Care Home: Leafield Residential Care Home

Similar services:

• St Vincents
• The Cotswold Home
• Winton House
• Rush Court
• Hillyfield Rest Home
• The Maypole Nursing Centre
• The Briars

What the care home does well The home provides highly individualised care for the people who live here and it is clean, comfortable and ‘homely’. The manager and staff take a lot of time to find out about how people who come to live here like to be helped and supported. Each person’s ‘care plans’ Leafield Residential Care Home DS0000013103.V376535.R01.S.doc Version 5.2 are well written and describe how best the staff should look after them and are drawn up with the help of the resident and their family as far as possible. The manager and staff work well together and with visiting health and social care colleagues, so this helps to develop good and supportive relationships with residents and their families. Comments we received included: ‘The home is run well and staff work well together’ ‘Small, friendly and seemingly well-run home’ ‘A homely care home, with some kind and caring staff’. What has improved since the last inspection? The home owner has continued to work with the home manager to continue with a planned refurbishment programme so that the appearance of the home and equipment needed for residents has been improved for their benefit and comfort. This includes the installation of a new assisted bath on the ground floor, new beds, new carpeting to lounges and most bedrooms and redecoration of all resident’s rooms. There is an improved company structure, with the manager having more support from an operational manager and more meetings with the managers of other Oxfordshire homes owned by Mr Brahmbhatt. The changes have improved the way in which the manager can check that the homes policies and procedures are up to date and that staff are following these, so that residents and their families, and staff are assured that they are living and working in a safe, clean environment. The staff recruitment process, training and supervision of staff and active participation by staff in offering their opinions about the way the home is run, has improved, so that skills of staff and their commitment to the care and support of the people who live here continues to develop. What the care home could do better: The home environment lacks enough storage space for necessary equipment and this does limit some people’s space, for example in their en-suite bathrooms. There has been no progress yet in starting building work that the provider has told us he intends to do, to extend and improve the facilities for residents - for example, the laundry, kitchen and storage space for equipment and increasing the number of rooms with en-suite facilities. The home has met the requirements we made at the last inspection, but the manager has withdrawn her application for registration with the commission as she has resigned because of changed personal circumstances and is working her notice. This means that the home will continue to have been without a registered manager since January 2007. Mr Brahmbhatt is aware that he must appoint a person to manage the home who will be registered (under Part 11 of the Care Standards Act 2000) and legally accountable (together with theLeafield Residential Care HomeDS0000013103.V376535.R01.S.doc Version 5.2 registered person) for maintaining the standards of care and facilities for the people living here. Any ‘good practice’ recommendations we made during this inspection were discussed with the manager and proprietor at the end of the visit, and are referred to in the relevant sections of the report. Key inspection report CARE HOMES FOR OLDER PEOPLE Leafield Residential Care Home 32a Springfield Drive Abingdon Oxfordshire OX14 1JF Lead Inspector Delia Styles Key Unannounced Inspection 11:20 2 September 2009 nd DS0000013103.V376535.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Leafield Residential Care Home DS0000013103.V376535.R01.S.doc Version 5.2 Page 2 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 Leafield Residential Care Home DS0000013103.V376535.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Leafield Residential Care Home Address 32a Springfield Drive Abingdon Oxfordshire OX14 1JF Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01235 530423 Leafieldhome@aol.com Mr Prashant Brahmbhatt Post vacant Care Home 24 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Leafield Residential Care Home DS0000013103.V376535.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (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) 2. Dementia (DE). The maximum number of service users to be accommodated is 24. Date of last inspection 24th July 2008 Brief Description of the Service: Leafield Care Home is situated to the north of Abingdon town centre, within a residential housing estate. The accommodation is provided on two floors and there is a passenger lift for access. There are 21 single rooms, 5 of which are en-suite, and 1 double room with en-suite facilities. The ground floor communal areas of the home - 2 lounges, a dining room and small lobby area - provide a choice of places to sit, or entertain visitors. There is a small garden area at the rear of the home that is accessible to residents. The home is registered to provide care for older people who are frail and may be mentally infirm. The current range of fees is £428 to £565.00 per week. Leafield Residential Care Home DS0000013103.V376535.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection of the service was an unannounced ‘Key Inspection’ during which we assessed a number of the standards considered most important (‘key’) by the Commission out of the 38 standards set by the government for care homes for older people. We took into account information provided by the homes manager in the form of the Annual Quality Assurance Assessment (AQAA) - a self-assessment and summary of services questionnaire that all registered homes and agencies must submit to the Commission each year; and any information that the Commission had received about Leafield Care Home since the last inspection. A tour of the building, and inspection of a sample of the records and documents about the care of the residents and the recruitment and training of staff, was part of the inspection. Talking with residents and the inspector’s observations during the visit gave us information about the home and people’s opinions about what it is like to live here. Some of the Commission’s comment cards (surveys) – ‘Have your say about Leafield Care Home’ - were sent the home for residents, staff, and visiting health and social care workers to have an opportunity to have their say about the home. We received completed surveys from 3 health care professionals, 1 member of staff and 3 relatives and their opinions are included in the report. The home owner and registered person, Mr. Brahmbhatt, the company operations manager and the home manager were available during the inspection for discussion about the home and the inspector’s findings on the day. We would like to thank all the residents, staff, and the manager for their welcome and the time taken to help us with the inspection process. What the service does well: The home provides highly individualised care for the people who live here and it is clean, comfortable and ‘homely’. The manager and staff take a lot of time to find out about how people who come to live here like to be helped and supported. Each person’s ‘care plans’ Leafield Residential Care Home DS0000013103.V376535.R01.S.doc Version 5.2 Page 6 are well written and describe how best the staff should look after them and are drawn up with the help of the resident and their family as far as possible. The manager and staff work well together and with visiting health and social care colleagues, so this helps to develop good and supportive relationships with residents and their families. Comments we received included: ‘The home is run well and staff work well together’ ‘Small, friendly and seemingly well-run home’ ‘A homely care home, with some kind and caring staff’. What has improved since the last inspection? What they could do better: The home environment lacks enough storage space for necessary equipment and this does limit some people’s space, for example in their en-suite bathrooms. There has been no progress yet in starting building work that the provider has told us he intends to do, to extend and improve the facilities for residents - for example, the laundry, kitchen and storage space for equipment and increasing the number of rooms with en-suite facilities. The home has met the requirements we made at the last inspection, but the manager has withdrawn her application for registration with the commission as she has resigned because of changed personal circumstances and is working her notice. This means that the home will continue to have been without a registered manager since January 2007. Mr Brahmbhatt is aware that he must appoint a person to manage the home who will be registered (under Part 11 of the Care Standards Act 2000) and legally accountable (together with the Leafield Residential Care Home DS0000013103.V376535.R01.S.doc Version 5.2 Page 7 registered person) for maintaining the standards of care and facilities for the people living here. Any ‘good practice’ recommendations we made during this inspection were discussed with the manager and proprietor at the end of the visit, and are referred to in the relevant sections of the report. 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. Leafield Residential Care Home DS0000013103.V376535.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Leafield Residential Care Home DS0000013103.V376535.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents and their families and representatives have sufficient information about the home before they come to stay, to make an informed decision about whether it is likely to suit them. EVIDENCE: The homes AQAA states that they have improved the Statement of Purpose to more accurately reflect the services and facilities of the home. The home is ain the process of producing a new brochure and developing a web-sited. These publications about the home, together with residents’ individual contracts, provide residents and their families with enough information on which to form an opinion about whether the home is likely to meet their needs. The manager assesses prospective residents’ needs before they come in to the home. This process includes family’s and other professional carers’ information and provides the basis for the resident’s individual care plans. Leafield Residential Care Home DS0000013103.V376535.R01.S.doc Version 5.2 Page 10 Of the 3 health care professional survey responses to the question ‘Do the care service’s assessment arrangements ensure that accurate information is gathered and that the right service is planned for people?, 2 answered ‘usually’ and one ‘always’. We looked at a sample of three residents care records and these had detailed information gathered as part of their pre-admission assessment about their care and support needs and included a ‘person-centred’ care assessment of the individual’s previous and current hobbies and interests, family, friends and social contacts. A resident told the inspector about her admission to the home and how welcoming and helpful the staff had been, making her feel at ease. All new residents have a ‘trial’ four week settling in period during which further assessment and discussions can take place so that the individual, their family and/or representatives and the home’s staff can be sure that the person’s assessed needs can be met. Leafield Residential Care Home DS0000013103.V376535.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Resident’s health care needs are well met with evidence of good communication between the home and health and social care professionals about ways to improve people’s health and wellbeing. Personal support is offered in such a way that promotes and protects residents’ privacy and individuality. EVIDENCE: We looked at a sample of 3 resident’s care plans. These were detailed about people’s likes and dislikes and how they wish to be cared for. Each resident has a ‘key worker’ member of staff allocated to them. The key worker assesses and plans the care for the residents to whom they are allocated. Individual plans of care are reviewed monthly by a senior member of staff and regularly audited by the home manager, to make sure they accurately reflect the resident’s care needs and are up to date. Additional reviews take place if a resident has involvement with social services or the NHS mental health service. Leafield Residential Care Home DS0000013103.V376535.R01.S.doc Version 5.2 Page 12 Since our last inspection the home has tried to improve the care plans by adding more information about people’s individual ‘life history’ and key events in their lives. Family and friends invited to help complete ‘reminiscence’ histories so that information about residents who are no longer able to communicate for themselves is known to staff. This helps staff to understand and recognise the significance of people’s past experiences to assist and support them in the present. The sample of care plans seen did not evidence that the individuals concerned (if able to) or family contacts had read and agreed the contents. We recommend that the home can demonstrate that residents and their representatives are involved in the process of drawing up care plans, and any updates and changes to information. This could be done by requesting that residents, or their relatives and representatives (if the person is not able to do so independently) sign the care records and/or that staff document when the care plans and any changes have been discussed and agreed with those concerned, at review meetings. Some of the sampled care plans did not have a summary of the individual’s care needs so that new or temporary staff would have to search through care files to find the relevant information to safely care for the individuals. Though the manager and operations manager have recently audited the care records, they agreed that this information was incomplete. The home manager said she would review and update the plans. In practice, it was evident from observing staff working with residents and hearing conversations between them, that staff are very aware of each individual’s preferences and needs. One resident, who was able to talk about her experience of care in the home, said that the staff were all very good – ‘nothing is too much trouble for them’ – and that she feels she can ask them for help at any time. The survey answers received from 3 health and social care professionals indicated that they felt the home ‘usually’ meets people’s social and health care needs, and ‘usually’ seek advice and act on it. The home staff communicate well with the district nurses and community psychiatric nurses about the care of any resident who needs temporary nursing care in the home. There was evidence that if residents need special equipment, such as pressure relieving mattresses or seat cushions, that these are promptly obtained through the community nursing service. We checked a sample of the Medication Administration Records (MAR); these were up to date and signed, showing that residents had received their prescribed medicines correctly. There was one error noted in that on three consecutive days staff had signed a person’s MAR indicating that they had been given two doses of a medication that is prescribed to be taken only once Leafield Residential Care Home DS0000013103.V376535.R01.S.doc Version 5.2 Page 13 a day, in the evenings. The manager and operations manager checked previous MAR sheets and the blister packs of medicines prepared by the chemist and were satisfied that the error had been in recording and that only the correct daily evening dose had been given to the resident. Staff should be careful to check and sign the MAR records accurately and not automatically ‘follow-on’ from other staff member’s entries. The home has introduced a system whereby a senior staff member checks the MAR and medications daily. It appears this daily audit had not identified the potential error; care should be taken to ensure that the homes systems for audit are thoroughly undertaken. The home manager confirmed that only staff who have had the relevant training and are assessed as competent, give out medicines to residents. None of the current residents are able to keep and administer their own medication. Respect for people as individuals is evident from discussion with staff and observation of their interaction with residents. Our survey question about whether the home promotes and protects residents’ privacy and dignity was answered ‘usually’ by 3 the health and social care professionals who responded. We noted that for the majority of those residents who do not have en-suite toilet facilities, the home provides older-style metal frame commode chairs in people’s rooms. It is our view that having commode chairs so visible in people’s rooms is undignified. The layout and space limitations in some rooms means that commodes cannot be stored out of sight and they need to be available for residents use, especially at night; we recommend that the home replaces the current outdated commodes with more discreet chair-type models. The matter of commodes was raised by a resident (who has her own small chair commode) who described her embarrassment at having to have staff empty her commode for her and their assurance that they were ‘used to it’ and did not mind. When we discussed this with Mr Brahmbhatt, the home proprietor, he immediately agreed to look at purchasing more appropriate commodes and the manager said she would identify how many were needed. The staff are of more varied ethnic backgrounds than the current residents. The home provides training for staff in equality and diversity issues and there is a booklet on this topic given to staff. From the evidence seen by the inspector and comments received, the inspector considers that this home would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. Leafield Residential Care Home DS0000013103.V376535.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers a range of activities that suit the individual resident’s abilities and needs so that residents have opportunities to participate in stimulating and motivating pursuits. The meals are good, offering appetising and nutritious food. EVIDENCE: The home has a member of staff whose specific responsibility is to encourage residents with individual and group activities – board games, floor games, and cookery on one day a week (during the afternoon of the inspection visit, a group of residents were enjoying being involved in baking cakes). At other times, care staff said they try involving residents in ‘ad hoc’ activities and chats during the day. This makes sure that there is the opportunity for residents to take part, or watch others, as they wish and caters for those whose concentration is poor but who benefit from feeling included in the home’s social life The homes AQAA tell us that they try to encourage residents to choose the types of activities they would like and that the home is continuing to try to involve residents’ families and friends in sharing ideas and suggestions for Leafield Residential Care Home DS0000013103.V376535.R01.S.doc Version 5.2 Page 15 outings and activities that people can enjoy together. Since our last inspection and recommendation, people’s preferences for particular activities are recorded in their care plans in more detail. The friend of one resident who completed our survey commented, ‘I think they [residents] could do with more social activity and outside trips to garden centres or zoo, plus more entertainment in the home. My friend used to go to the day centre and Alzheimer’s club which she thoroughly enjoyed. That was all stopped when she went in the home’. Staff said that residents are assisted to have as much choice and control over their lives as possible. Responses to our survey questions about how well residents’ different needs are met indicate that professionals and staff feel that the care service ‘usually’ manage to do so. The home holds regular social events where families and friends can talk to staff and discuss care and other issues relating to the home. In May the home has hosted a very well attended open morning for relatives. The home has set up a gardening project and intends to develop this with the support of local businesses and any residents, families and friends who are able to join in. By inviting family and friends to join in with activities and social events the home aims to help people feel involved and increase the support and social networks for both residents and their families. Visitors are welcomed in the home. From conversation with staff and their interactions with relatives and other visitors, we found that the home is welcoming and friendly. Staff clearly have a good knowledge about residents’ usual family and social support networks and encourage residents to keep in contact with their family and friends as far as possible. Most residents come to the dining room for main meals, but can remain in their rooms at mealtimes if they prefer. Several residents ate their lunch sitting in the conservatory, smaller TV lounge or at a table in the lobby area next to the staff office. The menus and meal choices seen show a good variety of traditional food. Locally grown fresh produce is used as much as possible and a local supplier for vegetables. The meal choices for the day were written up on a white board in the dining room. Residents spoken to were very complimentary about their lunch - gammon ham served in a mustard sauce with broad beans and broccoli and potatoes, and apple crumble and custard to follow. The food looked and smelled appetising. The home has developed the current menus to include as many as possible of people’s individual favourite dishes. One lady said she had particularly enjoyed the ‘sweet and sour with rice’ she had eaten recently and added “It’s surprising how much rice you can eat without feeling full up!” Leafield Residential Care Home DS0000013103.V376535.R01.S.doc Version 5.2 Page 16 The kitchen looked very clean and well organised. New work surfaces and a new freezer have been fitted since our last inspection. The AQAA tells us that the care staff and catering staff have completed the appropriate training in safe food handling and hygiene and that a food and hygiene audit is conducted monthly. Leafield Residential Care Home DS0000013103.V376535.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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, relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. There are procedures in place to protect residents from abuse. EVIDENCE: There have been no formal complaints made directly to the home and no complainant has contacted the Commission with information concerning a complaint made to the service since the last inspection. The manager confirmed that one ‘minor’ complaint had been resolved satisfactorily in a short time. A copy of the homes complaints procedure is displayed in the entrance hall. The health and social care workers’ surveys indicate that if they ever have cause to raise a concern with the home this is dealt with promptly and effectively. From observation of staff and residents’ interactions during the inspection, it was evident that residents felt at ease and able to talk to staff. Information about safeguarding of residents is included in induction training for all new staff and update sessions are held for all staff so that they are alert to the potential for abuse of vulnerable residents and will know how to report any suspected or actual incidents correctly. Since our last inspection, the manager has reviewed the information and training available for staff. A file has been put together so that staff can see examples of what might constitute abuse and how it should be reported. Leafield Residential Care Home DS0000013103.V376535.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 standard of décor in the home is good with many improvements made since our last inspection through an ongoing programme of redecoration and refurbishment. Overall, the home provides residents with an attractive, comfortable and homely place to live. However, the lack of storage space for equipment does have a negative impact on the ease of access to en-suite facilities and useable space for residents in some areas. EVIDENCE: Considerable improvements have been made to the environment since our last inspection. Residents’ rooms and the communal rooms have all been redecorated and most of the carpets replaced since our last visit. New soft furnishings and beds have replaced old, worn or unsuitable items. Leafield Residential Care Home DS0000013103.V376535.R01.S.doc Version 5.2 Page 19 The manager and proprietor have agreed programme of further improvements – for example, replacing old bedroom furniture. Some of the adjustable bed tables (and old commodes – see Health and Personal Care section above) were noted to be damaged with missing adjusters and chipped frames, and accumulated dirt and debris was seen along the edges of the bed table top ledges. The manager said that they have appointed an additional staff member to the housekeeping team, so that there is a cleaner on duty every day of the week. The home has introduced a schedule of room cleaning with a list of tasks to be completed and signed for when completed. The home looked very clean and there were no unpleasant odours. Some more attention needs to be paid to make sure that items of furniture are ‘deep cleaned’ routinely. For example, we observed that an armchair in a resident’s room had crumbs, food spillage and dust accumulations around and under the seat cushion; the sit-on weighing scales that are stored in the en-suite in the shared bedroom was dusty; and there were dark spots of mould in the seal around the base of the shower. The manager promptly asked the cleaner on duty to check and clean the areas mentioned. The two surveys we received from relatives and friends specifically mentioned the good standard of cleanliness in the home – ‘The rooms are always clean and tidy’ and ‘the home is always clean ...clothes and bedding are laundered frequently’. A resident also commented on the prompt return of her personal laundry and that clothing is nicely ironed. The home has insufficient storage space for equipment and disability aids for residents; for example, incontinence pads are stored in the en-suite facilities of bedrooms. The lack of storage space can only be improved by extending the premises to create additional rooms. Mr Brahmbhatt said that he has not been in a position to start the building work but hopes to do so in the near future. The improvements that were to be made in 2007 to the ground floor bathroom (to make it accessible for more dependent residents with staff assistance) have finally been completed and the new bath is proving very popular with residents. Two other baths in the home are not suitable for use by residents because they do not allow access to both sides of the bath. One bath is used routinely to disinfect commode inserts (there is no sluice disinfecting machine for the cleaning and disinfection of used sanitary equipment). We tested the hot water temperature at a bath outlet (not used by residents) and found the temperature was above the recommended maximum of ‘close to 43°C’ as it measured 46°C on the inspector’s probe thermometer. We recommend that the unused bathrooms are included in the homes routine Leafield Residential Care Home DS0000013103.V376535.R01.S.doc Version 5.2 Page 20 checks of hot water temperatures and adjusted, or the hot water supply disabled, to prevent the risk of accidental scalds should residents turn the taps on. Several rooms on the ground floor had no hot water at the room wash basins. The manager is aware of this problem and has got a plumber in to investigate and put this right. There is a very small laundry area that is cramped and also used as a storage area. The home uses an external commercial laundry service in the town for bed linen and towels; the homes own laundry is used for resident’s personal clothing only. The laundry was clean and tidy. There was a sunken patch of floor under the new floor covering in the laundry – this could present a trip hazard to staff using the laundry. This was reported to the proprietor who said he would arrange for this to be checked and repaired. Leafield Residential Care Home DS0000013103.V376535.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 staffing numbers and ratio of staff with appropriate qualifications and skills in care, is good and staff meet the care needs of the residents. EVIDENCE: The home staff rota and the staff on duty confirmed that overall, the numbers and skill mix of staff meet the current residents’ needs. On the morning of the inspection there was a senior carer and 3 care staff (one was supernumerary) available to care for 23 residents. The home manager, a cleaner, and cook were also on duty. The manager confirmed that there are always a minimum of 4 staff on duty in the morning and until 3 pm, with a senior and 2 carers until 10 pm when the 2 (waking) night staff start their shift. The manager said that they had had a poor response from a recent recruitment advertising campaign but had since had new suitable applicants to fill care worker vacancies. Due to holidays and sickness, the home was planning for a carer from another of Mr Brahmbhatt’s Oxfordshire homes to cover a shift. The manager said this was the first time they had needed to do this. The home does not use agency staff. The company’s operations director said that she is in the process of reviewing the training and development opportunities available to all staff and sourcing Leafield Residential Care Home DS0000013103.V376535.R01.S.doc Version 5.2 Page 22 new courses and trainers. They are prioritising training for staff in caring for people living with dementia (staff currently only have a short introductory course). The home is represented on the Oxfordshire Dementia Strategy Forum with the aim of developing their expertise and training for staff in caring for people with dementia. The manager told us in the AQAA that they are in the process of developing their knowledge and standards to meet the Gold Standard Framework for palliative end of life care. The home has a high proportion of its care staff who have achieved a nationally recognised qualification in care – 14 of the total of 19 permanent care workers has the National Vocational Qualification (NVQ) at Level 2 or above. The manager confirmed that all new care staff complete an induction training that meet the standard recommended by the Skills for Care training organisation. The home uses a commercially produced record of induction training for staff that they find is easier and more accessible to use than the NVQ format. Two people who completed our surveys said that communication is sometimes a problem with some care staff whose first language is not English – one person wrote ‘Leafield is less good than it used to be – some of the care workers speak so little English that we find difficulty in communicating, never mind the patients! The senior staff remain good and caring’. This was echoed by a staff member who wrote ‘when employing overseas staff they need to be checked on how well they can speak English – it’s very hard sometimes for residents and staff to communicate with certain people as the language barrier needs to improve’. The home manager acknowledged that some staff have language difficulties though they were very kind and hard working. Staff whose first language is not English are given access to English language courses. She said that the home no longer recruits staff direct through an overseas agency, and this means that the managers can interview and assess people’s communication skills in person when looking to appoint new staff. A sample of staff records was checked all had references and evidence of qualifications or experience (where relevant) to show their suitability for working in the home and that the home safeguards residents through its recruitment and employment procedures. One new carer was working under supervision of another carer because their full Criminal Record Bureau (CRB) clearance had yet not been received. The initial check (PoVAFirst) had been made to ensure that this individual’s name is not on the list of people excluded as unsuitable to work with vulnerable adults. The manager confirmed that they had been informed by the administrator at Leafield Residential Care Home DS0000013103.V376535.R01.S.doc Version 5.2 Page 23 the head office for the company that this initial check had been received and is satisfactory. Leafield Residential Care Home DS0000013103.V376535.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management arrangements in place are good and are meeting the needs of the service but must be formalised because a person registered with the Commission must manage the home. EVIDENCE: As we reported at the last inspection, the home has been without a registered manager since 2007. In the interim, the former deputy manager has taken on the responsibility for running the home with the support of the proprietor and more recently, a newly appointed operations director. Prior to being appointed as manager she had been deputy manager and has a good understanding of the home, the staff team and the people living here. She had applied to the Commission to become the registered manager, but has just withdrawn her Leafield Residential Care Home DS0000013103.V376535.R01.S.doc Version 5.2 Page 25 application because of a change in her personal circumstances, and has tendered her resignation. The registered person, Mr Brahmbhatt is aware that he must formalise the management arrangements of the home by ensuring that they propose a person who applies and successfully completes the ‘fit person’ process with the Commission in order to become the ‘registered manager’ for the home. It is a legal requirement that registered care homes and a registered manager runs establishments. The home has met the requirement we made at our last inspection in relation to ‘provider visits’ that are required to be made to the home under Regulation 26 of the Care Standards Act 2000 and Care Home Regulations 2001. These ‘provider visits’ are an important part of the way in which the registered person can evidence that the standard of care and facilities provided in the home is meeting residents’ needs and expectations and that any concerns are followed up and resolved. The operations manager now visits the home and there were reports of each monthly visit with actions to be taken by the manager to address any problems or issues. The home has also improved the way it gets the views of residents and their families about the standard of care and support provided. Questionnaires are sent to residents’ family representatives twice a year. The analysis of the most recent survey results (May 2009) were referred to in the home’s newsletter and reported that the home had scored ‘8.5 out of 10’ for the overall quality of the care provided, whilst responses to questions about staff qualities scored them ’10 out of 10’. The company structure has changed with the appointment of a Chief executive an operational manager and a finance director, and this has improved the organisation of the business and ability to plan the building and budgets for each of the homes owned by the provider. The home managers for all of the Oxfordshire homes now meet together regularly and this helps them to share good practice ideas and initiatives and resolve any problems more effectively together. The home is not responsible for any of the residents’ finances and staff are not allowed to accept gifts from residents. The home does keep small amounts of personal allowances on behalf of residents if requested. Residents’ money is kept in individual named folders in a secure facility with the receipts and records of any transactions made on their behalf – for example, paying the hairdresser or podiatrist. The manager or senior care staff are the only people with access to the safe. Two staff check and countersign any financial transaction in the records. Leafield Residential Care Home DS0000013103.V376535.R01.S.doc Version 5.2 Page 26 The manager said that there is still no external system of auditing the accounts for the residents’ money or the residents’ amenity fund (we recommended this as good practice at our last inspection). The amenity fund is made up from donations received by relatives and friends and is used to pay for additional treats and refreshments when residents go on organised outings and days out. The operations manager includes a spot check of the monies and the records held in the home as part of the provider’s ‘Regulation 26’ visits. The home, like the others in the group, now has better systems of audit in place, to make sure that the policies and procedures are being followed consistently by the staff. We noted that audits of the medicines, care plans, finances and health and safety matters – for example, regular checks on the water safety, and personal emergency evacuation plans for each resident (PEEPs)- are some of the things that are included in the regular checks of standards in the home. The homes AQAA – the self-assessment of the home and its standards of care and facilities – was much more fully completed this year, compared with last, and gave us a good picture of how the home operates, the things it has identified that they would like to improve, and how they plan to do this. The manager said that completing the AQAA had been a very useful exercise, because she had been able to look at all the improvements and positive changes they have made in the last 12 months that have benefited the people living here. Leafield Residential Care Home DS0000013103.V376535.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Leafield Residential Care Home DS0000013103.V376535.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Leafield Residential Care Home DS0000013103.V376535.R01.S.doc Version 5.2 Page 29 Care Quality Commission South East Region Citygate Gallowgate Newcastle upon Tyne, NE1 4PA National Enquiry Line: 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. Leafield Residential Care Home DS0000013103.V376535.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!