Care Home: Letheringsett Hall

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What the care home does well Letheringsett Hall is a large country manor house set amongst open landscaped gardens. It contains large pieces of furniture to coincide with the age and size of the building. Prospective residents are provided with clear written information to read and are visited by the manager to assess their individual needs. One resident said `The manager visited me at home, explained about the care and support I would receive and my daughter helped me move in`. `The staff are so kind and patient here, they help me when I need it`. Each person has a written plan of their care needs and this information is reviewed and updated on a regular basis to ensure the staff have all the information and guidance for them to care and support each person individually. People living at the home are offered choices throughout the day especially with their choice of meals, activities and where they wish to spend there time. There were positive comments received from residents regarding the sociable activities and outings arranged within the home. One resident said `I am very well looked after and can`t grumble`. Any complaints are listened to and acted upon appropriately. Visitors consulted said that they always feel welcomed into the home by the staff, and it was evident that the home and staffs welcoming atmosphere encourages people to visit. Due to the independent levels of residents currently living at Letheringsett Hall there is enough staff on duty to meet the needs of the residents currently living at the home, with a clear structure in place ensuring they increase their numbers of staff when required. What has improved since the last inspection? There were no requirements issued from the last inspection to follow up. The care plans are well written and follow the activities of daily living format to include residents personal tastes, views and how they wish to be occupied. There have been several areas, including the kitchen that have been redecorated and upgraded offering a comfortable homely environment to residents. The providers have invested in improving the training of staff including a good proportion of staff obtaining the recommended vocational qualifications in improving standards of care. What the care home could do better: The daily records within the care plans need to be logged and dated to reduce the risk of these being misfiled. One of the residents said that the main hot meal was sometimes served lukewarm, although, this had been looked at by the previous manager, with plate covers being introduced, it maybe beneficial for the plates to be heated first. There was also a concern regarding the amount and variety of sandwiches served at tea time which was discussed with the new manager to investigate. The top floor bathroom`s paint was flaking from the wall and should be attended to. Another area for improvement should be the standard of ironing of residents clothes, paying specific attention to mens trousers and shirts this was highlighted by one resident. Key inspection report Care homes for older people Name: Address: Letheringsett Hall Letheringsett Near Holt Norfolk NR25 7AR     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Hilda Stephenson     Date: 0 7 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Letheringsett Hall Letheringsett Near Holt Norfolk NR25 7AR 01263713222 01263713222 laura@imperialcarehomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Imperial Care Homes Limited care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: 20 Older people of either sex may be accommodated Bedrooms numbered 3 and 4 on the first floor are only to be occupied by service users who are sufficiently physically and mentally able, to minimise the risk involved in needing to access these rooms utilising a chairlift. Date of last inspection Brief description of the care home Letheringsett Hall is a care home providing personal care and accommodation for 20 older people. Imperial Care Homes Limited owns the home and the Proprietors are Mr Steve Smith and Mrs Laura Smith. Laura Smith is currently managing the home. The home is located in the village of Letheringsett, a mile outside of the historic town of Holt, and is close to all amenities. Letheringsett Hall provides quite grand accommodation and is set in spacious grounds with delightful views of the large grounds and surrounding countryside. Accommodation is provided on three floors providing 16 single rooms and 2 double rooms, most of which have en suite facilities. At the present time one of the double rooms is being used as a single room. The home has ample communal space and has a passenger lift to the first and second floor with a Care Homes for Older People Page 4 of 27 Over 65 20 0 Brief description of the care home stair lift that services two separate bedrooms on the first floor. The home is well maintained throughout. The weekly cost of accommodation and care is £360-470 a week. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The focus of the inspection undertaken by the Care Quality Commission is upon outcomes for people who use the service and their views on the service provided. The process considers the providers capacity to meet regulatory requirements, minimum standards of practice, and focuses on aspects of service provision that needs further development. One inspector conducted the unannounced visit. The main method of inspection used is called case tracking which involves selecting people who use the service and looking at the quality of care they receive by speaking to them, observation, reading their records and asking staff about their needs. The new manager and two members of staff, five residents and one relative were spoken with as part of the visit, records relating to medication management was also Care Homes for Older People Page 6 of 27 inspected to form an opinion about the quality of care provided. A partial tour of the building was undertaken which included peoples bedrooms and communal areas they frequent to make sure that the environment is homely and safe. A review of all the information we have received about the home since the last key inspection was considered in planning this visit which included the Annual Quality Assurance Assessment which was provided by the manager together with six Have Your Say Pre inspection questionnaires which were distributed to people at the home prior to the inspection process. The home has a 3 star rating showing that people living at Letheringsett Hall receive excellent outcomes. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? There were no requirements issued from the last inspection to follow up. The care plans are well written and follow the activities of daily living format to include residents personal tastes, views and how they wish to be occupied. There have been several areas, including the kitchen that have been redecorated and upgraded offering a comfortable homely environment to residents. The providers have invested in improving the training of staff including a good proportion of staff obtaining the recommended vocational qualifications in improving Care Homes for Older People Page 8 of 27 standards of care. 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 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering moving in have their needs assessed and are given the information in written format to assist them to make their decision to move into the home. Evidence: There is written information available for all prospective new residents to Letheringsett Hall in the format of a statement of purpose with the service users guide contained within this. This document explains the admission procedure for people who are considering moving into the home. The new manager explained the admission process and the records of the last resident who moved in was read and the resident was also spoken with to ensure that the initial procedure was followed. The resident stated This is a lovely place and the staff are so kind and helpful, the records showed that the owner had visited to discuss their individual care needs with Care Homes for Older People Page 11 of 27 Evidence: the resident and their relative to ensure that the staff could cater for their needs. A copy of the written guide was kept in the bedroom so the resident could refer to it when they needed to. The care records contained a pre-assessment format including personal preferences, likes and dislikes, individual care needs and past history. This information goes to form part of the care plan for the new resident. The new manager stated that the initial admission period was four weeks when a review of care meeting was arranged with the resident and their relative, to ensure that they wished to stay permanently. A contract is also drawn up which includes the fees payable, services offered, room to be occupied and how to move out if they wished to. The owner is currently overseeing each process until the new manager becomes registered, to ensure consistency with each procedure. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each resident has a care plan in place to record and review their individual care, medical and social needs. Evidence: Each resident has a care plan recording their individual assessed care, medical and social needs, with risk assessments in place for each person to continue maintaining their independent lifestyle. Many of the current residents require minimal assistance which initiates the current staffing levels. Both care plans contained the daily living activities, social needs, past interests and hobbies and family background, including risk assessments for the prevention of falls, nutritional risk and reducing hazards within the environment. The daily records showed evidence of how activities, outings, visits with friends and relatives, health care professional visits and other events were arranged. The daily notes need to be numbered, dated and a record of the individual it is Care Homes for Older People Page 13 of 27 Evidence: referring to, where some did not contain these and could easily get mixed up. Overall, the care plans were of a good standard and showed that residents needs are assessed on a regular basis and they have access to health care professionals when they require this. The staff have access to specialist equipment such as hoists and pressure relieving beds for a resident who has need of these. The medication records of the two residents who were case tracked were seen and found to be satisfactory. The new manager and one of the care staff explained the ordering, checking and returns of medication. Currently, the home does not have a controlled drug cabinet, and no residents who have been prescribed these, the owner may need to consider purchasing one of these secure cupboards in the future, in line with the medication requirements. The staff who administer medication receive the appropriate medication training for them to safely deliver this aspect of care. The training records were seen within the staff files. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to live an independent life, continue with their hobbies and offered a healthy diet. Evidence: A list of daily organised activities was displayed on the table in the hall. These tended to be between 3-4pm each afternoon arranged by the care staff. Other outings, visits and individual hobbies were recorded in care plans. For example one resident enjoyed painting and drawing and this was organised to suit her day. On the day of the inspection a clothes party had been organised so residents could see clothes offered for sale. There was also communion arranged later for those who wished to attend, and this was arranged at the local church. Several residents were spoken to, and comments received included were I go out for a walk around the grounds most days. I enjoy reading so tend to stay in my room. The staff organise games, so I go and join in sometimes. Care Homes for Older People Page 15 of 27 Evidence: I go out for my shopping to Holt and enjoy a visit to the tea rooms. There is one dining room and during lunch time the majority of residents tend to meet up. There are three dining tables seating up to six people, drinks are offered and tables are nicely arranged. The menu is displayed in the hall. The care staff tend to ask each resident if they would like the main cooked meal or alternative cooked meals are arranged. The lunch on the day of this visit was leek and chicken pie, with freshly prepared vegetables, with fruit and ice cream for dessert. The majority of the residents confirmed they enjoyed the home cooked meals. Although, one comment regarding the regularity of sandwiches at tea time was raised with the new manager, and another resident commented on that some main meals were not very hot when she received them. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples concerns are listened to and acted upon, and they will be protected at all times. Evidence: The AQAA stated there had been no complaints received by the previous manager. The new manager was aware when questioned on her role on dealing with complaints. The complaints procedure was contained within the guide, and displayed in the hall. There was also a suggestions box for relatives as well as the residents to put forward their ideas in between the regular meetings held for residents. The comment regarding the heat of the meals had apparently been dealt with, but one resident had highlighted this again and the new manager needs to address this. A second comment obtained when speaking with residents and relatives was they would appreciate clothes being ironed, and stored in drawers appropriately, especially for a resident who has a disability, and on occasion clothes had been lost. The new manager said that all clothes contained individual names and she was already investigating this incident. Staff receive adult protection training and one care staff who was spoken with confirmed they knew the various degrees of abuse and how they could be eliminated. Care Homes for Older People Page 17 of 27 Evidence: The adult protection procedures were read and staff training records showed these were up to date. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are offered a comfortable homely environment. Evidence: A tour of the building was undertaken and three residents own rooms were seen during this visit. The building is well maintained although there was one area requiring repainting. The second floor bathroom the paint was peeling and needed attention. The home is spread over three floors. There is one lounge, one large dining room and large hall on the ground floor making up the communal rooms. Bedrooms are situated on all three floors. The majority have ensuite facilities, and those that have not have a toilet and bathroom close by. All the bedrooms are large, and those that were seen contained residents own furniture and possessions making them very individual. One of the double rooms was currently occupied by a single resident. The grounds of the home are vast and the garden is well maintained, residents have access throughout. Residents also have access to the church next door to the home. The kitchen had recently been refurbished, several of the bedrooms had been redecorated and various carpets had been cleaned. The dining room had recently been repainted and refurbished to maintain the history of the building. Appropriate furniture was in place around the home maintaining an air of dignity to its surroundings, adding Care Homes for Older People Page 19 of 27 Evidence: to the comfort for residents. The home has adequate laundry facilities in place, although two issues regarding the ironing and naming of clothes was brought to the attention of the manager. The majority of residents spoken to confirmed they were completely happy with the old historic furniture, which is in line with the age of the building. One resident said Its beautiful here, much nicer than my own house. The views are so lovely. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by adequate numbers of well trained staff. Evidence: The duty rota showed there were three care staff on duty during the morning, when it changed to two care staff for the afternoon and evening period, usually reducing to one night carer, although there were two night carers on duty currently due to the recent change of dependence levels of a resident. During the day the cook prepared the morning and lunch time meals, replaced by a kitchen assistant who prepared and served tea time meals, then took over the laundry duties. The new manager said there was a vacancy for a cleaner, and the maintenance person was currently overseeing the cleaning duties. During the day of inspection some of the staff left early to attend a training course at one of the owners sister homes, so the afternoon staff changed over earlier than usual to ensure continuity of numbers. Two staff files were checked on the recruitment procedure, the owner has excellent staff records in place. The training of both staff were also seen, and these had been Care Homes for Older People Page 21 of 27 Evidence: updated with further training updates arranged. The owners have three homes and the training courses are arranged between these, so the majority of staff can attend regular training sessions. The AQAA states that seven out of thirteen members of staff have the recommended vocational training in care, which is good practice. One staff member said I didnt think I could enjoy working so much. The owner helps staff fulfill their potential with appropriate training. Could do with more staff for busy times. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well managed home. Evidence: The owner currently manages the home, and has recently employed a new manager who has been at the home for a month and will eventually become the registered manager. The new manager Donna Butterfield has experience as a deputy manager and has obtained the leadership and management certificate in care. Until she becomes the registered manager with the commission the owner Laura Smith will continue to manage the home. The last quality assurance survey was seen, on how the staff obtain feedback on the quality of the service they offer. The results from residents, relatives and other stakeholders were displayed in the hall. Care Homes for Older People Page 23 of 27 Evidence: The new manager who was in attendance throughout the inspection demonstrated how residents financial records were kept, one of the residents records was checked and found to be accurate. Records continue to be of a good standard. Staff files showed the manager continues to supervise staff on a regular basis, arranging training and monitoring individual needs within a private meeting. One of the care staff said I meet up with the manager regularly to discuss training and how I can adapt my ideas within the home setting. A random check of records on health and safety, fire, water temperatures, window restrictors, lift and central heating were all in place. There was an up to date insurance certificate displayed alongside the registration certificate showing the number and conditions the home can accommodate. Overall, the home offers a very good standard of care to residents living at the Hall, and there is consistency with the care records and required checks that are required to be in place. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 7 9 The daily records within the care plans should be numbered and dated to reduce the risk of being misfiled. The owner needs to consider purchasing a controlled drug cabinet as recommended in line with the medication regulations. Meals should reach residents at the correct temperature. The tea time menu of sandwiches should be reviewed and a wider variety would be more beneficial for residents who prefer these. The bathroom on the top floor needs repainting. 3 4 15 15 5 19 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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