Care Home: Leonora

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What the care home does well There is a clear admission procedure in place, which enables people to be assured that their needs will be met within the home. Clear focus is given to meeting people`s spiritual needs. Strategies to manage people`s continence needs have been reviewed and are recorded on the person`s care plan. The home is comfortable, well maintained and homely. The kitchen has been fully refurbished, which has minimised the risk of food being contaminated. The procedure for recruiting staff is organised and thorough so that people can be assured that any prospective staff member is suitable to work with them. Staff training is given priority so that staff have the knowledge and skills to meet people`s needs effectively. The staff team are motivated and committed to enhancing people`s wellbeing. A staff member allocated to domestic duties has been recruited to enable staff greater time with people using the service. What the care home could do better: People`s care plans should be more detailed to ensure that staff have the required information to support people effectively in a person centred way. Preventative measures to minimise any potential risks such as the development of sore areas of skin should be identified on the person`s care plan. Staff must ensure that they follow the home`s procedures in the safe handling of medicines so that errors with people`s medicines do not occur. The use of chairs which restrict people`s ability to move independently should be considered in line with the Deprivation of Liberties safeguards, within a multi-disciplinarysetting. Staffing levels should be further reviewed to ensure that there are sufficient staff on duty to meet people`s needs effectively. This particularly applies to people receiving one to one staff support without interruptions when being assisted to eat. Random inspection report Care homes for older people Name: Address: Leonora Wood Lane Chippenham Wiltshire SN15 3DY one star adequate service 13/07/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Alison Duffy Date: 2 8 0 5 2 0 1 0 Information about the care home Name of care home: Address: Leonora Wood Lane Chippenham Wiltshire SN15 3DY 03003031445 03003031449 chippenham@pilgrimhomes.org.uk www.pilgrimhomes.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Gaie Rachel Marshall Type of registration: Number of places registered: Conditions of registration: Category(ies) : Pilgrim Homes care home 20 Number of places (if applicable): Under 65 Over 65 0 20 dementia old age, not falling within any other category Conditions of registration: 20 0 The maximum number of service users who can be accommodated is: 20 The registered person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 20 Dementia - Code DE, maximum number of places: 20 Date of last inspection 1 3 0 7 2 0 0 9 Care Homes for Older People Page 2 of 12 Brief description of the care home Leonora is operated by Pilgrim Homes, which is a Protestant Christian organisation. People who apply to live at the home must be in full agreement with Pilgrim Homes doctrinal basis. The Registered Manager is Mrs Gaie Marshall. Mrs Marshall has been in post since November 2005. Leonora is a spacious detached property, which is situated within a residential area of Chippenham. The home also contains a sheltered and very sheltered housing scheme. Peoples bedrooms are located on the ground and first floor. A passenger lift gives level access to all but five bedrooms. These rooms are accessed by a number of small steps. There are two communal lounges and a separate dining room. Staffing levels are maintained at three carers and one senior carer on duty until 2pm and one senior carer and two carers throughout the rest of the afternoon and evening. There are also additional housekeeping and catering staff and an administrator and maintenance officer. At night, at present, there are two members of waking staff. An on call management system is also available. The contact details of the service have recently changed. The new e mail address is Chippenham@pilgrimsfriends.org.uk and the provider web address is www.pilgrimsfriends.org.uk Care Homes for Older People Page 3 of 12 What we found: This unannounced random inspection took place on the 28th May 2010 between 10.10am and 1.30pm. Mrs Gaie Marshall, registered manager was available throughout our visit and received feedback at the end. We sent the service surveys, for people to complete if they wanted to. We also sent surveys to be distributed to members of staff and health/social care professionals. This enabled us to get peoples views about their experiences of the service. Seven people using the service and six staff members completed surveys and returned them to us. Within our site visit, we looked at the assessment documentation and support plans of two people who had most recently moved to the service. We looked at accident reports and the recruitment and training documentation of two newly appointed members of staff. The last inspection of this service took place on the 9th July 2009. We saw that the assessments of the two people most recently admitted to the service were fully completed. They contained a tick style format yet additional information had been added to ensure greater clarity. The assessments showed a range of information about peoples health and personal care needs. Mrs Marshall told us that there had not been any changes to the assessment process since our last visit. She said she continued to meet people in their own environment in order to assess their care needs. This ensured that the home was suitable for people and that their needs would be met effectively. We looked at the care plans of two people. They contained basic information about peoples health and personal care needs. There was a front sheet, which summarised peoples needs and the support they required. The care plan identified long and short term goals. We advised that some areas of information could be expanded upon. One care plan identified that the person was prone to sore areas of skin. To address this staff had written report to senior if any problems or if skin reddens or appears sore. There were no preventative measures to minimise any soreness. Another care plan identified a persons weight loss. The plan of action stated offer food that XX likes. Offer drink regularly. Likes most food and drink. There was no information about how the persons weight was to be monitored or when any medical intervention should be sought. People told us that they were very happy with the service they received. One person told us they cant do enough for us. The staff are all so friendly and make it feel like home. Nothing is too much trouble. You just need to ask and if they can, they will do it for you. They told us that they had spoken to Mrs Marshall about a situation which they felt could be improved upon. They said the situation was addressed although it had reverted back. Mrs Marshall told us that she would look into other options which would potentially improve the situation. Another person told us I cant imagine being anywhere else. Im happy with everything from the food to the staff. At our last inspection, we made a requirement to implement alternative systems to satisfactorily manage a persons continence. This had been addressed. We saw that information identified times at which the person needed assistance to use the toilet. Care Homes for Older People Page 4 of 12 Since our last inspection, there had been seven errors with peoples medicines. Mrs Marshall told us that these had been investigated. A number had been made by the same staff members who were no longer administering medicines to people. We looked at the systems for handling peoples medicines. There were no apparent contributory factors, which would cause potential errors. We said that staff needed to follow the homes procedures in the safe handling of medicines so that errors did not occur. At our last inspection, we made a requirement that staff must sign the medicine administration record after administering medicines or applying a prescribed topical cream. This had been addressed. The record had been consistently signed. A member of staff had countersigned any hand written medicine administration instruction in order to minimise the risk of error. There were records to show the medicines received into the home. A list of homely remedies had been authorised by the GP. We saw that one person was prescribed a pain relieving patch. This was to be changed every 72 hours to ensure its effectiveness. There was no information about this within the persons care plan. We advised that body maps could be used to give staff information about the location of the patch. This would ensure it was applied correctly. We saw that another person was prescribed a spray to assist them with their breathing. They managed this, themselves. We said an assessment to show that the persons ability to do this effectively should be undertaken. Details of the medicines use should also be stated on the persons care plan. We looked at the accident records and saw that the majority of entries identified falls. We saw that one person fell on a more regular basis. We spoke to staff and Mrs Marshall about this. They said that the persons expression of choice and independence increased the number of falls they experienced. Mrs Marshall told us that staff had been unsuccessful in minimising the number of falls due to the persons determination to be active. We saw that all entries within the accident book were clear and well written. We saw that the environment was comfortable, clean and well maintained. At our last inspection, we made a requirement to refurbish the kitchen due to infection control issues and the potential of food being contaminated. We also made a requirement that the seal in the identified bathroom be replaced. Both requirements had been met. Staff told us that the refurbishment had significantly improved the kitchen facilities. One staff member told us that since our last inspection, some peoples bedrooms and the lounge and dining room had been redecorated. On a tour of the accommodation we saw that two people were sitting in chairs that they could not get out of without staff support. Mrs Marshall told us that this was to ensure their safety, as they slipped out of ordinary chairs. Mrs Marshall told us that that the use of the chairs had been discussed with the persons family. While acknowledging the importance of the persons safety, we said that the restriction of movement needed to be assessed in relation to the Deprivation of Liberty Safeguards. We looked at the recruitment and training records of the two most recently appointed staff members. The files were ordered and well maintained. There was an application form, two written references and a health care questionnaire. There was documentary evidence of the persons identity. There was evidence that the persons suitability to work with vulnerable people had been checked. Staff members had undertaken a range of mandatory training. This included first aid, Care Homes for Older People Page 5 of 12 health and safety, the protection of vulnerable adults, manual handling and fire safety. Staff told us that the opportunities for staff training were good. They said that they could request training in certain areas if needed. Staff told us that there were three care staff and a senior carer on duty in the morning. This reduced to two care staff and a senior during the evenings. At our last inspection, we made a requirement to review staffing levels in order to meet peoples needs effectively. In response to this, Mrs Marshall had recruited an additional domestic to assist with tasks such as serving drinks, clearing tables and washing up. She said that this meant that staff could concentrate on specific care issues. One staff member told us that the home continued to be short staffed at times. They said the employment of a domestic had helped although had not solved the situation. They said the domestic was not on duty each day so could not give support consistently. They said that the staff team was extremely motivated and worked had to achieve the best for people. They said at times, this was a challenge due to the number of staff on duty in relation to some peoples increased level of dependency. Staff told us that there were four people who needed the support of two staff to assist them with their personal care routines. Within their surveys, staff identified staffing levels as an area that could be improved upon. Specific comments were consider changes in residents care, due to deterioration need more personal care, more staff needed on pm shift and afternoon staff, there are only two of us to put around 11 residents to bed. We feel that they are rushed into bed. We have not got time to talk or listen to them, not even play a game with them. We need more staff. At lunch time, we saw that there were four people who needed full staff assistance to eat. There were not enough staff to support people effectively. We saw that two staff fed two people at the same time. They also got up from the table to support other people within the dining room. This meant that people did not receive individualised support. People also needed to wait between each mouthful of food they were given. We discussed this with Mrs Marshall. Mrs Marshall told us that the only alternative would be to support people needing assistance before everyone else had their meal. Mrs Marshall was concerned that this would remove the social aspect of the mealtime. We advised Mrs Marshall that the mealtime arrangements needed to be reviewed in order to ensure people received the support they required. Within surveys, people told us that they always received the care and support they needed. They said staff were available when they needed them. People said that staff listened and acted on what they said. They said the home was always fresh and clean. In relation to what the home did well, one person said this is a lovely Christian home, does all things well. Another person said cares for me physically and spiritually. Other specific comments were most things, everything, I am very satisfied with everything the home does and they are very good all round. In relation to what the home could do better, one person said Residents doing things together. Another person said Nothing, it is not possible to do better when you have at all times done your best and at Leonora, things are done for us in the very best way. Staff told us within their surveys that checks such as references and a Criminal Records Bureau disclosure were carried out before they started employment. They said they Care Homes for Older People Page 6 of 12 received training related to their role and were given up to date information about the needs of people they supported. One staff member said there were always enough staff to meet the individual needs of people. Two members of staff said there were sometimes enough staff. Three staff said there were usually enough staff available. In relation to what the service did well, one staff member said keeps staff well informed and carries out all training needs. Provides good accommodation and meals. Has good relationships with outside agencies. Provides good activities even though residents may not participate. Another staff member told us a peaceful environment for the residents. Plenty of opportunities for residents to join in if they wish to (activities.) Other comments were excellent care for our residents. Home kept clean and tidy. Good training for all staff. Kept up to date with any changes. As a Christian Home, all spiritual needs are met very well, the residents get excellent care from the care girls and we work well as a team. What the care home does well: What they could do better: Peoples care plans should be more detailed to ensure that staff have the required information to support people effectively in a person centred way. Preventative measures to minimise any potential risks such as the development of sore areas of skin should be identified on the persons care plan. Staff must ensure that they follow the homes procedures in the safe handling of medicines so that errors with peoples medicines do not occur. The use of chairs which restrict peoples ability to move independently should be considered in line with the Deprivation of Liberties safeguards, within a multi-disciplinary Care Homes for Older People Page 7 of 12 setting. Staffing levels should be further reviewed to ensure that there are sufficient staff on duty to meet peoples needs effectively. This particularly applies to people receiving one to one staff support without interruptions when being assisted to eat. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 12 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must stipulate the 30/09/2007 support people need, in order for staff to meet both long and short-term care needs. Staff must ensure that they 31/08/2009 administer all medication, as identified on the prescription. So that people receive their medication as required to maintain their wellbeing. 2 9 13 Care Homes for Older People Page 9 of 12 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, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Staff must ensure that they follow the homes procedure in the safe handing of medicines. To minimise the risk of error with peoples medicines. 14/07/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 The use of chairs which restrict a persons ability to move independently should be assessed in relation to the Deprivation of Liberty safeguards, within a multidisciplinary setting. Proactive measures to ensure healthy skin rather than reacting to soreness should be identified on the persons care plan. Care plans could be improved upon through adding additional detail about the persons needs and their aspirations, within a person centred approach. A review of mealtimes should be undertaken in order to ensure that the people needing full assistance to eat, receive support in an individualised, uninterrupted manner. 2 7 3 7 4 27 Care Homes for Older People Page 10 of 12 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 5 27 Staffing levels should be reviewed with particular attention given to busy periods such as mornings, evenings and mealtimes. Care Homes for Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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