Care Home: Leycroft Care Centre

What the care home does well People who live in the home and their representatives told us that they are well looked after. Comments included `I`m happy with everything, they treat my relative as an individual` and `first class accommodation`. People speak very highly of the staff at the home. People who live in the home told us `the nurse is brilliant`. Relatives commented `staff are always friendly and offer me a cup of tea. I can stay to lunch if I want to` and `staff are wonderful, if I could give them a medal I would`. Leycroft is a purpose built home. The environment provides good standards of accommodation for the people who live there. What has improved since the last inspection? The home has carried out work to meet a number of requirements that were made at the previous inspection. The Statement of Purpose and Service Users Guide have been updated so that people have up to date information about the home. The home now carries out comprehensive assessments to ensure that it will be able to meet the needs of people before they move into the home. As a result, no further incidents have taken place. The lunchtime experience was more settled and people appeared to enjoy their meal. Staff were observed chatting to people and assisting where necessary. People now have a personalised memory box by their bedroom door. This helps people with dementia to identify their door. Staff recruitment files were well organised and contained all of the required information and checks. The home has a manager designate who is in the process of applying to be the registered manager with the Commission. What the care home could do better: Relatives and staff told us that they would like to see some outings for people who live in the home. (The manager told us that there are plans to arrange outings). The home has carried out staff training in a number of areas since the previous inspection. There are still a number of gaps in training. The home must ensure that all staff have completed appropriate training so that they have the skills and knowledge to carry out their work, meet peoples needs and protect people from risk of harm. (Requirements relating to training were made at the previous inspection). The home should send out surveys to seek the views of people who live in the home, their representatives and other interested parties, as part of its quality assurance. Key inspection report Care homes for older people Name: Address: Leycroft Care Centre Leycroft Care Centre Roman Road Taunton Somerset TA1 2BB     The quality rating for this care home is:   one star adequate 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: Alison Philpott     Date: 2 6 0 5 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 26 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 26 Information about the care home Name of care home: Address: Leycroft Care Centre Leycroft Care Centre Roman Road Taunton Somerset TA1 2BB 01823279151 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): care@schealthcare.co.uk Southern Cross (Taunton) Opco Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 69 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: A suitably qualified and experienced clinical lead must be in place whilst Linda Knowles is the registered manager for this service The maximum number of service users who can be accommodated is 69 The registered person may provide the following category of service only Care home with nursing Code N 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 Code DE Date of last inspection Brief description of the care home Leycroft is a new purpose built home near to Taunton town centre. The home is registered with the Care Quality Commission (CQC) to provide a service for up to 69 Care Homes for Older People Page 4 of 26 Over 65 0 69 69 0 1 1 0 3 2 0 1 0 Brief description of the care home people with dementia care needs to include personal and nursing care. A passenger lift serves all floors. The ground floor has 34 bedrooms, dining room, 2 lounges, and an activity lounge. The first floor has 35 bedrooms with dining facilities, lounge areas, and a hair salon. All bedrooms have ensuite toilets and showers. In addition each floor has two bathrooms. The home has a internal courtyard garden and side garden. The registered provider is Southern Cross. The home currently has a manager designate who is in the process of registering as manager with the Commission. The current fee range (from 1st April 2010) is from £547.63 to £750.00. Continuing healthcare funding (CHC) will be discussed on an individual basis. Care Homes for Older People Page 5 of 26 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: one star adequate 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: This unannounced key inspection was conducted over one day (7 hours). On the day of the inspection, four people were living in the home and one person was staying for a respite break. One person was receiving nursing care, four people were receiving personal care only. The manager designate was available throughout the inspection. We were given unrestricted access to all parts of the home and all records requested for this inspection were made available to us. Some of the people who live in the home are unable to fully express their opinions, therefore we also observed care practice and interactions. We were able to meet with people using the service, staff and a visitor to the home. Further to the homes first key inspection on 11th March 2010, the manager sent us an improvement plan which told us what the home was doing to meet the requirements Care Homes for Older People Page 6 of 26 and recommendations made at the inspection. We would like to thank all involved for their time and cooperation with the inspection process. The term, we used throughout this report, refers to we the Commission. The focus of this inspection visit was to inspect the relevant key standards under the Inspecting for Better Lives 2 framework. This focuses on outcomes for people living in the home. The quality of the service is measured under four ratings. These are excellent, good, adequate and poor. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: Relatives and staff told us that they would like to see some outings for people who live in the home. (The manager told us that there are plans to arrange outings). The home has carried out staff training in a number of areas since the previous inspection. There are still a number of gaps in training. The home must ensure that all staff have completed appropriate training so that they have the skills and knowledge to carry out their work, meet peoples needs and protect people from risk of harm. (Requirements relating to training were made at the previous inspection). The home should send out surveys to seek the views of people who live in the home, their representatives and other interested parties, as part of its quality assurance. Care Homes for Older People Page 8 of 26 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 26 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 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive sufficient information so that they can make an informed decision about the home. The home carries out detailed assessments to ensure that it can meet the individual needs of people before they move into the home. Evidence: The homes Statement of Purpose and Service Users Guide contain a good level of detail about the home. The documents have been reviewed and updated. We looked at the pre admission assessment that the home had carried out for one person. This contained detailed information and it was evident that the home had undertaken a comprehensive assessment to ensure that they were able to meet this persons needs. The home had also obtained a copy of the assessment carried out by the placing authority. Care Homes for Older People Page 11 of 26 Evidence: Since the previous inspection, 16 staff have undertaken training in challenging behaviour. 15 staff have completed training in dementia awareness. Care Homes for Older People Page 12 of 26 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. People receive personal and healthcare support using a person centred approach. Medication and records relating to medicines are well managed. Staff treat people who live at the home with respect. Evidence: We looked at two care plans. These contained good information about what people need assistance with, what they can do independently and their preferences. Detailed daily records were being maintained. Appropriate risk assessments were in place. Care plans had been reviewed monthly. One person who lives in the home told us they were happy that their care needs were being met. Relatives told us the home keeps me informed, and was proactive when they had concerns and my relative is well looked after. We looked at records that showed that people have access to a range of health Care Homes for Older People Page 13 of 26 Evidence: professionals. We looked at the homes medication and records. The home uses a monitored dosage system. Each person has a front sheet with a photograph for identification purposes and information about allergies. The Medication Administration Record Sheets (MAR) were fully completed. Each person has a list of their medicines and the reason why it is prescribed. Where MAR Sheets had been written by hand, two staff had signed the sheet to evidence that checks for accuracy had been made. We looked at the stocks of controlled drugs and found these to balance. Room and fridge temperatures are monitored and recorded to make sure medicines are stored correctly. The home carried out a medication audit in April 2010. We observed staff knocking on peoples bedroom doors before entering. This shows that staff respect peoples privacy and dignity. Care Homes for Older People Page 14 of 26 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. The home provides activities for people who live in the home. This will be further enhanced once the home has an activities co-ordinator and outings are arranged. Meals at the home are balanced and nutritious. People appeared to enjoy the lunchtime experience. Evidence: At present, one of the care workers is assigned to do activities every morning. The home does not currently employ an activities co-ordinator. The manager told us that there are plans to recruit someone when the number of people living in the home increases. We spoke with the activities co-ordinator from another home owned by the group. They told us that they have been visiting Leycroft to carry out activities such as reminiscence, colour therapy, smell recognition, music, film afternoons and food tasting. They had also provided some activities training for staff. Individual activity records are kept for each person. People had taken part in one to one time, gardening, singing, laying the tables for tea, drawing, exercise and music therapy. During the inspection, we observed staff sitting in the garden with one person, playing a game with another person and chatting. People who live in the home Care Homes for Older People Page 15 of 26 Evidence: had enjoyed seeing the visiting dog. A barbecue was planned for the week after the inspection. Relatives and staff told us they would like to see some outings for people who live in the home. The manager told us that there are plans to arrange outings. We looked at an activities guide that showed us that the home is researching places to visit. At lunchtime, people were offered a choice of dishes. Staff were sitting with people, assisting where necessary and chatting. We observed nice interactions. Music was playing in the background. People appeared to be enjoying the lunchtime experience. People complimented the cook, saying very tasty. The food looked and smelt appetising. We observed that one person was able to request an alternative dessert of fruit salad. We spoke with one person who said they would have liked salad for lunch. We discussed this with the manager who said he would make sure that this person was advised what was for lunch earlier in the day so that they could choose what they would like to eat. Care Homes for Older People Page 16 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a clear complaints policy. People are confident that they will be listened to and any concerns acted upon. The home has policies and procedures for safeguarding people who live there from the risk of abuse. Some staff have not completed training in abuse or protection of vulnerable adults. Evidence: The home has a complaints policy. The manager told us that the home has not received any complaints. People who live in the home and their relatives told us that they would know how to make a complaint if they needed to. The home has policies relating to whistleblowing and abuse. Staff spoken with knew what to do if they had any concerns. Staff do not start work at the home until the appropriate checks have been carried out to prevent the risk of harm to people who live there. At the previous inspection on 11th March 2010, we found 7 of the 22 staff who work at the home have not completed training in abuse or protection of vulnerable adults. No further training has taken place since this inspection. The home has arranged for Safeguarding of Vulnerable Adults training to take place on 16th June 2010. Care Homes for Older People Page 17 of 26 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. The home is clean, well maintained, decorated to a high standard and provides a comfortable environment for the people who live there. Evidence: We viewed a number of areas of the home including the lounge, dining rooms, bedrooms, bathrooms, kitchen and laundry. All areas of the home are well maintained. Communal areas provide comfortable furniture. The home provides nursing care and dementia care. There are plans to divide the home into units when the number of people living there increases. Bedrooms were nicely personalised to reflect peoples tastes and interests. People have access to a call bell. The home has now placed a memory box outside of each of the bedrooms that are occupied. They are working with people who live in the home and their representatives to decide what familiar items should be placed in the box. These boxes will help people with dementia to identify their bedroom. The manager told us that the environment will be further developed as more people move into the home to meet their individual and group needs. There was a malodour in one bedroom. We discussed this with the manager and Care Homes for Older People Page 18 of 26 Evidence: housekeeping staff. They told us they carry out regular carpet cleaning but had been unable to remove the odour completely. We discussed alternative flooring that could alleviate the problem. We observed that the home was clean. The home employs housekeeping staff and laundry staff. The laundry contains a range of commercial washing machines. We observed that liquid soap and paper towels were available in all bathrooms and toilets. We observed staff wearing gloves and aprons to minimise the risk of spread of infection. Care Homes for Older People Page 19 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient staff on duty to meet the care needs of people who live in the home. The home has a comprehensive training programme. Some staff have not yet completed training that will give them the necessary skills and knowledge to carry out their work. The homes recruitment procedures protect people from risk of harm. Evidence: During the inspection, the following staff were on duty; manager designate; one Registered Nurse; senior carer, one care assistant, and catering, housekeeping and laundry staff. We looked at three staff recruitment files. These contained all of the required information and checks. We looked at the staff training matrix. Since the previous inspection, further training has been carried out in the following areas; moving & handling; food hygiene; fire safety; challenging behaviour; and dementia awareness. There are still some gaps in mandatory training. Care Homes for Older People Page 20 of 26 Evidence: Two staff at the home have completed a moving & handling trainers course so they can train other staff. During the week of the inspection, training in nutrition, and health & safety was planned. There are plans to hold a study day in September. This will include training in wound assessment & dressings; skin care; nutrition; pressure sores; medication administration and approaches to dementia care. Four staff have completed an NVQ at level 2 or above. Five staff have been enrolled on NVQ courses; three at level 2 and two at level 3. Care Homes for Older People Page 21 of 26 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a manager designate who is keen to make improvements. There are still some areas that need to be worked on. Quality Assurance systems are being developed. The homes health & safety policies generally protect peoples health, safety and welfare. Evidence: The manager designate has been in post since 15th March 2010. He has many years experience of managing homes. He is currently in the process of applying to be the registered manager with the Commission. Staff told us that things have improved since the new manager started. They find him approachable and they feel well supported. Care Homes for Older People Page 22 of 26 Evidence: The new manager and the staff team have worked hard to make improvements and as a result a number of the requirements made at the previous inspection have been met. The home told us on their improvement plan all training requirements have been identified and sessions booked for 27, 28 and 29th April 2010. It is concerning that a number of staff have still not completed all of the necessary training. We looked at posters that indicated that further training was planned for May and June 2010. The home has quality assurance systems in place. The area manager undertakes regular visits to the home to monitor quality by speaking to people and viewing the home. Records relating to these visits were viewed at inspection. The home carries out regular audits to check that the National Minimum Standards are being met. The home has not yet sent out surveys to seek the views of the people who live there, their representatives and other stakeholders. The home keeps small amounts of monies for some of the people who live there. These are stored individually. We checked the records and balance of monies for two people. Records are signed by two people to safeguard people and the balances were found to be correct. We looked at health & safety records. The servicing and checks for gas safety; lift; electrical installation; portable appliance testing; fire alarm systems; and fire extinguishers were all up to date. The hoists were last serviced on 06/10/09 and should have been serviced. During the inspection, the manager telephoned the contractor to arrange for this to be done. Care Homes for Older People Page 23 of 26 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 30 18 The registered provider must 31/05/2010 ensure that new staff undertake induction training. This is to ensure that staff have the skills and knowledge to meet the requirements of the job and peoples needs. 2 31 8 The registered provider must 31/07/2010 ensure they register a manager. To give clear leadership and direction to the home and ensure that care and support is of a high standard and appropriate to the needs of people living there. 3 38 13 The registered person must ensure that staff complete training in safe working practices. (This requirement was made at the previous inspection and the timescale has not been met). This is to promote and protect the health, safety and welfare of people who live in the home and staff. 30/06/2010 Care Homes for Older People Page 24 of 26 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 12 33 The home should keep the activities provision under review as the number of people who live in the home increases. The home should send out surveys to seek the views of people who live there, their representatives and other interested parties. Care Homes for Older People Page 25 of 26 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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