAA told us each service user has an individual care plan drawn up specific to their needs. This is completed using the initial assessment, involvement of the service user, their family or representative. The care plan is reviewed at least once a month or more regularly if the needs of the service user changes. We looked at two care plans during our visit. Both care plans contained a photo of the person which helps new staff identify individuals. Although care plans have improved, it was evident that some information was missing for example; one persons weight had not been carried out on admission and therefore any change in the persons weight could not be monitored. Rising and retiring times Care Homes for Older People Page 12 of 25 Evidence: had not been ascertained fully for people and some documents we expect to see within the care plan had not been signed or in one instance did not contain a name of the person using the service or a date of completion. We discussed our findings with the manager who acknowledged them and agreed to follow up with the staff. There was no evidence that the person living at the home had been involved in the care planning process by means of a signature from them or their representative. It was noted that the home records visits from other professionals such as GPs and district nurses. People told us the home will arrange for the doctor if required on their behalf. We saw specialist pieces of equipment that were identified in care plans in place in the rooms of people we spoke to. We asked the question what does the service do well? one health and social care professional told us all round care for the people who live at the residential home, very kind staff who look after the residents. It was stated on the completed AQAA that the home has policies and procedures in place for the safe handling of medication. We looked at the medication administration records and storage of medication. At the front of each persons medication administration record (MAR) there is a photo of the person so that new staff would know who to give medication to. MARs had been signed when medication had been given indicating that medication had been given as prescribed. Direct and indirect observation showed that staff speak to people in a kind manner that respects their dignity. Any assistance was given in a discreet way and staff were seen to knock on doors before entering. 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. People living at the home are provided with opportunities to experience a meaningful lifestyle that ensures self esteem and well being. People are provided with healthy, well presented meals according to their dietary requirements and choice. Evidence: The completed AQQA told us residents choose where to spend their day and eat their meals. An activity programme is displayed in the lounge and service users are informed of activities taking place. Service users have visitors at reasonable times of the day and can receive them in private if they wish. Service users are encouraged to bring their personal possessions into the home. People who live at the home can access the day centre where activities are provided, an activities plan is on display and contained a variety of activities on offer. On the day of our visit a musician was entertaining people during the afternoon. We also observed a member of staff carrying out manicures. A Christmas party for people living at the home and their relatives was being held on the evening of our inspection. Staff were working hard to make preparations for the event. People we spoke to told us there had been a shopping trip to Telford town centre and Care Homes for Older People Page 14 of 25 Evidence: to the safari park at the beginning of the month. A small number of respondents to our pre-inspection survey told us that they thought the home could do better by arranging more activities and outings. We discussed this feedback with the manager who told us that she would also like to arrange more outside activities but these are dependent on the availability of the voluntary drivers that drive the homes minibus. There is a four week menu which appears balanced and offers two main meal choices at lunchtime. People we spoke to told us the food is nice and that they are given choices about what they eat. Refreshments were seen to be served throughout the day. One person told us they choose to eat their meals in their room and they enjoy taking the tray back to staff at the kitchen door. People living at the home are encouraged to maintain contact with their family and friends. This was recorded in one persons plan as being important to them, when we spoke to this person they told us about their regular outing with their relative. We saw visitors coming and going during the inspection. 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. People living at the home have access to a complaints procedure, which is accessible and ensures the views of people are listened to. Staff receive training so that they have an understanding in adult protection to ensure people they support are protected from abuse, ensuring their well being. Evidence: There is a complaints procedure in place which is contained within the service user guide and further copies can be found around the home. It was stated on the completed AQAA and confirmed by the manager that there have been no complaints since our last visit. There have been no complaints to the Care Quality Commission. People we spoke to were complimentary about the service provided by the staff. Staff are trained in adult protection; we saw evidence of training certificates on staff training files. The manager has attended the deprivation of liberties safeguarding awareness day and adult protection training a recommendation made at a previous inspection. 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. People living at the home are provided with a clean and homely place to live, which is equipped to meet their individual needs and makes them feel safe and secure. Evidence: We took a tour of the home and found it to be clean and tidy. Bedrooms that we saw were personalised and people told us they were comfortable in their surroundings. An additional member of housekeeping staff has been employed since our last inspection to ensure complete coverage of the home is maintained. New monitoring systems have been put into place to include cleaning procedures. The laundry was clean and tidy. Staff spoken to confirmed that they have undertaken infection control training, we also saw evidence of certificates on staff training files. A recent infection control audit carried out in October 2009 noted the care home has some good practices in place and recommendations made were confirmed by the manager to have been actioned. Some upstairs bedrooms have been redecorated since our last inspection and the manager has devised a refurbishment list to address areas of the home that need improvement. A small quiet lounge at the front of the home can be accessed by people living at Lady Care Homes for Older People Page 17 of 25 Evidence: Forester care home. The grounds are accessible by people living at the home and in the warmer weather they can enjoy sitting in them. 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. The arrangement for staffing, their support and development ensures that the needs of the people living at the home are met. People have confidence in the staff at the home because checks are done to make sure that they are able to care for them. Evidence: It was stated on the completed AQQA before commencing work in the home all staff have a satisfactory CRB check in place and two references. Staff receive regular training and mandatory training is updated as necessary. Staff receive regular supervision. All staff have an NVQ 2 with the exception of two staff, these will be commencing this in January. We looked at the files of two staff employed since our last inspection to make sure that pre employment checks are undertaken so that staff are checked as being suitable to work with vulnerable adults. Files were well organised and contained all the checks required under regulation. All people consulted as part of the inspection told us that the staff treat them well and that they are happy with the care and support they receive. We observed staff supporting people throughout the day, they did this with respect and were professional at all times. Care Homes for Older People Page 19 of 25 Evidence: Training for the staff is good. We looked at training completed by staff and saw the relevant training certificates on staff files. Training included first aid at work, moving and handling, protection of vulnerable adults, infection control, stroke awareness and mental capacity act training. The manager stated in the completed AQAA that over 50 of the care staff have obtained a nationally recognised care qualification (NVQ) at level 2 or above. This exceeds national minimum standards. All staff are formerly supervised and appraised, we saw records to support this. Staff spoken to said they felt well supported by the manager of the home. The homes induction process, consistent with Skills for Care expectations, is thorough and conducted over a period of time. 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. People have confidence in the home because it is effectively managed in the best interests of the people living and working there. Evidence: The registered manager is suitably qualified to manage the care home and has a number of years experience in the care sector. The staff receive clear guidance on how to perform their role and there is a clear understanding from staff of what is expected of them. Staff report the care home is managed well and they feel supported by the manager to do their job. This ensures that people living at the home receive consistent care and support of a good standard. It was stated on the completed AQAA that there is a policy in place for the management of service users money and financial affairs. The manager reported small amounts of money are kept in safe keeping and strict financial handling procedures are in place to safeguard peoples money and valuables. Care Homes for Older People Page 21 of 25 Evidence: All checks required such as of the fire safety systems; hot water systems, lifting equipment and electricity are in place. People are protected through regular maintenance of systems and equipment and records to show this are well organised. The next quality assurance survey is due to be sent out in February 2010 therefore feedback from this could not be seen at this inspection. However, we received positive feedback from our survey carried out as part of the inspection process. One person living at the care home told us they give very good care, very attentive to needs. Good social communication. Comments from staff include I have seen some good changes with the introduction of more seniors and shift leaders to help with the paperwork and responsibilities of the smooth running of the home. The home gives personal care to our service users in a friendly family environment as small home we know our clients and their families, we offer a great level of care and treat our residents as individuals, encourage social interaction but dont force it. We work well as a team. Comments from relatives include the staff check on my mother and give her love and kindness, keep her clean and warm, and are very friendly and caring towards her. My mother is very happy at the lady Forester, its nice and clean and a pleasure to visit. Well done to the manager and all the staff, carers, cleaners and office staff. The Lady Forester is one of the cleanest and friendliest places I have visited, always a smile to greet you with. Many thanks for the caring way in which you and your staff looked after Dad. He was very happy to be with you. 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 1 7 Care plans could be further developed to ensure that staff have all the information they need to meet individuals health and social care needs fully. Evidence to show that the care plan has been discussed with the person using the service or their relative/representative would demonstrate people are consulted about the care/support they receive and how they would like it to be delivered to them. 2 7 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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