Care Home: Leaze Court

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What the care home does well People who are considering moving to a care home are given good information about Leaze Court before any decision to move in is made.Trial visits are encouraged and the manager, or deputy manager, will also carry out a careful assessment before anyone is admitted to the home to ensure their needs can be met. Not all people spoken to during this inspection were able to recall their admission to the home but all expressed complete satisfaction with the outcome. The home has drawn up care plans covering aspects of individuals care needs. Risk assessments have also been drawn up on aspects of health and personal care and clearly show how the home identifies potential health risks and puts preventative measures in place. The home has good links with all relevant health professionals and treatment has been provided where needed. The care staff have completed daily reports showing that the care plan has been followed and outcomes are being met. These give a clear picture of daily events for each person living at the home. Medications are stored safely and only experienced, trained staff carries out the administration. Records of medicines administered have been well maintained. Evidence was obtained in various ways through this inspection to show that those living at the home are treated in a dignified manner and their privacy is upheld at all times. Those who were able expressed complete satisfaction in the way they are treated by the staff. Throughout this inspection staff were calm and unhurried and assisted people in a friendly, caring and respectful manner. Care plans and daily reports showed that people are supported and encouraged to make choices and to take control of all aspects of their lives and some people talked about how they lead their lives just as they want without unnecessary rules or restrictions. The home provides a good range of activities to suit individual interests. Good arrangements are in place to ensure family and friends are made welcome at all times and are kept informed and involved in the daily life of the home. All people we spoke to praised the standard of meals provided. The menus are balanced, varied and nutritious meals and suit all individual dietary needs. People living at the home and their relatives and visitors can feel confident that complaints and concerns will be addressed promptly and a satisfactory outcome reached. All areas of the home are clean,safe and hygienic. The home employs sufficient staff to meet the needs of those living there. Good recruitment practices ensure people are safeguarded from abuse. Staff are competent and deliver high quality care in a safe manner. The home is well managed. There is an open and positive atmosphere throughout the home. In response to questionnaires sent before this inspection staff told us " we do well in every aspect of the clients care and hopefully give them respect and dignity" and " the home covers the needs of our clients well and is tailored to their individual needs and wishes". A health care profession told us that the home "reports any changes in a clients requirements and overseas treatment programmes as prescibed". We were also told " the home has undergone huge improvements and throughout this upheaval staff were always helpful and clients needs always received priority What has improved since the last inspection? The management of medication at Leaze Court has improved since the last inspection. Staff sign the medicine administration record at the time that medicines or creams are administered, when a prescribed medicine has not been administered, the reason is recorded on the medication administration record. Since the completeion of the extension and improvments to Leaze Court arrangements have been made to ensure that confidential information regarding people living in the home is protected at all times. The home has worked hard to ensure that people living at Leaze Courts have more opportunities for stimulation available through leisure activities, which are linked to their needs, interests and capacities. A choice of menu is now available and people are supported to make choices. Medicines are now stored in a medicines refrigerator. What the care home could do better: No requirements were made during this inspection. Three recommendations for good practice were made: Not all of the 3 pre admission assessments we looked at had been completed fully. Care plans should set out in detail the action which needs to be taken by care staff to ensure that all aspects of health, personal and care needs for the individual are met. this relates to details of some health care needs not being identified and recorded in a plan of care where the need can be monitored and information provided to enable staff to meet the need. Nutritional screening should be undertaken on admission and reviewed periodically to ensure that peoples` nutritional needs are monitored and met. Key inspection report Care homes for older people Name: Address: Leaze Court Leaze Court Hillside South Brent Devon TQ10 9AY     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: Michelle Oliver     Date: 2 2 0 7 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 32 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 32 Information about the care home Name of care home: Address: Leaze Court Leaze Court Hillside South Brent Devon TQ10 9AY 0136473267 0136473797 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Sally Jane Dyke,Steven Richard Dyke care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 32. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia aged 65 years and over (Code DE(E)) Physical disability aged 65 years and over (Code PD(E)) Date of last inspection Brief description of the care home Leaze Court is a detached property set in its own landscaped grounds in the South Hams village of South Brent on the edge of Dartmoor. Mr & Mrs Dyke, the registered providers, have owned Leaze Court since 1st November 2005 under a partnership arrangement. The home is part of a group of affiliated companies and partnerships Care Homes for Older People Page 4 of 32 0 0 0 Over 65 32 32 32 Brief description of the care home collectively known as The Court Group. This group comprises a number of care homes in South Devon and promotes a corporate identity and ethos. Leaze Court provides care for up to 32 older people who may also have dementia and/or physical disabilities. Accommodation is provided on the ground and first floor. Access to the first floor is currently provided via a shaft lift. Accommodation is provided 32 single rooms, which have en suite facilities. There is a spacious lounge leading into a light and airy dining room. Outside there are attractive gardens and a parking area. Since the last inspection the premises have been upgraded to provide additional accommodation. Fees currently range from #450 to #520. Written information is available for people considering going to live at Leaze Court and for those who are resident. A copy of the most recent CSCI inspection report was available. Care Homes for Older People Page 5 of 32 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 quality rating for this service is 2 stars. This means that people who use this service experience good quality outcomes. This inspection was undertaken over 6 hours in one day by one inspector. We spoke with people living there and staff and also spent time observing the care and attention given to people by staff. To help us understand the experiences of people living at this home we looked closely at the care planned and delivered to three people. Most people living at the home were seen or spoken with during the course of our visit and three people were spoken with in depth to hear about their experience of living at the home. We also spoke with 5 staff, including the manager, deputy and ancillary staff, individually. A tour of the premises was made and we inspected a number of records including assessments and care plans and records relating to medication, recruitment and health and safety. The current weekly fees range from 450.00 to 520. Services not included in this fee include hairdresser, chiropody, toiletries, optician and dentist. Care Homes for Older People Page 6 of 32 General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at /www.oft.gov.uk . Copies of the inspection report are available in the entrance hall of the home and from the manager. Care Homes for Older People Page 7 of 32 What the care home does well: People who are considering moving to a care home are given good information about Leaze Court before any decision to move in is made.Trial visits are encouraged and the manager, or deputy manager, will also carry out a careful assessment before anyone is admitted to the home to ensure their needs can be met. Not all people spoken to during this inspection were able to recall their admission to the home but all expressed complete satisfaction with the outcome. The home has drawn up care plans covering aspects of individuals care needs. Risk assessments have also been drawn up on aspects of health and personal care and clearly show how the home identifies potential health risks and puts preventative measures in place. The home has good links with all relevant health professionals and treatment has been provided where needed. The care staff have completed daily reports showing that the care plan has been followed and outcomes are being met. These give a clear picture of daily events for each person living at the home. Medications are stored safely and only experienced, trained staff carries out the administration. Records of medicines administered have been well maintained. Evidence was obtained in various ways through this inspection to show that those living at the home are treated in a dignified manner and their privacy is upheld at all times. Those who were able expressed complete satisfaction in the way they are treated by the staff. Throughout this inspection staff were calm and unhurried and assisted people in a friendly, caring and respectful manner. Care plans and daily reports showed that people are supported and encouraged to make choices and to take control of all aspects of their lives and some people talked about how they lead their lives just as they want without unnecessary rules or restrictions. The home provides a good range of activities to suit individual interests. Good arrangements are in place to ensure family and friends are made welcome at all times and are kept informed and involved in the daily life of the home. All people we spoke to praised the standard of meals provided. The menus are balanced, varied and nutritious meals and suit all individual dietary needs. People living at the home and their relatives and visitors can feel confident that complaints and concerns will be addressed promptly and a satisfactory outcome reached. All areas of the home are clean,safe and hygienic. The home employs sufficient staff to meet the needs of those living there. Good recruitment practices ensure people are safeguarded from abuse. Staff are competent and deliver high quality care in a safe manner. The home is well managed. There is an open and positive atmosphere throughout the home. In response to questionnaires sent before this inspection staff told us we do well in every aspect of the clients care and hopefully give them respect and dignity and the home covers the needs of our clients well and is tailored to their individual needs and wishes. A health care profession told us that the home reports any changes in a clients requirements and overseas treatment programmes as prescibed. We were also told the home has undergone huge improvements and throughout this upheaval staff were always helpful and clients needs always received priority Care Homes for Older People Page 8 of 32 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 9 of 32 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 32 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. The home provides clear, detailed information to people considering moving in. People can be confidant that they will receive the care and support they need if they do move into the home. Some improvement to the information recorded following a pre admission assessment of peoples health and personal care needs will further work towards person centred care. Evidence: During this inspection we looked at the admission records of three people, one of who had moved into the home within the last three months. We talked to them about how they chose the home, the information that was shared, and the discussions and agreements that were reached on the care they need. Not all were able to remember their admission clearly and generally their admission had organised by relatives or Social Services. Care Homes for Older People Page 11 of 32 Evidence: We found that the manager had visited them to carry out an assessment of their health and social care needs and to give them information about Leaze Court. Information is also gathered from the individual, staff on ward if appropriate, and relatives or representatives. The manager told us that the admission procedure is evaluated annually, to enable the service to achieve better understanding of their admission procedure and take action where appropriate. This means that before people are admitted to the Leaze Court they can be assured that the home is able, in relation to staffing, staff knowledge and environment, to meet their health and social care needs. Staff told us that the needs of potential users of the service are discussed before a person is admitted to the Home. This means that all care staff are aware of peoples health and social care needs. However, we looked at the assessment of health and social care needs recorded for a person who had moved to the home within the last month and found there were several gaps in this information. For example, there were no details of how the person communicates or their dietary needs, likes or dislikes. This means that people may be at risk of their needs not being met at the home as they have not been identified prior to their admission. All prospective residents and,or, their family or representatives are encouraged to visit the home, meet other residents and have a meal if they choose before the decision is made to make it their home. The manager told us that brochures, which provide comprehensive information about the Home, are sent out on request. Displayed in the entrance hall are the Homes Statement of Purpose and the most recent inspection report for visitors and people living at the home to refer to if they wish. A copy of the homes brochure, statement of purpose, service user guide and most recent inspection report are available in the bedrooms of all people living at Leaze Court. All people living at the home who we spoke to, who were able to communicate, confirmed that the home had provided ample information about Leaze Court before they decided to make it their home and the home had lived up to their expectations. One person told us that they could nor remember the events leading up to their admission but that they were very happy living at Leaze Court. Care Homes for Older People Page 12 of 32 Evidence: The home does not offer intermediate care. Care Homes for Older People Page 13 of 32 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. Care planning provides staff with the information they require to meet the needs of people living at the home in a safe and respectful manner, while promoting their dignity and independence. Ensuring that all health care needs are recorded in a plan of care will provide staff with up to date information to met peoples individual health care needs. Medication is generally well managed. Evidence: The home is continually working towards improving care planning for people living at Leaze Court, to ensure improvement in peoples health outcomes and to continue to enable staff to be well informed about individual needs and wishes of people living at Leaze Court. During this inspection three peoples files were looked at in detail. Care Homes for Older People Page 14 of 32 Evidence: Care plans are developed with people individually and relatives are involved with the persons consent. Plans are based initially on an up to date assessment covering all aspects of their health welfare and social care needs. ( please refer to standard 3) Plans of care were generally informative and included details of individual strengths, as well as what help individuals may need. This means that staff are provided with information to enable them to encourage people to live their lives as they wish. The plans were generally detailed, well written, clear and easy to understand. Staff also maintain daily notes, which show how peoples personal and social care needs are being met on a daily basis. We read some daily reports where information relating to changes in peoples health care needs had been identified. Although information had been recorded in daily reports a care plan setting out information of how the changes were to be managed, how care was to be undertaken, and by whom, and monitoring of the outcomes, had not been formulated. This means that people may be potentially at risk of changing health care needs not being met. For example an entry in a daily report for one person referred to the use of an inhaler and a recommendation for it to be used with an additional device. No care plan had been completed in relation to the health care need for this person. Another daily report included the fact that staff had been shown how to clear blocked tear ducts for a person who has problems with their eyes necessitating the use of eye drops. No care plan had been completed to monitor this health care need or how staff were to clear tear ducts if required to be done again. Some information included in assessment undertaken before people decided to make Leaze Court their home had not been included in care plans. For example; It takes a long time to coordinate (their) feet to take a few steps. No further information had been recorded to enable staff to be aware of how to encourage the person or strategies that could be developed to support the persons independence. A pre admission assessment stated a person suffers from depression. No further information had been recorded to enable staff to be aware of how to recognise signs of impending depression, what to do if the person did become depressed or any strategies that could be undertaken to prevent the situation. Other information included unable to use my right leg properly but there was no further information informing staff how the person was to be assisted Care Homes for Older People Page 15 of 32 Evidence: The home monitors peoples dental and optician checks and chiropodists are used according to peoples needs. Information relating to the involvement, and advice from health care professionals such as skin care specialists and nutritionists were included in peoples plans of care. This means that they benefit from the involvement of health care professionals to ensure that health care needs are met. Assessment of potential risks to people living at the home is undertaken as part of the care planning process and kept under review. This includes the risks of falling and environmental risks but did not include nutritional risk assessments. This means that people living at the home could be at potential risk of their nutritional needs not being met or monitored. Care plans are reviewed regularly and appropriate changes are made to reflect changing needs and individual choice. Individuals and relatives are encouraged and supported to be involved in this review. Clear details are recorded of any changes. Medication is well managed at the home; records were accurate, up to date and indicated that it is appropriately administered. Photos of individuals are kept with the administration records to reduce the risk to people, who are not always able to confirm their identity, of receiving incorrect medication. Staff who handle medicines have received training in the safe handling of medication. This means that people are kept safe by the homes management, storage and administration of medicines at the home. The ethos of the Home is that people should be encouraged to maintain their independence for as long as they wish or are able. As part of the pre admission assessment the wishes and abilities of individuals to manage their own medication is undertaken. At the time of this inspection we were told that no people are undertaking this. People felt that their privacy was respected and staff were seen to knock on doors and wait to be invited in before doing so and were also seen offering personal care in a discreet manner. Care Homes for Older People Page 16 of 32 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. Everyone living at the Leaze Court is offered good choices in all aspects of their daily life. Social activities are well managed, provide daily variation and interest for individuals and create opportunities for increasing their independence. Meals are nutritious and balanced and provide individuals with choice and variety. Evidence: We spoke to the manager and deputy who confirmed that the aim of the home is to make sure that people who live there are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. Information about how people have lived their lives, family background, occupation, important memories, achievements, important changes and what hobbies, pastimes or interests people may have had is also recorded in peoples individual files. This information enable staff to know people as individuals and to provide person centred care to all those living at Leaze Court. The service has a programme of activities, which people are told about and can take Care Homes for Older People Page 17 of 32 Evidence: part in if they wish. We were told by several people that they particularly enjoy the times when musicians/ entertainers visit the home. We were also told that a particular favourite TV programme was Countdown, which several people watched together. On the day of this inspection books from a mobile library were being exchanged, which takes place 3 monthly. We were told that if audio books were needed these would also be supplied by the library. During this inspection we saw staff assisting a group of people set up a knitting circle, another person was playing a game with a member of staff, people were chatting in groups and staff were speaking to people individually and in groups. We saw books, magazines and games available at the home. Details about peoples religious observances are also sought when they move to the home. We were told that monthly Holy Communion services are held at Leaze Court and individual religious needs would be made available on request, taking into account each persons cultural needs as recorded on admission Plans of care include details of individual preferences in relation to daily routines such as getting up, going to bed, social activities, interests, hobbies and contact with the community. Plans are regularly reviewed and details were made to meet peoples changing needs, choices and wishes. A record is kept of all activities people take part in. The manager told us that they hope to organise coffee mornings to promote more contact with the community, continue to monitor and review dementia activities and to continue to review the homes 4 weekly menu plan. During this visit we spoke to 8 people who live at the home, all were very complimentary about the care and support they receive. Several people spoke about how their relatives and visitors are made to feel welcome at the home. Visitors are offered drinks and are made to feel part of the family. We looked at the visitors book and it was clear that many people received visitors and they came at different times of the day. People moving into Leaze Court are encouraged to bring personal possessions and small items of furniture with them to make their rooms feel homely and this is agreed before admission. Most of the rooms seen during this inspection were personalised and people spoke about the pleasure having their own things around them gave them. Care Homes for Older People Page 18 of 32 Evidence: All of the people spoken to during this inspection agreed that the food served at Leaze Court was very good. Some said that it was not an easy job cooking for a number of people and told us you cant please all the people all the time. A choice of meals is always available at lunch and the evening meal, which also include a vegetarian option providing for personal request.. During the evening care staff tell people living at the home what meals are on menu for lunch the following day and ask them to make a choice of what they would like. When we spoke to some of those living at the home they could not recall being given a choice, but we saw a record of this being undertaken. We also saw people changing their minds about what they had chosen as their meals were being served. Staff were patient, kind and understanding and simply changed the meals to that of the persons choice. People can choose where they wish to have their meals and on the day of this inspection the majority of people living at the home had lunch in the spacious, airy comfortable dining room. Tables were well laid with place mats, napkins and a selection of condiments. A choice of drinks was offered during lunch and staff were available to assist those people who needed assistance. This was carried out discreetly and with gentle encouragement and praise. The meal was leisurely and no one was rushed. We heard one member of staff say to a person You take as long as you like, take all day if you like, theres no rush. Lunch served during this inspection was well presented and nutritious. Care Homes for Older People Page 19 of 32 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 Leaze Court can be confident that if they complain they will be listened to and the home will comply with its complaints policy and procedure. Staff have a good knowledge and understanding of the forms of abuse thereby ensuring that people living at the home are protected. Evidence: The service has a well documented complaints policy and procedure which is given to all staff and people living at Leaze Court. The procedure is also displayed in the entrance to the home and is included in information given to people, and their relatives or representatives, when a decision is being made about moving to Leaze Court. All the services written policies and procedures are read, and signed when read, by staff. A record is kept of all complaints and incidents that occur at the home together with details of follow up and actions taken. No complaints have been made to the home since the last inspection. One complaint has been made to the Care Quality Commission, which was looked into by an inspector and not upheld. We spoke to several people during our visit to the home and very few of them were aware of the actual complaints procedure. However, all told us that if they were unhappy about anything they would tell a member of staff or their relatives. All Care Homes for Older People Page 20 of 32 Evidence: confirmed that they would feel quite comfortable doing so. All staff receive training in recognising signs of abuse, protection of vulnerable adults and how to report any suspicions of poor practice or abuse and a record of all staff training attended is maintained. Since the last inspection the service has updated the training provided to staff and training sessions also now include Pova Part II. A guidance flow chart is displayed on the notice board for staff to refer to and policies and procedures are discussed in supervision sessions with staff to ensure all staff are updated with any new changes. This means that staff have undertaken training to enable them to be able to identify abusive or poor practice, ensuring that those living at the home are protected. Care Homes for Older People Page 21 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment has improved providing a comfortable, clean and safe environment for those living in, working at and visiting the home. Evidence: Leaze Court has been extended and updated since the last inspection. Work undertaken includes the addition of nine bedrooms, a new main entrance and managers office, a new, fully equipped kitchen, improved bathroom and toilet facilities and a shaft lift. Many existing bedrooms have also been refurbished. The home is well maintained and provides homely, comfortable accommodation, including spacious areas for people to move about freely and with access for wheelchair users. Several individual bedrooms were visited, with peoples permission, during this inspection. Bedrooms were comfortable and personalised with sentimental items, photographs and small pieces of furniture. People are encouraged to furnish their rooms with personal effects including furniture where possible and all rooms have temperature controls. This means that people are encouraged to make their rooms personal to them and to be able to maintain a comfortable environment. Care Homes for Older People Page 22 of 32 Evidence: Rooms at the Leaze Court are for single occupancy and have ensuite basins and toilets to ensure peoples privacy and dignity is respected. Rooms are refurbished regularly and all rooms seen during this inspection were well decorated and maintained. The home has the necessary equipment to assist people and meet their needs. Aids, hoists, and assisted toilets and baths are installed which are capable of meeting peoples individual needs. Staff told us they had the equipment they needed to ensure that care was provided safely, which includes, rails, bathroom heating, non-slip floors, toilet raisers and rails for showers, baths and toilets. The home is furnished with high quality furnishing and fittings and is maintained to a high standard. The home was clean and free from offensive odours throughout during this inspection. We had a full tour of the building during this inspection and all the areas were extremely clean and fresh. Hand washing facilities are provided in all rooms and bathrooms to ensure good hygiene practice at the home. Staff have the necessary protective equipment, such as gloves and aprons. There is liquid soap and disposable towels in toilets and bathrooms to promote good standards. Leaze Court has dedicated housekeepers to maintain the high level of cleanliness that is recognised by those living there and visitors. People responding with surveys said the home was. Leaze Court is set in beautifully well maintained landscaped grounds. There is also a level paved patio with seating and shaded areas provided for people who choose to sit out. Several people told us they enjoy sitting outside in good weather. The laundry is well equipped and necessary equipment is available, such as two washing machines and two dryers. A red bag system is used for any soiled laundry ensuring staff are protected. People spoken with said they were very satisfied with the laundry service provided and that their clothes were taken care of and always nicely pressed and returned in good condition. Care Homes for Older People Page 23 of 32 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. People benefit from having trained, skilled staff in sufficient numbers to support them, and the smooth running of the home. People living at the Leaze Court benefit from the robust recruitment procedure followed at the home. Evidence: The manager is generally on duty from 8am-5pm and aims to have three care staff on duty in the morning, two care staff in the afternoon ( plus an additional member of staff to help with evening meals between 5pm-7pm) and two carers throughout the night. A cook, domestic and maintenance person provide additional support. We were told this is the number of staff required to meet the needs of 18 people currently living at Leaze Court. The service is registered to accommodate 32 people and staffing would be adjusted accordingly to meet the needs of people as numbers increase. Information received prior to this inspection indicated that management undertakes regular monitoring of the staffing levels, rotas and allocations according to the needs of people living at the home. The managers said that maintaining a safe ratio of staff Care Homes for Older People Page 24 of 32 Evidence: to people living at the home at all times is a priority. Staff felt that generally staffing levels were adequate. Staff morale at the home is high and staff said they feel valued. People living at the home say that staff are always or usually available when needed, that they listen and act on what is said and that they are well cared for by staff. People who responded to surveys confirmed that staff responded to their needs promptly. This was confirmed during this visit when staff responded promptly to peoples needs in a kindly manner. Throughout the day we saw staff asking people if they wanted drinks, were comfortable, reassuring people, visiting those who wished to stay in their rooms and engaging people in conversation. People told us that staff were always or usually available when needed and felt they received the care and attention they needed. When asked people told us that staff come as quickly as they could to answer bells, one person said staff are there when I need them. Another person told us, I am very happy with care and help I get and the carers are wonderful always cheerful willing and helpful. The manager discussed the recruitment procedure at the home and how it has been developed so that it considers the needs of people living at the home. She stressed the importance, and time taken, to make sure that only good quality carers are recruited so that a high standard of service is offered at the Home. We looked at employment files for three staff who had recently been recruited at the home. All included evidence that the home had conducted a robust recruitment procedure. Files included details of past employment, application form, training certificates, health declarations, police checks and references. Staff files are stored in locked cabinets and are only accessible to management staff. This procedure means that people living at the home are protected by the homes recruitment procedure. All newly employed staff undergoes a period of training when they start working at the home, using the services own developed Induction package based on the National Skills for Induction. This is to enable them to get to know the people living there, the homes philosophy of care safety procedure care procedures and the general layout of the home. The time taken to complete this training will depend on past experience and individual ability. We were told that all staff are encouraged to undertake an NVQ that is relevant to Care Homes for Older People Page 25 of 32 Evidence: their role and that career advancement is encouraged within the home to all individuals who wish to pursue it and expand their skills. The Court Group employs its own training officer who undertakes a rolling programme of training at the services owned by the Company.We were told the home actively looks at introducing new training courses so the best quality of care can be offered at all times whilst also maintaining a safe living and working environment. The homes plans to continue to monitor and evaluate the training programmes offered at the home and to introduce stress management training. Training undertaken since the last inspection includes Safeguarding Adults,End of Life Training, Mental Capacity Act and Deprivation of Liberty Awareness, Supervision Skills for Senior Staff and Infection Control Training has been replaced and updated with the newer version issued and supplied by the Department of Health. Staff confirmed that there are ample opportunities for training offered at the home. Staff spoken to during this inspection told us they complete training feedback forms after each training session to ensure that all training is effective, relevant and learner friendly.Staff are also given test papers at the end of some training courses to test their knowledge and understanding of the topic. We looked at well maintained individual staff training records all of which included completed questionnaires and confirmation of all training undertaken and planned. This means that all staff are kept up to date with current good practice and that people living at the home are cared for by a well supported team of staff. Staff meetings are held quarterly, more frequent if required, to enable staff to discuss their role at the home any any areas of practice which could be changed or improved. In response to questionnaires staff commented that they are being provided with training relevant to their role, to meet the needs of individuals care needs and keeping up to date with new ways of working. Comments included in surveys returned by staff prior to this inspection included Leaze Court has improved over the last 18 months. The staff are now working well together. Care Homes for Older People Page 26 of 32 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 living at Leaze Court benefit from all staff working hard towards ensuring the home in run in peoples best interests. Health and safety is well managed at Leaze Court. Evidence: Lorraine Langford is the registered manager of Leaze Court. She has completed the National Vocational Qualification in Care at level 4 and a Registered Managers Award. She has 20 years experience in working in the care of older people including several years as the deputy manager of this home. The registered manager and staff team work together well to create a homely and open environment. During this inspection the Manager had an open friendly approach towards all living and working in the home. The manager and staff have worked hard to meet the requirements made at the last inspection. Prior to this inspection one of the Directors sent us information about the Care Homes for Older People Page 27 of 32 Evidence: management of the home and how the home has carried out improvements based on the feedback from the last inspection. Records are securely stored in lockable cabinets, and those seen were up to date. We were told that records would be made available to people living at the home, or their representative with their consent. Resident meetings are held regularly at the home and people are encouraged to discuss any topics they wish. Minutes are kept of all meetings held at the Home including staff meetings. Most people living at the home choose to have personal finances looked after by their family or legal representatives. The home will keep small amounts of money for people who receive services such as hairdressing, chiropody and other personal items that may be needed. Clear records and receipts are kept of all outgoings Staff told us that since the last inspection they receive regular supervision. They said they found it positive as it provided an opportunity for them to talk about their work and training needs. They confirmed that they had all had up to date training in relation to Safeguarding Adults and Moving and Handling. The home undertakes quality assurance surveys, sending questionnaires to people living at the home and their relatives. The results of the surveys are displayed and acted upon, an annual development plan is produced and the results allow the service to review their provision of care and other services and to achieve their aims and objectives as set out for the year. People living at the home told us that they feel they have a say in the running of Leaze Court. They confirmed that they are asked their opinions at meetings and that they can speak to staff or the manager about anything at anytime. Staff also complete annual quality assurance forms to enable management to monitor safe working practices and to obtain their views on the service that is being provided at Leaze Court. These are then evaluated and improvement undertaken where necessary. Monthly audits, covering all aspects of the day to day running of the home are undertaken and recorded and copies are sent to the Manager and Director each month. Some of the aspects covered are new admissions and procedures, resident and staff records, general cleanliness of the environment, feedback relatives, health professionals and from people living at the home, about the service provided, Care Homes for Older People Page 28 of 32 Evidence: monitoring of care plans, risk assessments, nutritional needs, menu choice, infection control, kitchen records, medication recording & storage, complaints and a record of action taken, recreational needs, updating of policies and procedures and housekeeping and maintenance requirements. All staff that responded to questionnaires and those spoken to during the inspection confirmed that the manager met with them regularly to give support and discuss how they were working. Comments included, All records of Maintenance including gas, fire safety and staff training are up to date and available in the office. Information received before this inspection indicated that all equipment is well maintained regularly all of which contributes towards ensuring that Leaze Court is a safe place for people to live. Care Homes for Older People Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 9 13(2) Staff must sign the medicine 20/07/2007 administration record at the time that medicines or creams are administered. When a prescribed medicine has not been administered, the reason must be recorded on the medication administration record. This is to ensure people receive the correct level of medication The registered manager 20/07/2008 must ensure that confidential information regarding people living in the home is protected at all times. 2 37 4(a) Care Homes for Older People Page 30 of 32 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 7 Pre admission assessments should be consistently detailed. Care plans should set out in detail the action which needs to be taken by care staff to ensure that all aspects of health, personal and care needs for the individual are met. Nutritional screening should be undertaken on admission and reviewed periodically. 3 8 Care Homes for Older People Page 31 of 32 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. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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